Podcasts about Pharmacy benefit management

On this episode of the Astonishing Healthcare podcast, host Justin Venneri speaks with Liya Lomsadze (Director, Product Management) at Capital Rx. Liya highlights her journey from data analytics on the provider side to leading the product development of Capital Rx's Unified Claims Processing™ product, Judi Health™. They dive into several recent updates to the Judi® platform, highlighting Judi's overall agility and how it aids in the administration of benefit plans for Capital Rx's clients. During the discussion, they also explore:Improvements to the Prior Authorization (PA) Tool, including a new supervisor dashboard for PA requests.Judi's ability to ingest historical claims data for seamless onboarding of new clients.The potential expansion of Unified Claims Processing to include other insurance (e.g., vision and dental).Capital Rx's new Medicare Prescription Payment Plan (M3P) and Judi's ability to meet evolving CMS requirements.Judi's Formulary Management Tool, which aims to improve how claims are adjudicated by making formulary data both accessible and functional.How Judi Health aims to streamline member care and improve the patient experience.Last, Liya praises one of Judi's most loved features - can you guess what it is? Hint: if, then.Related ContentCapital Rx Receives a US Utility Patent Covering its Enterprise Health Platform - Judi®Pharmacy Benefits 101: Prior AuthorizationsHow Our Favorite New JUDI Features Aid Pharmacy Benefit AdministrationAH027 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 1AH028 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 2For more information about Capital Rx and this episode, please visit Capital Rx Insights.

"If my child needs a gene therapy to live, they should get it and anyone's child should. So let's figure out how to pay for it." - Jake Frenz On the final of four podcasts filmed at a recent healthcare thinktank I hosted in Frisco, Texas, Jake Frenz, the founder and CEO of SmithRx, joined me to share his journey from the Marine Corps to Pharmacy Benefit Management, and what makes him so passionate about ending prescription drug price gouging.  Jake and I discussed what some of the core challenges are in the PBM space, why he was so inspired by Mark Cuban's venture Cost Plus Drugs, and what the “watershed” moment in US healthcare will look like.  I'm grateful to have had the opportunity to talk to one of the best minds in the PBM space, and I hope you enjoy this week's episode of Self-Funded with Spencer. Chapters: 00:00:00 Meet Jake Frenz 00:08:06 Consumer-Driven Healthcare 00:15:53 Transparency in the PBM Industry 00:20:57 The “Watershed Moment” in US Healthcare 00:36:14 Mark Cuban's Innovative Healthcare Venture 00:39:34 Subscription-Based Models Disrupting Pharmacy Competition 00:52:34 Revolutionizing Healthcare 00:55:14 Empowering Americans to Drive Healthcare Reform Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words:  Healthcare Insights, Pharmacy Benefit Managersm, Simplify Healthcare, Watershed Moment, Cost Plus, cost plus drugs,  mark cuban, Big Picture Healthcare, American Spirit, Healthcare Innovation, Affordable Medications, price gouging, self funded, podcast #HealthcareInsights #PharmacyBenefitManagers #SimplifyHealthcare #WatershedMoment #CostPlus #costplusdrugs #markcuban #BigPictureHealthcare #AmericanSpirit #HealthcareInnovation #AffordableMedications #pricegouging #selffunded #podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

"If my child needs a gene therapy to live, they should get it and anyone's child should. So let's figure out how to pay for it." - Jake Frenz On the final of four podcasts filmed at a recent healthcare thinktank I hosted in Frisco, Texas, Jake Frenz, the founder and CEO of SmithRx, joined me to share his journey from the Marine Corps to Pharmacy Benefit Management, and what makes him so passionate about ending prescription drug price gouging.  Jake and I discussed what some of the core challenges are in the PBM space, why he was so inspired by Mark Cuban's venture Cost Plus Drugs, and what the “watershed” moment in US healthcare will look like.  I'm grateful to have had the opportunity to talk to one of the best minds in the PBM space, and I hope you enjoy this week's episode of Self-Funded with Spencer. Chapters: 00:00:00 Meet Jake Frenz 00:08:06 Consumer-Driven Healthcare 00:15:53 Transparency in the PBM Industry 00:20:57 The “Watershed Moment” in US Healthcare 00:36:14 Mark Cuban's Innovative Healthcare Venture 00:39:34 Subscription-Based Models Disrupting Pharmacy Competition 00:52:34 Revolutionizing Healthcare 00:55:14 Empowering Americans to Drive Healthcare Reform Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words:  Healthcare Insights, Pharmacy Benefit Managersm, Simplify Healthcare, Watershed Moment, Cost Plus, cost plus drugs,  mark cuban, Big Picture Healthcare, American Spirit, Healthcare Innovation, Affordable Medications, price gouging, self funded, podcast #HealthcareInsights #PharmacyBenefitManagers #SimplifyHealthcare #WatershedMoment #CostPlus #costplusdrugs #markcuban #BigPictureHealthcare #AmericanSpirit #HealthcareInnovation #AffordableMedications #pricegouging #selffunded #podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

IN THIS EPISODE...Today's guest is Dr. Paul Peak, PharmD, the VP of Clinical Pharmacy at Sedgwick. With over a decade of expertise and nine years of prior pharmacy experience, Paul oversees Pharmacy Benefit Management partnerships and leads a clinical pharmacist team.In a dynamic landscape of pharmacy care, Dr. Paul Peak champions innovative strategies to manage employee wellness in workers' compensation. By aligning team vision with organizational goals and fostering a culture of open idea-sharing, he cultivates a collaborative environment that enhances professional growth while promoting a healthy work-life balance!------------Full show notes, guest bio, links to resources mentioned, and other compelling episodes can be found at http://LeadYourGamePodcast.com. (Click the magnifying icon at the top right and type “Dr. Paul”)Love the show? Subscribe, rate, review, and share! Learn more about us! https://shockinglydifferent.com/-------------WHAT TO LISTEN FOR:1. What are the current trends in pharmacy that impact the industry?2. How can teams align their vision with company goals effectively?3. How can organizations foster a culture of idea-sharing among teams?4. What key conversations are currently taking place in healthcare?5. How can individuals balance work and personal life in today's environment?6. What strategies can enhance leadership and team dynamics?7. How can leaders encourage open dialogue about personal and professional challenges?------------FEATURED TIMESTAMPS:[02:56] Paul's Personal Life[04:23] Paul and his team's Role at Sedgwick[08:56] Current Trends in Pharmacy[13:43] How to Align Team Vision with Company Goals[15:18] Signature Segment: Paul's entry into the LATTOYG Playbook: Leadership Approach and Team Dynamics[20:24] Strategies for Fostering Idea Sharing in Teams[22:07] Key Conversations in Healthcare[26:56] Balancing Work and Personal Life[29:58] Signature Segment: Paul's LATTOYG Tactic of Choice: Leading with Executive Presence[32:38] Connect with Paul------------ADDITIONAL RESOURCES FOR YOU:Overview: Our Signature Leadership Development Experience: http://bit.ly/DevelopYourGame

