AffirmedRx, a Public Benefit Corporation

𝗢𝗽𝘁𝘂𝗺 𝗥𝘅 𝗶𝘀 𝗺𝗮𝗸𝗶𝗻𝗴 𝗵𝗲𝗮𝗱𝗹𝗶𝗻𝗲𝘀 𝗳𝗼𝗿 𝗿𝗲𝗺𝗼𝘃𝗶𝗻𝗴 𝗽𝗿𝗶𝗼𝗿 𝗮𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 (𝗣𝗔) 𝗿𝗲𝗾𝘂𝗶𝗿𝗲𝗺𝗲𝗻𝘁𝘀 𝗳𝗼𝗿 𝗮𝗯𝗼𝘂𝘁 80 𝗱𝗿𝘂𝗴𝘀, 𝗽𝗼𝘀𝗶𝘁𝗶𝗼𝗻𝗶𝗻𝗴 𝗶𝘁 𝗮𝘀 𝗮 𝘄𝗶𝗻 𝗳𝗼𝗿 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀. 𝗕𝘂𝘁 𝗹𝗲𝘁’𝘀 𝘁𝗮𝗸𝗲 𝗮 𝗰𝗹𝗼𝘀𝗲𝗿 𝗹𝗼𝗼𝗸. • Many of these drugs should not have had a PA to begin with, based on standard of care clinical guidelines. • This is not eliminating the PA, only reauthorization, leading to only 10% decrease in total PA volume. • Most of these drugs are already highly rebated—meaning Optum is still maximizing its profits. 𝗔𝗹𝘁𝗵𝗼𝘂𝗴𝗵 𝗣𝗔 𝗶𝘀 𝗶𝗻𝘁𝗲𝗻𝗱𝗲𝗱 𝗮𝘀 𝗮 𝘁𝗼𝗼𝗹 𝘁𝗼 𝗲𝗻𝘀𝘂𝗿𝗲 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝘀𝗮𝗳𝗲𝘁𝘆 𝗮𝗻𝗱 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗲𝗳𝗳𝗶𝗰𝗮𝗰𝘆, 𝘁𝗼𝗼 𝗼𝗳𝘁𝗲𝗻 𝗶𝘁 𝗶𝘀 𝘂𝘀𝗲𝗱 𝘁𝗼 𝘀𝘁𝗲𝗲𝗿 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘁𝗼𝘄𝗮𝗿𝗱 𝗺𝗼𝗿𝗲 𝗽𝗿𝗼𝗳𝗶𝘁𝗮𝗯𝗹𝗲 𝗱𝗿𝘂𝗴𝘀 𝗿𝗮𝘁𝗵𝗲𝗿 𝘁𝗵𝗮𝗻 𝘁𝗿𝘂𝗹𝘆 𝗻𝗲𝗰𝗲𝘀𝘀𝗮𝗿𝘆 𝗼𝘃𝗲𝗿𝘀𝗶𝗴𝗵𝘁. Traditional PBMs frequently use PA and other utilization management (UM) tactics as bargaining chips in formulary placement negotiations with drug manufacturers. Now, Optum Rx is walking back some of these unnecessary restrictions—but only on drugs that already bring in high rebates. Meanwhile, 𝗰𝗼𝘂𝗻𝘁𝗹𝗲𝘀𝘀 𝗺𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀 𝘁𝗵𝗮𝘁 𝗮𝗰𝘁𝘂𝗮𝗹𝗹𝘆 𝗻𝗲𝗲𝗱 𝗣𝗔 𝗿𝗲𝗹𝗶𝗲𝗳 𝗿𝗲𝗺𝗮𝗶𝗻 𝘀𝘁𝘂𝗰𝗸 𝗶𝗻 𝗯𝘂𝗿𝗲𝗮𝘂𝗰𝗿𝗮𝘁𝗶𝗰 𝗹𝗶𝗺𝗯𝗼, delaying access and driving up healthcare costs. A recent American Medical Association survey found that 88% of physicians report PA leads to higher overall healthcare utilization, including additional office visits, emergency care, and hospitalizations. The impact isn’t just on patients—it’s on the entire healthcare system. At AffirmedRx, we take a different approach: • 𝗙𝗲𝘄𝗲𝗿 𝗺𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀 𝗿𝗲𝗾𝘂𝗶𝗿𝗲 𝗣𝗔 𝗳𝗿𝗼𝗺 𝘁𝗵𝗲 𝘀𝘁𝗮𝗿𝘁 because we design our formularies to balance access and cost upfront. • 𝗪𝗵𝗲𝗻 𝗮 𝗣𝗔 𝗶𝘀 𝗻𝗲𝗲𝗱𝗲𝗱, 𝘄𝗲 𝗮𝗰𝘁 𝗳𝗮𝘀𝘁—while many PBMs leave providers waiting days, we prioritize quick and efficient approvals. • Our 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗖𝗮𝗿𝗲 𝗔𝗱𝘃𝗼𝗰𝗮𝘁𝗲𝘀 (𝗣𝗖𝗔𝘀) 𝗽𝗹𝗮𝘆 𝗮 𝗽𝗶𝘃𝗼𝘁𝗮𝗹 𝗿𝗼𝗹𝗲 in reducing PA burdens. 40% of PCA interactions are PA-related, ensuring members and providers get the support they need without unnecessary delays. • 𝗪𝗲 𝗺𝗮𝗸𝗲 𝗻𝗼 𝗽𝗿𝗼𝗳𝗶𝘁 𝗳𝗿𝗼𝗺 𝗣𝗔𝘀. Unlike traditional PBMs that charge per-PA fees—creating an incentive to require excessive authorizations just to drive revenue—we have zero financial stake in PA volume. That means we only apply PA when it’s clinically necessary, not as a money-making scheme. 𝗥𝗲𝗮𝗹 𝗣𝗔 𝗿𝗲𝗳𝗼𝗿𝗺 𝗶𝘀𝗻’𝘁 𝗮𝗯𝗼𝘂𝘁 𝗽𝗿𝗲𝘀𝘀 𝗿𝗲𝗹𝗲𝗮𝘀𝗲𝘀—𝗶𝘁’𝘀 𝗮𝗯𝗼𝘂𝘁 𝗿𝗲𝗺𝗼𝘃𝗶𝗻𝗴 𝘂𝗻𝗻𝗲𝗰𝗲𝘀𝘀𝗮𝗿𝘆 𝗯𝗮𝗿𝗿𝗶𝗲𝗿𝘀 𝗯𝗲𝗳𝗼𝗿𝗲 𝘁𝗵𝗲𝘆 𝗯𝗲𝗰𝗼𝗺𝗲 𝗽𝗿𝗼𝗯𝗹𝗲𝗺𝘀. #PBM #PriorAuthorization #Transparency #HealthcareReform

