The Pharmacy Benefit

PCMA Vice President, Policy, Angela Banks talks with health policy expert Alex Brill about competition in the prescription drug marketplace and why this is the best way to reduce prescription drug costs. They discuss recent reports on big drug companies gaming the patent system to increase prescription drug prices for American patients and families.Alex Brill is a health policy researcher and the founder and CEO of Matrix Global Advisors, an economic consulting firm specializing in healthcare, tax, and fiscal policy.

November is National Diabetes Month. In this conversation, hosted by PCMA's Angela Banks, we discuss the work that PBMs are currently doing to help millions of patients with diabetes manage their care.  Express Scripts' Chief Medical Officer Dr. Christine Gilroy joins us as our guest.

Our focus is on prescription drug rebates. How do they work? Why do they work? How do they benefit consumers? And why are they currently under attack by some policymakers and drug manufacturers? The guest is Alex Brill, a health policy researcher and the founder and CEO of Matrix Global Advisors, an economic consulting firm specializing in healthcare, tax, and fiscal policy. He has extensive health policy research experience and previously served on the staff of the House Ways and Means Committee and the White House Council of Economic Advisers. Alex is also the author of a recent research study entitled “Understanding Drug Rebates and Their Role in Promoting Competition.”

When it comes to lowering prescription drug costs, competition is key throughout the prescription drug supply chain.  If you've listened to some in Washington, you might be led to believe that there is very little competition in the PBM marketplace. On this episode, we talk with Jason Borschow, President and CEO of Abarca and Mike Ellis, CEO of Maxor who say that is simply not the case. Competition is very healthy in the industry

Every day, PBMs are working to prevent potentially hazardous drug interactions, alerting their providers to potential problems, and monitoring patients' adherence to drug regimens so that they can avoid hospital stays and live healthier lives. On this episode, JC Scott talks with Dr. William Fleming, Segment President, Pharmacy Solutions & Chief Corporate Affairs Officer at Humana, Inc. about all of the work PBMs do in the area of clinical care. If you're listening to this podcast, you have insurance, and you've ever taken a prescription drug, we want you to have a clear idea of how your PBM works with your pharmacy and maybe even your provider behind the scenes between the time your prescription is ordered by a doctor to when the drug is in your hands.

This episode highlights the important role that PBMs play in lowering prescription drug costs amid the Federal Trade Commission's (FTC) recent interest in conducting a PBM study. The episode features Ross Margulies, a Partner with the law firm Foley Hoag. Mr. Margulies outlines the role that PBMs play in Medicare, and how PBM tools and technology are working to lower drug costs for patients as well as improving their pharmacy experience.

Pharmacy DIR (direct and indirect remuneration) is a value-based tool that's getting a lot of buzz on Capitol Hill and at CMS. To better understand Pharmacy DIR and how it affects Medicare beneficiaries, JC Scott talks with Dr. William Fleming, Segment President of Pharmacy Solutions and Chief Corporate Affairs Officer for Humana, Inc.  Dr. Fleming explains what pharmacy direct and indirect remuneration (DIR) means for pharmacists, why it should be thought of as value-based contracting, and how it engages with the pharmacist community to increase medication adherence and keep pharmacies accountable for increasing quality for patients.

JC Scott talks with Julie Goon, Senior Vice President of Public Affairs for Anthem, Inc., and Tim Dube, PCMA's Vice President of Regulatory Affairs. Together, they discuss good versus bad transparency, how transparency has evolved in healthcare, how it can empower the consumer to have more control over the prices they pay through evolved technology, and which transparency rules decrease prescription drug prices, and which rules actually increase prices.

