SmithRx’s Post

Big Blue Drops CVS/Caremark This past week the king of our industry got put in check by a pawn. The story of Blue Shield of California dropping Caremark as their Prescription Benefits Manager (PBM) on Thursday. They have signed on with Mark Cuban’s Cost Plus Drug Company to handle their medications. “That's a signal that the market believes this could be an indicator of things to come," Peter Bonis, chief medical officer at Wolters Kluwer Health told Axios. Major companies are looking for better solutions for healthcare benefits. The days of 15 to 20% annual price hikes are forcing changes and the membership based model is starting to make it mark. Premier Rx - We’re Redefining What a PBM is with better pricing, better benefits and rebates back to you not the middleman. We’re a membership based prescription drug benefit program. Let’s schedule a time to talk: [email protected]

📢 Pressure Mounts for PBM Reform: Diverse Coalition Calls for Action 🛑💊 A coalition representing nearly 2,000 stakeholders, including employers, patient advocates, pharmacies, and providers, has raised its voice against the practices of pharmacy benefit managers (PBMs) that are blamed for driving up drug prices. Led by FMI – The Food Industry Association and the National Community Pharmacists Association, the coalition, which includes notable names like The Kroger Company and the American Pharmacists Association, has sent a letter to the U.S. Congress urging for legislative reform of PBM practices. The coalition is encouraged by recent legislation introduced in Congress targeting PBMs, such as the Transparency in Coverage Act and the Pharmacy Benefit Manager Reform Act. However, they emphasize that more work needs to be done. While requesting passage of PBM reform measures, the coalition also stresses the importance of not inhibiting state efforts to regulate PBM-pharmacy relationships, which have seen success in promoting transparency and curbing anticompetitive behavior. The coalition asserts that Congress has the power to lower prescription drug costs, alleviate financial burdens on patients and the healthcare system, enhance access to affordable medications, and foster a competitive business environment through PBM reform measures. This collective call for action comes at a time when scrutiny of PBMs' practices continues to intensify, with both legislative and investigative measures gaining momentum. 🌐🔍 #PBMReform #DrugCosts https://buff.ly/45LHVLc

Analyzing the performance of Pharmacy Benefit Managers (PBMs) is crucial for organizations that utilize self-funded medical and Rx programs because it helps control costs, ensures transparency, and optimizes the use of prescription benefits. Pharmacy claims are a leading cost driver and understanding a PBM's performance can lead to better decision-making and improved overall healthcare management. #assuredpartners #centerofexcellence #employeebenefits #pharmacybenefits

Did you know, a study of pharmacy professionals performed by RedSail Technologies shows that "31% of pharmacies have had to cut payroll; 28% have reduced owner pay; 24% have reduced services." This is just scratching the surface on the impact that PBMs have had on independent pharmacies. We'll be speaking about PBMs impact on independent pharmacies, understanding your cash flow, fundamental accounting, and more at the PioneerRx Pharmacy Software Catalyst Connect Conference in May! Register today if you haven't already and come see us speak: https://lnkd.in/gwqiDwSY

Don't be fooled by thinking you are getting a "good deal" because you have high "discounts" in your pharmacy benefit contract. I am sure J&J and most fortune 100 employers were able to use a pharmacy consultant to negotiate "high discounts" on their behalf. Unfortunately, that does not always lead to lower costs as seen in a pricing comparison done in our most recent blog post. #pharmacybenefits #PBMs #employeebenefits #fiduciary #drugcost https://lnkd.in/gnN3ZfjE

According to data gathered by Mercer, prescription drug costs saw a 31.3% surge in 2023 compared to 2022. Marking 2024 as a pivotal year in the battle against escalating pharmacy costs and building on our commitment to revolutionize the pharmacy landscape. How is SmithRx ensuring better medication affordability? Our innovative Connect 360 programs and strategic initiatives have resulted in substantial savings, surpassing $200 million last year alone– and that’s just the beginning! Our partnerships with Transparency-Rx, along with PBM reform introduced by Congress, will make healthcare more accessible and cost-effective for everyone. Learn more at www.smithrx.com #healthcare #pbms #prescriptiondrugs #smithrx

--Do broker owned pharmacy coalitions/consortiums actually save you money on your Rx spend, or do they simply maximize how much a broker makes? --If a broker is getting paid on one of their own broker owned pharmacy coalitions, can you be assured that they can give you unbiased PBM guidance...would they recommend something they aren't getting paid on? --If you are with a broker owned coalition, do you know how much your broker is getting paid from that coalition? --Are you aware that brokers that offer their own, broker owned pharmacy coalition gain substantial revenue from their client's pharmacy programs? --If you are self-funded, are you able to fulfill fiduciary duties in a broker owned coalition? Inquiring minds want to know...you may have guessed it, but USI does not have a broker owned pharmacy coalition. We are not incentivized through revenue to put your pharmacy plan with any specific PBM (pharmacy is not a revenue stream for USI). I am NOT a pharmacy expert, but I'm glad I have experts in my corner who help our clients with PBM procurement, auditing and contractual language and guarantees... https://lnkd.in/gdSZSc2f

What is transparency in pharmacy? And how will increasing it benefit you and your clients? Read our latest blog to learn how different stakeholders are answering the call for greater transparency and how you can determine which options deliver the most value. 💡

Navigating the complexities of Direct and Indirect Remuneration (DIR) fee changes isn't just about financials; it's about ensuring the continuity of quality care. https://hubs.ly/Q02jnCQP0 👉 Learn from Geoff Dutcher, Senior Sales Manager at Capsa Healthcare, as he shares insights from pharmacy leaders who are ahead of the curve in managing these industry changes. Delve into their experiences and strategies in our latest blog post. #DIRFees #CMSDIRFees #Pharmacy #PharmacyAutomation #PharmacyTech