On this episode of the Astonishing Healthcare podcast, Kevin Sundquist, VP of Product at Capital Rx, joins host Justin Venneri to discuss the journey of a pharmacy claim, from the prescription at the doctor's office to the pharmacy counter. Kevin explains how JUDI® allows claims to be processed efficiently and transparently and why benefit design, network selections, and utilization management programs such as prior authorization ultimately dictate how easy it is for plan members to fill their prescriptions at their local pharmacies or through the mail. Kevin aims to help people find the best prices and live healthier lives.AH037 builds on Episodes AH027 and AH028 with Jillian Lonson, PMP®, Sr. Director, Benefits Administration & Operations, and Jean Beman, Manager, Benefits Operations & Administration - our two-part What is Pharmacy Benefit Management? series that describes the importance of benefit design and configuration, as well as his webinar, The Story of a Claim. If you've ever wondered how products are developed and processes and workflows are refined to ensure medications reach patients smoothly and affordably or what a future with unified claims looks like, this episode is for you!Related ContentReplay – The Future of Pharmacy Claims Processing: A Deep Dive into a Modern Adjudication SystemPharmacy Benefits 101: Prior AuthorizationsHow Our Favorite New JUDI Features Aid Pharmacy Benefit AdministrationFor more information about Capital Rx and this episode, please visit Capital Rx Insights.

Our US Public Policy Strategist explains the potential impact of the upcoming presidential election on the healthcare sector, including whether the outcome is likely to drive a major policy shift.----- Transcript -----Welcome to Thoughts on the Market. I'm Ariana Salvatore, Morgan Stanley's US Public Policy Strategist. Along with my colleagues bringing you a variety of perspectives, today I'll focus on what the US election means for healthcare. It's Tuesday, September 17th at 10am in New York. Around elections what we tend to see is voters rank healthcare pretty high among their priority list. And for that reason it's not surprising that it generates significant debate as well as investor concern – about everything from drug pricing to potential sweeping reforms. We think that the 2024 election is unlikely to transform the US healthcare system. But there are still policies to watch that could change depending on the outcome. We outlined these in a recent note led by our equity research colleagues Erin Wright and Terence Flynn. To start, we think bipartisan policies should continue uninterrupted, regardless of the election outcome. Certain regulations requiring drug price and procedural transparency, for example, which affect hospitals and health plans, are unlikely to change if there is a shift of power next year. We've seen some regulations from the Trump era kept in place by the Biden administration; and similarly during the former president's term there were attempts at bipartisan legislation to modify the Pharmacy Benefit Management model. There are some healthcare policies that could be changed through the tax code, including the extension of the COVID-era ACA subsidies. In President Biden's fiscal year [20]25 budget request, he called for an extension of those enhanced subsidies; and Vice President Kamala Harris has proposed a similar measure. As we've said before on this podcast, we think tax policy will feature heavily in the next Congress as lawmakers contend with the expiring Tax Cuts and Jobs Act. So many of these policies could come into the fold in negotiations. Aside from these smaller potential policy changes, we think material differences to the healthcare system as we know it right now are a lower probability outcome. That's because the creation of a new system - like Medicare for All or a Public Option - would require unified Democratic control of Congress, as well as party unanimity on these topics. Right now we see a dispersion among Democrats in terms of their views on this topic, and the presence of other more motivating issues for voters; mean[ing] that an overhaul of the current system is probably less likely. Similarly, in a Republican sweep scenario, we don't expect a successful repeal of the Affordable Care Act as was attempted in Trump's first administration. The makeup of Congress certainly is important, but there are some actions that the President can leverage unilaterally to affect policy here. For example, former President Trump issued several executive orders addressing transparency and the PBM model. If we look at some key industries within Healthcare, our equity colleagues think Managed Care is well positioned heading into this relatively more benign election cycle. Businesses and investors are focusing on candidates' approaches to the Medicare Advantage program and the ACA Exchange, which has subsidies set to expire at the end of 2025. Relative to prior elections, Biopharma should see a lower level of uncertainty from a policy perspective given that the Inflation Reduction Act, or the IRA, in 2022 included meaningful drug pricing provisions. We also think a full-scale repeal of the IRA is unlikely, even in a Republican sweep scenario. So, expect some policy continuity there. Within Biotech, the path to rate cuts is likely a more significant driver of near-term Small and Mid-Cap sentiment rather than the 2024 election cycle. Our colleagues think that investors should keep an eye on two election-related factors that could possibly impact Biotech including potential changes to the IRA that may impact the sector and changes at the FTC, or the Federal Trade Commission, that could make the M&A environment more challenging. As always, we will continue to keep you abreast of new developments as the election gets closer. Thanks for listening. If you enjoy the show, please leave us a review wherever you listen to podcasts and share Thoughts on the Market with a friend or colleague today.

In this Part 2 episode of Astonishing Healthcare, Justin Venneri continues the discussion about what a pharmacy benefit manager (PBM) does with Capital Rx team members Jillian Lonson, PMP®, Sr. Director, Benefits Administration & Operations, and Jean Beman, Manager, Benefits Operations & Administration. They dive deeper into the weeds and geek out on topics including benefit configuration, enhancements, and testing to be sure everything is set up correctly! They also explain how JUDI® is different and makes several aspects of the process far simpler than they've experienced in the past with legacy software solutions.Jillian and Jean also share their perspectives on the common challenges employers, for example, face when configuring and implementing a new PBM. They offer advice to ensure things go smoothly, emphasizing the importance of considering member experience. Last, Jean explains how JUDI's design enables the deployment of enhancements such as a new Medicare Prescription Payment Plan (M3P) solutions with relative ease.Related Content:AH027 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 1Government Programs: The True Meaning of Customization (with Jason Barretto)Pharmacy Benefits 101: Successful ImplementationsPlease visit Capital Rx Insights for more information, including this episode's transcript!

In this episode of the Astonishing Healthcare podcast, Jillian Lonson, PMP®, Sr. Director, Benefits Administration & Operations, and Jean Beman, Manager, Benefits Operations & Administration, join host Justin Venneri for part one of a two-part discussion about what pharmacy benefit management (PBM) entails. They describe the basics and then peel back the layers of what PBMs do to ensure that a prescription processes correctly - per your pharmacy benefit - so you can pay the correct amount at the pharmacy counter or receive your medication in the mail.Jillian and Jean also share their professional journeys within the PBM industry, highlighting how their roles and teams are central to configuring and testing plan benefits so that formularies, the network, and clinical programs are set up correctly. This informative episode sets the table for a deeper dive into the configuration and testing that go on behind the scenes!Related Content:AH001 - Building a PBM: Tech, Navigating Growth, and Delivering Value with AJ LoiaconoWhat Is the Role of a Pharmacy Benefits Manager (PBM)?Pharmacy Benefits 101: What is a Formulary?Please visit Capital Rx Insights for more information, including this episode's transcript!

