Anthem started the new year by forecasting earnings that could miss expectations even after the health insurer books gains from a new business.

The Blue Cross-Blue Shield insurer expects earnings adjusted for one-time items to be greater than $22.30 per share in 2020. That includes income from IngenioRx, a pharmacy benefits management business it launched ahead of schedule this year.

Analysts on Wall Street expect earnings of $22.72 per share, according to FactSet.

Anthem also reported Wednesday fourth-quarter earnings that fell just short of expectations, and its shares slipped in early-morning trading.

Indianapolis-based Anthem Inc. runs insurance plans in several states, including big markets like California, New York and Ohio. It covers 41 million people as the nation’s second-largest insurer.

Enrollment grew nearly 3% in the final quarter of 2019, helped by gains from the company’s Medicare and Medicaid business of 14% and 8%, respectively.

Medicare is the federal government’s coverage program mainly for people age 65 and over, while Medicaid is a state-and-federally funded program that focuses on the poor. Anthem, like other insurers, is counting more on these programs for growth as the market for commercial coverage matures.

Anthem said it also was helped in the quarter by the launch of IngenioRx, which contributed to a $535 million operating gain from the insurer’s commercial and specialty business. That total jumped nearly 70% jump compared to the final quarter of 2018.

Anthem started enrolling patients in IngenioRx, which the company started with help from CVS Health Corp., in last year’s second quarter.

The insurer also saw its largest expense, the cost of benefits, jump 13% to $21.38 billion in the fourth quarter.

Overall, Anthem’s net income more than doubled to $934 million in the quarter. Adjusted results came to $3.88 per share while operating revenue climbed 16 percent to $27.13 billion.

Analysts expected earnings of $3.90 per share on $26.85 billion in revenue, according to Zacks Investment Research.

For the year, the company reported profit of $4.81 billion, on $103.14 billion in revenue.

Company shares fell more than 3% or $10.60, to $279.85 in premarket trading.

Anthem shares climbed more than 15% last year, with the price topping $300 to reach a new all-time high. That’s nearly half the gain of the roughly 29% advance from the broader S&P 500 index.

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Follow Tom Murphy on Twitter: @thpmurphy

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Elements of this story were generated by Automated Insights (http://automatedinsights.com/ap) using data from Zacks Investment Research. Access a Zacks stock report on ANTM at https://www.zacks.com/ap/ANTM