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The Pharmacy Benefit
PCMA
26 episodes
5 months ago
JC Scott, President & CEO of the Pharmaceutical Care Management Association, discusses 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 topics like how employers, unions, and others use Pharmacy Benefit Managers (PBMs) to drive value for their members in the face of growing healthcare costs. You'll also learn about advancements in gene therapy, biologics, other cutting edge therapies, and the patient benefits and cost challenges that come with them. The Pharmacy Benefit will also analyze the latest news from inside the industry and give you an educated perspective on where things currently stand and where we think they're headed.
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Medicine
Government,
Health & Fitness
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JC Scott, President & CEO of the Pharmaceutical Care Management Association, discusses 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 topics like how employers, unions, and others use Pharmacy Benefit Managers (PBMs) to drive value for their members in the face of growing healthcare costs. You'll also learn about advancements in gene therapy, biologics, other cutting edge therapies, and the patient benefits and cost challenges that come with them. The Pharmacy Benefit will also analyze the latest news from inside the industry and give you an educated perspective on where things currently stand and where we think they're headed.
Show more...
Medicine
Government,
Health & Fitness
Episodes (20/26)
The Pharmacy Benefit
A More Affordable Future Through Competition

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, tax, and fiscal policy.

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2 years ago
24 minutes

The Pharmacy Benefit
PBMs and Diabetes Care
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.
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3 years ago
22 minutes

The Pharmacy Benefit
Understanding Prescription Drug Rebates
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?
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3 years ago
24 minutes

The Pharmacy Benefit
Competition in the PBM Marketplace
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.
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3 years ago
23 minutes

The Pharmacy Benefit
PBM Care Coordination

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 insurance, and you’ve ever taken a prescription drug, we want you to have a clear idea of how your PBM works with your pharmacy and maybe even your provider behind the scenes between the time your prescription is ordered by a doctor to when the drug is in your hands.

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3 years ago
20 minutes

The Pharmacy Benefit
Importance of PBMs in Health Care Costs
he 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.
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3 years ago
22 minutes

The Pharmacy Benefit
Understanding DIR and Pharmacy Value-Based Contracting
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.
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3 years ago
14 minutes

The Pharmacy Benefit
PBM Transparency
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.
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4 years ago
27 minutes

The Pharmacy Benefit
Understanding the Value of Biosimilars
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 Senior Vice President and Innovation & Supply Chain Officer. Prime Therapeutics recently announced a major program addressing the increased use of biosimilars. Jarrod explains the differences between traditional drugs vs. biologics and generics drugs vs. biosimilars. Jarrod and Dr. Leach discuss what it means for biosimilars to be interchangeable, how they confront fears and misperceptions on biosimilars, what roles PBMs must play to drive the cost-savings from adoption of biosimilars, and how policies and incentives can encourage the use of biosimilars.
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4 years ago
22 minutes

The Pharmacy Benefit
Competition in the Prescription Drug Market
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 their patent shenanigans, and potential solutions in creating sustainable methods for affordable drug pricing. They also talk about the current landscape in Congress and the Administration when it comes to political strategies to lower drug costs.
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4 years ago
26 minutes

The Pharmacy Benefit
Exploring the Impact of the Robinson-Patman Act: Historical Insights and Future Considerations
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 shaped the drug supply chain.
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4 years ago
20 minutes

The Pharmacy Benefit
Achieving Widespread COVID-19 Vaccination, Part Two
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 of CVS Caremark. Claire, Dr. Rios, and Dr. Chaguturu discuss the unique social determinants for why these inequities exist, why it’s important to reframe COVID-19 vaccination campaigns for specific demographic groups, and how PBMs are working to educate underserved populations on the safety and efficacy of the COVID-19 vaccine.
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4 years ago
15 minutes

The Pharmacy Benefit
Achieving Widespread COVID-19 Vaccination Part One
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 of CVS Caremark. Claire, Dr. Rios, and Dr. Chaguturu discuss the unique social determinants for why these inequities exist, why it’s important to reframe COVID-19 vaccination campaigns for specific demographic groups, and how PBMs are working to educate underserved populations on the safety and efficacy of the COVID-19 vaccine.
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4 years ago
15 minutes

The Pharmacy Benefit
What’s Next for the Rebate Rule?
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, PCMA General Counsel, Vice President of State Regulatory Affairs; and Mark Newsom, principal and founder at Health Evaluation, LLC. JC, April, and Mark discuss the PCMA lawsuit, the impact of the last-minute rebate rule, and the Biden Administration's approach to addressing the rule.
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4 years ago
25 minutes

The Pharmacy Benefit
COVID-19 Vaccine Education and Equity
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 Claire Wulf 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 potential messages and messengers that may help improve understanding.
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4 years ago
24 minutes

The Pharmacy Benefit
What Could Health Policy Look Like In 2021?
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.
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4 years ago
29 minutes

The Pharmacy Benefit
How PBMs Reduce Insulin Costs
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.
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5 years ago
25 minutes

The Pharmacy Benefit
How PBMs Use Data to Help Patients During COVID-19
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 both before, during, and after the pandemic.
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5 years ago
34 minutes

The Pharmacy Benefit
How PBM Mail-Service Pharmacies Help Patients
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.
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5 years ago
20 minutes

The Pharmacy Benefit
How Reviving HHS’ Rebate Rule Will Raise Medicare Premiums
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.
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5 years ago
19 minutes

The Pharmacy Benefit
JC Scott, President & CEO of the Pharmaceutical Care Management Association, discusses 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 topics like how employers, unions, and others use Pharmacy Benefit Managers (PBMs) to drive value for their members in the face of growing healthcare costs. You'll also learn about advancements in gene therapy, biologics, other cutting edge therapies, and the patient benefits and cost challenges that come with them. The Pharmacy Benefit will also analyze the latest news from inside the industry and give you an educated perspective on where things currently stand and where we think they're headed.