A "New Breed" of PBMs Are Hijacking 340B—And Gaslighting Hospitals While They Do It   PBMs have turned gaming the system into an art form—this time, by hijacking 340B drug discounts meant for hospitals and redirecting them into the pockets of commercial employers.   Here’s the scam: PBMs steer patients toward 340B pharmacies regardless of need, extract the savings, and leave safety-net hospitals bleeding dry. Then, when hospitals struggle, PBMs and drug manufacturers shift the blame onto the very program they’ve exploited. Classic misdirection. They profit, hospitals suffer, and patients pay the price.   At AffirmedRx, we don’t play these games. We believe in transparency, integrity, and making sure federal programs like 340B actually help the hospitals and patients they were designed for.   340B isn’t broken—PBMs are breaking it. Time to call it what it is and hold them accountable. https://lnkd.in/e-f5veZG   #PBMReform #340B #Accountability #StopTheScam

𝗔𝗻𝗼𝘁𝗵𝗲𝗿 𝗱𝗮𝘆, 𝗮𝗻𝗼𝘁𝗵𝗲𝗿 𝗹𝗮𝘄𝘀𝘂𝗶𝘁—this time, JPMorgan employees are suing, claiming they overpaid for prescriptions under a CVS-managed plan. 𝗦𝗼𝘂𝗻𝗱 𝗳𝗮𝗺𝗶𝗹𝗶𝗮𝗿? 𝗜𝘁 𝘀𝗵𝗼𝘂𝗹𝗱. This is what happens when employers stick with PBMs that put profits over people. How confident are you that your company isn’t overpaying too? The Big 3 PBMs make 𝗯𝗶𝗹𝗹𝗶𝗼𝗻𝘀 by keeping drug pricing complicated and employers in the dark. And year after year, businesses foot the bill. 𝗘𝗻𝗼𝘂𝗴𝗵 𝗶𝘀 𝗲𝗻𝗼𝘂𝗴𝗵. At AffirmedRx, we do things differently. No hidden fees. No games. Just real transparency. 𝗜𝗳 𝘆𝗼𝘂𝗿 𝗣𝗕𝗠 𝗶𝘀𝗻’𝘁 𝘄𝗼𝗿𝗸𝗶𝗻𝗴 𝗳𝗼𝗿 𝘆𝗼𝘂, 𝗶𝘁’𝘀 𝘄𝗼𝗿𝗸𝗶𝗻𝗴 𝗮𝗴𝗮𝗶𝗻𝘀𝘁 𝘆𝗼𝘂. https://lnkd.in/eKTisbNi

