Topics:

(11:00) Pharmacy benefit management basics

(15:28) Rebates and pricing benchmarks

(18:34) Blue Shield of California’s pharmacy care reimagined initiative

(21:25) Capturing real-world evidence to asses new medications

(23:52) Transforming the pharmacy benefits industry with partnerships and alliances

(29:32) Baseline drug prices and innovative contracting approaches

(33:52) Shifting to a value-based model to make drug pricing more cost-effective

(37:13) The need for systemic change and holistic health in the pharmacy benefit industry 

About Health Care Rounds

Health Care Rounds is a podcast developed for health care leaders who are at the forefront of health care delivery and payment reform. Join Darwin Research Group founder and CEO John Marchica as he discusses the latest advancements in health care business news and policy developments. 

About Alison Lum

As Blue Shield Vice President, Pharmacy Services, Alison Lum leads the team that is transforming the Blue Shield pharmacy benefit into one that is worthy of our family and friends and sustainably affordable. At Blue Shield, she has taken an active role in employee engagement, management training, and leadership development. Prior to joining Blue Shield, Alison was the Director of Clinical Services at a managed Medicaid plan,

San Francisco Health Plan, where she was responsible for pharmacy benefits, utilization/case management, and provider relations. 

Alison also has experience in Medicare Part D, PACE programs, and account management. She holds a doctorate of pharmacy degree from the University of California, San Francisco, and completed the California Healthcare Foundation Leadership Fellowship. Alison participated on the California Pharmacist Association state-wide task force for SB493 payment models and was a keynote speaker on the topic at the 2015 West Coast Pharmacy Exchange. She was honored with the Blue Shield Team Mission and Values in Action awards for 2016 and 2013 and the inaugural San Francisco Health Plan’s first Here For You award in 2008.

About John Marchica, Host of Health Care Rounds

John Marchica is a veteran healthcare strategist and CEO of Darwin Research Group, a strategic consulting and market intelligence firm focused on hospitals, health systems, physician groups, and the evolving healthcare ecosystem. John has a degree in economics from Knox College, an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow. 

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⚙️ Health Care Rounds is produced by Grippi Media