Today, spending on biologic drugs makes up 43% of total drug spending. This is a growing area of new innovation for a multitude of therapeutic areas, and also an area of growing cost. To increase the use of biosimilars, strategies must be implemented to focus on biologics and drive cost-savings. To share these strategies, host JC Scott is joined by two members of Prime Therapeutics, Dr. Joseph Leach, Prime Senior Vice President and Chief Medical Officer, along with Jarrod Henshaw, Prime Senior Vice President and Innovation & Supply Chain Officer. Prime Therapeutics recently announced a major program addressing the increased use of biosimilars. Jarrod explains the differences between traditional drugs vs. biologics and generics drugs vs. biosimilars. Jarrod and Dr. Leach discuss what it means for biosimilars to be interchangeable, how they confront fears and misperceptions on biosimilars, what roles PBMs must play to drive the cost-savings from adoption of biosimilars, and how policies and incentives can encourage the use of biosimilars.

To stop significant increases in drug pricing, greater competition is needed in the drug manufacturing industry. To analyze the role public policy plays in this challenge, host JC Scott talks with Lauren Aronson, health policy expert and Executive Director of the Campaign for Sustainable Rx Drug Pricing (CSRxP). Lauren shares the defining moment that started CSRxP, the main challenges policy experts face in rising drug prices, examples of manufacturers' unsustainable pricing methods including their patent shenanigans, and potential solutions in creating sustainable methods for affordable drug pricing. They also talk about the current landscape in Congress and the Administration when it comes to political strategies to lower drug costs. 

We explore how The Robinson-Patman Act, an antitrust law intended to shield businesses acting as buyers from unfair competition, has impacted the pharmaceutical market from a historical standpoint, how it might be applied in the future, and what it means for public policy on drug pricing and rebates. To explain this, JC Scott sits down with Ross Margulies, a Partner with special expertise in Medicare and Medicaid law at Foley Hoag LLP. JC and Ross discuss the antitrust litigations that have shaped the drug supply chain.

Although the COVID-19 vaccine rollout has had a successful start, major health inequities still exist in vaccine access for underserved communities and underrepresented minorities. 2 million Americans are being vaccinated a day, but less than 20% are underrepresented minorities. In this episode, guest host Claire Winiarek sits down with Dr. Elena Rios, President and CEO of the National Hispanic Medical Association (NHMA), and Dr. Sree Chaguturu, Senior Vice President and Chief Medical Officer of CVS Caremark. Claire, Dr. Rios, and Dr. Chaguturu discuss the unique social determinants for why these inequities exist, why it's important to reframe COVID-19 vaccination campaigns for specific demographic groups, and how PBMs are working to educate underserved populations on the safety and efficacy of the COVID-19 vaccine. 

Although the COVID-19 vaccine rollout has had a successful start, major health inequities still exist in vaccine access for underserved communities and underrepresented minorities. 2 million Americans are being vaccinated a day, but less than 20% are underrepresented minorities. In this episode, guest host Claire Winiarek sits down with Dr. Elena Rios, President and CEO of the National Hispanic Medical Association (NHMA), and Dr. Sree Chaguturu, Senior Vice President and Chief Medical Officer of CVS Caremark. Claire, Dr. Rios, and Dr. Chaguturu discuss the unique social determinants for why these inequities exist, why it's important to reframe COVID-19 vaccination campaigns for specific demographic groups, and how PBMs are working to educate underserved populations on the safety and efficacy of the COVID-19 vaccine. 

The Trump administration enacted the Rebate Rule just before leaving office in November 2020. Analyses on the rule, including from government actuaries, show that the rebate rule would increase Medicare Part D premiums by 25% and increase taxpayer costs by 170 billion dollars. PCMA filed a lawsuit to stop the rebate rule from taking effect. In this episode, host JC Scott speaks with April Alexander, General Counsel and Vice President of State Regulatory Affairs of PCMA; and Mark Newsom, principal and founder at Health Evaluation, LLC. JC, April, and Mark discuss the PCMA lawsuit, the impact of the last-minute rebate rule, and the Biden Administration's approach to addressing the rule.

