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Episode 12: A Refreshing Look at Pharmacy Benefits (Part 1)
Manage episode 313694753 series 3282256
Treść dostarczona przez Cristy Gupton. Cała zawartość podcastów, w tym odcinki, grafika i opisy podcastów, jest przesyłana i udostępniana bezpośrednio przez Cristy Gupton lub jego partnera na platformie podcastów. Jeśli uważasz, że ktoś wykorzystuje Twoje dzieło chronione prawem autorskim bez Twojej zgody, możesz postępować zgodnie z procedurą opisaną tutaj https://pl.player.fm/legal.
00:00 Intro
00:40 In today's episode
00:58 Vinay Patel of Self Insured Pharmacy Networks
02:16 What is a PBM?
02:32 PBM = claim processor just like a TPA on the medical side
03:15 but also rebate management, clinical management, etc.
04:17 what about the cost?
04:42 episode 8, "transparency"
05:08 Tim Thomas, quote on transparency
05:50 There's money in here, if you can find it--it's yours
06:02 Do we just need transparency? Or do we need a fiduciary?
08:00 It all depends on what's in the contract
08:56 Fiduciary principles mean I'm acting in the best interests of my client
09:57 NADAC = National Average Drug Acquisition Cost
11:09 University of Lynchburg Master's Program in Health Benefits Design
12:06 All things being the same, the price fluctuates by hundreds of dollars
13:00 Supply & Demand still exists but Rx prices can still be normalized
13:13 Manufacturers adjust brand names twice per year
14:17 Average Wholesale Price (AWP) means wholesalers are setting the prices
14:55 A little disruption might be in order here
15:25 We should have a buyer's market, not a seller's market
15:50 Direct Primary Care doctors are also dispensing Rx onsite
16:40 Let's step back and highlight DPC
17:20 Patients want a relationship with their providers, Providers want that too
18:12 Now that DPC has primary care handled, let's give them better access to Rx
18:57 A subscription model for Rx also
20:00 How many pharmacies are locally owned?
20:39 Answer = one third, about 22,000 pharmacies
21:47 A superior customer experience with care catered to the patient
23:40 Pharmacists in big box stores want to cater to patients but can't because of the system
25:30 A "concierge" pharmacist? Yes, it's possible
26:39 Local care team like Carl Schuessler says in the "Marcus Welby days"
28:12 Quadruple Aim means the physician/provider experience is important too
29:01 Cliffhanger--What's a day in the life of a community pharmacists?
29:08 That's all for today
29:16 Thank you, visit us at www.custombenefits.work, #letsfixhealthcare
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