Today is an encore because I am going on vacation next week. It always feels a little bit like a time warp because by the time this show will air, I will be back from vacation. This show with Paul Holmes was one of the most popular episodes of 2023 and definitely is just as relevant now. A lot of the things that Paul talks about are worth repeating or listening to again. For a full transcript of this episode, click here. Before we kick in, though, I'm gonna repeat something that Ge Bai, PhD, CPA, says a lot: There's no angels and there's no devils in the healthcare industry. But we are talking about for-profit entities. And if there's one thing that's generally true about a for-profit entity, especially one that is publicly traded, it's gonna do whatever it can get away with. It becomes up to the customer to set expectations and using the purchasing discipline that they probably use everywhere else in the business because it basically is good business to have purchasing discipline. Before we kick into the episode, just a couple of things. Thing one, if you haven't, do subscribe to the weekly email that goes out describing the show. Here's just one reason to do so. It's really efficient because what is transcribed in that email is the whole beginning half (usually) of the introduction. So, if later on you are trying to remember which episode you heard something in, you can just search your email and find the show. How you subscribe is go to relentlesshealthvalue.com, hang out for probably 15 seconds, and there will be a pop-up. And while you're on the Web site, here's something else you could do. Go to the lower right-hand corner of the Web site. You will notice a little button. It's an orange button. There's a microphone. Click on that; say something like your name, your company name, maybe a word or two about Relentless Health Value; and then encourage others to subscribe to the weekly email that goes out, similarly to what I just did. Then what our team will do is take that recording and potentially use it at the end of some of the shows so we can hear somebody else talk besides myself. So, please do go over to the Web site, click on that little microphone, and record something that you might want to share with the other members of the Relentless Tribe. And with that, here's your encore. If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren't a CFO, pretend that you are so that you get the full effect here. So, now that we're all CFOs, let's pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. Beat up a vendor. We also could go over and have a strident conversation with sales leadership about what they can do to jack up their sales revenue. Top line begets bottom line and all that. Or, here's another idea: In this healthcare podcast, I am speaking with Paul Holmes, who is an ERISA (Employee Retirement Income Security Act) attorney with a specialty in PBM (pharmacy benefit manager) contracts, especially the PBM contracts from the big PBMs that get jammed in employer plan sponsor faces by whomever and which they are told look fine and that the employer plan sponsor should just go ahead and sign. Now, if we, meaning all of us CFOs, sign that paper, or someone on our benefits team signs the paper … fun fact, our company just spent 30% to 40% over market for our pharmacy benefits. That contract we just signed contains all kinds of expensive little buried treasures—treasures accruing to the PBM and other parties, to be clear, and coming at our expense. There's 17-ish very common treasures in your typical PBM contract, and none of us will ever spot them unless we know what we are looking for. But let's dig into this for a sec, especially for all of us newly minted CFOs because the real ones already did this math. Say our company spends whatever—we're a bigger company, and we spend $100 million a year on our drugs. That's a minimum of $30 million that we got taken for … $30 million a year. Because of the huge dollars at stake (30% to 40% of drug spend), it's certainly the advice of almost anybody that you talk to who's an expert in PBM contracts to have a third party—not your EBC (employee benefit consultant), which we'll get into in a sec, but somebody else (a third party)—review every PBM contract. I mean, what's the worst that can happen for anybody considering having an independent third party review their PBM contract? It costs a couple grand in lawyer fees, and they give it a stamp of approval. Knowledge is power, and now we know. But let's just say this third-party review doesn't happen. We all go with a “devil may care” about this whole PBM overcharging us by 30% to 40% possibility. And let's say the PBM contract is, in fact, a ride on the Hot Mess Express but we don't know it. Here's two pretty bad downsides, especially now, this year, since the passage of the CAA (the Consolidated Appropriations Act). Number one bad thing: Plan sponsors may get sued as per the CAA for ERISA violations. It's not just the company paying that extra $30 million, or 30% to 40%, right? It's also employees. This is risk exposure, bigly. Just like it was on the 401(k) side of the house, which Paul Holmes, my guest today, mentions later on in the interview. He talks about just how much those lawsuits cost and, yeah, exposure. As I mentioned three times already, today I am speaking with Paul Holmes about PBM contracts in all their stealthy glory. The one thing I came to appreciate is that these things are works of art … if you're into those paintings of pretty flowers where, if you look hard enough, you spot a skull tucked in the greenery (memento mori). Paul is a longtime ERISA attorney. He has dedicated his career to helping plan sponsors in their negotiations with PBMs and trying to help them reduce drug spend, especially drug spend that isn't actually paying for drugs. Here's a link to an article we discuss about how a school district in Florida is suing their longtime EBC for taking $2 million a year in alleged secret payments. We also mention an episode with AJ Loiacono (EP379). And along similar lines, Jeff Hogan mentioned on LinkedIn the other day, “It's pretty amazing that just in the course of the [past few] weeks, I'm reading, seeing, and hearing about big new CAA breach of fiduciary duty cases.” So, Paul Holmes says this more eloquently, but if you're a plan sponsor, definitely get your PBM contract reviewed and maybe consider working with an EBC who's happy to sign the disclosure statement that your lawyer has provided without disclaimers. Also mentioned in this episode are Ge Bai, PhD, CPA; AJ Loiacono; and Jeffrey Hogan.   You can learn more by emailing Paul at pbh@williamsbarbermorel.com.   Paul B. Holmes, JD, is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined Williams Barber & Morel Ltd. recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul is one of the few ERISA lawyers in the United States, concentrating his practice on PBM contracting and oversight. Paul represents large employers, Taft-Hartley welfare funds, and governmental units in their selection, contracting, auditing, and disputes with large pharmacy benefit managers (PBMs). This work includes active oversight of the request for proposal (RFP) process for selecting a PBM, the negotiation and customization of PBM contracts, and legal audits of PBM compliance with their contracts. Paul provides insightful guidance on the prudent selection of independent pharmacy benefit consulting firms (who do not receive indirect compensation from PBMs), which independence is expressly required under Section 202 of the Consolidated Appropriations Act of 2021 (CAA). Recent efforts have focused on reducing wasteful drug spend promulgated by large PBMs in dozens of categories. These include the preference of Humira® biosimilars, reducing off-label utilization of GLP-1s, reducing huge markups on certain specialty generics, and customizing PBM formularies and clinical protocols to better control spend. He was selected, through a peer-review survey, for inclusion in The Best Lawyers in America® (2020 and 2021) in the field of Employee Benefits (ERISA) Law. Paul received his bachelor's degree from Bradley University and his Juris Doctor degree from the University of Illinois College of Law.   07:41 What are Paul's usual observations when a PBM contract crosses his desk? 08:34 “If you just sign … one of their model contracts …, you're probably gonna pay 30% to 40% above market on your drug spend.” 12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 17:12 EP379 with AJ Loiacono. 17:40 Who is on the hook for the cost of the PBM contracts? 21:05 What's the problem with most ERISA lawyers today? 22:56 Lawsuit about PBM contract. 27:43 What's Paul's advice for benefits consultants? 31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM?   You can learn more by emailing Paul at pbh@williamsbarbermorel.com.   Paul Holmes discusses #PBMContracts on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363)  

