The Pharmacy Benefit

PCMA Vice President, Policy, Angela Banks talks with health policy expert Alex Brill about competition in the prescription drug marketplace and why this is the best way to reduce prescription drug costs. They discuss recent reports on big drug companies gaming the patent system to increase prescription drug prices for American patients and families.

Alex Brill is a health policy researcher and the founder and CEO of Matrix Global Advisors, an economic consulting firm specializing in healthcare, tax, and fiscal policy.

November is National Diabetes Month. In this conversation, hosted by PCMA’s Angela Banks, we discuss the work that PBMs are currently doing to help millions of patients with diabetes manage their care.  Express Scripts’ Chief Medical Officer Dr. Christine Gilroy joins us as our guest.

Our focus is on prescription drug rebates. How do they work? Why do they work? How do they benefit consumers? And why are they currently under attack by some policymakers and drug manufacturers?

The guest is Alex Brill, a health policy researcher and the founder and CEO of Matrix Global Advisors, an economic consulting firm specializing in healthcare, tax, and fiscal policy. He has extensive health policy research experience and previously served on the staff of the House Ways and Means Committee and the White House Council of Economic Advisers. Alex is also the author of a recent research study entitled “Understanding Drug Rebates and Their Role in Promoting Competition.”

When it comes to lowering prescription drug costs, competition is key throughout the prescription drug supply chain.  If you’ve listened to some in Washington, you might be led to believe that there is very little competition in the PBM marketplace. On this episode, we talk with Jason Borschow, President and CEO of Abarca and Mike Ellis, CEO of Maxor who say that is simply not the case. Competition is very healthy in the industry

Every day, PBMs are working to prevent potentially hazardous drug interactions, alerting their providers to potential problems, and monitoring patients’ adherence to drug regimens so that they can avoid hospital stays and live healthier lives.

On this episode, JC Scott talks with Dr. William Fleming, Segment President, Pharmacy Solutions & Chief Corporate Affairs Officer at Humana, Inc. about all of the work PBMs do in the area of clinical care. If you’re listening to this podcast, you have insurance, and you’ve ever taken a prescription drug, we want you to have a clear idea of how your PBM works with your pharmacy and maybe even your provider behind the scenes between the time your prescription is ordered by a doctor to when the drug is in your hands.

This episode highlights the important role that PBMs play in lowering prescription drug costs amid the Federal Trade Commission’s (FTC) recent interest in conducting a PBM study. The episode features Ross Margulies, a Partner with the law firm Foley Hoag. Mr. Margulies outlines the role that PBMs play in Medicare, and how PBM tools and technology are working to lower drug costs for patients as well as improving their pharmacy experience.

Pharmacy DIR (direct and indirect remuneration) is a value-based tool that’s getting a lot of buzz on Capitol Hill and at CMS. To better understand Pharmacy DIR and how it affects Medicare beneficiaries, JC Scott talks with Dr. William Fleming, Segment President of Pharmacy Solutions and Chief Corporate Affairs Officer for Humana, Inc. 

Dr. Fleming explains what pharmacy direct and indirect remuneration (DIR) means for pharmacists, why it should be thought of as value-based contracting, and how it engages with the pharmacist community to increase medication adherence and keep pharmacies accountable for increasing quality for patients.

JC Scott talks with Julie Goon, Senior Vice President of Public Affairs for Anthem, Inc., and Tim Dube, PCMA’s Vice President of Regulatory Affairs. Together, they discuss good versus bad transparency, how transparency has evolved in healthcare, how it can empower the consumer to have more control over the prices they pay through evolved technology, and which transparency rules decrease prescription drug prices, and which rules actually increase prices.

Today, spending on biologic drugs makes up 43% of total drug spending. This is a growing area of new innovation for a multitude of therapeutic areas, and also an area of growing cost. To increase the use of biosimilars, strategies must be implemented to focus on biologics and drive cost-savings. To share these strategies, host JC Scott is joined by two members of Prime Therapeutics, Dr. Joseph Leach, Prime Senior Vice President and Chief Medical Officer, along with Jarrod Henshaw, Prime Senior Vice President and Innovation & Supply Chain Officer. Prime Therapeutics recently announced a major program addressing the increased use of biosimilars. Jarrod explains the differences between traditional drugs vs. biologics and generics drugs vs. biosimilars. Jarrod and Dr. Leach discuss what it means for biosimilars to be interchangeable, how they confront fears and misperceptions on biosimilars, what roles PBMs must play to drive the cost-savings from adoption of biosimilars, and how policies and incentives can encourage the use of biosimilars.

To stop significant increases in drug pricing, greater competition is needed in the drug manufacturing industry. To analyze the role public policy plays in this challenge, host JC Scott talks with Lauren Aronson, health policy expert and Executive Director of the Campaign for Sustainable Rx Drug Pricing (CSRxP). Lauren shares the defining moment that started CSRxP, the main challenges policy experts face in rising drug prices, examples of manufacturers’ unsustainable pricing methods including their patent shenanigans, and potential solutions in creating sustainable methods for affordable drug pricing. They also talk about the current landscape in Congress and the Administration when it comes to political strategies to lower drug costs.