Eric Bricker, MD’s Post

Eric Bricker, MD

Chief Medical Officer AHealthcareZ

2mo Edited

What's So Special about #SpecialtyPharmacy? Learn How the Big 3 Specialty #Pharmacies Owned by the Big 3 #PBMs Should Really by Called '#Monopoly Pharmacies.' Specialty Pharmacies dispense prescription medications that require 'high touch' 1) #distribution, 2) #administration and 3) patient #management. Specialty Pharmacies began in the 1970s and even in the 1990s were very #small with there being only about 30 different specialty medications. Specialty Pharmacies make up only 3% of total pharmacies and are #accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC). The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much #bigger because the PBMs will only pay for specialty medications if they are #filled at their own specialty pharmacy--limiting #competition. The #SupremeCourt gave states the right to regulate PBMs in 2020 and Oklahoma passed a law #forbidding PBMs from only using their own specialty pharmacies. However, the PBMs #sued Oklahoma and won in an Appeals Court. Subsequently, 32 states have asked the Supreme Court to #overrule the Appeals Court. The Supreme Court has yet to respond. **Update… Elevance Health subsidiary Carelon acquired Kroger Specialty Pharmacy on 10/4/24. Sources at AHealthcareZ YouTube Channel.

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Transcript

Hello, this is Doctor Eric Bricker and thank you for watching a healthcare. See, today's topic is what's so special about specialty pharmacy. So we're going to explain specialty pharmacy today. What in the world is a specialty medication? It is a medication that requires quote UN quote high touch distribution. Administration, distribution, meaning like how it gets from the pharmaceutical manufacturer out to the actual pharmacy itself. Administration, in other words, the patient, typically it's like a shot, the patient giving it to themselves and then finally management. So this is where there's like HIV medications that are pills where they're not necessarily complicated to to distribute or administer because they're pills, but the management of HIV medications is complicated and you've got to do like. Genetic testing on the virus itself to figure out which drugs work on the virus and individual people. So it's complicated, OK? There is not a sort of quote UN quote official definition. Like there's no like grand high arbiter that says, hey, this is what a specialty medication is. So this is just like the general definition, OK? But there's nothing, quote UN quote, official about it. OK. What's the history of specialty pharmacy? OK, Get ready for the most boring topic humanly possible, the history of specialty. Pharmacy in America, OK, this started in the 1970s just when you started having these medications for like these orphan diseases like hemophilia, right? So very few people have hemophilia. It's a bleeding disorder and very few people have it, OK. So but but these medications were like super complicated to treat these very few diseases, OK? Even in the 1990s, there was only 30 different medications that quote UN quote, were specialty pharmacy. So it was rather small. All right, So what why in the world did these pharmacies sort of pop up? Well, the way that these quote UN quote specialty medications used to be dealt with, they were hugely expensive. The patient had to pay out of pocket for it and then they had to fill out a whole bunch of paperwork to then be reimbursed by the insurance company or by Medicare. And so the specialty pharmacies were like, OK, well, as one of our sort of quote UN quote value add services will like. Hope you fill out your paperwork so that you can get paid back by the insurance company. Also, because these medications were for very rare diseases, if you went to like your typical like random pharmacy, like they wouldn't have it in stock. Do you have any hemophilia medication that costs $100,000? And they'd be like, Nope, OK, so they would have it in stock. And then finally, a lot of these medications they had to have home delivery because maybe they needed to be refrigerated or it was sort of a very particular situation, like they had to be like on ice or dry ice or what? Have you right, So the delivery was very unique. So there are these these pharmacies popped up to facilitate this sort of quote UN quote special nature of these medications. Again, a lot of them were injections. OK, Now there actually is accreditation for specialty pharmacies and in fact only 3% of all pharmacies are actually accredited as specialty pharmacies and there's two accrediting bodies. There's the accreditation Commission. For health care, they accredit a whole bunch of other stuff as well. It's a private organization. And then there's Yurak. I'm sure many of you are familiar with your act because it is the Utilization Review Accreditation Commission, so that both of these organizations accredit a whole bunch of different things in healthcare. And OHH, by the way, they just happen to accredit specialty pharmacies as well. Alright, now let's look at the specific specialty pharmacies in America. Obviously, there's the three big ones that you're familiar with, CVS Specialty