Last August, Blue Shield of California made headlines when it revealed plans to eschew the traditional, bundled contract with a pharmacy benefit manager and instead select multiple carriers to provide key services.
This shift included ditching its contract with CVS' Caremark, though the PBM will still provide specialty pharmacy services as one of five contributors to the Pharmacy Care Reimagined model, which will kick in partially in 2024 and then into 2025.
Eric Palmer, CEO of Cigna's Evernorth, which houses the country's largest PBM in Express Scripts, said that while the company hasn't seen a spike in similar demand in the market, the team views the potential of "unbundling" as an opportunity.
"We're positioned really well to tackle these different solutions," Palmer said Tuesday at the J.P. Morgan Healthcare Conference.
Cigna CEO David Cordani likened it to a similar evolution in medical benefit models. Ultimately, plan sponsors and patients want predictability and affordability, with offerings that are simple to understand and manage.
The challenge then becomes offering these solutions in an individualized or population-based way at a broad scale. Express Scripts and Evernorth more broadly have the pieces necessary to succeed in this, he said.
"We saw that journey on the medical side of the equation, and we'd like to believe we led that journey in terms of the service-oriented, the shared risk-oriented, etcetera," he said, "and we seek to do so on the pharmacy side."
At the dawn of the new year, the PBM picked up a massive new client, with Centene's membership officially coming into the fold. Palmer said that the company has also established strong "momentum" in retaining clients and winning new ones through new products and contracting models.
There has been no shortage of conversation around the role of pharmacy benefit managers in the pharmaceutical supply chain, and concern around if and how they may contribute to rising drug prices. As the market shifts toward greater transparency, Express Scripts has rolled out multiple programs in the past year that aim to address some of the central criticisms of the industry.
For one, it embraced the cost-plus pricing model with its ClearNetwork program, which was unveiled in November. The PBM said that builds on other initiatives launched in 2023, such as its ClearCareRx model, which seeks to provide its clients with a more transparent contracting model.
In addition, the PBM unveiled Copay Assurance, which builds on the existing Patient Assurance program to cap the costs of certain generic and preferred branded or specialty drugs for enrolled patients.
Policymakers are poised to take action to reform the industry, and the Federal Trade Commission is undertaking a broad probe of PBMs and their business practices. While Cordani said he couldn't definitively say what conclusions the agency will reach, he said the value PBMs provide is clear.
CVS CEO Karen Lynch made similar remarks on Monday.
"We're confident the facts will yield that the PBM industry, not just ourselves...delivers a significant amount of value," Cordani said. "We will ensure we continue to support that with independently validated research."