MMIT Payer Portrait: Independence Health Group

Independence Health Group is the parent company of Independence Blue Cross, the second-largest Blues insurer in Pennsylvania (behind Highmark Health), and AmeriHealth Caritas, a managed Medicaid payer serving more than 2.3 million beneficiaries in seven states and the District of Columbia. It also operates the AmeriHealth Insurance Company of New Jersey, a commercial payer serving about 209,000 members. Founded in 1938 as the Associated Hospital Service of Philadelphia, Independence now counts more than 4.5 million members across the spectrum of health insurance products. Still based in Philadelphia, it leads its home state’s individual, self-funded (administrative services only, or ASO) and managed Medicaid insurance markets. Optum’s FutureScripts serves as the primary pharmacy benefits manager for Independence Blue Cross. AmeriHealth Caritas, meanwhile, operates its own in-house PBM, PerformRx.

Independence Blue Cross is one of the five founding partners of Evio Pharmacy Solutions, a Blues-backed startup that aims to drive down the cost of prescription drugs through value-based and outcomes-based contracting arrangements. “Part of me says that this is an attempt by the Blue Cross folks to standardize some kind of value-based purchasing arrangement in a way that would work over multiple plans, which probably would make it more effective,” Jeff Myers, senior vice president of market access and reimbursement strategies with Catalyst Health Care Consulting, told AIS’s Radar on Drug Benefits in June 2021. The company unveiled its biosimilar strategy in March 2022, which will focus on autoimmune and oncology therapies covered under the medical benefit. All five of its founding insurers are participating in the initiative.

Moving further into the specialty pharmacy space, Independence in January said it will launch an Advanced Network for Gene-Based Therapeutics in March 2023. The insurer is partnering with Penn Medicine and the Children’s Hospital of Philadelphia in the creation of the new network, noting both providers “have played pivotal roles in the development and clinical trials of first-in-the-nation gene-based therapies.” Independence also noted it will work to pursue outcomes-based arrangements with drug manufacturers as new gene therapies launch.

NOTES: Independence Blue Cross, the AmeriHealth Caritas Family of Companies and the AmeriHealth Insurance Company of New Jersey maintain separate listings in DHP.

SOURCE: AIS’s Directory of Health Plans as of February 2023; MMIT Analytics as of 1Q 2023.

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