Pharmacy. Is part of the CVS PBM. So believe it or not, the largest specialty pharmacy in America by far. Is part of the largest PBM in America by far, and they make about 73 billion a year in revenue. Just as part of CVS specialty pharmacy, the dispensing of specialty medications. The next largest is Accredo. What in the world is a credo? Nobody on the planet has ever heard of a credo before. What's that? It's the specialty pharmacy pharmacy for Express Scripts. Which is now called ever N, which is part of Cigna, right? All these names are super confusing. They keep changing. Anyway, a credo is the Express Scripts specialty pharmacy. It is the second largest. They make 60 billion a year in specialty pharmacy revenue. Again, dispensing specialty medications like Humira, OK. The next one is Optum Specialty, which of course is part of Optum RX, the third largest PBM in America. OK, they have 32 billion. In revenue, just as part of the Optum specialty pharmacy, OK, those are the top three. And then look what happens when you get to #4 guess what? Walgreens, large pharmacy chain in America, they've got a specialty pharmacy as well. Look at their revenue, only 8 billion. And then there's other major corporations in America, major pharmacies in America that also have specialty pharmacies. Walmart and Kroger, the grocery store chain also have pharmacies and they have specialty pharmacies. Guess what? Walmart and Kroger specialty pharmacies, they only make about 3 billion a year each in revenue. What? How in the world it's like 73 billion versus 3 billion. 73 billion is 24 times more. The CVS specialty pharmacy is 24 times larger than the Walmart specialty pharmacy. Why is that? How could Walmart ever let this happen? Walmart must be totally incompetent. No, of course not. That's not the reason. The reason why the PBMS own the specialty pharmacies that by far are the largest specialty pharmacies is because the PBM requires the use of their own specialty pharmacy to fill a specialty medication. That's right. If it's like an HIV medication or it's a medication for rheumatoid arthritis or Crohn's disease, etcetera, then and if you have. A health insurance plan through your job that happens to you CVS Caremark as the PBN and you need to take a specialty medication. The only way that your insurance will pay for your specialty medication is if it is filled by the CVS specialty itself. Same thing is true for Accredo and Express Script. Same thing is true for Optum Specialty. Hmm, that sounds like a lack of choice. So anytime we have a lack of choice then? We know that things are going to get expensive and the service is not going to be very good because without competition, what in the world incentivizes them to provide good prices and good service? OK, so believe it or not, this has made it to the courts. So the, the, the legal status of this whole relationship between the PBM's and the specialty pharmacies that they operate, believe it or not, it was first challenged back in 2020 when all the way up. The Supreme Court and the Supreme Court said, look, the states can actually regulate PBMS themselves if they want. OK, So Oklahoma and other states, but Oklahoma was the most aggressive about it. Oklahoma passed a law that says PBM's can no longer require employers and their employees to have to fill their specialty prescriptions at a specialty pharmacy that the PBN owns. They can go to a different specialty pharmacy. They could go to the Walmart or the Kroger. Specialty pharmacy OK Guess what happened? The Pharmaceutical Care Management Association, the PCM A sued the state of Oklahoma. What is the PCM A? It's the trade association for. PBM's. OK, So that's like a euphemism, OK. Like there's three. OK, So the PC MA is a trade association. It's a lobbying group for CVS. Express Scripts, Cigna and Optum United. So keep it so it's not there's there's no association, it's just it's just a lobbying organization for three companies. It's a lobbying organization for for CVS, Aetna, for Cigna and for United. That's all it is. OK. And guess what? The PCA, they won their suit against the state of Oklahoma. They said look, the states cannot. Regulate PBMS because it's an objection to Arissa and I won't get into ERISA. That's another video for another day. But the 10th Circuit effectively blocked the Oklahoma. And so since then, 32 different States Attorney generals from both Republicans and Democrats have since petitioned the Supreme Court. The state of Oklahoma has petitioned the Supreme Court and said Supreme Court. Will you please look at what the 10th Circuit did? And could you override or overrule what the 10th Circuit said so that this Oklahoma law and other state laws can actually go forward? And guess what? Crickets. We haven't heard anything yet. So as of August 2024, we don't know what's gonna happen with the Supreme Court. So as of now, what the 10th Circuit said stands. The Oklahoma law was struck down and Oklahoma cannot regulate. EBMS, but who knows, we'll see if the Supreme Court takes this up and what they have to say about it. So that's what's so special about specialty pharmacy and that's what I wanted to share with you today. Thank you for watching a Healthcare Z.

