Drugs are way too expensive. It has got to be from someone in the middle taking up all the money. Blame the pharmacy benefits managers! Right? Not so fast. If you’re like me and have gotten derailed by complicated flow charts trying to understand PBMs in the past, this is the episode for you.
AJ Loiacono is the CEO of Capital Rx, a new PBM injecting some much-needed trust back into the system. By starting fresh and denouncing business
Highlights from There Are No Drug Prices in the US
- What do you mean by, “There are no drug prices in the US”?
- The dangers of an inefficient market.
- Does the PBM have an inherent conflict of interest?
If someone is being prescribed a $50,000 medication, my company makes $5. If someone’s being prescribed a
million dollarmedication, my company makes $5. My competitor on a million dollar medication might make $200,000. That incentive is not aligned with both the patient care or the plan, and that’s a problem. Personally, I think it should be completely against the law for any pharmacy benefit manager to be taking spread on drug and receiving payments from pharmaindustry.
- The abandonment curve: When do groceries matter more than medications?
- Capital RX is a clearinghouse, just like the New York Stock Exchange.
There’s a price to everything. Words and definitions and things to fight about and exclusions and going through a hundred-page contract, that is an artfully constructed pitfall.
- Proving value and building trust with EDI 835 and EDI 837.
- Risk assessment and level-funded products.
- An outcome-based rebate schedule.
Anthony J. Loiacono, CEO
A.J is a successful Entrepreneur and CEO of Capital Rx. He has over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administered in the US
Capital Rx is redefining the way prescriptions are priced and administered in the U.S. Through its Clearinghouse ModelSM, Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes. The company’s commitment to innovation, technology, and service is why Capital Rx is the fastest-growing pharmacy benefit manager in America.
Links and Related Episodes
- National average drug acquisition cost
- EDI 835 and EDI 837
- Website: https://www.cap-rx.com/
- Twitter: https://twitter.com/cap_rx?lang=en
- Linkedin: https://www.linkedin.com/company/cap-rx/
- Made in America, 1/19/20-1/21/2020
- PSG Summit, 1/21/20
- Episode 109: Driving Down Pharmacy Spending w/ David Henka
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