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Blues plan switches to a United-owned PBM

On January 7, Modern Healthcare reported that Blue Cross Blue Shield of Michigan and Blue Care Network will switch from Express Scripts to OptumRx. Learn why this move is worth a mention.

Blue Cross Blue Shield of Michigan and Blue Care Network recently announced they are switching from Express Scripts (owned by Cigna) to OptumRx (owned by UnitedHealth Group) with the intention of reducing prescription costs and more effectively delivering services to members.

Sure, switching to a larger PBM owned by one of the largest health insurance companies in the industry could help BCBS bring in new tools and digital technology to better manage overall drug spending. But it begs the bigger question of what’s in it for United? Gaining the Michigan Blues business gives United greater leverage in the pharmacy space, and more control over a larger network of businesses. If United owns the intermediary that contracts with pharmacies and negotiates discounts and rebates with drug manufacturers, it only increases the control they have across the healthcare industry.

BCBS of Michigan has more than 4.5 million members in Michigan and 1.6 million in other states; that’s 6.1 million people (and their data) to which United’s OptumRx just got access. This follows a trend of insurers moving from dipping their toes into specialty markets, to full-on swimming in them, as we discussed when Centene announced the acquisition of Magellan behavioral health network and specialty pharmacy insurer Pantherx. We will be keeping an eye on what else United consumes, but from the looks of it they’re paying no mind to the old advice: don’t eat before you swim.

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