For many Americans, pharmacy benefits are a source of frustration. Confusing rules and unpredictable drug prices can overwhelm not only those needing care, but also the plan sponsors providing it. As a result, one of the largest healthcare organizations in the United States saw the need for a more member-centric approach. It announced the creation of IngenioRx, an innovative pharmacy benefit manager (PBM) that uses clinical expertise and a digital-first approach to personalize member experiences.
What followed was an unprecedented move of millions of members to IngenioRx — the largest transition in PBM history, including over 25,000 benefit plan designs — in less than one year.*
Conducting the transition
In addition to the ways IngenioRx could support members’ health, leadership projected more than $4 billion in gross annual savings for Anthem Blue Cross and Blue Shield, its first and largest client, and affiliated health plans.* Seeing the impact it could achieve, IngenioRx agreed to an ambitious launch date for its first wave of members: May 1, 2019. The timeline required creative solutions, and the PBM rose to the task.
Keeping members first, IngenioRx built a dedicated Pharmacy Member Services team to assist members by phone 24/7, as well as offering a single website and mobile app where members with both medical and pharmacy benefits through Anthem Blue Cross and Blue Shield, Anthem Blue Cross, Empire BlueCross, or Empire BlueCross BlueShield could access all their information at once. Members could use the website or app to find a pharmacy, refill a prescription, price a medication, or click to chat. These were just a few of the over 1,400 IT solutions* IngenioRx created while building its uniquely member focused PBM model.
To help centralize the transition, IngenioRx established a 24/7 command center in Atlanta, Georgia. It notified retail pharmacies of the transfer schedules in advance and reached out to members who took specialty drugs to introduce them to IngenioRx’s dedicated specialty pharmacy. If issues arose with a member’s medication, the IngenioRx Care Team promptly stepped in to mediate.
“We were not only able to complete the transition with minimal member disruption, but we worked on an accelerated schedule and delivered as promised,” said Cindy Dorris, Director of Pharmacy Operations Support. “It was truly a team effort.” The newly formed PBM kept clients, providers, brokers, and consultants up to date on the transition plan and resolved 99% of access-to-care issues within 24 hours.*
Two years later
Since its creation, IngenioRx has worked relentlessly to improve health outcomes. Through measures like encouraging the use of generic drugs when possible and increasing the percentage of members receiving 90-day supplies, IngenioRx helped more than 78% of nonadherent members improve their proportion of days covered (PDC) scores. 64% of those members become fully adherent from 2019 to 2020, including those who were previously non-adherent to multiple drugs.*
Additional member-focused programs include:
- Site of Care, which ensures patients receive the highest-quality care at the lowest-possible cost site. Enhancements made to the program in 2020 resulted in $40 million in overall savings.*
- Specialty Condition Management, which offers extra support, including drug therapy and disease education, for managing the overall health of members with chronic conditions. This program saved clients an average of $330 per member per month (PMPM) in 2020 in cost of care.
- Proactive PA, which combines integrated claims data for faster approvals and less administrative work. This program resulted in a 21% reduction in prior authorization (PA) volume in 2020.*
- Pilot programs, some including artificial intelligence (AI), that explore how technology may predict health issues and improve outcomes
- ZipDrug, a concierge service with personalized fulfillment and scheduled hand-delivery that IngenioRx acquired in July 2020, further personalizes members’ pharmacy experience.
Committed to thought leadership, IngenioRx reports the results of its efforts in regular publications and its annual DiRxections conference. The company’s revenue in 2020 — its first full year of operations — was $21.9 billion, with significant growth projected well into 2025.*
IngenioRx disrupted the pharmacy benefit industry with its historic member transition. Having proved its potential, the PBM is positioned to serve an even wider audience. An ever-growing list of clients is choosing IngenioRx for its member-focused, innovative approach. In 2021, the PBM aims to expand its commercial footprint. As IngenioRx eyes future growth opportunities, it remains committed to its original vision: leveraging innovation, personalization, and expertise — all in the name of better health.