This week features host Marc Cunningham's conversation with Paul King (Chief Client Officer at myMatrixx), which took place at this year's RIMS RISKWORLD2024 conference. Paul covers all things Pharmacy Benefit Management (PBM)—from implementation to challenges to benefits.Join us as we discuss:How clinical edits fit into the PBM processThe concept of benefit neutrality and treating whole-person healthUsing virtual healthcare platforms in managing conditions like COPD, asthma, and obesity

I interviewed AJ Loiacono, CEO of Capital Rx about how the world of pharmacy and Pharmacy benefit management has evolved. Episode Resources Connect with Arundhati Parmar aparmar@medcitynews.com https://twitter.com/aparmarbb?lang=en https://medcitynews.com/ Connect with AJ Loiacono https://www.cap-rx.com/team/anthony-j-loiacono https://www.linkedin.com/in/capitalrx/   Review, Subscribe and Share If you like what you hear please leave a review by clicking here Make sure you're subscribed to the podcast so you get the latest episodes. Click here to subscribe with Apple Podcasts Click here to subscribe with Spotify Click here to subscribe with Podbean Click here to subscribe with RSS

Adam Kautzner, President of Express Scripts, highlights the role pharmacy benefit management companies play in negotiating prices with drug companies and pharmacies. They also perform health safety checks to ensure patients get the correct medications and updates, and those with multi-morbidities are checked for possible drug interactions. Overcoming the supply chain challenges during the pandemic, Express Scripts continues to develop more effective solutions to lower the cost of drugs and improve access.   Adam explains, "Unfortunately, prescription drugs are becoming even more expensive. So our role in that space is to work for employers, or potentially for health plans, that hire us to help improve, for patients, medication affordability, to improve patient outcomes, and ensure that for patients there is predictability at the pharmacy counter to navigate their pharmacy benefit."   "We're able to do that because, as the most utilized benefit, we have a bird's eye view of all the different patients' needs that they may have. We're able to look over, if you're going to multiple doctors, getting prescribed multiple drugs from multiple doctors. We can actually perform safety checks across all of that to ensure that when you're refilling a prescription or getting a new prescription everything is safe, and there aren't going to be drug interactions. We're able to ensure that you have predictability and affordability for your pharmacy benefits." "So yes, comorbidities continue to become a broader and broader issue. I would say there are also more drugs now to treat many of those comorbidities, and some products can even treat multiple types of conditions where they've been approved for things like cardiovascular and diabetes. Those drugs that treat multiple conditions can also be helpful as well because you can actually eliminate some drugs and minimize the number of different products that you have to take." #ExpressScripts #Evernorth #PharmacyBenefitManagement #PBM #DrugCosts evernorth.com ExpressScripts.com The facts about home delivery Listen to the podcast here

Adam Kautzner, President of Express Scripts, highlights the role pharmacy benefit management companies play in negotiating prices with drug companies and pharmacies. They also perform health safety checks to ensure patients get the correct medications and updates, and those with multi-morbidities are checked for possible drug interactions. Overcoming the supply chain challenges during the pandemic, Express Scripts continues to develop more effective solutions to lower the cost of drugs and improve access.   Adam explains, "Unfortunately, prescription drugs are becoming even more expensive. So our role in that space is to work for employers, or potentially for health plans, that hire us to help improve, for patients, medication affordability, to improve patient outcomes, and ensure that for patients there is predictability at the pharmacy counter to navigate their pharmacy benefit."   "We're able to do that because, as the most utilized benefit, we have a bird's eye view of all the different patients' needs that they may have. We're able to look over, if you're going to multiple doctors, getting prescribed multiple drugs from multiple doctors. We can actually perform safety checks across all of that to ensure that when you're refilling a prescription or getting a new prescription everything is safe, and there aren't going to be drug interactions. We're able to ensure that you have predictability and affordability for your pharmacy benefits." "So yes, comorbidities continue to become a broader and broader issue. I would say there are also more drugs now to treat many of those comorbidities, and some products can even treat multiple types of conditions where they've been approved for things like cardiovascular and diabetes. Those drugs that treat multiple conditions can also be helpful as well because you can actually eliminate some drugs and minimize the number of different products that you have to take." #ExpressScripts #Evernorth #PharmacyBenefitManagement #PBM #DrugCosts evernorth.com ExpressScripts.com The facts about home delivery Download the transcript here

Cheers to Episode 21! 

In this episode, Dr. Jan Berger and I explore the arcane and hardly transparent world of PBMs. Her wisdom deals good advice for employers who purchase healthcare, benefit consultants who work with those employers and providers whose prescriptions may have a profound impact on businesses that pay for healthcare. Dr. Berger is CEO of Health Intelligence Partners, a global healthcare consulting company. Links: Jan Berger MD Biography The Chicago Network Re-Engaging in Trust: The Missing Ingredient to Fixing Healthcare LinkedIn 360° of Healthcare podcast on Dr. Berger's book

Ever wondered how the Pharmacy Benefit Management (PBM) industry really works? Join us for an enlightening chat with our guest, Dave Parker, the Vice President of Sales and Marketing at TrueScript, as we unravel the intricacies of the traditional PBM relationship. Gain insight as Dave dissects key terms like average wholesale price and net cost, and unveils the ways PBMs make their money. We also delve into the trend of manufacturers moving closer to employers to shake off spread pricing models. More importantly, discover why it's crucial to ask the right questions in a PBM relationship.We also step into the fascinating world of pharmacogenomics testing for prescription drugs, a game-changing approach that could redefine the healthcare industry. Picture this - a one-time test that prevents the misprescribing of medications, saving patients and doctors from hefty medical bills and hospital stays. Indeed, such a test already exists, and some PBMs are benefiting from the potential savings it brings. We'll also investigate the prospect of making this a routine test for newborns and what it could mean for stop loss carriers. Last but not least, Dave returns to introduce us to the emergence of transparent PBMs - a revolutionary shift that is transforming the industry and proving particularly appealing to younger consumers. Tune in for an episode packed with industry insights and thought-provoking discussions.

