If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.
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If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.
AH079 - Capital Equilibrium, a New Level-Funded Pharmacy Plan, with Mike Miele, FSA, MAAA
The Astonishing Healthcare Podcast
16 minutes 9 seconds
2 months ago
AH079 - Capital Equilibrium, a New Level-Funded Pharmacy Plan, with Mike Miele, FSA, MAAA
In this episode of the Astonishing Healthcare podcast, Mike Miele, FSA, MAAA (SVP of Insured Services), joins us in the studio again for a discussion about a new product and the growth of level-funded pharmacy plans. What are level-funded plans? How does Capital Rx's "Capital Equilibrium" work? Listen in to hear how these plans, positioned between self-funded and fully insured models, offer employers budget certainty while maintaining flexibility and transparency. Mike highlights the scenarios where a level-funded plan can truly help - e.g., a municipality with a fixed budget and the role stop-loss plays (building on Episode 55). He also notes that not all level-funded plans are equal, and plan sponsors should look for transparency around rebates and whether any savings - if a plan's performance is better than the guarantee - ultimately benefit the plan.
The Astonishing Healthcare Podcast
If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.
