MMIT Payer Portrait: Anthem, Inc.

Anthem, Inc. is the second-largest health insurer in the U.S., serving more than 33 million lives nationwide. It is also the largest Blue Cross and Blue Shield affiliate, acting as a Blues licensee in 14 states. Anthem’s in-house PBM unit, IngenioRx, manages most of its pharmacy benefits, though CVS Specialty Pharmacy serves as its specialty PBM vendor. Anthem also operates Anthem Behavioral Health, and completed an acquisition of Beacon Health Options, one of the largest independent providers of behavioral health services in the U.S., in May 2020.

After cutting ties with Cigna Corp.’s Express Scripts, Anthem launched IngenioRx in March 2019, and the PBM has since been a boon for the company’s financials, particularly with health care utilization in flux amid the COVID-19 pandemic. The PBM saw an operating gain of $363 million in the fourth quarter of 2020, its first full year of operation, according to a Feb. 11 article in AIS’s RADAR on Drug Benefits. Overall, Anthem saw a 16.2% year-over-year increase in operating revenue. CEO Gail Boudreaux during the company’s Jan. 27 earnings call said she is “really pleased with the performance of IngenioRx” and hopes to see increased interest from fellow Blues plans. Blue Cross of Idaho signed on as the PBM’s first external pharmacy contract in July 2019.

Anthem on Feb. 2 unveiled efforts to expand its market presence to Puerto Rico through a planned acquisition of InnovaCare Health, L.P.’s managed care subsidiary, MMM Holdings, LLC. MMM currently operates the largest Medicare Advantage (MA) organization in Puerto Rico, with 267,000 members, while its managed Medicaid plan serves 302,000 lives. This would be the insurer’s largest public-sector deal since its 2013 acquisition of Amerigroup Corp., and could boost its combined Medicare and Medicaid enrollment by 6.9%.

Spotlight on the Public Sector and Year-Over-Year Enrollment Change in Key Lines of Business

Like other large insurers, Anthem is making heavier investments in the public sector markets. While some recent Medicaid gains were spurred by employer plan losses caused by the COVID-19 pandemic, Anthem in January 2020 took over Medicaid contracts in Missouri and Nebraska from WellCare Health Plans, Inc. to allow WellCare’s acquisition by Centene Corp. to move forward. In addition, Anthem has consistently boosted its Medicare Advantage business year over year. As of the 2021 Annual Election Period, Anthem’s MA enrollment is up more than 16% from 2020. Anthem expanded the number of counties in its MA service area by 20% in 2021, and entered the Iowa market for the first time.

SOURCE: DHP, AIS’s Directory of Health Plans; MMIT Analytics. Subscribers can read the RADAR on Drug Benefits article about Anthem’s 4Q20 earnings here: https://bit.ly/3uM9jYa. See the press release about Anthem’s InnovaCare acquisition here: https://bwnews.pr/2NIDgrr.

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