Many Americans have expressed strong reservations about vaccines in general and a COVID-19 vaccine in particular, and remain unsure about whether to be vaccinated against the coronavirus (SARS-CoV-2). In this episode, guest host ClaireWulf Winiarek speaks with Janet McUlsky, convener of the COVID-19 Vaccine Education and Equity Project, and Susan Winckler, a former Chief of Staff to the FDA Commissioner and current CEO of the Reagan-Udall Foundation for the FDA, about these concerns and the potential messages and messengers that may help improve understanding. Only by meeting individuals where they are, and with empathy, can we promote equity and trust in the vaccines and support informed decision-making regarding whether to be vaccinated—particularly among communities of color.To learn more about the important work underway by the COVID-19 Vaccine Education and Equity Project, or to join the initiative, visit covidvaccineproject.org. Findings from the COVID-19 Vaccine Confidence Project, led by the Reagan-Udall Foundation for the FDA, are at covid19.reaganudall.org.A Historic Effort and Collaboration. Susan discusses that the vaccine was able to move along quickly due to significant collaboration and large numbers of people who were eligible for clinical trials. To ensure the vaccine could be distributed as soon as possible, manufacturers continued working on it at risk while they were under regulatory review so it could be distributed as soon as it was authorized. FDA staff members reviewed regulatory packages of the vaccine to move authorization along as quickly as possible. Janet shares that the thorough oversight and monitoring by the FDA, researchers, and physicians helped ensure the safety and effectiveness of the vaccine even though the process was much quicker.  Previous pandemics and other infectious threats in the last decade also resulted in more research that allowed manufacturers to advance the vaccine more quickly in the COVID-19 pandemic.  Handling Vaccine Skepticism. Janet and Susan agree that to distribute the vaccine to more individuals, it will take conversation and dialogue over dismissiveness to answer the questions of those hesitant to receive it. Much of the hesitance comes from marginalized communities due to racial and ethnic disparities in healthcare. It's necessary to invite questions to discuss how the vaccine was developed so quickly, who authorized the vaccines, and how the clinical trials were diverse across race, ethnicity, and age to make sure the vaccine works for everyone. Distributing Vaccine Information. Trusted messengers are necessary in both listening to concerns and responding thoughtfully. Local healthcare professionals are credible messengers to answer questions in one-on-one conversations. Janet shares that the COVID-19 Vaccine Education and Equity project provides discussion guides for people to talk among various groups about the data behind the vaccine to ensure no shortcuts were taken, especially among marginalized groups and those with prior health conditions. Personal conversations can answer why the “risk-benefit” weighs on the side of getting the vaccination. All Hands On Deck. The private sector is helping employers by passing around data and information to help people feel calm and confident that the vaccine is safe and effective. Susan adds that it's necessary to give health professionals the right information as they tend to be the de facto health experts in their social circles. Health professionals should be prepared with answers and resources to welcome questions and provide accurate answers.  COVID-19 Vaccine Discussion Guide. You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms. 