Product in Healthtech is community for healthtech product leaders, by product leaders.For more information, and to sign up for our free webinars, visit www.productinhealthtech.com.To view this full episode on YouTube: https://youtu.be/mHCeS7aswck  Product in Healthtech is community for healthtech product leaders, by product leaders. For more information, and to sign up for our free webinars, visit www.productinhealthtech.com.

Lesley Weir, senior director, customer and product success at Veradigm, and Kate Wormington director, product management, analytics at Veradigm Payer Analytics, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health.In this 31-minute podcast, they discuss the risk adjustment and quality changes in the final rules and their recommendations and strategies for organizations going forward. About Lesley WeirLesley Weir, senior director of customer and product success at Veradigm, has over 30 years' experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment, and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member's health and experience. Prior to her role at Veradigm, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan.  She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.About Kate WormingtonKate Wormington, director, product management, joined Veradigm in January of 2023 leading theQuality Analytics solutions. For the past 20 years, Kate has focused on HEDIS® and quality reporting for both payers and providers.  Kate spent close to 10 years managing complex operations of a quality analytics program supporting HEDIS, CMS Star, IHA AMP, QARR, QRS, and Medicaid State measurement sets for innovative health care organizations.  She has deep experience leading a multi-state Client Success Support and Implementation team, supporting 27 clients across three products.  Additionally, Kate has led an NCQA Data Aggregator Validation (DAV) project team through Cohort 2, and was in the middle of Cohort 4, providing targeted HEDIS standard supplemental data using C-CDA files. She began as a software engineer specializing in software quality, with a Masters degree in IT.   She embraced the business side, utilizing product, project and client management skills. Wormington lives in Denver, Colo., originally from the UK, starting her career in health care working for the National Health Service.  About Veradigm Veradigm Payer Analytics (formerly Pulse8) is health care analytics and technology solution delivering complete visibility into the efficacy of your Risk Adjustment, Quality, and Pharmacy Benefit Management programs. Veradigm empowers health plans and providers to eliminate waste and achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance while also improving efficiency for payers and at-risk providers through high-speed clinical data exchange. Veradigm's patented Dynamic Intervention Planning offers a suite of uniquely pragmatic solutions that identify the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information or to schedule a demo, please email payersolutions@veradigm.com

Join host Spencer Smith on another episode of Self-Funded with Spencer, as he welcomes the PBM Princess, Rachel Strauss from EHIM. In this engaging and informative podcast episode, Rachel shares valuable insights about the Pharmacy Benefits Management industry and EHIM's merger with ProCare Rx. Rachel and Spencer also take a deep dive into the importance of transparency in PBMs and how it affects the relationship between PBM and clients. Rachel shares her journey of becoming a PBM consultant and how she found her niche as a problem solver, helping clients navigate complex healthcare systems and policies. This episode discusses PBM selection and highlights the challenges of determining which PBM would work best for your company. Rachel shares her thoughts on a pricing model called "Cost Plus", which Mark Cuban has popularized recently in the world pf Pharmacy Benefit Management. Additionally, the podcast highlights the need to align PBM incentives to client goals, the importance of understanding client priorities, and writing RFPs that align with them. In this engaging conversation, Rachel shares her prediction on the reporting mandates that will track dollars and rebates, potentially affecting the earnings of some companies. Another important aspect of Rachel's work is in fixing problems, rather than just identifying them. She explains that her role is not just about diagnosing issues but providing actionable solutions that can make a difference in the lives of patients and providers. Rachel's work is guided by her passion for improving healthcare access and quality, and she encourages others to find their own purpose and drive in their work. Don't miss the fun banter between Spencer and Rachel as they share stories, opinions, and experiences. Tune in now for an engaging and informative conversation on pharmacy benefits management, self-funding, and everything in between! Chapters; [00:00:00] Introducing "PBM Princess" Rachel Strauss [00:02:32] PBM Princess's Impact in Sales & EHIM's Merger [00:05:50] The Rise of Transparent PBMs [00:08:59] EHIM's Integration into ProCare for Advanced Tech [00:11:59] Navigating emotional experience of company acquisition [00:14:46] Navigating the Complex PBM Industry [00:17:44] Pharmacy Benefit Management complexities and Mark Cuban's involvement [00:20:26] Spread Pricing in Pharmacy Benefit Industry and Mark Cuban's Launch [00:23:22] Strategies for Saving Costs in PBM Industry [00:26:14] PBM Tactics and Rebates Issues [00:29:05] The Deceptive Nature of Pharmaceutical Rebates [00:32:04] EHIM's formulary strategy and committed rebate transparency [00:35:00] Private Equity in PBMs [00:40:37] Turning Healthcare Data into Actionable Insights [00:43:30] Customized Services for Diverse Client Goals [00:46:30] Third-party Vendor Blacklisting and PBM Priorities [00:49:30] Debate on Ozempic coverage for weight loss [00:52:27] Insurance Coverage of Bariatric Surgery [00:55:19] Creativity and Collaboration in PBM #PBMs #pharmacybenefits #consultants #EHIM #ProCareRx #specialtydrugs #transparency #rebates #formulary #privateequity #dataanalytics #medicalcompliance #Ozempic #obesity #bariatricsurgery #creativity #partnerships #healthcareindustry #podcasts #podcastingtips #podcastingcommunity #businessstrategies #salesindustry #employersponsoredplans #specialtypharmacy #pharmacycosts --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

Join host Spencer Smith on another episode of Self-Funded with Spencer, as he welcomes the PBM Princess, Rachel Strauss from EHIM. In this engaging and informative podcast episode, Rachel shares valuable insights about the Pharmacy Benefits Management industry and EHIM's merger with ProCare Rx. Rachel and Spencer also take a deep dive into the importance of transparency in PBMs and how it affects the relationship between PBM and clients. Rachel shares her journey of becoming a PBM consultant and how she found her niche as a problem solver, helping clients navigate complex healthcare systems and policies. This episode discusses PBM selection and highlights the challenges of determining which PBM would work best for your company. Rachel shares her thoughts on a pricing model called "Cost Plus", which Mark Cuban has popularized recently in the world pf Pharmacy Benefit Management. Additionally, the podcast highlights the need to align PBM incentives to client goals, the importance of understanding client priorities, and writing RFPs that align with them. In this engaging conversation, Rachel shares her prediction on the reporting mandates that will track dollars and rebates, potentially affecting the earnings of some companies. Another important aspect of Rachel's work is in fixing problems, rather than just identifying them. She explains that her role is not just about diagnosing issues but providing actionable solutions that can make a difference in the lives of patients and providers. Rachel's work is guided by her passion for improving healthcare access and quality, and she encourages others to find their own purpose and drive in their work. Don't miss the fun banter between Spencer and Rachel as they share stories, opinions, and experiences. Tune in now for an engaging and informative conversation on pharmacy benefits management, self-funding, and everything in between! Chapters; [00:00:00] Introducing "PBM Princess" Rachel Strauss [00:02:32] PBM Princess's Impact in Sales & EHIM's Merger [00:05:50] The Rise of Transparent PBMs [00:08:59] EHIM's Integration into ProCare for Advanced Tech [00:11:59] Navigating emotional experience of company acquisition [00:14:46] Navigating the Complex PBM Industry [00:17:44] Pharmacy Benefit Management complexities and Mark Cuban's involvement [00:20:26] Spread Pricing in Pharmacy Benefit Industry and Mark Cuban's Launch [00:23:22] Strategies for Saving Costs in PBM Industry [00:26:14] PBM Tactics and Rebates Issues [00:29:05] The Deceptive Nature of Pharmaceutical Rebates [00:32:04] EHIM's formulary strategy and committed rebate transparency [00:35:00] Private Equity in PBMs [00:40:37] Turning Healthcare Data into Actionable Insights [00:43:30] Customized Services for Diverse Client Goals [00:46:30] Third-party Vendor Blacklisting and PBM Priorities [00:49:30] Debate on Ozempic coverage for weight loss [00:52:27] Insurance Coverage of Bariatric Surgery [00:55:19] Creativity and Collaboration in PBM #PBMs #pharmacybenefits #consultants #EHIM #ProCareRx #specialtydrugs #transparency #rebates #formulary #privateequity #dataanalytics #medicalcompliance #Ozempic #obesity #bariatricsurgery #creativity #partnerships #healthcareindustry #podcasts #podcastingtips #podcastingcommunity #businessstrategies #salesindustry #employersponsoredplans #specialtypharmacy #pharmacycosts --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

