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,...
May 02, 2023•25 min
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.
Nov 14, 2022•22 min
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 Committe...
Jul 28, 2022•24 min
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
May 26, 2022•24 min
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 ...
Apr 28, 2022•21 min
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.
Mar 22, 2022•22 min
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...
Jan 27, 2022•14 min
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.
Nov 04, 2021•28 min
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 Senio...
Sep 07, 2021•22 min
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 t...
Jul 01, 2021•27 min
We explore how The Robinson-Patman Act, an antitrust law intended to shield businesses acting as buyers from unfair competition, has impacted the pharmaceutical market from a historical standpoint, how it might be applied in the future, and what it means for public policy on drug pricing and rebates. To explain this, JC Scott sits down with Ross Margulies , a Partner with special expertise in Medicare and Medicaid law at Foley Hoag LLP . JC and Ross discuss the antitrust litigations that have sh...
May 11, 2021•20 min
Although the COVID-19 vaccine rollout has had a successful start, major health inequities still exist in vaccine access for underserved communities and underrepresented minorities. 2 million Americans are being vaccinated a day, but less than 20% are underrepresented minorities. In this episode, guest host Claire Winiarek sits down with Dr. Elena Rios , President and CEO of the National Hispanic Medical Association (NHMA) , and Dr. Sree Chaguturu , Senior Vice President and Chief Medical Officer...
Apr 20, 2021•16 min
Although the COVID-19 vaccine rollout has had a successful start, major health inequities still exist in vaccine access for underserved communities and underrepresented minorities. 2 million Americans are being vaccinated a day, but less than 20% are underrepresented minorities. In this episode, guest host Claire Winiarek sits down with Dr. Elena Rios , President and CEO of the National Hispanic Medical Association (NHMA) , and Dr. Sree Chaguturu , Senior Vice President and Chief Medical Officer...
Apr 07, 2021•15 min
The Trump administration enacted the Rebate Rule just before leaving office in November 2020. Analyses on the rule, including from government actuaries, show that the rebate rule would increase Medicare Part D premiums by 25% and increase taxpayer costs by 170 billion dollars. PCMA filed a lawsuit to stop the rebate rule from taking effect. In this episode, host JC Scott speaks with April Alexander, General Counsel and Vice President of State Regulatory Affairs of PCMA; and Mark Newsom, principa...
Feb 25, 2021•25 min
Many Americans have expressed strong reservations about vaccines in general and a COVID-19 vaccine in particular, and remain unsure about whether to be vaccinated against the coronavirus (SARS-CoV-2). In this episode, guest host ClaireWulf Winiarek speaks with Janet McUlsky , convener of the COVID-19 Vaccine Education and Equity Project, and Susan Winckler , a former Chief of Staff to the FDA Commissioner and current CEO of the Reagan-Udall Foundation for the FDA, about these concerns and the po...
Jan 25, 2021•25 min
Host JC Scott speaks with Megan Hauck , a former Health Policy Advisor to President George W. Bush, Senator Mitch McConnell, and Chris Jennings , former Senior Advisor for Health Policy for both the Clinton and Obama Administrations. In this episode, Scott, Hauck, and Jennings discuss the election results, what a new president and Congress will mean for healthcare policies, and speculate how shifts in the House and Senate will impact the future of healthcare. The failure of polling. The results ...
Nov 24, 2020•29 min
Host JC Scott speaks with Amy Bricker , Senior Vice President of Health Services Supply Chain at Express Scripts and previous commissioner for MedPac. November is National Diabetes Month, and the discussion this week revolves around how PBMs help keep the costs of insulin down and improve patient care. Getting Support for Diabetes in America List prices for insulin have not gone down, leaving some diabetes patients with high costs for the live-saving medicine, either as high insurance co-pays or...
Nov 10, 2020•25 min
Host JC Scott speaks with two guests from Humana Pharmacy Solutions. The first, Dr. Mona Siddiqui, is senior vice president of clinical strategy and quality at Humana. Her background is in public service, especially with HHS and the Center for Medicaid and Medicare Innovation. The second is Dr. Scott Greenwell, senior vice president of pharmacy solutions at Humana, who played an integral role in launching Humana’s Medicare Part D program. The discussion is around innovation in service delivery b...
