The Pharmacy Benefit with JC Scott is a podcast series from the Pharmaceutical Care Management Association. This podcast highlights the PBM industry and the value PBMs bring to tens or millions of people throughout the country. PCMA President & CEO JC Scott explores and discusses a wide variety of topics with experts and industry leaders.

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.

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.

Importance of PBMs in Health Care Costs

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.

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.

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.

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, Senior Vice President and Chief Medical Officer, along with Jarrod Henshaw, 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.