Billy Lambrinides

Billy Lambrinides

Pharmacy Manager at CVS Health, Pink Chair Project, RVA

2mo

Question. I have come across situations where a pharmacist has contacted physician’s offices to transfer the patients “specialty” meds to their pharmacy (as they have the ability to fill the med and provide “medication management” at a competitive cost -if not better-to the patient) only to be ignored or stalled.. in short, are the main providers (the physician or manged care outfit) also a part of the equation… a recipient of some sort of back end reimbursement?

Steven T. Brown, Jr

Steven T. Brown, Jr

Business Operations & Transformation Leader | Orchestrating High Performing Organizations | Strategy, Delivery, Profitability, Client Success

2mo

Specialty Pharmacy aids in the distribution, administration and management for drugs to treat rare, complex and high-cost illnesses. In the old days patients had to find a treatment (if it existed), pay out of pocket and then seek reimbursement from the insurance company on their own. Has resulted in a massive improvement in both accessibility and personalization for the patient, but unfortunately there are some wrinkles to sort out around affordability as we see these PBM's trending towards a monopoly. Surely an interesting case to watch if the SCOTUS takes on the 10th circuit ruling against case brought by state of OK.

Daniel Plocker, MBA, DPT

Daniel Plocker, MBA, DPT

Agency Relationship Manager with Medica Health Plans. MBA recipient from the University of St. Thomas. Licensed Physical Therapist.

2mo

Great post. Have you done any videos on the pros and cons of specialty carve out arrangements?

Tina Patel Gunaldo, PhD, DPT, MHS

Tina Patel Gunaldo, PhD, DPT, MHS

Building interprofessional teams with ease | Bridging science to practice | Team development strategies | Patient Advocate | Let's build high performing teams together!

2mo

Eric Bricker, MD - well I hope the Supreme Court responds soon. There is a monopoly in healthcare and it extends past pharmacy. There is a difference in wanting to support a patient throughout their journey by creating these massive health systems and learning how to support a patient throughout their health journey by collaboration and caring. All of my health team have been selected by me and do not work for the same system or practice.

Director - Blue River Financial Group

2mo

Why isn’t the fulfillment requirement a violation of the anti-kickback statute or Stark?

Controlling your health insurance costs shouldn’t be so difficult. You deserve a benefits program that supports your growing business.

2mo

Your video worked! SCOTUS announced it will hear the case. https://www.benefitspro.com/2024/10/11/supreme-court-takes-up-pbm-case-does-erisa-preempt-states-efforts-to-regulate-drug-prices/

Patrick Desamours, PA-C, MBA, SFHM, CHCQM

Patrick Desamours, PA-C, MBA, SFHM, CHCQM

Entrepreneur | Hospitalist PA | Healthcare Leader | Multifamily Real Estate Investor | Public Speaker | Mindset Coach

2mo

There’s nothing special other than profit. Eric Bricker, MD

Strategic Business Growth Leader. Executive Leadership, Business Development, Marketing, Strategy & Operations (Domestic & International, B2B & B2C)

2mo

Love it! Great info delivered with animation and gusto! Great job! Thank you. 🙂

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John Edwards

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2mo Edited
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Below you will find a great synopsis of Specialty Pharmacies... Dr Bricker regularly covers topics in healthcare and I highly recommend following him to increase your knowledge of the healthcare ecosystem. In my experience working with multiple Specialty Pharamacies, they have grown quickly outpacing the growth of other Provider areas by far. with this rapid growth they have significant room for process improvement and operational efficiencies. With the critical role they plan in access to life changing medications, the people side of the process needs to be considered and addressed for providers, patients and payers. Changing regulations around prior authorizations will drive further need in this sector. If you would like to explore how Citius Healthcare Consulting can help you improve your operations activities through interoperability, automation, RPA and AI please drop me a note and Let's explore together. #citiushealthcare #specialtypharmacy #ai #operationsefficiency