Host JC Scott speaks with Megan Hauck, a former Health Policy Advisor to President George W. Bush, Senator Mitch McConnell, and Chris Jennings, former Senior Advisor for Health Policy for both the Clinton and Obama Administrations. In this episode, Scott, Hauck, and Jennings discuss the election results, what a new president and Congress will mean for healthcare policies, and speculate how shifts in the House and Senate will impact the future of healthcare. The failure of polling. The results of the election, specifically regarding the performance of Republicans in the House and Senate, were a big surprise to many. Hauck calls for polling to be modernized while Jennings argues that the media and its consumers over-utilize polling. With the massive turnout, the voters clearly called for collaboration in fighting Covid-19. Policies the Trump Administration might push in these final weeks. Regarding healthcare, the administration is currently examining the Rebate Rule and a proposal to tie drug prices to an international benchmark. It's normal for an administration to push out prioritized regulations in their last eight weeks. Technically, Congress can overturn them under the Congressional Review Act, but this can be an arduous process. Hauck points out that the Trump administration will prioritize its own policies over those that will help Congress in the long run, something that is unusual compared to previous presidents' administrations. Narrow majority chambers, will they come together for healthcare? Jennings suggests that there will be bipartisan interest in preventing future pandemics, once we have control over the virus. Until then, Covid-19 is expected to be the primary focus regarding healthcare. The pandemic has also exposed the shortcomings of the healthcare system and exacerbated Medicare solvency, leaving public healthcare and Medicare as the next big issues to tackle. President-elect Biden will likely address states who have not expanded Medicaid. Hauck and Jennings also discuss how Biden's previous experience in the Senate will impact his ability to navigate Congress as President. Refusal to transition. With President Trump refusing to concede, there is an unprecedented lack of communication between the Trump and Biden teams. This means that the incoming Biden administration does not have access to key departments and information for fighting Covid-19, including the distribution of vaccines and testing dynamics. Hauck and Jennings both share experiences of their duties when they worked during presidential transitions, agreeing that it's a patriotic duty to assist the next team coming in and that the delays are inexcusable — but not insurmountable. More elections to come, more predictions. Midterm elections are coming in 2022. With narrow majorities in both chambers, Hauck and Jennings offer their predictions for the House and Senate outcomes.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Amy Bricker, Senior Vice President of Health Services Supply Chain at Express Scripts and previous commissioner for MedPac. November is National Diabetes Month, and the discussion this week revolves around how PBMs help keep the costs of insulin down and improve patient care. Getting Support for Diabetes in AmericaList prices for insulin have not gone down, leaving some diabetes patients with high costs for the live-saving medicine, either as high insurance co-pays or deductibles or the high cost of insulin itself. While there have been some improvements in delivery technology and formulations, Bricker points out that these innovations don't justify the high prices pharmaceutical companies continue to charge. To some extent, the lack of competition in the market is causing this, which is why PBMs are so important.How Express Scripts is HelpingLast year Express Scripts saw a 5% decrease in spending from those enrolled in their clinical solution, thanks in part to discounts but more critically through leveraging formularies, utilization, and diabetes care value program that ensures patients get complete care, communicated in ways that work best for them.The Effects of Coupon and Discount ProgramsBricker argues that well-intentioned programs like 340B are out of control and no longer helping patients. She believes this and other coupon programs require major reform or even elimination, because they operate in the background and disrupt formularies.CMS Part D Senior Savings ModelThe Centers for Medicare & Medicaid Services established a voluntary Part D plan that limits insulin's cost share to $35 a month per beneficiary. Approximately a third of Medicare beneficiaries are affected by diabetes and companies such as Express Scripts and Cigna will participate in this program. While Medicare Part D definitely needs reform, steps such as these are a great starting point and crucial to those within the program.What Does the Future Look Like?Bricker says we need to encourage manufacturers to lower prices, but that needs to be encouraged by legislation or regulation — while always keeping the patient top of mind. She advocates for Part D reform to establish more programs like the #35/month cost share.