MMIT Payer Portrait: SelectHealth

SelectHealth is the wholly owned health insurance unit of Intermountain Healthcare, a Salt Lake City-based health system of 33 hospitals and more than 3,800 physicians. SelectHealth is the largest insurer in Utah and also has a presence in Idaho and Nevada. The majority of SelectHealth’s members are enrolled in commercial risk-based products, with the insurer holding a robust Affordable Care Act exchange presence in Utah, where it dominates the individual market. SelectHealth also holds a Medicaid contract in Utah and has expanded its Medicare Advantage presence in recent years.

Intermountain’s PBM subsidiaries, SelectHealth Prescriptions and Intermountain Specialty Pharmacy, manage SelectHealth’s pharmacy benefits. The health system is also one of seven founding members of Civica, Inc., having spearheaded the initiative in 2018. Civica works to guarantee predictable supplies of common drugs to its hospital partners and drive down the cost of generic drugs in the U.S. through its transparent pricing model. The company’s drug manufacturing unit, CivicaScript, launched its first generic drug, a 250 mg abiraterone acetate tablet, in August 2022. Its initial availability was limited to Intermountain pharmacies and Navitus Health Solutions’ Lumicera Health Services.

“Our hope is that we make this very, very successful and show that it is possible and show the value that we can provide within the health system to pass that cost through and provide that lowest net cost,” Ben Heiser, Lumicera’s vice president of pharmacy operations and business development, told AIS’s RADAR on Drug Benefits. “It kind of almost forces the hand of other organizations to say, ‘You know what? We’ve got to step up to the plate. We’ve got to do something like this, help control drug cost, help for the betterment of the patients and things like that.'”

Intermountain in April 2022 completed its planned merger with SCL Health, a Broomfield, Colorado-based Catholic health system of eight hospitals. SCL was folded into Intermountain’s branding, though its hospitals will retain their previous names. The move also expanded Intermountain’s reach to Kansas, Montana and Wyoming. The successful deal comes less than two years after Intermountain’s failed merger with Sanford Health, a nonprofit health system and regional insurer in South Dakota.

SOURCE: AIS’s Directory of Health Plans as of August 2022; MMIT Analytics as of 3Q 2022.

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