Humana/Anthem PBM Venture Could Attract More Blues Plans

Humana Inc. and Anthem, Inc. are teaming up with hedge fund administrator SS&C Technologies Holdings, Inc. to create DomaniRx, a new joint venture that aims to offer a “best-in-class” PBM cloud-based claims adjudication platform. Humana will be the first customer for DomaniRx, the companies say, and industry observers predict a potential market among Blues plans and Medicare Advantage plans.

The “second generation” claims adjudication platform will leverage SS&C’s technology capabilities and will reside on SS&C’s private cloud, according to the company.

SS&C already has a suite of pharmaceutical management services available, including formulary and rebate management, drug utilization management, specialty drug management, real-time benefit information at the point of care, and pharmacy network optimization.

Ashraf Shehata, national sector leader for health care and life sciences at KPMG, says the partnership between SS&C, Anthem and Humana is “a pretty bold move that I call ‘leading with tech,’” which he says ultimately could result in potent new patient-facing and pharmacy tools to manage drug benefits.

© 2023 MMIT
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