Capital Rx
What’s Behind the Price Tag of Medication, a panel discussion at ViVE 2023, included Capital Rx Co-Founder & CEO AJ Loiacono; Solomon Banjo, Managing Director, Life Sciences and Ecosystem Research, Advisory Board (Moderator); Katie Martin, President and CEO, Health Care Cost Institute; Nimesh S Jhaveri, R.Ph., Executive Vice President and Chief Impact Officer, McKesson; and Tina Wu, M.D., Chief Medical Officer, Waltz Health. It was an incredible discussion highlighting the key issues with drug pricing and access in America, the impact high prices have on vulnerable populations, and how to realign incentives. We're excited to share the highlights below.
Pharmacy Benefit Management (PBM): The Coming Divide Between Administration & Fulfillment
AJ describes the divide that's coming between the administration and fulfillment functions in the pharmaceutical supply chain. The blending of the two over the years has created an "opaque, overly complex system that unfortunately does not benefit the patient or the plan," he says. However, choosing to be an administrator and receiving a flat fee "removes all inherent conflicts of interest." And, if you'd like to be in fulfillment, "Fine, you may mark up a drug."
Restoring Trust via an Aligned PBM Model
An agnostic PBM model like Capital Rx's helps to remove friction from the health care system, allowing for a better consumer experience. Drug pricing really should be "easy," and if everyone saw and could get the same price at the counter, it would restore trust back to the pharmacy.
The Consolidated Appropriations Act (CAA): Kudos to the Department of Labor
The Department of Labor has oversight over self-insured pharmacy benefit plans under ERISA. After cleaning up the pension and 401(k) space, the Department of Labor got around to the healthcare side. The CAA includes an amendment to section 408(b)(2) under ERISA - 408(b)(2)(B) - that requires all compensation received by third parties, including PBMs, brokers and consultants, and other services providers, to be disclosed to the plan fiduciaries and government agencies. There's some pretty onerous reporting, and AJ thinks we're starting to see people taken to task, and it'll help to "clean things up" in the industry.
Overall, it was a great panel discussion at a great event, and we appreciate all HLTH does to bring thought leaders together to share their diverse experiences and opinions to help shape the future of health care in America.
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