Express Scripts and Anthem have been locked in a feud for more than a year after Anthem claimed Express Scripts withheld billions in savings and overcharged Anthem for its services by $3 billion annually.
Anthem on Tuesday said it will stop selling policies on Ohio's health insurance exchange in 2018, citing volatility in the individual insurance market and uncertainty over funding for cost-sharing subsidies. The national health insurer said those two factors made it difficult to set next year's rates.
For months, Anthem has been hinting that it may pull out of some Affordable Care Act exchanges, but Ohio marks its first retreat. The Indianapolis-based insurer sells policies on exchanges in 13 other states. Anthem covers about 1.1 million exchange members.
"Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance," Anthem said in a statement.
Anthem said that while some steps have addressed challenges plaguing the individual market, continued uncertainty surrounding funding for cost-sharing subsidies that help low in-income Americans afford exchange coverage and the taxes on fully insured health plans keep the market from stabilizing.
Anthem is the only insurer in 2017 selling plans in all 88 Ohio counties. Its exit would leave at least 18 Ohio counties without an insurer, according to the state's insurance regulators. About 10,500 enrollees receive coverage in those counties.
"For the past few years we have seen a weakening in the federal insurance marketplace as a number of companies have withdrawn from the exchange," Chris Brock, a spokesman for the Ohio Department of Insurance, said in a statement. "We have always argued the private insurance market is the most severely impacted by the federal law and that is where congressional action is needed to restore stability."
Anthem has filed 2018 rates in several other states, including Connecticut, Maine and Virginia, but could still pull out of those states in the coming weeks. The federal deadline for insurers to file 2018 rates is June 21. The deadline for insurers to file rates in Ohio was Monday.
In late April, CEO Joseph Swedish said Anthem's individual market claims were improving compared with prior years, but still higher than expected. He said Anthem would file rates assuming the cost-sharing subsidies would be funded, but would adjust those rates or exit markets if funding was still uncertain by early June.