Civica Rx’s Post

Teachable Tuesday! Welcome to our monthly informational series where we address pharmacy-specific queries. If you have a question, drop it in the comments, and it might be featured in an upcoming Teachable Tuesday! For this month's #TeachableTuesday, we’re addressing common misconceptions about Pharmacy Benefit Managers (PBMs). A common misconception is that all PBMs are the same. In reality, there’s a wide range of PBMs, from large, traditional ones to boutique PBMs like PCA Rx. Each offers different services and approaches to patient care. At PCA Rx, we prioritize personalized care and work closely with healthcare providers to ensure optimal patient outcomes. Another common misconception about PBMs is that they only exist to increase drug prices. In reality, PBMs, like PCA Rx, play a crucial role in managing prescription drug benefits and work to negotiate lower prices with drug manufacturers. We aim to make medications more affordable for patients by securing rebates and discounts, managing formularies, and promoting the use of cost-effective generic drugs. While there are certainly areas for improvement within the industry, PCA Rx strives to control healthcare costs and ensure patients have access to the medications they need. Another common misconception about PBMs is that they only benefit insurance companies and not the patients. In fact, PCA Rx is designed to serve the interests of patients by negotiating better prices for medications and managing drug benefits efficiently. We strive to keep out-of-pocket costs lower for patients, provide access to a wide range of medications, and implement programs to improve medication adherence and overall health outcomes. PCA Rx plays a role in balancing cost, access, and quality in the healthcare system. Thank you for joining us for this month's #TeachableTuesday! We hope this session has helped clear up some common misconceptions about Pharmacy Benefit Managers (PBMs) and highlighted how PCA Rx is dedicated to improving patient care. Remember, our goal is to provide personalized, affordable, and accessible medication solutions. If you have any more questions or topics you’d like us to cover, drop them in the comments below. Stay tuned for our next #TeachableTuesday! #PBMfacts #HealthcareInsights #PCAeducation #PharmacyBenefitManagers #AffordableHealthcare #HealthcareMyths #PCARx #TeachableTuesday

I've been saying this for years: 1/4 of the equation is pharmacy, while 3/4 is medical claims. Don’t get me wrong—both need thorough evaluation and reviews, but let’s not ignore the biggest elephant in the room! Total U.S. hospital spending in 2017 reached $1.1 trillion, compared with $333 billion for prescription drugs, according to a new study by the Centers for Medicare and Medicaid Services (CMS). For the year ending December 31, 2017, hospital costs rose 4.6%, compared with a 0.4% rise in drug costs, again according to CMS. For the previous year, hospital costs rose 5.6%, or more than two-and-a-half times the rate of inflation. Drug costs in 2016 rose 2.3%. Hospital spending increases are outstripping drug increases again in 2018. Overall, hospitals represent 33% of U.S. health care costs; physician and clinical spending, 20%; and drugs, 10%. “One of the great mysteries in recent years is why pharmaceutical companies are portrayed as the villains in the story of rising U.S. health care costs while hospitals are virtually ignored.” INDEPENDENT BILL REVIEW Free from private equity and investors— us-beacon.com #healthcare #pricetransparency #billreview #fraudwasteabuse #usbeacon https://lnkd.in/gJc73KhC

NEW in Forbes: PBMs prioritize profits over patients. Action is needed NOW. The Forum supports efforts to reform PBMs, support free market competition and make lower-cost biosimilars accessible to patients. "...the Biosimilars Forum, supports Senators Wyden and Crapo in urging Congress to pass comprehensive PBM reform. Their executive director, Juliana Reed, stated on March 14 that “PBMs stifle free market competition...PBMs block patients from having access to lower-cost biosimilars. There is no better example than biosimilars for Humira.” #biosimilars #drugpricing #pbms #patients #providers https://lnkd.in/g6du9fEs

