PBM
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MedCity Moves Podcast: Recent Hires, Layoffs & an Interview with Danny Sanchez, CEO of EmpiRx Health
In this month’s episode, we dive into some of the recent executive appointments occurring in the healthcare sector, as well as layoffs affecting the industry. We also hear from Danny Sanchez, who recently became the new CEO of EmpiRx Health, a value-based pharmacy benefit manager.
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How AI Will Change the Way Patients Get Medication
There is a huge opportunity for PBMs and health systems to use AI to help address the challenges surrounding the affordability and accessibility of medicines, from navigating formularies to resolving prior authorization. More automation in pharmacies and with ordering workflows is one piece of that puzzle.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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Consumer / Employer, Health Tech, Pharma
Medicare Drug Negotiation Is the Model for the Future of Drug Pricing, Abarca CEO Says
For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it’s the latter.
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Getting off the PBM Merry-go-Round: How Late-stage Offer Tricks Take Employers for a Ride
Requiring that PBMs bid on a per member per month guarantee would reduce the employer’s uncertainty by securing the actual per member per month cost to the employer.
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States should be allowed to regulate PBMs, according to 35 state AGs advocating in Oklahoma case
A trade association for PBMs says that state PBM regulations in Oklahoma are preempted by federal ERISA and Medicare regulations.
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How EmpiRx Health’s value-based model led to less drug spending on mental health, decreased opioid use
EmpiRx found in its data that pharmacy claims for behavioral health treatments increased 9.4% from 2020 to 2021. For antidepressants, utilization increased 12% during this time period, but per claim spend fell 1.8%. ADHD medications saw a 20.2% increase in utilization and a 9.1% decrease in per claim spend.
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Should the same entity be allowed to own a retail pharmacy, a PBM and an insurance company?
The question elicited predictable and unexpected responses from panelists that included a senior executive from CVS Caremark and executives from startup companies working to change the pharmacy benefits landscape.
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Register for MedCity INVEST Digital Health and take part in a discussion on pharmacy benefit management
The MedCity INVEST Digital Health conference in Dallas September 28 in collaboration with Health Wildcatters marks our first conference in the Lone Star state and new themes embracing employee benefits and the financial experience in healthcare. Register today!
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Capital Rx snags $106M to enhance digital platform, increase user base
Capital Rx recently closed a $106 million Series C funding round, bringing its overall funding to $175 million. The upstart pharmacy benefit manager will use the funds to enhance its digital pharmacy platform as well as grow its user base.
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Applying Remote Patient Monitoring to Surgery Prep and Recovery, Oncology and Women’s Health
Join us to learn about the latest trends in remote monitoring and how to extend its benefits beyond chronic conditions to more patients – all while using fewer staff resources.
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3 forecasts for the PBM industry in 2022
The current landscape heading into 2022 will keep pharmacy benefits under the microscope. Plan sponsors will evaluate their PBM’s pricing model to determine if their contract will deliver predictable costs, more opportunities for increased savings and improved care for their members.
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GoodRx leadership downplays Amazon Pharmacy worries despite lackluster stock price
In a month where GoodRx’s stock has been trading below IPO levels, the startup’s leadership says Amazon Pharmacy still isn’t a threat. Citing third-party data, the company said uptake of Amazon’s pharmacy services have been low, though the retailer still could pose a threat with its growing healthcare business.
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WithMe raises $20M to help patients navigate their prescriptions
WithMe Health, a startup trying to build a new approach to pharmacy benefits, spun off a medication guidance service that can be layer on top of existing PBMs. It also raised $20 million in funding, led by OMERS Ventures.
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GoodRx raises more than $1B in IPO
GoodRx began trading on Nasdaq in an upsized IPO. The company priced its stock at $33 per share, up from its expected range of $24 to $28 per share.
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Startups, Pharma, Payers, Policy
Some startups grapple with USPS delays in medication delivery
Some healthcare startups that offer at-home prescription deliveries and test kits have experienced delays with the USPS. They shared how they’re navigating the changes.
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CVS builds out digital health program with five more companies
CVS Caremark added five new companies to its Point Solution Management Service, which it launched last year to make it easier for businesses to implement digital health tools. CVS Caremark CMO Sree Chaguturu shared more about the PBM’s plans for digital health.
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Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
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Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