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What's So Special about #SpecialtyPharmacy? Learn How the Big 3 Specialty #Pharmacies Owned by the Big 3 #PBMs Should Really by Called '#Monopoly Pharmacies.' Specialty Pharmacies dispense prescription medications that require 'high touch' 1) #distribution, 2) #administration and 3) patient #management. Specialty Pharmacies began in the 1970s and even in the 1990s were very #small with there being only about 30 different specialty medications. Specialty Pharmacies make up only 3% of total pharmacies and are #accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC). The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much #bigger because the PBMs will only pay for specialty medications if they are #filled at their own specialty pharmacy--limiting #competition. The #SupremeCourt gave states the right to regulate PBMs in 2020 and Oklahoma passed a law #forbidding PBMs from only using their own specialty pharmacies. However, the PBMs #sued Oklahoma and won in an Appeals Court. Subsequently, 32 states have asked the Supreme Court to #overrule the Appeals Court. The Supreme Court has yet to respond. **Update… Elevance Health subsidiary Carelon acquired Kroger Specialty Pharmacy on 10/4/24. Sources at AHealthcareZ YouTube Channel.

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Douglas Dew, MD, MBA, FAAOS

CEO Automated Clinical Guidelines, LLC
1mo
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The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much #bigger because the PBMs will only pay for specialty medications if they are #filled at their own specialty pharmacy--limiting #competition.

Eric Bricker, MD

Chief Medical Officer AHealthcareZ
2mo Edited

What's So Special about #SpecialtyPharmacy? Learn How the Big 3 Specialty #Pharmacies Owned by the Big 3 #PBMs Should Really by Called '#Monopoly Pharmacies.' Specialty Pharmacies dispense prescription medications that require 'high touch' 1) #distribution, 2) #administration and 3) patient #management. Specialty Pharmacies began in the 1970s and even in the 1990s were very #small with there being only about 30 different specialty medications. Specialty Pharmacies make up only 3% of total pharmacies and are #accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC). The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much #bigger because the PBMs will only pay for specialty medications if they are #filled at their own specialty pharmacy--limiting #competition. The #SupremeCourt gave states the right to regulate PBMs in 2020 and Oklahoma passed a law #forbidding PBMs from only using their own specialty pharmacies. However, the PBMs #sued Oklahoma and won in an Appeals Court. Subsequently, 32 states have asked the Supreme Court to #overrule the Appeals Court. The Supreme Court has yet to respond. **Update… Elevance Health subsidiary Carelon acquired Kroger Specialty Pharmacy on 10/4/24. Sources at AHealthcareZ YouTube Channel.

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Holland Haynie, MD

Chief Medical Officer at Central Ozarks Medical Center
2mo
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Specialty pharmacies provide essential medications for chronic and complex conditions, but the way the largest PBMs control access to these medications raises significant concerns. For patients in rural areas, being forced to use a PBM-owned specialty pharmacy limits access to timely and personalized care. We already face barriers like transportation, limited local pharmacy options, and challenges with medication management. When PBMs restrict specialty medications to their own pharmacies, it creates yet another hurdle for patients who rely on high-touch care. This system leaves out smaller, independent specialty pharmacies that often provide more tailored services and could offer a lifeline to rural patients who need a more localized and accessible option. The fact that PBMs are suing states like Oklahoma, which have tried to pass legislation to break up this monopoly, shows just how much power these corporations wield. It’s troubling that profit motives are dictating patient care. Instead of focusing on improving outcomes and expanding access, these monopolies further complicate the lives of people who already struggle to navigate our fragmented healthcare system. For rural providers like myself, this dynamic forces us into difficult positions. We want to do what’s best for our patients, but the lack of competition means higher costs, longer delays, and less flexibility in treatment plans. I support efforts to regulate PBMs and ensure that patients—regardless of where they live—can access the medications they need without being boxed into a corporate system that prioritizes revenue over well-being. Let’s hope the Supreme Court steps in and affirms the rights of states to protect their patients from this monopolistic control.

