The Pharmacy Benefit is a podcast series from the Pharmaceutical Care Management Association. This podcast highlights the pharmacy benefit industry and the value pharmacy benefit companies bring to tens or millions of people throughout the country. We explore and discuss a wide variety of topics with experts and industry leaders.

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.

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.

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.

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.