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The double-team PBM scheme from Anthem and Humana

What happens when two top insurers team up together to take over the PBM world? A July 26 article in Insider Intelligence has us wondering.

Two major insurers in cahoots? Couldn’t be.

Sure enough, Anthem and Humana are combining powers to acquire SS&C, a software solutions company, to develop a new pharmacy benefits management (PBM) platform, called DomaniRx. According to an eMarketer article, the new BFFs poured nearly $140M into the joint venture.

Seems odd, since they both have their own super profitable PBMs. What’s the benefit in teaming up with another payor for more PBM data? What’s the end goal? Because to us, it seems like more of an attempt to drive profits than to improve patient care and “comply with regulations.”

Another motive speculation for this joint venture: the opportunity to go after the largest PBM, OptumRX, led by none other than UnitedHealthcare. (For scale, United’s PBM, which dominates the market, pulled in 2020 revenues of $40 billion. Almost makes Anthem look like a scrappy upstart, with its meager $21.9 billion in 2020 revenues.)

Where will this dynamic duo go next? We can’t say, but we have a feeling it’ll be profitable.

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