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Ingenuity is at the center of pharmacy care

Welcome to IngenioRx! We are a pharmacy benefit manager focused on people, not just prescriptions. We look at everything through a clinical-first lens, drawing on our pharmacy expertise and deep medical insights. We work to remove barriers, personalize experiences, and improve health outcomes, no matter where our members are in their healthcare journey.

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IngenioRx

by the numbers

 

 

  • 24/7
    Access to pharmacy experts
  • 92%
    * Specialty pharmacy member satisfaction
  • 34.9%
    ** More care gaps closed from member engagement
  • 3.6%

    *** 2021 overall drug trend Medical + Rx

    Read the full report

Information for

Members

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Plan sponsors and brokers

Learn how we use our ingenuity to solve issues, lower costs, and help improve our members’ health outcomes. Learn more

Providers

We support doctors and pharmacists at every step in our members’ healthcare journey, including digital resources for prior authorization and prescribing. Learn more

The latest from IngenioRx

Acquisition deepens Elevance Health’s capabilities in specialty pharmacy

INDIANAPOLIS – November 9, 2022 – Elevance Health (NYSE: ELV) today announced that it has entered into an agreement with CarepathRx, a portfolio company of Nautic Partners, to acquire BioPlus, a comprehensive specialty pharmacy. BioPlus provides a complete range of specialty pharmacy services for patients living with complex and chronic conditions, such as cancer, multiple sclerosis, hepatitis C, autoimmune diseases, and rheumatology. This acquisition will help Elevance Health meet the specialty drug needs of its clients and customers with a whole-health approach, supported by integrated programs across Elevance Health and Carelon, Elevance Health’s healthcare services brand.

“As a trusted, lifetime health partner, the acquisition of BioPlus helps us deliver on our whole-health strategy that gives our consumers improved access and reliability to their prescriptions when they need it most,” said Pete Haytaian, Executive Vice President, Elevance Health and President, Carelon. “In making BioPlus part of the Elevance Health family, we are committed to leveraging our resources to scale and broaden the reach of BioPlus’ best-in-class specialty pharmacy capabilities, delivering greater affordability and access to critical medications.”

The company will look to expand BioPlus’ speed and service models across more complex disease treatment areas to provide timely access to medication, deliver leading support services for both providers and patients, and ensure individuals receive distinctive clinical expertise and service at all levels of care.

BioPlus currently offers Centers of Excellence (CoEs), which address therapeutic areas such as oncology and multiple sclerosis, and Elevance Health will look to build out additional CoEs for therapeutic areas to serve consumers. CoEs include teams of specialized pharmacists and clinicians knowledgeable in therapeutics areas who partner with patients throughout their treatment journey. These services help ensure medication access, adherence, and high-quality health outcomes.

After the acquisition closes, the specialty pharmacy will operate as part of IngenioRx, Elevance Health’s pharmacy benefit manager within Carelon, Elevance Health’s healthcare services brand. BioPlus’ offerings will complement IngenioRx capabilities and will increase Elevance Health’s ability to provide end-to-end pharmacy services, act as a patient advocate for integrated services, and promote affordability.

After BioPlus is integrated into Elevance Health, consumers who receive both medical and pharmacy benefits from Elevance Health’s subsidiaries will benefit from the company’s ability to leverage medical and pharmacy data to deliver proactive, whole-health insights. Carelon will connect its businesses through its digital platform, so in situations where BioPlus’ pharmacy team identifies a patient who may need behavioral health support or in-home care services, that team will be able to seamlessly connect that patient to services to address their whole health needs.

he acquisition is subject to customary closing conditions and is expected to close in the first half of 2023. BioPlus is not expected to have a material impact on adjusted earnings per share in 2023.

About Elevance Health, Inc.

Elevance Health is a lifetime, trusted health partner fueled by its purpose to improve the health of humanity. The company supports consumers, families, and communities across the entire care journey – connecting them to the care, support, and resources they need to lead healthier lives. Elevance Health’s companies serve more than 119 million people through a diverse portfolio of industry-leading medical, digital, pharmacy, behavioral, clinical, and complex care solutions. For more information, please visit www.elevancehealth.com or follow us @ElevanceHealth on Twitter and Elevance Health on LinkedIn.

About CarepathRx

CarepathRx seeks to transform pharmacy care delivery for health systems and hospitals by delivering improved patient outcomes that drive clinical, quality, and financial results. Through an industry leading, comprehensive, end-to-end hospital pharmacy care delivery model, CarepathRx works to turn hospital pharmacy into an active care management strategy and revenue generator while providing support across the patient’s complete healthcare journey. The company takes an enterprise approach, providing a powerful combination of technology, market-leading clinical pharmacy services, and wrap-around services that aim to optimize pharmacy performance for fully integrated pharmacy operations, expanded healthcare services, improved ambulatory access, minimized clinical variation, and new health system revenue streams. Today, CarepathRx serves more than 20 health systems and 600 hospitals, with more than 2,000 employees nationwide. For more information about CarepathRx, visit www.carepathrxllc.com.

About Nautic

Nautic Partners, LLC (“Nautic”) is a middle-market private equity firm that focuses on three industries: healthcare, industrials, and services. Nautic has completed over 150 platform transactions throughout its 35-plus year history. Nautic's strategy is to partner with management teams to accelerate the growth trajectory of its portfolio companies via add-on acquisitions, targeted operating initiatives, and increased management team depth. For more information, please visit www.nautic.com.