At AffirmedRx, we know that meaningful change in the benefits industry starts with open, honest conversations. This week at the Employer Benefits Accelerator Roundtable, we’re joining industry leaders to discuss the biggest challenges facing employers and the solutions that can drive real impact. One of the most pressing issues? The lack of transparency in pharmacy benefits. For too long, PBMs have operated behind closed doors, making it nearly impossible for employers to understand where their dollars are going. At AffirmedRx, we’re changing that. We’re advocating for a system where transparency isn’t just a talking point—it’s the foundation of how we do business. These discussions matter because they push the industry forward. Employers deserve better visibility into their benefits, employees deserve access to affordable care, and PBMs should be held accountable for the role they play in healthcare. We’re here to be part of that change. World 50 Accelerator

PBMs have had a stranglehold on drug pricing for too long—operating in the shadows, prioritizing profit, and leaving patients to suffer the consequences. But their grip is slipping. 𝗖𝗵𝗮𝗻𝗴𝗲 𝗶𝘀𝗻’𝘁 𝗷𝘂𝘀𝘁 𝗰𝗼𝗺𝗶𝗻𝗴—𝗶𝘁’𝘀 𝗮𝗹𝗿𝗲𝗮𝗱𝘆 𝗵𝗲𝗿𝗲. Yesterday’s House Committee on Energy and Commerce hearing made that crystal clear. Chairman Buddy Carter didn’t hold back, exposing the brutal reality of PBM abuse. He shared the devastating story of 𝗠𝗮𝘁𝘁𝗶𝗲 𝗠𝗰𝗖𝗼𝘆, 𝗮 16-𝘆𝗲𝗮𝗿-𝗼𝗹𝗱 𝗴𝗶𝗿𝗹 𝗱𝗲𝗻𝗶𝗲𝗱 𝗹𝗶𝗳𝗲-𝘀𝗮𝘃𝗶𝗻𝗴 𝗺𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗯𝘆 𝗖𝗩𝗦 𝗖𝗮𝗿𝗲𝗺𝗮𝗿𝗸, landing her in the hospital. This isn’t some abstract policy debate—𝘁𝗵𝗲𝘀𝗲 𝗮𝗿𝗲 𝗿𝗲𝗮𝗹 𝗹𝗶𝘃𝗲𝘀 𝗼𝗻 𝘁𝗵𝗲 𝗹𝗶𝗻𝗲. 𝗔𝗻𝗱 𝗳𝗼𝗿 𝗼𝗻𝗰𝗲, 𝗹𝗮𝘄𝗺𝗮𝗸𝗲𝗿𝘀 𝗮𝗿𝗲 𝗽𝗮𝘆𝗶𝗻𝗴 𝗮𝘁𝘁𝗲𝗻𝘁𝗶𝗼𝗻. Shawn Gremminger pulled back the curtain on how 𝘀𝗲𝗹𝗳-𝗳𝘂𝗻𝗱𝗲𝗱 𝗲𝗺𝗽𝗹𝗼𝘆𝗲𝗿𝘀 𝗮𝗿𝗲 𝗯𝗲𝗶𝗻𝗴 𝗲𝘅𝗽𝗹𝗼𝗶𝘁𝗲𝗱, forced to fork over billions to PBMs while trapped in a rigged system. The so-called "competition" among PBMs? A total illusion. The reality? PBMs have gamed the system to keep employers, patients, and even regulators in the dark. This isn’t just another round of empty talk. 𝗧𝗵𝗶𝘀 𝗶𝘀 𝘁𝗵𝗲 𝘀𝘁𝗮𝗿𝘁 𝗼𝗳 𝗮 𝗿𝗲𝗰𝗸𝗼𝗻𝗶𝗻𝗴. Bipartisan momentum is building. Investigations are deepening. 𝗧𝗵𝗲 𝘂𝗻𝗰𝗵𝗲𝗰𝗸𝗲𝗱 𝗲𝗿𝗮 𝗼𝗳 𝗣𝗕𝗠 𝗱𝗼𝗺𝗶𝗻𝗮𝗻𝗰𝗲 𝗶𝘀 𝗿𝘂𝗻𝗻𝗶𝗻𝗴 𝗼𝘂𝘁 𝗼𝗳 𝘁𝗶𝗺𝗲. 𝗧𝗵𝗲 𝗰𝗹𝗼𝗰𝗸 𝗶𝘀 𝘁𝗶𝗰𝗸𝗶𝗻𝗴. The power shift has begun. 𝗧𝗵𝗲 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻 𝗶𝘀—𝗮𝗿𝗲 𝘆𝗼𝘂 𝗿𝗲𝗮𝗱𝘆 𝗳𝗼𝗿 𝘄𝗵𝗮𝘁 𝗰𝗼𝗺𝗲𝘀 𝗻𝗲𝘅𝘁? 𝗔𝗳𝗳𝗶𝗿𝗺𝗲𝗱𝗥𝘅 𝗶𝘀. Let’s talk about how we’re leading the charge into a new era of pharmacy benefits.