“We're the richest country on the planet, healthcare access has to be core to who we are,” says Karthik Ganesh, CEO of EmpiRx Health, one of the fastest growing healthcare services companies in the country and the industry's only value-based Pharmacy Benefit Manager.  Ganesh and his team believe that radical changes are needed in the country's healthcare system and they're working to create a better experience for patients, providers, businesses, and insurance companies alike.  Ganesh has deep experience in the healthcare insurance industry and health data management with stops in his career at Aetna, Express Scripts and Deloitte, and he's also the author of The Happiness Model: A Roadmap to Inner Peace. In his conversation with host Michael Carrese, Ganesh talks about why employers need to learn more about value-based care, and how healthcare needs to become a less transactional relationship with the provider.  He also touches on some of the key factors that make EmpiRx different from traditional PBMs. “We are as equally focused on health outcomes as we are financial outcomes.” Mentioned in this episode: https://www.empirxhealth.com/ 

Your host, Sri Chellappa, talks with Karthik Ganesh, CEO of Empirx Health. Empirx Health is a Pharmacy Benefit Management company that takes a patient centered approach to healthcare.To learn more about Karthik's work, visit, https://www.empirxhealth.com/If you think you'd be a great guest on our show, apply here. Want to learn more about Sri's work at Engagedly? Check out their website at https://engagedly.com/.

The "PBM Princess" joins me again on Self-Funded with Spencer on the road, this time in St. Louis at the most recent True Captive Summit, held at Busch Stadium. In this mini-episode, Rachel highlights the convoluted supply chain in Pharmacy Benefit Management. So many different entities have a hand in the Rx supply chain, from payers, wholesalers, contracts with PBM's, marketing firms, insurance companies, etc, which makes it very difficult to uncover why prescription drug trends continue to increase at a rapid rate. This had led to further scrutiny of PBMs, especially with the question "How does my PBM get paid"? Thank you again to David Voorhees of True Captive for inviting me to this industry-leading event to deliver my podcast on the road. --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

The "PBM Princess" joins me again on Self-Funded with Spencer on the road, this time in St. Louis at the most recent True Captive Summit, held at Busch Stadium. In this mini-episode, Rachel highlights the convoluted supply chain in Pharmacy Benefit Management. So many different entities have a hand in the Rx supply chain, from payers, wholesalers, contracts with PBM's, marketing firms, insurance companies, etc, which makes it very difficult to uncover why prescription drug trends continue to increase at a rapid rate. This had led to further scrutiny of PBMs, especially with the question "How does my PBM get paid"? Thank you again to David Voorhees of True Captive for inviting me to this industry-leading event to deliver my podcast on the road. --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

Jared, Vanessa and Adam are joined by three industry specialists, Steve Maike, Laura Birkel and Frank Bacon, to talk about some of the emerging trends in pharmacy spending. Our panel jumps into all things pharmacy benefits, with the basics of what is a Pharmacy Benefit Manager (PBM) and the difference between carved in vs. carved out. They also address complicated items like managing specialty drug spend and what a copay maximizer program is. Connect with the hosts: Jared Bowcutt Vanessa Longnecker Adam Compton

Rachel Strauss joined me in OKC to discuss the vital role of a transparent PBM, such as her employer EHIM. She has been a previous podcast guest (Episode 10), and she is one of the most knowledge people when it comes to Pharmacy Benefit Management. She implores employers to ask the simple question, "How does my PBM get paid"? Rachel also relates the problem of "rebates", to getting money back on your tax return. Is it really better to overpay, and then wait 12 months to get money back? She sees the market is now more open to change, and the "No Surprises" act is a step in the right direction towards more transparency in the healthcare marketplace. Hope you enjoy! --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

Rachel Strauss joined me in OKC to discuss the vital role of a transparent PBM, such as her employer EHIM. She has been a previous podcast guest (Episode 10), and she is one of the most knowledge people when it comes to Pharmacy Benefit Management. She implores employers to ask the simple question, "How does my PBM get paid"? Rachel also relates the problem of "rebates", to getting money back on your tax return. Is it really better to overpay, and then wait 12 months to get money back? She sees the market is now more open to change, and the "No Surprises" act is a step in the right direction towards more transparency in the healthcare marketplace. Hope you enjoy! --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

This is the MORE-On PBMs Podcast.  This podcast digs into the dark corners of the unregulated PBM business practices & sets the record straight! This lack of transparency in patients' drug coverage can interfere with sound medical practice and may lead to delays in and other disruption to necessary medical treatment, thus, the ability of patients and their physicians to have the information and even the latitude they need to make key decisions regarding medication has been hampered by the sort of practices that state legislation of PBMs can properly address. Our host has a family pedigree in Community Pharmacy, PBM practices, and working with employer insurance programs to help millions of people live better lives.  Kyle Fields CEO - Appro-Rx  Kyle has been the owner of Appro-Rx since 2008 and has served as President and COO since 2010 and CEO since 2016. Kyle oversees all aspects of the daily operations at Appro-Rx including sales, plan implementation, call-center operations, member and pharmacy help desk, contract negotiations, client retention and acquisition, government relations, and quality control. Kyle has an extensive background in Insurance and Insurance management, government relations, government finance, and extensive business and contract negotiating experience. Kyle is a former Waynesville City Councilman and was named to the 2014 40 Under 40 of Dayton, Ohio. Kyle has also been featured as a contributor on Squawk Box on CNBC and speaks nationally on all matter pertaining to Pharmacy and Pharmacy Benefit Management. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

