Centene plans national RxAdvance rollout, maintains marketplace profitability

Drugs and money
Centene plans to integrate total medical costs with data from RxAdvance, of which it owns a 28% stake. (Getty/LIgorko)

With two of its biggest competitors joining forces with pharmacy benefit managers, Centene isn’t getting left out in the cold.

The insurer currently owns 28% of tech-forward PBM RxAdvance after announcing an initial investment in March. In September, Centene made another investment in the form of convertible preferred stock, according to a third-quarter financial filing on Tuesday.

RxAdvance reported that as a $50 million funding round earlier this month.

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

The two companies have positioned (PDF) the partnership as a “true alternative” to companies like Aetna and Cigna that are merging with PBMs to get a leg up on medical costs, or insurers like UnitedHealthcare that built a PBM in-house.

RELATED: Centene-backed RxAdvance closes $50M funding round

During an earnings call on Tuesday, CEO Michael Neidorff said the insurer is planning a “first-stage rollout” of RxAdvance before the end of the year, with a national market-by-market rollout slated throughout 2019. He called the partnership “a game changer.”

“We will be moving to a different operating model which is built around transparency and more focused on cost-sharing for total cost of care,” Jesse Hunter, Centene’s executive vice president of mergers and acquisitions and chief strategy officer said in an earnings call Tuesday morning.

Centene reported $16.2 billion in third-quarter revenues, up $11.4 billion during the same quarter last year. But the company’s net earnings dropped from $205 million in the third quarter last year to $19 million this year due to $140 million in reconciliation payments to California’s In-Home Support Services program and $170 million tied to an expiring Department of Veterans Affairs contract.

RELATED: Centene expands ACA marketplace footprint, adds 4 new states

The insurer continues to make significant gains in the ACA marketplace, adding more than 500,000 members since last year thanks, in part, to its acquisition of Fidelis Care for $3.75 billion. Commercial revenues jumped 56% over the last year, accounting for $3.1 billion in the third quarter.

“Our strategy remains specific focusing on low income subsidized population,” Neidorff said. “We do not see a significant change in the competitive dynamics of the market.”

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