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 as usual, AJ is giving control back to self-insured entities while looking after the community and specialty pharmacies that historically haven’t had negotiating power. Don is joined by Shahid today and the tough questions are coming in hot! Enjoy!

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 dollar medication, 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 pharma industry.

  • 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

VBP Forward is building a bridge between community-based organizations and healthcare delivery. VBP Forward: The Conference 2020 will be held in Albany, NY on April 28-30, 2020. Join us as we work to fully leverage the value of community-based organizations to realize healthcare’s loftiest goals AND ensure they are properly funded to continue and expand their efforts. https://www.vbpforward.com/

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Music by StudioEtar