NBPP Rule: A Disappointing Mixed Bag on Accumulators and Maximizers Yesterday, CMS issued its final Notice of Benefits and Payment Parameters rule for 2025. It’s decidedly a mixed bag for patient access. CMS fails (again) to require insurers to recognize payments made by patients with the assistance of drug makers in calculating out-of-pocket maximums. But the agency does take a step towards putting an end to the practice of treating drugs needed by patients as “non-essential” benefits. The Good News First: The final rule prohibits individual and small group plans from classifying drugs as “non-essential” when not included in the state benchmark plan. Insurers had been increasingly employing this practice, using it as a means to dramatically increase co-insurance obligations—as high as 75% or more. These excessive co-insurance obligations permitted the insurers and their PBMs to swoop in with maximizer programs. Those programs “capture” the full value of manufacturer assistance without giving any credit towards the patient’s out-of-pocket maximum. Unsuspecting patients, thinking that their massive drug co-insurance payments had satisfied their annual deductibles find out that is not so when they go to access other health care services. As a consequence, many patients are forced to forego medically necessary treatment. CMS says that the Departments of Labor, Treasury, and HHS will issue another rule addressing this “non-essential” benefit problem in large group and self-funded plans. Accordingly, the good news is, for now, only partial good news. The Bad News: Although the agency moved against “jacked up” co-insurance percentages, CMS utterly fails to prohibit insurers from targeting patients with debilitating and disabling conditions by refusing to include payments made by these patients, with drug maker assistance, in out-of-pocket maximums. The most CMS has to say on this critical threat to access is that “[w]e will consider copay maximizer programs, as relevant, in any subsequent policy making about drug manufacturer assistance programs.” No commitment on timing. Or content. Hardly reassuring. The backdrop, here, of course is HHS’ stated refusal to enforce its prior regulation—that CURRENTLY requires insurers to recognize ANY payment a patient makes with drug maker assistance, so long as the drug at issue does not have a generic equivalent. So, as we wait for a new rule, patients continue to be harmed—every day—by both accumulators and maximizers. Apparently, appeasing insurers is more important than protecting patients. At this point, with the next NBPP to be issued likely not taking effect before 2026, it looks like the only option to move the needle now are patient lawsuits against their insurers. So. Very. Disappointing. #accumulators #maximizers #cms #hhs #insurancediscrimination #healthequity #copays #medicaldebt #patientsfirst #access #aca #insurers #pbms

Q&A: GoodRx on partnerships for reducing drug prices - MobiHealthNews #Q&A: GoodRx Partnerships In a recent interview with MobiHealthNews, GoodRx discusses their partnerships aimed at reducing drug prices. Here are some key takeaways: #Collaboration with Healthcare Providers GoodRx partners with healthcare providers to help patients access affordable medications. By integrating their platform into electronic health records, they make it easier for providers to prescribe cost-effective drugs. #Pharmacy Partnerships GoodRx collaborates with pharmacies to offer discounts on prescription medications. Through these partnerships, they help patients save money on their prescriptions and improve medication adherence. #Telehealth Integration GoodRx has integrated telehealth services into their platform, allowing patients to consult with healthcare providers remotely. This helps patients access care and medications without leaving their ai.mediformatica.com #goodrx #about #consumers #prescription #telehealth #acce #partnership #platform #this #prescriptiondrug #provider #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/4d5gcJV)

"The Burden of Prescription Costs: A Reality Many Face 📈💊 Prescription drug costs have long been a significant concern for many Americans. According to a recent article by Kaiser Family Foundation: -- Over 1 in 4 adults have reported not taking prescribed medicines due to their high costs. --The average annual out-of-pocket spending on prescription drugs for Medicare beneficiaries is a staggering $645. --The U.S. has higher prescription drug prices than many other countries, making it challenging for many to afford their medications. These statistics highlight the immense burden that prescription costs can place on individuals, especially those on fixed incomes or with chronic conditions. But there's hope for our Teammates and Candidates! 🌟 At Onin Staffing, we recognize the challenges you face. That's why our insurance plans offer $5 prescription copays, aiming to make essential medications more affordable. We believe that no one should have to choose between their health and other necessities. Explore the benefits of partnering with Onin Staffing. Because with us, you're not just a number; you're part of the Onin family. "

“White bagging” a term to describe Insurers requiring specialty pharmacies delivering medications instead of having the physician provide and administer the drug in the process shifting the cost from a medical benefit to a prescription benefit and diverting the profits to PBM pharmacies which they own or have a business relationship with. This leads to increased profits for them with increased costs for patients and decreased reimbursements for Physicians and medical practices already operating on tight margins. Proper oversight and reform is needed with Insurance companies to make sure they do right by vulnerable patients and physicians as the decisions and practices they follow are life changing for a lot of people.

Adopting a patient-focused strategy for navigating step therapy in today's healthcare climate can lead to promoting optimal treatments and better outcomes. By working collaboratively with patients, providers, pharmaceutical companies and policy makers, we can mold step therapy into a vital resource for achieving accessible, fair, and high-quality healthcare for everyone. https://hubs.li/Q02qstkl0

Biosimilars are cost-effective treatment alternatives, however limited coverage from Medicare and insurance providers can still impede patient access. Currently, only half of Medicare Part D plans cover adalimumab biosimilars. This has the potential to limit patient access to treatment and decrease investments into new research. #biosimilar #medicare #healthcare #HealthcareAccess

#AI technology is helping pharmacies navigate the shift to value-based care by streamlining processes and improving medication access. With AI, pharmacies can better manage reimbursements, monitor adverse drug reactions, and even enhance prescription accuracy. This integration bridges financial and clinical care, ensuring that patient outcomes remain the priority. Pharmacies adopting AI are not only boosting efficiency, but reducing costs and improving quality of care. #VBC #ValueBasedCare #Pharmacy #Healthcare