Unlocking Transparency in PBM Pricing
Dan Reedy, senior director of pricing and underwriting for Abarca, spoke recently with MedCity News about what payers should consider as they explore new models and press for greater transparency.
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Pivot Podcast: A Conversation with Capital Rx CEO A.J. Loiacono
Season 2 of the MedCity Pivot Podcast has launched with a special focus on the evolution of pharmacy and pharmacy benefit management. The first guest this season is A.J. Loiacono, who leads Capital Rx.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
If Dexcom’s CEO Had a Magic Wand …
Kevin Sayer would love to bring his company's Dexcom G7 continuous glucose monitor to more people and more quickly. But despite being CEO of a successful device company, he feels frustrated from time to time about how and what the U.S. health system will pay for.
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The PBM Model of the Future: Why Payers Are Unbundling PBM Services
Javier Gonzalez, Chief Growth and Commercial Officer at Abarca, about why payers are increasingly looking for alternatives to the traditional PBM model.
PBMs Are in Regulators’ Crosshairs But Are Regulators Missing the Point?
Proposals targeting misaligned financial incentives, price transparency, and pharmacy access are important and necessary reforms. But the consequences of failing to address pharmacy benefit managers’ use of market power to block competition and extract monopoly profits from payers and consumers will not be limited to drug costs – it will change all of healthcare for generations.
MedCity Moves Podcast: Recent Hires, Layoffs & an Interview with Danny Sanchez, CEO of EmpiRx Health
In this month's episode, we dive into some of the recent executive appointments occurring in the healthcare sector, as well as layoffs affecting the industry. We also hear from Danny Sanchez, who recently became the new CEO of EmpiRx Health, a value-based pharmacy benefit manager.
Unlocking Transparency in PBM Pricing
The TSX Venture Exchange has a strong history of helping early-stage health and life sciences companies raise patient capital for research and development.
How AI Will Change the Way Patients Get Medication
There is a huge opportunity for PBMs and health systems to use AI to help address the challenges surrounding the affordability and accessibility of medicines, from navigating formularies to resolving prior authorization. More automation in pharmacies and with ordering workflows is one piece of that puzzle.
Medicare Drug Negotiation Is the Model for the Future of Drug Pricing, Abarca CEO Says
For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it's the latter.
Getting off the PBM Merry-go-Round: How Late-stage Offer Tricks Take Employers for a Ride
Requiring that PBMs bid on a per member per month guarantee would reduce the employer’s uncertainty by securing the actual per member per month cost to the employer.
States should be allowed to regulate PBMs, according to 35 state AGs advocating in Oklahoma case
A trade association for PBMs says that state PBM regulations in Oklahoma are preempted by federal ERISA and Medicare regulations.
Using Informed Awareness to Transform Care Coordination and Improve the Clinical and Patient Experience
This eBook, in collaboration with Care Logistics, details how hospitals and health systems can facilitate more effective decision-making by operationalizing elevated awareness.
How EmpiRx Health’s value-based model led to less drug spending on mental health, decreased opioid use
EmpiRx found in its data that pharmacy claims for behavioral health treatments increased 9.4% from 2020 to 2021. For antidepressants, utilization increased 12% during this time period, but per claim spend fell 1.8%. ADHD medications saw a 20.2% increase in utilization and a 9.1% decrease in per claim spend.
Should the same entity be allowed to own a retail pharmacy, a PBM and an insurance company?
The question elicited predictable and unexpected responses from panelists that included a senior executive from CVS Caremark and executives from startup companies working to change the pharmacy benefits landscape.
Register for MedCity INVEST Digital Health and take part in a discussion on pharmacy benefit management
The MedCity INVEST Digital Health conference in Dallas September 28 in collaboration with Health Wildcatters marks our first conference in the Lone Star state and new themes embracing employee benefits and the financial experience in healthcare. Register today!
Capital Rx snags $106M to enhance digital platform, increase user base
Capital Rx recently closed a $106 million Series C funding round, bringing its overall funding to $175 million. The upstart pharmacy benefit manager will use the funds to enhance its digital pharmacy platform as well as grow its user base.
3 forecasts for the PBM industry in 2022
The current landscape heading into 2022 will keep pharmacy benefits under the microscope. Plan sponsors will evaluate their PBM’s pricing model to determine if their contract will deliver predictable costs, more opportunities for increased savings and improved care for their members.