Episode 83 of the Astonishing Healthcare podcast features returning guest, Bridget Mulvenna (VP, National Business Development at Capital Rx)! We discuss specialty drugs, pharmaceutical manufacturer rebates, and the shift to biosimilars. Yes, GLP-1s come up as well (how could they not?), and Bridget explains how employer plan sponsors can consider opportunities to provide access to these medications while not ignoring their inflationary potential and the economic impact on the plan - i.e., how to pivot from a rebate-driven models to a net-cost approach, facilitating more accurate cost management and budgeting.

Highlights

• Traditional PBMs remain focused on rebate value, which doesn’t always mean the lowest net cost for the plan sponsor.
• Biosimilar adoption and precision formularies/benefits are a threat to old models.
• Plan sponsors must get [and use] their data - without detailed information, it's impossible to determine the true net cost or implement effective communication and education strategies.
• GLP-1s should be supported by wellness programs, and respecting FDA labeling is crucial.
• Surprisingly, many plan sponsors still choose the PBM that offers the highest rebates.

Related Content

• Will Biosimilar Rebates Pass-Through?
• Health Benefits 101: The Importance of a Transparent PBM Model
• How to Manage Pharmacy Benefit Spend in a GLP-1 World
• Pharmacy Benefits 101: What is a Formulary?
• Pharmacy Benefits 101: Pharmaceutical Rebates

For more on the importance of access to plan data:

🎧 AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan

🎧 AH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric Bricker

For more information about Capital Rx and this episode, please visit Capital Rx Insights.