Eric Bricker, MD

Chief Medical Officer AHealthcareZ
2mo Edited

What's So Special about #SpecialtyPharmacy? Learn How the Big 3 Specialty #Pharmacies Owned by the Big 3 #PBMs Should Really by Called '#Monopoly Pharmacies.' Specialty Pharmacies dispense prescription medications that require 'high touch' 1) #distribution, 2) #administration and 3) patient #management. Specialty Pharmacies began in the 1970s and even in the 1990s were very #small with there being only about 30 different specialty medications. Specialty Pharmacies make up only 3% of total pharmacies and are #accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC). The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much #bigger because the PBMs will only pay for specialty medications if they are #filled at their own specialty pharmacy--limiting #competition. The #SupremeCourt gave states the right to regulate PBMs in 2020 and Oklahoma passed a law #forbidding PBMs from only using their own specialty pharmacies. However, the PBMs #sued Oklahoma and won in an Appeals Court. Subsequently, 32 states have asked the Supreme Court to #overrule the Appeals Court. The Supreme Court has yet to respond. **Update… Elevance Health subsidiary Carelon acquired Kroger Specialty Pharmacy on 10/4/24. Sources at AHealthcareZ YouTube Channel.

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Proper Consulting Group

157 followers
9mo
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🔥 CarelonRx set to acquire Kroger Specialty Pharmacy! 💊 Kroger retaining rest of pharmacy portfolio including in-house and clinics. 📅 Agreement is still subject to regulatory approval later in 2H2024. 🔄 Second major acquisition for CarelonRX, following Bioplus in 2023. Read the full story: https://shorturl.at/doptL #Pharmacy #PharmacyAcquisition #Healthcare #BusinessStrategy

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Eric Bricker, MD

Chief Medical Officer AHealthcareZ
4mo
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What's So Special About #SpecialtyPharmacy?? Specialty Pharmacy Explained. Specialty Pharmacies dispense #prescription medications that require 'high touch' 1) distribution, 2) administration and 3) patient management. Specialty Pharmacies began in the 1970s and even in the 1990s were very #small with there being only about 30 different specialty medications. Specialty Pharmacies make up only 3% of total pharmacies and are accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC). The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much bigger because the PBMs will only #pay for specialty medications if they are filled at their #own specialty pharmacy--limiting #competition. The #SupremeCourt gave states the right to regulate PBMs in 2020 and #Oklahoma passed a law forbidding PBMs from only using their own specialty pharmacies. However, the PBMs #sued Oklahoma and won in an Appeals Court. Subsequently, 32 #states have asked the Supreme Court to #overrule the Appeals Court. The Supreme Court has yet to respond. Sources at AHealthcareZ YouTube Channel.

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Jacqueline Madrigal,CSFS®

Human Resource Benefits Professional | Strategic Planning, Compliance
4mo Edited
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Dr. Bricker, Thank you for discussing this topic. It’s often not talked about when we’re at the negotiation table as an employer with our broker and the PBM provider. Every time I am introduced to a new vendor I always ask the following questions. 1. How are you connected to our broker and our carriers? For example are they part of a collaborative or do they direct contract with the carrier and/or is there an exclusivity clause in the agreement? 2. How are you paid and is our carrier or broker receiving a discount for booking X amount of business with your organization? 3. If I switch brokers or switch carriers, am I able to still do business with your organization directly?

