Do you think this dumpster fire will ever get acquired by a better PBM?
10 replies (most recent on top)
No but trust me — Carelon the PBM is doing much better than Carelon pharmacy. I feel bad for employees that got acquired when buying up other pharmacies. Now those employees need to deal with Illegal practices and a--hole people
How dare you imply that our fine company does make every step and decision spot on in the best way to move us forward as the industry leader?? Elevate and advance! It’s not only in our blood, it’s in our name! (Place fall wave here)
@12k Throughout the years, CarelonRx never made serious effort to develop and promote internal leadership. In fact they did just the opposite. New people were constantly brought in from outside organizations. This led to the departure of many talented and loyal people, people who understood the integrated whole Anthem+PBM services.
I’ve been with CarelonRx for 18 years, long before it carried this name. Throughout that time, I have been part of pharmacy management within Anthem, and I have seen the organization evolve through multiple phases. We have had challenges, of course, and historically we were never a fully independent PBM. We relied on partners like Express Scripts and CVS, and while that wasn’t ideal, we still managed to operate effectively.
What has fundamentally changed in recent years is the leadership structure at CarelonRx. In the PBM industry, deep domain expertise is not optional, it’s essential. Understanding how margins are generated, how funds flow through complex systems, and how contractual and operational levers affect profitability is critical. This is a highly specialized field, and leadership must reflect that.
But when the lady on top came into power- she started putting presidents and leaders in place with no PBM experience.
Those leaders, in turn, have brought in additional individuals, often from outside the industry, who lack the background needed to navigate the complexities of pharmacy benefit management. This has put us in a position where strategic decisions are being influenced or led by consultants and new hires who don’t have the necessary foundation. It is not a sustainable model. E15s who are supposedly consultants have been hired with ZERO experience. Many of them sit under the president.
The results speak for themselves; membership isn’t growing, we are losing money, and much of this stems from the absence of experienced PBM leadership guiding strategy. To succeed in the PBM industry, you must understand it.
And to turn things around, we need leadership that brings genuine PBM knowledge and experience back to the center of decision making. The old PBM leaders (before 2020) were not perfect but they have solid experience.
If we are bringing back 73 year old SLT members out of the wood work that are awful I think we need to bring back the professional pbm folks back to make carelonRX succeed.
Would you buy it?
@jf it's still a sh!t show though.
What a d-mb post...like it or not CarelonRx is a multi billion dollar, highly profitable division of Elevance. Pretty sure "selling it" isn't on the horizon.
Been there done that worst thing that ever happened.
Why did they ever think that acquisition was a good idea?
Too broken.