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with two guests from Humana Pharmacy Solutions. The first, Dr. Mona Siddiqui, is senior vice president of clinical strategy and quality at Humana. Her background is in public service, especially with HHS and the Center for Medicaid and Medicare Innovation. The second is Dr. Scott Greenwell, senior vice president of pharmacy solutions at Humana, who played an integral role in launching Humana's Medicare Part D program. The discussion is around innovation in service delivery both before, during, and after the pandemic. Analyzing Trends to Improve Programs: Data-driven program design utilizing almost-real-time data from CMS or FDA can have an enormous impact on end users. Bringing together data assets from Humana's insurance side, home segment, and pharmacy segment has provided insight into differing needs of pharmacy customers, most recently during the pandemic.Social Determinants During the Pandemic: During Covid social determinants of health are of paramount interest. Humana focused on listening to customer needs, including food scarcity, loneliness, transportation access, early prescription refills, mail delivery, and allowing periodic lab requirements to be postponed. Will Changes Made During the Pandemic Last?: You can't put the genie back in the bottle. Consumers will expect changes like mail delivery to remain in place even after the pandemic is under control. Surprisingly, even seniors preferred an end-to-end digital experience; they are used to seamless digital experiences now because of entities like Amazon. Meeting Consumer Expectations with Technology: Humana began in 2015 with the real-time benefit check transaction as an early transparent digital process. This was integrated into the physician's existing workflow and the response was that this was just what had already been expected. Even those who have been uncomfortable with digital tools approve of them when the experience is frictionless for patients and providers.Specialty Drugs in Disease-specific Clinical Initiatives: Where traditional rebate tools will not work, as with specialty drugs, Humana sometimes uses value-based contracting. The company also has a program called UM Ultra, which creates personalized utilization management, such as looking at dose optimization, so that patient value is balanced with drug cost. Promoting Covid Testing: In addition to covering testing costs, Humana has also made at-home testing kits available. And it created a drive-thru PCR test partnership with Wal-Mart that delivers results digitally and refers out as well, when necessary. And, again, the purely digital process has proved more popular than the drive-thru process, counterintuitively for some. You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Claire Winiarek, the VP for Policy of PCMA, about the increased use of mail delivery for prescriptions. Winiarek discusses the value of mail service for prescriptions both relative to the pandemic and beyond it.PBM Mail Service Increases During the Pandemic: The top-line trend is increased mail delivery by 20 percent through July, year on year. At the tail end of the first quarter, early refills drove an increase, as well as at the end of the second quarter as people reached the end of their 90-day prescriptions.PBM Response to Increasing Demand for Home Delivery: Part of the response was working with pharmacies to provide home delivery as well as mail delivery and to make consumers aware of the service. In addition, educating consumers about 90-day refills and arranging auto-ship through the mail has been an essential contribution to slowing the spread of the virus by making it possible for people to stay home. PBMs and Pharmacies Working Together: PBMs and pharmacies worked together early in the pandemic to develop practical, common sense alternatives to delivery signature requirements. PBMs and Delivery Challenges: Some PBMs are trying alternative carriers or changing when prescriptions are shipped to allow