Latest Changes in the WorkComp PBM World

Friday, July 18, 2014 | 0

Helios is the new name for PMSI/Progressive. The idea is to have a single name for the two different firms, both of which had positive brand images in the work comp world. In talking to the marketing folks, their take was that while both brands had strong equity, neither legacy name would work for the combined entity.

It seems a shame to end PMSI’s decades-long run, especially after Eileen Auen, Jay Krueger and their excellent colleagues rescued the pharmacy benefit manager from what seemed like a sure path to oblivion. Instead of watching the demise, they turned it into one of the top players in the business. That said, Progressive had a well-earned and well-deserved reputation as a VERY customer-focused PBM, beginning under founder Dave Bianconi (one of the best people in the business…ever). If anything, that focus has grown under the current Auen-Young-Sisson triumvirate; customers are (with rare exceptions) universally pleased.

So, Helios it is.

That will be a d/b/a; due to legal, regulatory, compliance matters I would not expect to see the Helios name show up on provider contracts and other legal stuff, as that may well trigger all kinds of refiling and jumping through legal hoops. But what we’ll very likely see is a big rebranding push, with lots of PR, a new logo and a splash in Florida next month and Vegas in the fall.

Meanwhile, Aetna’s much-discussed sale of its workers’ comp sub (I know, I owe a bunch of folks on my mis-call on this one) hasn’t been finalized – as far as I know. In conversations with several potential financial buyers, Coventry WorkComp’s declining revenues and earnings, coupled with the problems inherent in re-contracting a provider network without mother Aetna’s market clout and concern about PBM First Script’s strong ties to network Express Scripts makes for a “sub-optimal-go-forward-scenario.”

Yup, that’s a direct quote. I think it means the potential investor doesn’t think they can pay what Aetna wants and get a decent return on that investment.

Undoubtedly, someone else will come up with a different scenario; whether it’s enough is to be seen.

Side note: Long-time First Script Exec Brain Carpenter has joined Healthcare Solutions as their top clinical pharmacist. HCS has been dramatically increasing the number and expertise of its pharmacist corps, and the addition of Brian is a big plus. Brian will report to EVP Jim Andrews; kudos to Jim (who I am fortunate to consider a good friend) for successfully building HCS’s clinical programs.

What does this mean for you?

Stability at one PBM…