Reinventing the pharmacy benefits experience

Better experience

Reinventing the pharmacy benefits experience

Joshua Yelverton, IngenioRx clinical pharmacist

We created IngenioRx to restore trust and confidence in pharmacy care. Today, people view pharmacy as a runaway train of escalating costs, and something needs to change. We believe that by integrating IngenioRx with our medical coverage, we can not only address the challenges of pharmacy costs but also simplify complex processes and eliminate silos. The result is a better patient experience.

Deepti Jain, President, IngenioRx

Consumers and plan sponsors have long been frustrated by the inefficient and fragmented system of approving and delivering prescription medicines in the U.S. But with the 2019 introduction of IngenioRx, our new pharmacy benefits manager, Anthem is making cost and patient care improvements that once seemed impossible.

Anthem launched IngenioRx eight months earlier than expected, transitioning 15 million consumers with near-flawless execution – among the largest one-time pharmacy transitions in the history of the industry. Now, Anthem can engage more directly with consumers about not only medications, but their overall health and well-being. We can access integrated data, including consumers’ medical histories, and offer personalized insights and guidance to help them improve their health and save money.

The story of one Anthem consumer who suffers from seizures is a case in point. Before his pharmacy benefits were integrated, he was prescribed a branded medication, which he stopped taking due to the cost. As a result, he had seizures that caused him to be hospitalized multiple times and resulted in a car accident – all of which cost tens of thousands of dollars in medical bills.

Ashley Mims, Pharmacy Services Lead, and Joshua Yelverton

Under Anthem’s integrated plan, Joshua Yelverton, an IngenioRx clinical pharmacist, reviewed the man’s medical records and prescription data. Joshua realized that, based on the man’s medical diagnosis, he could benefit from taking a generic form of the seizure medication instead of the branded medication.

“After speaking to him and understanding more about his unique circumstances, I saw that we could help him,” Joshua explains. “Now he pays only $10 for a three-month supply of medication. By having the ability to see the bigger picture, we found a way for him to avoid serious problems and achieve long-term health and well-being.”

Savings go back to customers and consumers

Integrating benefits means healthier consumers, lower costs and a simplified healthcare experience. Anthem’s integrated pharmacy and medical benefits resulted in average lower medical costs of $368 per year for each consumer compared with those who had “carved-out” pharmacy benefits.1

Integrated benefits had:1

lower outpatient costs
lower inpatient costs

Looking at results for consumers who participated in Anthem’s comprehensive diabetes management program, the savings and health benefits are also clear: 29 percent more care gaps were closed, the number of people engaged with disease management programs doubled, medical costs per year decreased by $1,236, and the cost of inpatient stays per year decreased by $840.2

In total, Anthem expects to achieve at least $4 billion of gross pharmacy savings annually. “The majority of these savings are being handed back to our customers in the form of more affordable healthcare. And since we accelerated the launch, these savings started to be realized almost a full year earlier than expected,” says Deepti Jain, President of IngenioRx.

Helping to demystify pharmacy even further and increase transparency, IngenioRx has launched robust digital tools that help members better understand the cost of their prescriptions and identify cost-saving opportunities. Additionally, given the nature of pharmacy utilization, we now provide member service 24/7.

Since the launch of IngenioRx on May 1, 2019:

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million Rx claims were processed
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home delivery prescriptions were filled
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specialty prescriptions were filled

In 2019, Anthem announced its first external pharmacy contract win with Blue Cross of Idaho, which started on January 1, 2020. “This win further demonstrates the strength of our pharmacy offering and our ability to deliver more affordable care with a simplified consumer experience,” Deepti says.

“With the prospects of cost savings, more direct contact with consumers, and better health outcomes from the integration of pharmacy and medical benefits, we are excited about future opportunities in the marketplace.”

1. Anthem and Health Core Inc. Integration of Pharmacy and Medical Benefits (2019). Study looked at 700,000 members from more than 600 employers from 2015 to 2018.

2. IngenioRX. Value of Medical/Pharmacy Integration – Type II Diabetes (December 2019). Versus members with pharmacy carved out. Care gap closure rate refers to members with diabetes and cardiovascular risk.