PBMs are driving up drug costs—and even President Donald Trump called them "middlemen" that need to be knocked out. Pharmacy Benefit Managers (PBMs) were originally designed to improve access to affordable prescription medications by negotiating prices and managing formularies. Today, "PBMs have my best interests in mind" can't be said with confidence. The solution? A shift to a pass-through pricing model—one that prioritizes transparency and simplicity. Under this model, employers and insurers pay the actual cost of medications plus a clearly defined administrative fee, eliminating hidden markups and ensuring savings are passed directly to those who need them. At AffirmedRx, we're standing up for patients and employers by restoring trust and leading with a model that delivers real value. Read more: https://lnkd.in/e7yqRT94 #affirmedRx #passthroughpricing

“We all as Americans deserve medications that are doctors and us have decided is in our best interest. People’s lives, their healthcare, their wellbeing doesn’t have a price tag on it.” Patients face numerous hurdles created by traditional PBM’s. These include high and unexpected out-of-pocket costs, confusion over coverage, delayed access to vital medications, and limited choices which could include the most expensive kinds. AffirmedRx, a Public Benefit Corporation puts patients over profits, always. They are fighting for PBM reform that will include increased transparency and regulation over prices. Plus, their Patient Care Advocates empower patients and organizations to give them the confidence in navigating this confusing system.   https://lnkd.in/eaC2icsv #PBGH #PBGHPA #PeopleYouTrust #PBM #Transparency #Partner  

Pharmacy benefits are more complex than ever—but they don't have to be. Healthcare costs continue to rise and patients face increasing complexity when it comes to accessing and affording their medications. Prescription costs, confusing coverage details and lengthy approval processes leave many feeling lost in a system that should be supporting them. 🔍 AffirmedRx's response? A patient-centered approach to pharmacy benefit management that prioritizes transparency, advocacy and empowerment. Patient Care Advocates (PCAs): ✔️ Proactively address medication access issues ✔️ Simplify complex coverage details ✔️ Empower patients with clear, actionable solutions By removing barriers and providing real-time support, PCAs ensure that patients get the care they need when they need it without frustration. This isn't just about lowering costs—it's about putting patients first and creating a system that works for them, not against them. Read more: https://lnkd.in/eJ3MxBKm #affirmedRx #PBMReform

There's a dark side to traditional PBMs, and it's not just money at stake: https://lnkd.in/epReUPB7 PBM reform matters because patients and employers need a solution that delivers clarity, transparency, cost control, and the education and support necessary to make informed healthcare decisions that, at their root, put the patient first. Together, we can push against the challenges stemming from greed and a lack of transparency. Read more: https://lnkd.in/eaC2icsv #AffirmedRx #PBMReform

Traditional PBM models leave patients feeling confused and so overwhelmed. Enter AffirmedRx, a Public Benefit Corporation and their Patient Care Advocates (PCAs)!  PCA’s are dedicated to empowering patients by making sure they understand their pharmacy benefit plans, as well as ensuring the proper medication is being provided without any hassle. Read more about this new era of pharmacy benefits management at https://lnkd.in/eJ3MxBKm Interested in adding AffirmedRx to your organization? Contact Maurice Notkin at maurice.notkin@pbghpa.org.  #PBGH #PBGHPA #PeopleYouTrust #Partners #PBM #Transparency #PCA