Episode 12: A Refreshing Look at Pharmacy Benefits (Part 1)

00:00 Intro

00:40  In today's episode

00:58  Vinay Patel of Self Insured Pharmacy Networks

02:16  What is a PBM?

02:32  PBM = claim processor just like a TPA on the medical side

03:15  but also rebate management, clinical management, etc.

04:17  what about the cost?

04:42  episode 8, "transparency" 

05:08  Tim Thomas, quote on transparency

05:50  There's money in here, if you can find it--it's yours

06:02  Do we just need transparency?  Or do we need a fiduciary?

08:00  It all depends on what's in the contract

08:56  Fiduciary principles mean I'm acting in the best interests of my client

09:57  NADAC = National Average Drug Acquisition Cost

11:09  University of Lynchburg Master's Program in Health Benefits Design

12:06  All things being the same, the price fluctuates by hundreds of dollars

13:00  Supply & Demand still exists but Rx prices can still be normalized

13:13  Manufacturers adjust brand names twice per year

14:17  Average Wholesale Price (AWP) means wholesalers are setting the prices

14:55  A little disruption might be in order here

15:25  We should have a buyer's market, not a seller's market

15:50  Direct Primary Care doctors are also dispensing Rx onsite

16:40  Let's step back and highlight DPC

17:20  Patients want a relationship with their providers, Providers want that too

18:12  Now that DPC has primary care handled, let's give them better access to Rx

18:57  A subscription model for Rx also

20:00  How many pharmacies are locally owned?

20:39  Answer = one third, about 22,000 pharmacies

21:47  A superior customer experience with care catered to the patient

23:40  Pharmacists in big box stores want to cater to patients but can't because of the system

25:30  A "concierge" pharmacist?  Yes, it's possible

26:39  Local care team like Carl Schuessler says in the "Marcus Welby days"

28:12  Quadruple Aim means the physician/provider experience is important too

29:01  Cliffhanger--What's a day in the life of a community pharmacists?

29:08  That's all for today

29:16  Thank you, visit us at www.custombenefits.work, #letsfixhealthcare