Capital Rx Insights (December 2024)
Wow, 2024 flew by! Are you as excited about 2025 as we are??
We've packed this final Insights Newsletter of 2024 with the most popular content we've published over the last 12 months, a "save the date," and more. We're already working on new webinars, we have fresh episodes of the Astonishing Healthcare Podcast starting January 3rd, and we have several articles and an eBook in final draft form.?But what would you like to see, hear, or read from our team?
Would more Pharmacy Benefits 101s or coverage of advanced or nuanced topics in or around drug pricing, "the spreadsheet," pharmacies, or clinical programs be valuable? How about opinions and expectations about health policy and PBM reform or a view into new JUDI? features and enterprise health technology developments? We'll keep an eye on the comments in case anyone wants to chime in.
From our team to you and yours, have a happy, healthy New Year!
Save the date (or RSVP now ??) for “5 Ways to Improve your PBM Procurement Process in 2025,” featuring former pharmacy program director and plan sponsor Bridget Mulvenna, Vice President of Business Development here at Capital Rx.
2024's Most Read, Viewed, and Listened to Content
MOST READ: The Upside of Modern Technology vs. Legacy Claims Processing Systems eBook
MOST VIEWED: Replay: The Story of a Claim, with Kevin Sundquist
MOST LISTENED TO: AH033 - Never Move Again?, a Paradigm Shift in Pharmacy Benefits, with A. J. Loiacono
AH046 - What's Hot In and Around the Pharmacy Supply Chain, with RSM's Tom Evegan
On Episode 46 of the Astonishing Healthcare podcast, Tom Evegan , Principal, National Consulting Leader, Life Sciences at RSM , a leading provider of tax, assurance, and consulting services in the US, joins Justin Venneri for a discussion about topics ranging from health policy to drug pricing and how to provide equitable drug access. Tom shares his background and path to RSM, explaining how his experiences at a major pharmaceutical manufacturer, pharmacy benefit manager (PBM), and a biotech launching a new therapy shaped his experience and aided him in becoming a "gross-to-net expert."
Tom has helped hundreds of drug manufacturers launch, acquire, or divest assets and bring products from the regulatory phase to commercialization, so he's seen a lot and pays close attention to issues impacting drug prices and market access. Given his broad experience across the pharmaceutical supply chain, almost no topic is off the table. The conversation dives into the Inflation Reduction Act (IRA), the Chevron Ruling and 340B program, AI, why rebates likely aren't going anywhere soon, and the most astounding thing Tom's seen (hint: it relates to GLP-1s)!
AH047 - What Project 2025, RFK Jr., and Dr. Oz Could Mean for the Business of Healthcare Under Trump
On this episode, we cover the potential future of U.S. healthcare policy under the Trump administration, focusing on the business of healthcare services and possible changes to Medicare and Medicaid, support for telehealth, solving workforce issues, and managing chronic diseases. Our guest from Episode 13, Redefining Virtual Care: A Blueprint for Effective RPM, Robert Longyear , Co-Founder of Avenue Health, returns to the show and shares his view from K Street after reviewing Project 2025 and evaluating what RFK Jr. and Dr. Mehmet Oz could prioritize in their roles.
Robert shares the highlights of his analysis, including what he found most interesting and what he'll be watching for on payment policy (e.g., there's bipartisan support for payment reform and price transparency), potential changes to Medicare Advantage and Medicaid, initiatives to increase competition, pediatric care, how to reduce administrative burden and alleviate provider burnout, abortion policies, the use of artificial intelligence to crack down on FWA, and access to patient data. If health policy matters to you, this episode is a "must-listen!"
Best of '24! AH020 - Why NADAC is a "Ray of Sunshine," with AJ Loiacono and Antonio Ciaccia
On this episode of the Astonishing Healthcare podcast, Capital Rx Co-Founder and CEO AJ Loiacono and 3 Axis Advisors President/ 46brooklyn Research CEO Antonio Ciaccia dive into drug prices in the U.S., and NADAC - national average drug acquisition cost - was the focus of our discussion. Recent methodology changes - NADAC Methodology Changes - Executive Summary (June 2024) - and a new survey participant have combined to drive meaningful deflation in generic drug prices recently, amounting to a nearly $500 million change! AJ and Antonio dive into why this is significant and other factors stakeholders should consider.
NADAC serves as a crucial price benchmark, providing visibility and some level of understanding - a "source of truth" - of drug pricing in the United States. Average wholesale price (AWP) and other indexes fail to reflect actual acquisition cost/supply chain economics but have prevailed for years. Is it the pharmacy benefits managers (PBMs)? Is it the wholesalers? At Capital Rx, we have always preferred to leverage NADAC whenever possible despite its imperfections. Nothing is perfect in the pharmaceutical supply chain regarding drug pricing, and NADAC remains the best, most reliable option.
