Capital Rx Insights (March 2024)

Two themes dominated the news around Capital Rx this past month: validation of JUDI? as the leading modern enterprise health platform in the pharmacy benefit management (PBM) industry and the question: “Is it possible to run a better pharmacy procurement process?”

First, we are excited about our alliance with Prime Therapeutics and bringing the benefits we’ve experienced with JUDI to their team and plans that serve over 50 million members.

Second, “Yes.” We think it’s possible to run a better procurement process, and we will continue to share what we’ve learned over the years to help our clients, prospective clients, channel partners, and other stakeholders ask better questions, recognize misalignment, and realize achievable savings wherever possible.

Read on for the usual roundup of news and insights from the Capital Rx team, and CLICK HERE to learn more about our strategic alliance with Prime !?

Running a Better PBM Procurement Process

The process to procure (i.e., purchase) a PBM solution has always been notoriously complex, arduous, and opaque. With increased scrutiny on PBMs – from both governmental bodies and plan sponsors – it is more important than ever to know, with confidence, that you are working with an aligned, transparent PBM that places the plan and your members’ benefits above everything else.

Bridget Mulvenna ’s webinar on March 21, 2024 highlighted 5 strategies that plan sponsors/fiduciaries, benefits managers, and other industry professionals can immediately employ. CLICK HERE for the Replay !

Related Content?

??? Pharmacy Benefit Procurement: How to Ensure That Savings Materialize (IFEBP)?

?? AH002 - A Former Pharmacy Program Director's View on Controlling Pharmacy Costs ?

?? 5 ways to improve your PBM procurement process in 2024 (Benefits Pro)

Astonishing Healthcare?

If you haven’t yet, visit our Astonishing Healthcare Podcast page or subscribe on Apple or Spotify !?

March 2024 Episodes?

• AH011 - Navigating CMS' M3P, PDE, and Other Regulatory Changes, with Jason Barretto ???? (3/29)
• AH010 - The Power of PMPM: Holding PBMs Accountable for Total Drug Spend , with Kristin Begley (3/22)?
• AH009 - Modern Technology in Healthcare: Enhancing Efficiency & Security , with Ryan Kelly (3/15)?
• AH008 - Ask the Right Questions to Future-Proof Your Pharmacy Benefit Plan , with Josh Golden (3/8)?
• AH007 - There’s No Value-Based Care Without Considering Pharmacy with Sunil Budhrani MD MPH MBA (3/1)?

Knowledge Exchange

The leadership of SoNE HEALTH recently sat down to discuss why they decided to run an RFP for a new PBM, why they chose Capital Rx, their implementation experience, their cost trend before and after, and much more (including some suggestions for other plan sponsors about what to look during the procurement process)!

How can JUDI? meet the level of flexibility, adaptation, and vigilance required with Medicare and Medicaid? In our blog, How Our Favorite New JUDI? Features Aid Government Programs , we chatted with Jason Barretto ???? (VP, Government Program Operations at Capital Rx) about specific JUDI features that bring efficiency and precision to government programs.?

Drug Pipeline & Clinical Update - February 2024: The Capital Rx Clinical Team highlighted three key new drug approvals, all "first" of their respective kinds -- Eohilia? (budesonide), Aurlumyn? (iloprost), & Amtagvi? (lifileucel) -- three notable expanded indications, and Six generic launches.

Consultant Corner: Running a Fair Procurement Process?

Channel Partners,? ?

The industry is evolving rapidly, and plan sponsors’ and administrators’ understanding of how PBMs make money, drug prices, etc., is improving. We think it’s time for the procurement process to evolve as well. Here are the top three things I find myself discussing with channel partners related to running a better – dare I say, “fairer” – procurement process:?

1. Drug Mix – It matters, a lot. Consultants are beginning to push the analysis beyond discounts and rebates, which is just one part of the procurement process. Evaluating drug mix may not yield higher rebates, but the focus is lowering overall plan spend.?

1. Exclusions - PBMs will show limited exclusions during procurement, which allows for higher-cost drugs, with rebates, to look good on a spreadsheet (high rebates won’t = lower plan spend).?

1. Procurement with coalition vs. direct pricing - While you can compare the two, it is important to understand the difference in contracting and pricing guarantees when running your pharmacy procurement. Be sure the client is aware of the differences when comparing results.?

I’ll finish with a shameless plug: “Start your pharmacy procurement EARLY!”??

I’m here to help. Let me know if you’d like to chat.

Brian TenEyck , National Director, Consultant Relations || [email protected]

Most Read News at Capital Rx?

• Eli Lilly taps Amazon Pharmacy to help deliver weight loss drug Zepbound, other medicines to patients (3/13; CNBC)?
• Medicare paves way for weight loss drug coverage (3/21; Becker’s)?
• 'Ozempic babies' are surprising women taking weight loss drugs. Doctors think they know why. (3/21; USA Today)?
• Medicare plans can now cover Wegovy for patients at risk of heart disease (3/22; NPR)?
• No matter the risks, more employers are choosing self-funded plans (3/22; Benefits Pro)?
• Medicare Spending on Ozempic and Other GLP-1s Is Skyrocketing (3/22; KFF)?

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