Capital Rx Insights (August 2024)
With the launch of Never Move Again?, we're bringing transparency, advanced technology, and the option to "unbundle" the pharmacy benefit program to larger employers. Why? Good question. Our most sophisticated clients – health plans – value this approach most, and there's a real need for an unconflicted claims administration solution in the market. Capital Rx Co-Founder & CEO A. J. Loiacono highlighted the new offering at our inaugural Partner Summit, and we're excited to expand the audience and invite you to join us for a webinar on September 19th at 2 PM ET: Build a Lasting Pharmacy Benefit Strategy with Never Move Again?.?
AJ will join Josh Golden , SVP of Strategy, to explain how all this came to be, the advantages of combining our award-winning technology ( JUDI? ) AND customer service as the foundation of a pharmacy benefit plan, why this approach aids CAA compliance, what "commodity services" can be put out to bid, and much more. You're not going to want to miss this!?
It was amazing to see so many people who care about the future of pharmacy benefits in the U.S. come together at our first Partner Summit to share their ideas and opinions. We are so thankful for everyone's time and look forward to doing it again next year!
Related Content?
Astonishing Healthcare
If you haven’t yet, visit our Astonishing Healthcare Podcast page or subscribe on Apple or Spotify!
Nicholas Van Hook (VP, Commercial Markets) joins host Justin Venneri to discuss the pharmacy benefits selling season and the importance of building relationships and trust in B2B sales, especially in healthcare. They start with Nick's career journey - from pursuing a professional golf career and not knowing what a pharmacy benefit manager (PBM) is to consulting and, ultimately, Capital Rx - and then dive into the top questions and issues Nick fields and must address while building personal connections and closing deals with larger employers, including health systems and universities, where he tends to focus his time.
Nick shares his insights on current market trends, such as the significant impact specialty drugs and GLP-1s are having on employers' overall plan spend. He also explains drug mix and how Capital Rx differentiates itself by leveraging JUDI? to maintain independence and administer aligned pharmacy benefit programs that meet clients' needs without the conflicts of interest that arise from owning dispensing assets and engaging in spread pricing, for example.
Jeffrey Hogan , President of Upside Health Advisors, returns to the show for a timely discussion with Justin Venneri about why the timing is perfect for health plan sponsors and fiduciaries to engage their partners to secure necessary disclosure requirements and access to their data: it's renewal season!
The Consolidated Appropriations Act (CAA) placed additional responsibilities on plan fiduciaries, including the need to make attestations. With gag clauses removed from contracts, the door is open. Jeff stresses the importance of analyzing the plan's data to make informed decisions and meet the fiduciary obligations. "The industry is craving trust," and fiduciaries need a trusted source of data and analytics to help them identify areas of waste and make changes that will benefit their plans. Whether it's pharmacy benefits, hospital spend, or the commissions paid to brokers/consultants, there's a unique opportunity to gain the insight needed and avoid the rising risk of liability right now. Plan fiduciaries have the power, and JUDI? can help.
In this episode, Capital Rx's Kristin Begley , PharmD, Chief Commercial Officer, and Mike Miele , FSA, MAAA, Senior Vice President of Insured Services, discuss some of the finer points of pharmacy benefit management (PBM) procurement and pharmacy program cost evaluation, including how misaligned incentives can drive costs higher than they should be for plan sponsors. They delve into the misleading nature of focusing on unit costs and high rebates and advocate for a per member per month (PMPM) model to gain a clearer picture of true costs and hold PBMs accountable.
Kristin and Mike suggest ways to update and improve legacy PBM evaluation methods, encouraging stakeholders to more carefully consider everything from the questionnaires leveraged to screen potential PBM partners to the true value of clinical programs for utilization management - such as prior authorization - and the actual number of units used to forecast spending.
We dive into the National Pharmaceutical Council 's recent employer survey on rebates and rebate guarantees published in the AJMC - The American Journal of Managed Care , Prescription Rebate Guarantees: Employer Insights (7/19/24). NPC CEO John O'Brien , PharmD, MPH, and Senior Research Director Julie Patterson , PharmD, PhD joined Capital Rx's Co-Founder and CEO A. J. Loiacono in the studio for the discussion, which covered everything from how and why rebates have become so important to employers and traditional PBMs and what "pass-through" means to "the spreadsheet" and the difficulty in comparing traditional and more modern PBMs and how rebates impact a plan's net total cost.
AJ and John highlight how PBMs manipulate drug prices through rebate incentives, resulting in higher costs for employers and patients, and Julie reviews the results of their survey, explaining why employers?must "break the addiction to rebates." They emphasize the importance of transparency and the role of employer benefits consultants in PBM procurement and evaluation as well (at Capital Rx, we value objective, helpful advice on benefit design for our employees).
AJ Loiacono, co-founder & CEO of Capital Rx, discussed Never Move Again? on the show, explaining the details of the "unbundled" pharmacy benefit administration solution for large employers. It turns out larger employer groups, TPAs, and other groups with 50,000+ lives are very similar to health plans, which value the flexibility and transparency an unconflicted administrator provides. Supported by JUDI?, our single scalable enterprise health platform and a world-class call center, plan fiduciaries now have an option that addresses the pain points of CAA compliance and the friction of switching PBMs over time.
领英推荐
Capital Rx Press & Knowledge Exchange
In More Employers Turning to Benefit Startups to Manage Drug Costs (Bloomberg Law; 8/22), Capital Rx is prominently featured. After savings of $4M in year one, our client, Philadelphia Teamsters H&W Fund, saw expenses consistently come in below projections—nearly 10% lower than expected over four years (from 2019 – 2022).?
Capital Rx ranked No. 411 on the 2024 Inc. 5000, Making the List of America’s Fastest-Growing Private Companies for the Third Year. Our sustained growth reflects the demand for an independent, modern technology platform that addresses the needs of today’s benefits plans, said AJ Loiacono. We’re grateful for the opportunity to serve our clients and members.?
Our clinical team published the monthly Drug Pipeline & Clinical Update - July 2024, highlighting two key new drug approvals, including orphan drug PiaSky? for PNH, one notable expanded indication (Zoryve? for atopic dermatitis), and a handful of biosimilar and generic updates. The Updated Drug Recall Report is also available?HERE.
A complement to one of our more popular podcast episodes this year, Pharmacy Benefits 101: Prior Authorizations highlights the basics of prior authorization (PA) in pharmacy, misperceptions about the process, who decides which medications require a PA, reasons for denials, and how JUDI helps with decisioning PAs.?
Consultant Corner: September is Upon Us?
Channel Partners,? ?
For most PBMs, a 90-day implementation is standard operating procedure. So, if you've got clients up for renewal or who have outstanding RFPs, finalizing those deals in September for January 1, 2024, is essential. In September, I often hear, "The client doesn't have time to make a decision and is just renewing for another year," which isn't acceptable any longer. You can set your clients up for success and help them comply with their CAA obligations, but time is of the essence!?
On our end, the goal is to ensure smooth implementations for our channel partners and plans, and anything past October 1 either a) is too late, or b) comes with unnecessary friction. Check out Pharmacy Benefits 101: Successful Implementations for more information.?
Get in touch now to learn more about how we consistently achieve 100% implementation satisfaction and what we can do for your clients!?
Brian || [email protected]
Most Read News at Capital Rx?
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bs pharmaceutical sciences at Temple University
3 个月Great opportunity!