AffirmedRx, a Public Benefit Corporation

?????????? ???? ???? ???????????? ?????????????????? ?????? ???????????????? ?????????? ?????????????????????????? (????) ???????????????????????? ?????? ?????????? 80 ??????????, ?????????????????????? ???? ???? ?? ?????? ?????? ????????????????. ?????? ??????’?? ???????? ?? ???????????? ????????. ? Many of these drugs should not have had a PA to begin with, based on standard of care clinical guidelines. ? This is not eliminating the PA, only reauthorization, leading to only 10% decrease in total PA volume. ? Most of these drugs are already highly rebated—meaning Optum is still maximizing its profits. ???????????????? ???? ???? ???????????????? ???? ?? ???????? ???? ???????????? ?????????????? ???????????? ?????? ?????????????????? ????????????????, ?????? ?????????? ???? ???? ???????? ???? ?????????? ???????????????? ???????????? ???????? ???????????????????? ?????????? ???????????? ???????? ?????????? ?????????????????? ??????????????????. Traditional PBMs frequently use PA and other utilization management (UM) tactics as bargaining chips in formulary placement negotiations with drug manufacturers. Now, Optum Rx is walking back some of these unnecessary restrictions—but only on drugs that already bring in high rebates. Meanwhile, ?????????????????? ?????????????????????? ???????? ???????????????? ???????? ???? ???????????? ???????????? ?????????? ???? ???????????????????????? ??????????, delaying access and driving up healthcare costs. A recent American Medical Association survey found that 88% of physicians report PA leads to higher overall healthcare utilization, including additional office visits, emergency care, and hospitalizations. The impact isn’t just on patients—it’s on the entire healthcare system. At AffirmedRx, we take a different approach: ? ?????????? ?????????????????????? ?????????????? ???? ???????? ?????? ?????????? because we design our formularies to balance access and cost upfront. ? ???????? ?? ???? ???? ????????????, ???? ?????? ????????—while many PBMs leave providers waiting days, we prioritize quick and efficient approvals. ? Our ?????????????? ???????? ?????????????????? (????????) ???????? ?? ?????????????? ???????? in reducing PA burdens. 40% of PCA interactions are PA-related, ensuring members and providers get the support they need without unnecessary delays. ?????? ???????? ???? ???????????? ???????? ??????. Unlike traditional PBMs that charge per-PA fees—creating an incentive to require excessive authorizations just to drive revenue—we have zero financial stake in PA volume. That means we only apply PA when it’s clinically necessary, not as a money-making scheme. ???????? ???? ???????????? ??????’?? ?????????? ?????????? ????????????????—????’?? ?????????? ???????????????? ?????????????????????? ???????????????? ???????????? ???????? ???????????? ????????????????. #PBM #PriorAuthorization #Transparency #HealthcareReform

A "New Breed" of PBMs Are Hijacking 340B—And Gaslighting Hospitals While They Do It ? PBMs have turned gaming the system into an art form—this time, by hijacking 340B drug discounts meant for hospitals and redirecting them into the pockets of commercial employers. ? Here’s the scam: PBMs steer patients toward 340B pharmacies regardless of need, extract the savings, and leave safety-net hospitals bleeding dry. Then, when hospitals struggle, PBMs and drug manufacturers shift the blame onto the very program they’ve exploited. Classic misdirection. They profit, hospitals suffer, and patients pay the price. ? At AffirmedRx, we don’t play these games. We believe in transparency, integrity, and making sure federal programs like 340B actually help the hospitals and patients they were designed for. ? 340B isn’t broken—PBMs are breaking it. Time to call it what it is and hold them accountable. https://lnkd.in/e-f5veZG ? #PBMReform #340B #Accountability #StopTheScam

?????????????? ??????, ?????????????? ??????????????—this time, JPMorgan employees are suing, claiming they overpaid for prescriptions under a CVS-managed plan. ?????????? ????????????????? ???? ????????????. This is what happens when employers stick with PBMs that put profits over people. How confident are you that your company isn’t overpaying too? The Big 3 PBMs make ???????????????? by keeping drug pricing complicated and employers in the dark. And year after year, businesses foot the bill. ???????????? ???? ????????????. At AffirmedRx, we do things differently. No hidden fees. No games. Just real transparency. ???? ???????? ?????? ??????’?? ?????????????? ?????? ??????, ????’?? ?????????????? ?????????????? ??????. https://lnkd.in/eKTisbNi

At AffirmedRx, we know that meaningful change in the benefits industry starts with open, honest conversations. This week at the Employer Benefits Accelerator Roundtable, we’re joining industry leaders to discuss the biggest challenges facing employers and the solutions that can drive real impact. One of the most pressing issues? The lack of transparency in pharmacy benefits. For too long, PBMs have operated behind closed doors, making it nearly impossible for employers to understand where their dollars are going. At AffirmedRx, we’re changing that. We’re advocating for a system where transparency isn’t just a talking point—it’s the foundation of how we do business. These discussions matter because they push the industry forward. Employers deserve better visibility into their benefits, employees deserve access to affordable care, and PBMs should be held accountable for the role they play in healthcare. We’re here to be part of that change. World 50 Accelerator

