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

00:00 Intro00:40  In today's episode00:58  Vinay Patel of Self Insured Pharmacy Networks02:16  What is a PBM?02:32  PBM = claim processor just like a TPA on the medical side03:15  but also rebate management, clinical management, etc.04:17  what about the cost?04:42  episode 8, "transparency" 05:08  Tim Thomas, quote on transparency05:50  There's money in here, if you can find it--it's yours06:02  Do we just need transparency?  Or do we need a fiduciary?08:00  It all depends on what's in the contract08:56  Fiduciary principles mean I'm acting in the best interests of my client09:57  NADAC = National Average Drug Acquisition Cost11:09  University of Lynchburg Master's Program in Health Benefits Design12:06  All things being the same, the price fluctuates by hundreds of dollars13:00  Supply & Demand still exists but Rx prices can still be normalized13:13  Manufacturers adjust brand names twice per year14:17  Average Wholesale Price (AWP) means wholesalers are setting the prices14:55  A little disruption might be in order here15:25  We should have a buyer's market, not a seller's market15:50  Direct Primary Care doctors are also dispensing Rx onsite16:40  Let's step back and highlight DPC17:20  Patients want a relationship with their providers, Providers want that too18:12  Now that DPC has primary care handled, let's give them better access to Rx18:57  A subscription model for Rx also20:00  How many pharmacies are locally owned?20:39  Answer = one third, about 22,000 pharmacies21:47  A superior customer experience with care catered to the patient23:40  Pharmacists in big box stores want to cater to patients but can't because of the system25:30  A "concierge" pharmacist?  Yes, it's possible26:39  Local care team like Carl Schuessler says in the "Marcus Welby days"28:12  Quadruple Aim means the physician/provider experience is important too29:01  Cliffhanger--What's a day in the life of a community pharmacists?29:08  That's all for today29:16  Thank you, visit us at www.custombenefits.work, #letsfixhealthcare