Even as regulators are cracking down on pharmacy benefit managers, some payers have been leaning into their own businesses in 2025.
Here are six payer moves indicating growing PBM interest:
1. Independent Health’s PBM subsidiary, Pharmacy Benefit Dimensions, is one driver behind the insurer’s plans to join MVP Health Care. “Some of the opacities that the larger pharmacy benefit management companies have used are going to be stripped away, and having a truly transparent model, where all of the efficiencies and savings are passed on to the customer, is where things are going to end up,” Independent Health CEO and President Michael Cropp, MD, told Becker’s.
2. During a third-quarter earnings call, CVS Health emphasized its PBM’s evolution, such as through its TrueCost model, point-of-sale rebates and GLP-1 formulary changes.
3. The Cigna Group’s Evernorth is transitioning to a rebate-free pharmacy benefit model. Fully insured members will have access in 2027, and all clients will in 2028. Evernorth said the new approach may lower monthly brand-name prescription costs by 30% for people with high-deductible plans. Still, the model could see growing pains.
4. Blue Shield of California’s former chief pharmacy officer, Matt Gibbs, PharmD, stressed how health plans should manage their own pharmacy benefits. “Taking control of that function is key to your future existence as a health plan, no matter how big or small you are,” he said. “We saw the big health plans early on merge with big PBMs because they saw this coming. They knew that pharmacy had to be an owned and controlled asset if you wanted to control your healthcare destiny.”
5. Salt Lake City-based Intermountain Health has continued to leverage its insurance arm, Select Health, for its in-house PBM, Scripius. In an interview with Becker’s, Eric Cannon, PharmD, now chief commercial officer and general manager of Scripius, highlighted how health systems are making the move “due to concerns about the lack of transparency and high costs associated with for-profit PBMs.” The PBM remains a priority of Select Health’s business.
6. At the start of the year, former UnitedHealth Group CEO Andrew Witty told investors that Optum Rx will pass all of its negotiated rebates to consumers by the end of 2028.
