California | Winter | 2010 | Health Plan Analysis

A change in pharmacy benefit management at California's largest health insurer paves the way for a gradual shift in focus to home delivery of medications, particularly generics. Analysts say the potential to grow mail-order penetration, and thus profits, was a key motivation behind Express Script's purchase of the NextRx PBM from WellPoint Inc. The range and speed of Express Script's influence will depend upon the cooperation of WellPoint and its Anthem Blue Cross subsidiary, which retain control over formulary decisions and benefit designs. Despite the rough economy, a couple of California carriers managed to grow commercial enrollment during the first half of 2009. In the public sector, Medi-Cal system is undergoing an overhaul to improve care management for Medicaid members. If managed care plans are designated as medical homes, they could pick up another 272,000 members. That would presumably shift more of the pharmacy benefit to health plans, which employ tighter controls on prescriptions. Meanwhile, California became the latest state to ban gender as a factor in rate-setting on individual insurance policies.