for potential delays. They're also allowing for early refills and transition fills at local pharmacies. Behind the scenes, there are proprietary systems mapping the transit of prescriptions through the system so that delivery can be continuously fine- tuned. A well-funded Postal Service is critical for the affordability of this option.Home Delivery Benefits Consumers: Prescription adherence rates improve from 77 percent for pharmacy pick up to 87 percent for mail delivery. This adherence, in turn, drives improvements to other outcomes such as emergency room utilization and rehospitalizations. Dispensation of medication is also safer when performed en masse in a factory setting as opposed to in local pharmacies. Of course, the scale also drives costs down for consumers, as does the convenience itself. Having 24/7 access to prescription counseling through PBMs can be another benefit both in terms of convenience and confidentiality. Data from IQVIA suggest that these increases in home delivery will be here to stay, along with telehealth and tele-pharmacy options. COVID-19 Test Kits Via PBMs: UnitedHealth Group is beginning to send lower-nose tests that are as effective as the tests developed earlier in the pandemic. CVS is also sending out test kits. Outlook for a Vaccine: Winiarek leads a stakeholder group with other drug supply chain partners, including pharmacies, manufacturers, grocers, and hospital pharmacists that has been discussing drug shortages and now plans for a COVID-19 vaccine. The discussion has centered around how the supply chain can support a scientific and evidence-based process of evaluation of vaccines. Planning ahead for the fact that supplies of the vaccine will be limited and developing policies for allocation, access, and safety are central to the group's efforts. You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Mark Newsom, the principal and founder at Health Evaluations LLC, on one of the executive orders Trump signed on drug pricing that affects prescription drug rebates for public programs. Newsom discusses how prescription drug premiums will certainly increase with the implementation of this rule.What a Post-Rebate System Would Look Like For PBMs: With the removal of rebates for such programs, many players in the system are skeptical about how the shift in power will disturb the establishment of drug prices. Newsom speculates the balance shifting towards consumers sticking to the pricier branded drugs rather than their generic counterparts.The Executive Order Could Still Have Its Meaning Altered: JC and Mark discuss what mysteries await with how Secretary of Health and Human Services, Alex Azar, moves forward with Trump's order. Newsom also brings up how big changes in sectors such as pharmaceuticals and healthcare would bring risks if not properly tested and ironed out beforehand.Taking a Step Back to See What is and isn't Working: Newsom gives his own take on how the system as whole can fix the issues being presented while also keeping every party happy. From creating sufficient competition without giving one stakeholder too much leverage to how out-of-pocket protection can be implemented, most problems can be solved when everyone is on the board to discuss.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Dan Judy, Analyst and Polling Expert at North Star Opinion Research, about his recent polls finding that benefits managers are overwhelmingly satisfied with results on Pharmacy Benefit Managers (PBMs). Despite these positive results, JC and Dan discuss why PBMs still suffer from a “trust deficit” in the public eye.High Satisfaction with PBMs: Overall, North Star's polling results found that the vast majority of employers/benefit managers are satisfied with PBMs. Most benefits managers also agreed that their contracts with PBM are transparent and that PBM tools and programs (such as mail orders) are helpful to their employees.Stabilizing Drug Costs: More than half of North Star's surveyed benefits managers reported that drug costs remained stable over the past year. JC notes that stabilized drug prices improve consumer experiences and point to increased satisfaction with PBMSs.Overcoming the Trust Deficit: Despite these positive polling results, JC and Dan discuss why there remains a perception that PBMs are non-transparent and increase drug costs. They offer that the combination of charged political discourse on drug pricing and “blame-shifting” within the healthcare industry have fostered continued public skepticism toward PBMs. You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

