Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs - Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs EPISODE 52
Pharmacy Marketplace and Rx Purchasing Round Table
00:00:00 00:52:38

Pharmacy Marketplace and Rx Purchasing Round Table

Topics:

  • Pharmacy Benefit Manager (PBM)
  • Misaligned Incentives
  • Price Transparency 
  • Efficacy versus Effectiveness
  • Consumerism
  • Specialty Drugs
  • Drug Waste
  • Drug Manufacturer Rebate Steerage

 

In this episode, Michael introduces you to Mort Jorgensen, the Co-founder, and CEO of Rx’n Go, Paul Ford, the Founder of OrchestraRx and Pramod John, the CEO of VIVIO Health. Join our round table as we dive into the current state of the Pharmacy Marketplace and ideas to challenge the inefficiencies and problems in traditional Rx purchasing. 

Here’s a glance at what we discuss in this episode:

  • The table’s opinion about the current mergers of the largest PBMs with insurance companies and how this could impact the marketplace
  • The complexities and challenges with the current pharmacy purchasing structure 
  • How payors have zero visibility into the pricing for Generics, Brand and Specialty Drugs
  • How current benefit design is a part of the transparency problem 
  • The Pareto Principle, how it relates to drug spend and why employers need to take a more proactive stance on what drugs are allowed to be used if they want to save money
  • How the presence of multiple middlemen in the drug distribution system creates additional cost and inefficiency
  • Why our biggest problem may not be a lack of transparency, but rather an unwillingness for payors to stop doing business with the vendors who profit off of higher drug costs
  • Misconceptions about drug manufacturer rebates and why the impact of rebate driven drug steerage should be a greater concern than how much the drugs cost
  • Understanding which stakeholders benefit from drug manufacturer rebates 
  • Understanding that consumerism doesn’t really work when it comes to drug choice given it is usually a provider who is the one selecting the drug for the patient
  • The differences between efficacy versus effectiveness and why we continue to pay for drugs that do not work
  • How employers can reduce waste within their benefit design
  • How employers can protect themselves from Big Pharma and Specialty Drug costs
  • Why FDA approval of a drug doesn’t necessarily warrant covering it on an employer’s formulary
  • Why paying for bad drugs that don’t work creates a disincentive for Pharma to create drugs that actually work
  • Why employers need to start taking a more proactive role in selecting what drugs they are willing to cover and pay for
  • Questions that an employer should be asking to ensure their pharmacy vendors have aligned incentives 
  • The government’s role in creating policies that address data sharing, drug pricing, and transparency
  • To learn more about Rx’n Go visit: https://www.rxngo.com/
  • To learn more about OrchestraRx visit: https://www.orchestrarx.com/
  • To learn more about VIVIO Health visit: https://viviohealth.com/