PBMs have had a stranglehold on drug pricing for too long—operating in the shadows, prioritizing profit, and leaving patients to suffer the consequences. But their grip is slipping. ???????????? ??????’?? ???????? ????????????—????’?? ?????????????? ????????. Yesterday’s House Committee on Energy and Commerce hearing made that crystal clear. Chairman Buddy Carter didn’t hold back, exposing the brutal reality of PBM abuse. He shared the devastating story of ???????????? ??????????, ?? 16-????????-?????? ???????? ???????????? ????????-???????????? ???????????????????? ???? ?????? ????????????????, landing her in the hospital. This isn’t some abstract policy debate—?????????? ?????? ???????? ?????????? ???? ?????? ????????. ?????? ?????? ????????, ?????????????????? ?????? ???????????? ??????????????????. Shawn Gremminger pulled back the curtain on how ????????-???????????? ?????????????????? ?????? ?????????? ??????????????????, forced to fork over billions to PBMs while trapped in a rigged system. The so-called "competition" among PBMs? A total illusion. The reality? PBMs have gamed the system to keep employers, patients, and even regulators in the dark. This isn’t just another round of empty talk. ???????? ???? ?????? ?????????? ???? ?? ??????????????????. Bipartisan momentum is building. Investigations are deepening. ?????? ?????????????????? ?????? ???? ?????? ?????????????????? ???? ?????????????? ?????? ???? ????????. ?????? ?????????? ???? ??????????????. The power shift has begun. ?????? ???????????????? ????—?????? ?????? ?????????? ?????? ???????? ?????????? ????????? ???????????????????? ????. Let’s talk about how we’re leading the charge into a new era of pharmacy benefits.

PBMs are driving up drug costs—and even President Donald Trump called them "middlemen" that need to be knocked out. Pharmacy Benefit Managers (PBMs) were originally designed to improve access to affordable prescription medications by negotiating prices and managing formularies. Today, "PBMs have my best interests in mind" can't be said with confidence. The solution? A shift to a pass-through pricing model—one that prioritizes transparency and simplicity. Under this model, employers and insurers pay the actual cost of medications plus a clearly defined administrative fee, eliminating hidden markups and ensuring savings are passed directly to those who need them. At AffirmedRx, we're standing up for patients and employers by restoring trust and leading with a model that delivers real value. Read more: https://lnkd.in/e7yqRT94 #affirmedRx #passthroughpricing

“We all as Americans deserve medications that are doctors and us have decided is in our best interest. People’s lives, their healthcare, their wellbeing doesn’t have a price tag on it.” Patients face numerous hurdles created by traditional PBM’s. These include high and unexpected out-of-pocket costs, confusion over coverage, delayed access to vital medications, and limited choices which could include the most expensive kinds. AffirmedRx, a Public Benefit Corporation puts patients over profits, always. They are fighting for PBM reform that will include increased transparency and regulation over prices. Plus, their Patient Care Advocates empower patients and organizations to give them the confidence in navigating this confusing system. ? https://lnkd.in/eaC2icsv #PBGH #PBGHPA #PeopleYouTrust #PBM #Transparency #Partner ?

Pharmacy benefits are more complex than ever—but they don't have to be. Healthcare costs continue to rise and patients face increasing complexity when it comes to accessing and affording their medications. Prescription costs, confusing coverage details and lengthy approval processes leave many feeling lost in a system that should be supporting them. ?? AffirmedRx's response? A patient-centered approach to pharmacy benefit management that prioritizes transparency, advocacy and empowerment. Patient Care Advocates (PCAs): ?? Proactively address medication access issues ?? Simplify complex coverage details ?? Empower patients with clear, actionable solutions By removing barriers and providing real-time support, PCAs ensure that patients get the care they need when they need it without frustration. This isn't just about lowering costs—it's about putting patients first and creating a system that works for them, not against them. Read more: https://lnkd.in/eJ3MxBKm #affirmedRx #PBMReform

There's a dark side to traditional PBMs, and it's not just money at stake: https://lnkd.in/epReUPB7 PBM reform matters because patients and employers need a solution that delivers clarity, transparency, cost control, and the education and support necessary to make informed healthcare decisions that, at their root, put the patient first. Together, we can push against the challenges stemming from greed and a lack of transparency. Read more: https://lnkd.in/eaC2icsv #AffirmedRx #PBMReform

Traditional PBM models leave patients feeling confused and so overwhelmed. Enter AffirmedRx, a Public Benefit Corporation and their Patient Care Advocates (PCAs)!? PCA’s are dedicated to empowering patients by making sure they understand their pharmacy benefit plans, as well as ensuring the proper medication is being provided without any hassle. Read more about this new era of pharmacy benefits management at https://lnkd.in/eJ3MxBKm Interested in adding AffirmedRx to your organization? Contact Maurice Notkin at [email protected].? #PBGH #PBGHPA #PeopleYouTrust #Partners #PBM #Transparency #PCA??