This is the MORE-On PBMs Podcast.  This podcast digs into the dark corners of the unregulated PBM business practices & sets the record straight! This lack of transparency in patients' drug coverage can interfere with sound medical practice and may lead to delays in and other disruption to necessary medical treatment, thus, the ability of patients and their physicians to have the information and even the latitude they need to make key decisions regarding medication has been hampered by the sort of practices that state legislation of PBMs can properly address. Our host has a family pedigree in Community Pharmacy, PBM practices, and working with employer insurance programs to help millions of people live better lives.  Kyle Fields CEO - Appro-Rx  Kyle has been the owner of Appro-Rx since 2008 and has served as President and COO since 2010 and CEO since 2016. Kyle oversees all aspects of the daily operations at Appro-Rx including sales, plan implementation, call-center operations, member and pharmacy help desk, contract negotiations, client retention and acquisition, government relations, and quality control. Kyle has an extensive background in Insurance and Insurance management, government relations, government finance, and extensive business and contract negotiating experience. Kyle is a former Waynesville City Councilman and was named to the 2014 40 Under 40 of Dayton, Ohio. Kyle has also been featured as a contributor on Squawk Box on CNBC and speaks nationally on all matter pertaining to Pharmacy and Pharmacy Benefit Management. See omnystudio.com/listener for privacy information.

Pharmacy Benefit Management. Three words that bring confusion, complexity, and mystery to health plans. Learn about PBMs from Greg Greenlee at Verus Rx as he peels back the layers of complexity to shine some light on this mysterious industry.Support the show (https://healthcareamericana.com/sponsors/)

Today, we are excited to feature Eric Levin, CEO at Scripta Insights. Eric discussed how his company brings transparency to the prescription drug market and delivers real savings to employers, payers, and members. We cover the cost issue of prescription medicines in healthcare, shifting the balance of power from seller to buyer by educating buyers through better insights and expertise, saving millions of dollars on prescriptions, reducing payer cost, improving member outcomes, and more. Eric's insights, motivation, and passion are truly inspirational. This is a great conversation you shouldn't miss, so please tune in! Click this link for the show notes, transcript, and resources: outcomesrocket.health

Aaron Howell is an experienced Pharmacist with a demonstrated history of working in the hospital & health care industry. Skilled in Pharmacy Benefit Management, Patient Counseling, Pharmacy Automation. Strong healthcare services professional with a Bachelor of Science (BS) focused in Pharmacy from West Virginia University. Aaron shares his journey about how he started his real estate investments and how real estate has provided freedom to his family.

Aaron Howell is an experienced Pharmacist with a demonstrated history of working in the hospital & health care industry. Skilled in Pharmacy Benefit Management, Patient Counseling, Pharmacy Automation. Strong healthcare services professional with a Bachelor of Science (BS) focused in Pharmacy from West Virginia University. Aaron shares his journey about how he started his real estate investments and how real estate has provided freedom to his family.

We cover a variety of items: 1.) CVS Health's integration with Aetna and the Pharmacy Benefit Management landscape: https://tek2day.com/2020/02/08/cvs-health-aetna-post-deal-integration-hiccups/ 2.) Crypto currency: https://tek2day.com/2020/02/11/will-cryptocurrencies-turbocharge-online-marketplaces/ 3.) Share repurchases are a corporate governance risk: https://tek2day.com/2020/02/10/insider-selling-and-share-repurchases/ 4.) Jes Staley and Barclays: https://tek2day.com/2020/02/13/why-does-jes-staley-remain-barclays-ceo/ 5.) Our upcoming article: "Go Vertical Or Go Home".

On Part Three of the PBM Reform Podcast Series we talk with Mary Ellen S. Jones a PSEA UniServ Representative and Anthony J. Loiacono / Chief Executive Officer of Capital Rx, a pass-thru Pharmacy Benefit Management company.  PSEA is 181,000 members strong – a community of education professionals who make a difference in the lives of Pennsylvania’s students every day.   PSEA members are teachers, education support professionals, higher education staff, nurses in health care facilities, retired educators, and college students preparing to become teachers.  PSEA’s strength comes not only from our members, but from our beliefs, our values, and our passion. Every time we speak up for what we believe, we harness the power of collective action. Anthony J. Loiacono / AJ is a successful entrepreneur, with over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administrated in the US. Prior to Capital Rx, AJ was a co-founder of Truveris, where he served for eight years as CEO, Chief Innovation Officer, and Board Member, leading the company to record growth (Deloitte FAST 500 and Crain’s Fast50). Prior to Truveris, AJ co-founded SMS Partners, a joint venture with Realogy (RLGY), and in 2010 exited the partnership with a buyout. In his first venture, AJ started Victrix, a supply chain consultancy, and successfully sold the company to Chrysalis Solutions in 2007.  https://www.cap-rx.com/company#leadership-team 

On Part Three of the PBM Reform Podcast Series we talk with Mary Ellen S. Jones a PSEA UniServ Representative and Anthony J. Loiacono / Chief Executive Officer of Capital Rx, a pass-thru Pharmacy Benefit Management company.  PSEA is 181,000 members strong – a community of education professionals who make a difference in the lives of Pennsylvania's students every day.   PSEA members are teachers, education support professionals, higher education staff, nurses in health care facilities, retired educators, and college students preparing to become teachers.  PSEA's strength comes not only from our members, but from our beliefs, our values, and our passion. Every time we speak up for what we believe, we harness the power of collective action. Anthony J. Loiacono / AJ is a successful entrepreneur, with over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administrated in the US. Prior to Capital Rx, AJ was a co-founder of Truveris, where he served for eight years as CEO, Chief Innovation Officer, and Board Member, leading the company to record growth (Deloitte FAST 500 and Crain's Fast50). Prior to Truveris, AJ co-founded SMS Partners, a joint venture with Realogy (RLGY), and in 2010 exited the partnership with a buyout. In his first venture, AJ started Victrix, a supply chain consultancy, and successfully sold the company to Chrysalis Solutions in 2007.  https://www.cap-rx.com/company#leadership-team  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Vinay Patel founder of Self Insured Pharmacy Networks (SIPN) talks about PBM reform and the new business model disrupting the status quo.  SIPN is a Pharmacy Benefit Management company founded by pharmacists Vinay Patel and Ritesh Patel who have over 20 years of combined experience in clinical practice and management/ownership of independent retail pharmacies. Here is the team that is working tirelessly to bring better solutions for the self funded employer marketplace. Vinay Patel, Pharm.D. Founder, Self Insured Pharmacy Networks LLC vinay.patel @ sipharmacynetwork.com 919-436-3359 ext 101 office www.sipharmacynetwork.com See omnystudio.com/listener for privacy information.

