Webinars & Videos

thINc360 PBM 2.0 Market Insight Panel; Taming the Prescription Drug Beast and Driving a Paradigm Shift with Alignment and Technology

August 26, 2022

Justin Venneri

On May 23, 2022, Capital Rx’s Chief Growth Officer, Kristin Begley, was joined by an exceptional panel of experts on stage at thINc360, including Jeffrey Hogan, President, Upside Health Advisors; Bridget Mulvenna, Director, Pharmacy Programs, Erickson Senior Living; Craig Domeracki, President of Markets, Friday Health Plans; and Sarah Biggs, Sr. Network Director, HR Initiatives, St. Luke’s University Health Network.

At Capital Rx, clients and members come first. We are grateful that these three clients were willing to share their real-world experience with our pharmacy benefit management and administration (PBA) solutions, as well as our team(s). As you’ll hear or read below, there’s more work to do, but with focus, an aligned business model, and a painless integration process, it is possible to rein in pharmacy program spend and reverse the double-digit pharmacy program cost inflation that plagues the industry. And we can do it without sacrificing client service or member experience!

Timestamps and Transcript

Edited lightly for length and clarity.

00:00 – Introduction: Jeff Hogan’s background, problems with the current environment and existing system/pharmacy supply chain, and an overview of a “new way” to operate with cost controls and improved outcomes, new fiduciary standards, and the importance of an aligned business partner.

03:45 – Craig Domeracki and Friday Health Plans

04:36 – Bridget Mulvenna and Erickson Sr. Living

05:08 – Sarah Biggs and St. Luke’s

05:44 – Kristin Begley and Capital Rx

14:43 – Change in healthcare is hard. Pharma used to be 6% of an employer’s total cost of care, and now it’s up to over 30%. It must take courage to look at pharma and say, “We’re going to do something different.” How did your organizations gain the courage to do something different, and what did the journey look like?

23:04: A follow-up question. Were there any detractors in the process (payers, brokers/consultants)? Can you talk about that?

25:15: Can you talk about the value of a deflationary benchmark inside the plans? When you look at a PBM contract, it’s a word puzzle of opaque language. How important was the [NADAC] benchmark and getting rid of AWP and MAC?

28:55: That’s a perfect segue to the payer – Craig, give us some context for your existing plan and history. Given your experience with BUCA(H)s and that you’re operating a direct-to-consumer (D2C) plan, what have you seen for pharma solutions, and how did your organization get your head around moving to something more consumer-oriented and predictable?

35:48: When we look at individual plans, they are very competitive. It’s the threshold predictability as well. The question – how are you using JUDI™ and the analytics to formulate plans and strategies (financial or provider performance)? It’s a unique platform we haven’t seen with other PBMs in the marketplace.

40:10: For direct-to-employer businesses, they can use this logic. What has happened to rebates in your total cost?

43:20: The Consolidated Appropriations Act (CAA) – there are new responsibilities/burdens for employers, brokers and consultants must disclose primary and secondary compensation, and provider groups must post and update prices. What’s your prediction for how this changes things and if it drives employers toward new solutions?

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