Anthem, Humana join hedge fund to launch PBM

pharmacy, PBMs, drugs, prescriptions

pharmacy, PBMs, drugs, prescriptions

Anthem and Humana have entered into a joint venture with hedge fund and private equity administrator SS&C Technologies Holdings to create DomaniRx, a pharmacy benefit manager.

SS&C Technologies holds an 80.2% interest in the joint venture, while Louisville, Kentucky-based Humana and Indianapolis-based Anthem each hold a minority interest.

The joint venture will develop a cloud-native, application programming interface-driven claims adjudication platform to support its operations. DomaniRx will be a full-service pharmacy benefits manager, which are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans and large employers.

“DomaniRx will focus on disrupting the industry through open-source technology to interface with other systems quickly,” said Danny Delmastro, the company’s general manager, in a press release.

DomaniRx’s platform will enable users to glean insights from millions of claims transactions, which will provide them with the information needed to customize programs and select flexible tools, he said.

SS&C Technologies, Humana and Anthem have committed approximately $925 million for the launch of the joint venture, according to a July 15 filing with the Securities and Exchange Commission. This figure includes $138.3 million in initial cash contributions and certain assets, including a non-exclusive license of SS&C Technologies’ claims processing platform known as RxNova.

Humana, which runs its own pharmacy benefit manager, will be DomaniRx’s first customer.

“DomaniRx will provide a modern and scalable, cloud-based pharmacy benefits platform that meets current and future technological needs,” said Mark Taylor, a spokesperson for Humana, in an email. “The platform…will bring market-leading flexibility to our clients and new patient-facing tools to increase transparency, cost savings and clinical outcomes.”

The news of the joint venture comes as new players in the healthcare market ramp up their pharmacy offerings. Last November, Amazon launched its much-anticipated pharmacy business, and just last month, the online retail giant began offering six-month drug prescriptions starting at $6.

In addition, Walmart began offering its Walmart+ subscription service members access to its prescription drug savings benefit in June.

But even as retailers enter the pharmacy benefit management space and new companies sprout up, the industry remains under legislative scrutiny. Earlier this month, a U.S. district judge ruled that Sanofi, Eli Lilly and Novo Nordisk, along with three pharmacy benefit managers, will have to face racketeering charges.

In June, Centene agreed to pay a combined $143 million to settle allegations that it overcharged Ohio and Mississippi’s respective Medicaid departments for prescription drugs.

Photo: megaflopp, Getty Images