Pharmacy Benefit Managers, Part 1

As patients take on more of their medication costs through higher deductibles and coinsurance, Pharmacy Benefit Managers (PBMs) are becoming more and more crucial to the process. PBMs are key to determining the medications available to patients and what patients have to pay for them. Yet, there can be an alternative to PBMs, and on this episode, we explore how health care organizations can find alternative solutions for skyrocketing drug costs, solutions that are at the level of the individual patient and the provider and not at the macro level taken by PBMs.

 

Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Senior Principal, Clinical Operations and Quality
Vizient

 

Guest:
Priyesh Patel, PharmD, MBA
Vice President and General Manager, Alluma
Vizient

 

Show Notes:

[01:07] Addressing skyrocketing drug costs – the Alluma solution

[02:04] Pharmacy Benefit Managers (PBMs)

[03:07] 75% of Vizient member organizations are self-employed insurers (8M lives)

[03:51] Health care workers are not healthy

[05:21] PBMs are not health providers – they manage lives at a macro level

[06:42] Working at a clinical level

[09:55] Complex issues around new, complex drugs

[11:21] Controversy around PBMs: the extravagant profits and the rebate issue

 

Links | Resources:

To contact Modern Practice: modernpracticepodcast@vizientinc.com

Priyesh Patel’s email: priyesh.patel@allumaco.com

“PBM Impact on Employers & Risk to Health Systems” (Alluma white paper): Click here

 

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