Eric Bricker, MD

Chief Medical Officer AHealthcareZ
4mo

What's So Special About #SpecialtyPharmacy?? Specialty Pharmacy Explained. Specialty Pharmacies dispense #prescription medications that require 'high touch' 1) distribution, 2) administration and 3) patient management. Specialty Pharmacies began in the 1970s and even in the 1990s were very #small with there being only about 30 different specialty medications. Specialty Pharmacies make up only 3% of total pharmacies and are accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC). The largest Specialty Pharmacies are owned by the three largest PBMs: 1) CVS Specialty Pharmacy... $73B in annual revenue 2) Accredo by Evernorth (specialty pharmacy of Express Scripts)... $60B in annual revenue 3) Optum Specialty... $32B in annual revenue 4) Walgreens Specialty Pharmacy... $8B in annual revenue 5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each The PBM-owned specialty pharmacies are so much bigger because the PBMs will only #pay for specialty medications if they are filled at their #own specialty pharmacy--limiting #competition. The #SupremeCourt gave states the right to regulate PBMs in 2020 and #Oklahoma passed a law forbidding PBMs from only using their own specialty pharmacies. However, the PBMs #sued Oklahoma and won in an Appeals Court. Subsequently, 32 #states have asked the Supreme Court to #overrule the Appeals Court. The Supreme Court has yet to respond. Sources at AHealthcareZ YouTube Channel.

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Josh Surber

Employee Benefits Consultant. I help employers save money, save time, and make their employees happy.
9mo
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Kroger Specialty Pharmacy made the announcement earlier this week that it has entered into an agreement to be sold to CarelonRx (owned by Elevance / Anthem). This is just another example of Pharmacy Benefit Managers acquiring control of specialty pharmacies, in order to control the supply chain and benefit from that.

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Chris Columbkille Biddle

CEO at Dóchas Life Sciences
8mo
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How GoodRx is Evolving Its Reimbursement Approaches to Help Pharmacies and Consumers: Today’s guest post comes from Jim Sheninger, Pharmacy Strategy Officer at GoodRx. Jim describes GoodRx's emerging pharmacy contracting strategies. In addition to working through pharmacy benefit managers (PBMs), GoodRx now also contracts directly with Walgreens, CVS, and other national and regional pharmacies. These direct agreements are based on acqusition cost, which helps pharmacies stabilize gross margins while still providing low pricing for consumers. To learn more about GoodRx and its pharmacy partnerships, reach out to [email protected]. Read on for Jim’s insights. Read more » © 2006-2024 HMP Omnimedia, LLC d/b/a Drug Channels Institute, an HMP Global Company. All rights reserved. This Feed is for personal non-commercial use only. #pbm #lifesciences #financial

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Dóchas Life Sciences

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How GoodRx is Evolving Its Reimbursement Approaches to Help Pharmacies and Consumers: Today’s guest post comes from Jim Sheninger, Pharmacy Strategy Officer at GoodRx. Jim describes GoodRx's emerging pharmacy contracting strategies. In addition to working through pharmacy benefit managers (PBMs), GoodRx now also contracts directly with Walgreens, CVS, and other national and regional pharmacies. These direct agreements are based on acqusition cost, which helps pharmacies stabilize gross margins while still providing low pricing for consumers. To learn more about GoodRx and its pharmacy partnerships, reach out to [email protected]. Read on for Jim’s insights. Read more » © 2006-2024 HMP Omnimedia, LLC d/b/a Drug Channels Institute, an HMP Global Company. All rights reserved. This Feed is for personal non-commercial use only. #pbm #lifesciences #financial

How GoodRx is Evolving Its Reimbursement Approaches to Help Pharmacies and Consumers

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Brittani Bilse

Strategist-Consultant-Speaker
7mo
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Are you tracking the next steps at the Texas Pharmaceutical Initiative? Is this an example below likely something the business plan will look over and put forward for consideration? It does exist. Will it be for all drugs or just some? What is the estimated ROI on grouping the various populations? How will they treat the different models-e.g. does it work better to do a direct buy for the TDCJ pop and state facilities versus the more traditional pop that might benefit from a larger grouping of the population?

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President, Drug Channels Institute, an HMP Global company
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Notable: GoodRx $GDRX & Kroger $KR sign a direct agreement for #pharmacy reimbursement based on acquisition cost. This contracting approach bypasses #PBM network rates. 👀 P.S. See Section 8.4.2. of DCI's 2024 pharmacy/PBM report https://drugch.nl/3WIowd1

GoodRx and Kroger Sign Direct Contracting Agreement

businesswire.com
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Eric Bricker, MD

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