Forward-Looking Statements

This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan” and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward- looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent otherwise required by federal securities laws, we do not undertake any obligation to republish revised forward-looking statements to reflect events or circumstances after the date hereof. These risks and uncertainties include, but are not limited to: the impact of large scale medical emergencies, such as public health epidemics and pandemics, including COVID-19, and catastrophes; trends in healthcare costs and utilization rates; our ability to secure sufficient premium rates, including regulatory approval for and implementation of such rates; the impact of federal, state and international law and regulation, including changes in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; our ability to contract with providers on cost-effective and competitive terms; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; reduced enrollment; the impact of a cyber-attack or other cyber security breach resulting in unauthorized disclosure of member or employee sensitive or confidential information, including the impact and outcome of any investigations, inquiries, claims and litigation related thereto; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services Star ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; risks and uncertainties related to our pharmacy benefit management (“PBM”) business, including non-compliance by any party with the PBM services agreement between us and CaremarkPCS Health, L.L.C.; medical malpractice or professional liability claims or other risks related to healthcare and PBM services provided by our subsidiaries; general risks associated with mergers, acquisitions, joint ventures and strategic alliances; changes in tax laws; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness; a downgrade in our financial strength ratings; the effects of any negative publicity related to the health benefits industry in general or us in particular; failure to effectively maintain and modernize our information systems; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; intense competition to attract and retain employees; risks associated with our international operations; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.

Media Contact:
Leslie Porras
Leslie.Porras@elevancehealth.com

Investor Relations:
Stephen Tanal
Stephen.Tanal@elevancehealth.com

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IngenioRx Clients Use RxGuide to Make Data-Driven Decisions

In 2021, IngenioRx launched RxGuide, an intuitive, self-serve digital reporting tool. RxGuide empowers users to track, report on, and respond to key performance indicators (KPIs), such as plan pharmacy costs, per member per month (PMPM) costs, drug utilization data, and member demographics. We created RxGuide in response to market research showing data tracking as the third most important feature of a pharmacy benefit manager (PBM) to our clients.[1] Using RxGuide, our clients can confidently make potential health-improving, cost-saving decisions, knowing they’re backed by powerful data.

IngenioRx plan sponsors and brokers can use RxGuide at no added cost. Instead of relying on external vendors, RxGuide users can independently monitor pharmacy spend analytics and generate custom reports. “The tool is very fast and interactive,” says Marissa Bateman, Director of Reporting and Data Analytics at IngenioRx. RxGuide loads in seconds, and our team updates the application monthly with the latest benefits usage data. Clients can personalize their dashboards with dozens of custom tools. From there, they can explore trends and make plan improvements with the help of IngenioRx account managers.

RxGuide breaks down companies’ costs, such as total plan cost PMPM and member cost share. It also provides a more in-depth view into subcategories of these trends, including formulary versus nonformulary, specialty versus nonspecialty, and generic versus brand-name drugs. RxGuide’s data is uniquely benchmarked by industry, age group, funding type, and line of business. Users can analyze data from the past and future at the same time, getting a full timeline of their relationship with IngenioRx.

Our goal is to make RxGuide as customized as possible and connect it with other IngenioRx tools to benefit our clients and members. In one example, we linked RxGuide to a major client’s insights and analytics tool. Now the client’s medical data and RxGuide’s pharmacy data is available in one place, with no need to access additional programs or websites.

Use Case: HR Manager Finds Key PMPM Drivers[2]

 

Sara, a human resources (HR) manager, sees her company’s PMPM costs have increased over three straight months. She asks her IngenioRx Account Manager, Jeremy, what could be driving this trend. Jeremy uses RxGuide to dig into detailed cost data. He finds that Sara’s member cost share is less than her competitors’. Jeremy wants to monitor these numbers going forward, so he customizes Sara’s dashboard to track trends and effectively manage her company’s pharmacy plan.

Jeremy also wants to search for ways in which Sara’s PMPM savings can be reached without negatively affecting her employees. He uses one of the many modules available to model plan savings if certain changes were made to the plan’s design. He also understands, however, that this network would change which pharmacies are available to Sara’s employees. Jeremy customizes her dashboard to include the Network Adequacy tool. He toggles from “Base” to the “Advantage” network and sees that most members still live within a two-mile radius of the nearest pharmacy. Jeremy exports his findings into a slide deck and shares it with Sara.

Months later, after the plan design changes have been put into action, the company’s PMPM costs are trending down.

What’s Next for RxGuide

 

Knowing the value RxGuide can deliver, we are expanding its features, as well as who can use it.

Upcoming additions to RxGuide include data sorting by location, a specialty pharmacy management module, and opportunity analysis features. One of the most-anticipated upgrades is the forecasting tool. Clients will be able to see side-by-side displays that compare plan designs. The data can help answer client questions, such as “How would trends change if I purchase a new product?” “What will I save?” and “How will this change help my members?” IngenioRx plans to launch RxGuide to consultant groups and additional clients in 2022.

 

RxGuide is just one example of IngenioRx’s digital-first solutions. “It has been a big win,” says Bateman. We look forward to growing this tool and empowering more IngenioRx plan sponsors to make well-informed, data-driven choices about their pharmacy benefits.

 

[1] IngenioRx internal research, October 2021.

[2] Fictional example for illustrative purposes only.

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Multifaceted specialty pharmacy strategy goes beyond the basics

IngenioRx recognizes that when it comes to specialty drugs, you need an approach that centers on member care while balancing the growing costs of specialty medications. We’re focused on delivering a comprehensive strategy that takes a holistic approach to whole health, member advocacy, and cost management.

Studies show members who take specialty medications are a small percentage of an employer’s overall population, however, specialty drugs account for 59% of total drug spend. 1 So how do you manage constantly rising specialty drug costs? First, you start at the foundation, whole health.

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