Best of '24! AH041 - ERISA Litigation Outlook and Meeting CAA Requirements, What Can Plan Fiduciaries Do?
On this final encore episode of the Astonishing Healthcare podcast this year, we're replaying Episode 41, which featured three experts weighing in on rising litigation against employers and pharmacy benefit managers (PBMs) and was one of our most popular. We also want to take the opportunity to say, "Happy Holidays and New Year!" and thank our listeners and guests this year, including current and former colleagues; we couldn't have done it without you!
So, what can employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and assess how "reasonable" the fees they pay are? Chris Deacon , Founder of VerSan Consulting; Jonathan Levitt , trial attorney and Co-Founding Partner at Frier Levitt; and Julie Selesnick , Senior Counsel in the employee benefits and ERISA Group at Berger Montague, explain:
This episode built on previous conversations, including AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan.
Chris, Jon, and Julie also share their opinions about the similarities - or lack thereof - of the health plan lawsuits to the 401(k) and pension litigation of the early 2000s, the reality and frustration of relying on traditional PBMs and carriers for data (and what to do about it), and why Julie has a "fainting couch!"
领英推荐
Best of '24 Press & Knowledge Exchange?
Prime Therapeutics and Capital Rx Enter Into Transformative Strategic Alliance?topped the list. We know how diligently our teams are working behind the scenes, and we look forward to unlocking the full potential of this alliance with Prime Therapeutics !
In?Insurers, employers see payoffs switching to smaller PBMs, Modern Healthcare's Lauren Berryman highlights the upside of switching to a more "refreshing model" that can help control costs. Was 2024 the year that plan sponsors finally saw the light? Only time will tell.
Prioritizing member and patient care is central to our model.?
Capital Rx’s Customer Care Team Won 5 Stevie? Awards?for Customer Service in 2024, and if you listen to Will Tafoya in?AH034 - Customer Care in Healthcare: Setting a Higher Bar, you can understand why and how we do it.
We recorded a special Astonishing Healthcare podcast?episode with Amy Stockton, PharmD , Symara Schmidt, PharmD, PMP, CHC, BCGP , Lauren Carroll , PharmD, BCACP; and Marissa Badzik-Miller, PharmD , to celebrate WPD 2024!
In?AH032 - Prescription Rebates: Agreements, Guarantees, and More, with NPC's John O'Brien, PharmD, MPH, and Julie Patterson, PharmD, PhD, we dove into?Prescription Rebate Guarantees: Employer Insights?((7/19/24) with AJ Loiacono and the team at the National Pharmaceutical Council .
There is no shortage of GLP-1 content on Insights.?Replay - Innovative partnerships for GLP-1 management, featuring Capital Rx Chief Clinical Officer Sara Izadi, PharmD , and Richard Frank, MD, MHSA of Vida Health , was among the most popular webinars of 2024. And?How to Manage Pharmacy Benefit Spend in a GLP-1 World?is a great complement to the webinar!
Happy New Year, Channel Partners!? ?
The holidays always remind me how important relationships are.?
Whether in your personal life or work, strong relationships built on trust and clear communication make life easier, especially when things don’t go as planned or as you’d like!
?? I was on our podcast nearly one year ago -?AH003 - What's New in the Partner Channel?- and when asked what advice I’d give to someone newer to our industry, I responded: “Engage your vendors, your PBMs, the folks you're working with, and really build good relationships, because ultimately things are going to come up where you need a solution very quickly.”??
With plans going live tomorrow, all the planning and collaboration of the last few months will come to life. There will undoubtedly be some friction somewhere in your book of business. I hope it’s minimal, but if you need a question answered or some other sort of support or information, those strong connections with partners who can help become vital.??
The top issues for members usually involve prior authorization or plan design changes and require education and, sometimes, a little more patience than usual, too. Lean on your partner for member and client support, and don’t sacrifice quality of care for speed. Some resources that may help include:?
I’m looking forward to what’s to come in 2025 always happy to trade notes. Reach out if you’d like to chat, and have a happy, healthy New Year! ???
Brian | [email protected]
Most Read News at Capital Rx
We’re hiring! If you are looking or know anyone looking for a new role in the PBM industry, from clinical and client operations to compliance and technology, and everything in between, please visit our careers page to review open positions.
We hope you're enjoying this newsletter. We welcome your feedback, questions, and suggestions for future content. If you'd like to discuss how unbundling with Capital Rx's?Never Move Again??can help future-proof your pharmacy program, we'd love to hear from you!
Thank you for reading, and cheers to 2025! ??
* Based on page sessions, 1/1/24 to 12/31/24.