Topics:   Pharmacy Care Manager vs. Pharmacy Benefit Manager Misaligned Incentives Formulary and Clinical Program Alignment Rebate Chasing Medication Adherence Cost Savings Concierge Service In this episode, Michael introduces you to Bill Resnick who is the Chairman and CEO of EmpiRx Health, a revolutionary Pharmacy Benefit Management company. Join us as we discuss EmpiRx Health’s unique model of pharmacy care management and its impact on decreased pharmacy utilization, increased cost transparency and ultimately, lower healthcare costs. Here’s a glance at what we discuss in this episode: Bill Resnick’s background and how he went from working for large insurance carriers and PBM’s to launching his own consulting agency and ultimately EmpiRx Health How perverse incentives in the PBM and drug industry drive higher costs Defining transparency in prescription drug pricing and the healthcare industry Understanding the intricate roles of Pharmacy Benefit Managers, Drug Manufacturers, Pharmacies and Physicians How EmpiRx Health’s model is different from the traditional pharmacy benefit manager How EmpiRx Health is trying to address the employer’s total net cost and clinical outcomes The importance of looking beyond the prescription drug discounts and rebates   How EmpiRx Health uses sophisticated pharmacy analysis, benchmarking and pharmacists to identify inefficienct client spend The difference between traditional PBM discount guarantees and EmpiRx Health aggregate and PMPM  cost savings guarantees How EmpiRx Health engages providers to ensure appropriate medication usage EmpiRx Health’s concierge service model and how they are equipped to steer the patient to the lowest cost option and empowered to create a better consumer experience EmpiRx Health’s fee structure and who they are a good fit for EmpiRx Health’s website: (http://www.empirxhealth.com/)

True North talks about the Senior Care Pharmacy Coalition, pharmacy benefit managers, and ongoing long term care pharmacy trends and issues with Alan Rosenbloom; President and CEO of the Senior Care Pharmacy Coalition.  The Senior Care Pharmacy Coalition's mission is to be a strong, unified and influential advocate for independent Long Term Care pharmacies in Washington, DC. We offer opportunities for every member to participate – the SCPC exists to benefit all independent LTC pharmacies, the businesses that support them and the patients they serve. If your organization is interested in learning more about pharmacy and business member opportunities, please contact us by calling 202-534-1783 Website: http://seniorcarepharmacies.org/  See omnystudio.com/listener for privacy information.

True North talks about the Senior Care Pharmacy Coalition, pharmacy benefit managers, and ongoing long term care pharmacy trends and issues with Alan Rosenbloom; President and CEO of the Senior Care Pharmacy Coalition.  The Senior Care Pharmacy Coalition’s mission is to be a strong, unified and influential advocate for independent Long Term Care pharmacies in Washington, DC. We offer opportunities for every member to participate – the SCPC exists to benefit all independent LTC pharmacies, the businesses that support them and the patients they serve. If your organization is interested in learning more about pharmacy and business member opportunities, please contact us by calling 202-534-1783 Website: http://seniorcarepharmacies.org/ 

RxPreferred Benefits is a privately held Pharmacy Benefit Manager founded, and solely owned, by independent pharmacy representatives who understand the importance of what true PBM transparency means. RxPreferred offers a full line of Pharmacy Benefit Management solutions for employer groups, municipalities, school districts, and third party administrators. We focus on guaranteed savings and cost-containment strategies, while providing our clients with innovative, efficient, and effective pharmacy benefit management services. Headquartered in Nashville, Tennessee, RxPreferred is a mission-driven organization, dedicated to outperforming the expectations of our clients, members, and shareholders. RxPreferred Benefits – Headquarters 506 N Mt. Juliet Road  Mt. Juliet TN 37122   888.666.7271  info@rxpreferred.com   See omnystudio.com/listener for privacy information.

RxPreferred Benefits is a privately held Pharmacy Benefit Manager founded, and solely owned, by independent pharmacy representatives who understand the importance of what true PBM transparency means. RxPreferred offers a full line of Pharmacy Benefit Management solutions for employer groups, municipalities, school districts, and third party administrators. We focus on guaranteed savings and cost-containment strategies, while providing our clients with innovative, efficient, and effective pharmacy benefit management services.

We interview Kyle Fields - with ApproRx, a transparent PRO-Independent Pharmacy Benefit Management company. Appro‐Rx is a growing Health Information Technology (HIT) company dedicated to payer medical cost reduction and improvement in patient health outcomes via their provider network. Through the use of Pharmacy Benefit Management (PBM) technologies, Appro‐Rx provides customers with prescription drug claims processing, prescription benefit management tools and other IT needs. Appro‐Rx's claims processing engine currently processes prescriptions through its PBM Software backbone for more than 400 thousand covered lives spread over 500+ employer plans and processing approximately 1 million claims per month. The principals of Appro‐Rx believe strongly that the PBM model is broken, and we have set out to be industry game changers. We are targeting current practices – spread pricing on prescription drugs, manufacturers' rebates and mandatory mail order programs that benefit PBMs instead of employers and patients. Our mission to bring pricing fairness and transparency to the PBM industry will enable employers to realize significant cost savings and improved health outcomes for their employees. Appro‐Rx has backing from independent pharmacists and pharmacy owners; various municipalities throughout the United States; and political and governmental groups. Kyle Fields, PharmD, RPhOwner/Vice PresidentApproRx513-897-1476866-900-3711Fax: 513-897-1446Cell: 513-850-9519www.ApproRx.comEmail: kyle.fields@approrx.com See omnystudio.com/listener for privacy information.

We interview Kyle Fields - with ApproRx, a transparent PRO-Independent Pharmacy Benefit Management company. Appro‐Rx is a growing Health Information Technology (HIT) company dedicated to payer medical cost reduction and improvement in patient health outcomes via their provider network. Through the use of Pharmacy Benefit Management (PBM) technologies, Appro‐Rx provides customers with prescription drug claims processing, prescription benefit management tools and other IT needs. Appro‐Rx’s claims processing engine currently processes prescriptions through its PBM Software backbone for more than 400 thousand covered lives spread over 500+ employer plans and processing approximately 1 million claims per month. The principals of Appro‐Rx believe strongly that the PBM model is broken, and we have set out to be industry game changers. We are targeting current practices – spread pricing on prescription drugs, manufacturers’ rebates and mandatory mai

Luis González, co-founder and co-CEO of Vida Link, the leading Pharmacy Benefit Management company in Latin America, joins us for an interview.

Pharmacy Benefit Management companies or PBMs play a big role in employee health insurance and healthcare benefits. Bob Eisendrath, Area VP of National Accounts at a major PBM, explains PBMs and discusses the healthcare sales jobs and account management roles at PBMs in this interview with Marc Luber of Careers Out There.