JC Scott speaks with Doug Long, Vice President of Industry Relations at IQVIA, about the impact of COVID-19 on the pharmaceutical market. Long discusses the data trends for pharmaceutical companies during COVID-19 and, most importantly, how these trends impact healthcare patients. Prescription Stockpiling: With news of the impending pandemic, patients around the US began to stockpile 90-day prescriptions in March. As a consequence, the pharmaceutical marketplace experienced a major decrease in demand in the following two months. Long describes the effects of this “prescription rush” and subsequent demand decrease on the pharmaceutical industry.Access Prescriptions and Shortages: JC and Long discuss methods by which patients are receiving their prescriptions during COVID-19. Mail-order and other socially distant methods (such as deliveries) have grown in popularity. Long also details how the pharmaceutical industry has responded to recent supply chain shortages. Overall, he is impressed by the resilience of the pharmaceutical supply chain (which includes manufacturing, PBMs, pharmacies, wholesalers, and logistics companies) during COVID-19.Growth of TeleHealth: Long touches on the impact of telehealth on the healthcare marketplace and medical prescriptions. He notes the dramatic growth of telehealth in a matter of just a few months, and he believes that telehealth is here to stay. However, he cautions that telehealth may have a negative impact on prescription trends for patients.  You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Mostafa Kamal, CEO of Magellan Rx Management, about the evolving role of the PBM market in delivering solutions to its clients. JC and Mostafa also discuss challenges to Medicaid during the current economic downfall, as well as upcoming technological innovations to improve the patient experience. PBM Tools Drive Affordability and Care for Medicaid: Recent unemployment hikes are expected to put severe strains on Medicaid. States across the US will have budgetary pressures to cope with the surge of new patients. Magellan Rx Management is delivering solutions to US States and DC to lower costs and improve efficiency for their Medicaid programs.New PBM Market Disruptors Are Emerging: Innovators (i.e., “disruptors”) identify and eliminate market inefficiencies to improve customer experiences. In the age of COVID-19 and changing consumer expectations, Mostafa anticipates an increase in the pace of PBM market disruptions. JC and Mostafa discuss some major disruptions on the horizon, including drone home deliveries, real-time information sharing, and predictive modeling to identify medication non-adherence risks.Greater Personalized Care in the Future: Mostafa believes that future PBM market disruptors will focus on the personalization of medicine. He foresees a customized, genetic-based pharmacy experience for each patient.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Tim Wentworth, the president of Cigna Express Scripts and Cigna Services, about how Cigna--along with the entire pharmaceutical industry--are addressing the COVID-19 pandemic. Wentworth is optimistic that the ingenuity of the US healthcare system can combat COVID-19 and that current industry-wide collaborations can survive beyond the current pandemic. Some key points from the conversation include:Cigna Continues to Put the Patient First During COVID-19: Since the start of the outbreak in March, Cigna has focused on the safety of its employees, customers, and most of all, patients. Wentworth emphasizes that Cigna is dynamically managing the supply chain and acting flexibly and nimbly to ensure pharmaceutical access to the clients. It is also working with federal and state officials to ensure a balanced pharmaceutical policy.The Pharmaceutical Industry is Collaborating To Address the Current Health Crisis: Wentworth is optimistic about the cooperation between industry members to ensure the patients continue to receive care. For example, Cigna is now collaborating with retail pharmacies to put in place a new program with deep discounts for uninsured patients. The entire industry is working to ensure that those suffering from healthcare and economic fallouts from COVID-19 are not forgotten. He believes that such collaboration can continue in the future.US Health Sector Innovation Is the Best Bet Against COVID-19: US biotechnology and pharmaceutical companies are working in an unprecedented manner to find solutions to COVID-19. Wentworth believes that Cigna, and the entire industry, will find a way to ensure access to COVID-19 for its patients. He stresses that it is a public health decision more than it is a commercial decision.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Host JC Scott speaks with Mark Newsom, the principal and founder at Health Evaluations LLC, on the core role of Pharmacy Benefit Managers (PBMs). Newsom goes through the process PBMs take to get us, the consumers, the most effective medications for the lowest premiums. He also discusses PBMs and their role in conjunction with the other players in the industry. Some key points from the conversation include:Why PBMs Exist And How Savings Are Generated For The Consumers: Newsom accentuates how PBMs' role in doing the formulary is one of the biggest steps in reducing costs of prescriptions while also increasing the safety of the consumer. He also focuses on how negotiations between manufacturers and pharmacies is a key area for lowering prices. These savings from each individual step help consumers save 40-50% on their annual costs in the form of lower premiums.A Breakdown Of Where The Money Flows And The Thin Line Of Profit PBMs Tread On: JC Scott breaks down the purchasing dollar and where it goes within the pharmaceutical industry and questions Newsom about the low profit margins of PBMs. Newsom explains how much money is saved for every dollar spent on PBMs, and how even a low percentage of the total money involving pharmaceutical drugs goes a long way when there are billions of prescriptions every year. What Actions Undermine The Work Of PBMs: Newsom discusses how everyone wanting everything hurts the effectiveness of PBMs working to get people quality prescriptions at lower costs. With individual preferences and politics getting involved, PBMs must work around these obstacles in order to provide the best service they can.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

Welcome to The Pharmacy Benefit! Hosted by JC Scott, President and CEO of the Pharmaceutical Care Management Association, The Pharmacy Benefit talks about the latest trends, public policy developments, and political challenges impacting drug pricing and healthcare.You'll hear the nation's top thought leaders, policy experts, and political analysts on a wide variety of topics from insulin affordability to advancements in gene therapy, biologics, other cutting edge therapies.The Pharmacy Benefit will also analyze the latest news from inside the industry and give you an educated perspective on where things stand and where they're headed.  Subscribe today on Apple Podcasts, Google Podcasts, Spotify or wherever you get your podcasts.