Oct 13, 2020•35 min
Host JC Scott speaks with Claire Winiarek , the VP for Policy of PCMA, about the increased use of mail delivery for prescriptions. Winiarek discusses the value of mail service for prescriptions both relative to the pandemic and beyond it. PBM Mail Service Increases During the Pandemic : The top-line trend is increased mail delivery by 20 percent through July, year on year. At the tail end of the first quarter, early refills drove an increase, as well as at the end of the second quarter as people...
Sep 29, 2020•20 min
Host JC Scott speaks with Mark Newsom , the principal and founder at Health Evaluations LLC, on one of the executive orders Trump signed on drug pricing that affects prescription drug rebates for public programs. Newsom discusses how prescription drug premiums will certainly increase with the implementation of this rule. What a Post-Rebate System Would Look Like For PBMs : With the removal of rebates for such programs, many players in the system are skeptical about how the shift in power will di...
Aug 04, 2020•20 min
Host JC Scott speaks with Dan Judy , Analyst and Polling Expert at North Star Opinion Research , about his recent polls finding that benefits managers are overwhelmingly satisfied with results on Pharmacy Benefit Managers (PBMs). Despite these positive results, JC and Dan discuss why PBMs still suffer from a “trust deficit” in the public eye. High Satisfaction with PBMs : Overall, North Star’s polling results found that the vast majority of employers/benefit managers are satisfied with PBMs. Mos...
Jul 27, 2020•22 min
JC Scott speaks with Doug Long , Vice President of Industry Relations at IQVIA , about the impact of COVID-19 on the pharmaceutical market. Long discusses the data trends for pharmaceutical companies during COVID-19 and, most importantly, how these trends impact healthcare patients. Prescription Stockpiling: With news of the impending pandemic, patients around the US began to stockpile 90-day prescriptions in March. As a consequence, the pharmaceutical marketplace experienced a major decrease in...
Jul 06, 2020•28 min
Host JC Scott speaks with Mostafa Kamal , CEO of Magellan Rx Management, about the evolving role of the PBM market in delivering solutions to its clients. JC and Mostafa also discuss challenges to Medicaid during the current economic downfall, as well as upcoming technological innovations to improve the patient experience. PBM Tools Drive Affordability and Care for Medicaid : Recent unemployment hikes are expected to put severe strains on Medicaid. States across the US will have budgetary pressu...
Jun 11, 2020•28 min
Host JC Scott speaks with Tim Wentworth , the president of Cigna Express Scripts and Cigna Services, about how Cigna--along with the entire pharmaceutical industry--are addressing the COVID-19 pandemic. Wentworth is optimistic that the ingenuity of the US healthcare system can combat COVID-19 and that current industry-wide collaborations can survive beyond the current pandemic. Some key points from the conversation include: Cigna Continues to Put the Patient First During COVID-19 : Since the sta...
May 20, 2020•29 min
Host JC Scott speaks with Mark Newsom , the principal and founder at Health Evaluations LLC, on the core role of Pharmacy Benefit Managers (PBMs). Newsom goes through the process PBMs take to get us, the consumers, the most effective medications for the lowest premiums. He also discusses PBMs and their role in conjunction with the other players in the industry. Some key points from the conversation include: Why PBMs Exist And How Savings Are Generated For The Consumers: Newsom accentuates how PB...
May 20, 2020•15 min
Welcome to The Pharmacy Benefit ! Hosted by JC Scott, President and CEO of the Pharmaceutical Care Management Association, The Pharmacy Benefit talks about the latest trends, public policy developments, and political challenges impacting drug pricing and healthcare. You'll hear the nation's top thought leaders, policy experts, and political analysts on a wide variety of topics from insulin affordability to advancements in gene therapy, biologics, other cutting edge therapies. The Pharmacy Benefi...
Apr 22, 2020•2 min
