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In Land of Giants, Smaller PBMs Find a Niche

  • 10/15/2020
  • Managed Healthcare Executive

In the consolidated PBM industry, smaller companies say they can be nimble and not driven by rebates. But are they acquisition targets?

The pharmacy benefit management (PBM) industry used to occupy a rather small, obscure corner in the back offices of the American healthcare system. PBMs were just prescription claims processors. But over the past 20 years or so, the industry consolidated and the remaining companies became powerful middlemen in the complex pharmaceutical supply chain. Now the industry has an increasingly high profile (not always for favorable reasons) and has consolidated even further, with its large players owned by or partnering with even larger companies.

Yet plenty of smaller players have survived and even thrived by finding a niche, such as workers’ compensation, specialty drugs or certain types of diseases. They offer an alternative to dominant companies and the traditional marketplace, which can be layered and complicated.

3 strategies to promote the value of medication adherence among plan members

  • 10/1/2020
  • BenefitsPRO

As the pandemic exacerbates barriers to adherence, promoting the value of taking medications as prescribed is more critical than ever to improve member health and cost savings.

Even before the COVID-19 pandemic rattled the country, medication non-adherence—when patients fail to take their prescriptions as prescribed by a doctor or pharmacist—has been an ongoing issue causing serious health consequences and unnecessary medical costs. In fact, non-adherence to medication leads to a financial burden of $100 billion to $290 billion on the U.S. health care system annually, which causes significant ramifications for plan sponsors who consequently experience higher medical costs and lost earnings and productivity.

A Look at the Year in Generics

  • 9/9/2020
  • Drug Topics

The generic pipeline continues to provide significant value to payers and patients as key products in top therapeutic classes lose patent protection.

Ryan Schmidt, associate director of formulary services for Madison, Wisconsin–based Navitus Health Solutions, says that overall, the generic market this past year has been relatively slow.

“There haven’t been many blockbuster generic releases, and the ones that hit the news are generally ‘authorized generics,’ where the manufacturer of the generic product either has an agreement with the brand manufacturer, or in some instances is the brand manufacturer,” he said. “The other thing that limits impact of these releases is a lot of them have come from classes with multiple alternative generic options already, meaning the amount of use in the brand space has been limited.”

Maintaining affordable access to prescriptions in a post-pandemic world

  • 5/29/2020
  • MedCity News

As the Covid-19 pandemic continues to evolve, pharmacy networks have largely delivered against the challenge to meet critical health care needs. Pharmacies across the country remain open to accommodate patients, and anticipated drug shortages and supply chain concerns from early in the pandemic have not come to fruition.

As patients start to head back to doctors’ offices for routine care and elective procedures, there may be a pent-up demand for prescription drugs as people start new medications and adjust their current ones. In this time of global disruption and change, it’s imperative that plan sponsors have a transparent and accessible pharmacy benefit manager (PBM) to manage their pharmacy benefit and ensure plan members receive affordable prescription drugs.

Navitus Achieves Double-Digit Savings for New Clients in 2019

  • 5/28/2020
  • RADAR on Drug Benefits

Navitus Health Solutions, a PBM that touts a 100% rebate pass-through model and a lowest-net-cost formulary, says it is seeing success in moderating total net cost per-member per-month (PMPM), particularly for new clients.

The company’s 2019 Drug Trend report, released in May, said Navitus achieved an “industry-leading” total net cost PMPM of $78.12 across its commercial business, 16% lower than the forecasted industry average of $93.11 PMPM.

3 considerations for selecting a truly transparent pharmacy benefits partner

  • 5/14/2020
  • BenefitsPRO

While the word “transparency” is commonly used across the PBM industry, the reality is that not all transparency is created equal.

Prior to the COVID-19 pandemic rattling the economy, data from the National Pharmaceutical Council showed that 63% of employers felt that pharmacy benefit managers (PBMs) are not transparent. With many companies looking to better manage expenses and ensure affordable access to prescriptions in today’s uncertain landscape, it’s more important than ever for benefits professionals to work with a transparent partner and find ways to reduce prescription drug costs for their employees.

PQA Presents Quality Awards to 24 Medicare Plan Contracts for High Achievement in Medication Quality

  • 5/14/2020
  • Pharmacy Quality Alliance

The Pharmacy Quality Alliance (PQA) has recognized 24 Medicare plan contracts with a quality award for high achievement or significant improvement in PQA measures of medication safety and appropriate use. The awards are based on published CMS Medicare Part D Star Ratings.

Navitus MedicareRx is recognized with an Excellence in Quality Award for PDPs and Dean Health Plan is recognized with an Excellence in Quality Award for MAPDs.

With Costco Now in its Corner, PBM Navitus Thinks Big

  • 5/14/2020
  • RADAR on Drug Benefits

Serving just 6.2 million members, Navitus Health Solutions — a PBM owned by St. Louis, Mo.-based integrated health system SSM Health — is hardly one of the industry’s major players. But given that it features a “pass-through” business model in an era when opaque PBM structures are facing scrutiny, and Costco Wholesale Corp. recently purchased a minority stake in the firm, Navitus may be poised for a bigger spotlight.

NW Prescription Drug Consortium announces Moda and Navitus as contractors for their pharmacy benefit

  • 3/5/2020
  • Oregon Health Authority

The NW Prescription Drug Consortium is pleased to retain Moda as their contracted program administrator and begin using Navitus as their pharmacy benefit manager (PBM) effective January 1, 2022.

This announcement comes after an extensive eight-month procurement and evaluation process. Customer satisfaction and service excellence were paramount considerations throughout this process to obtain the best value for NW Prescription Drug Consortium.

Business Group Achieves First-Year Pharmacy Savings

  • 2/20/2020
  • Milwaukee Business Journal

Employer costs for pharmacy benefits are continuing to increase partly due to the costs of specialty medications, said Jeff Kluever, executive director of the Business Health Care Group. Pharmacy benefit managers, which are third-party administrators of prescription drug programs for insurers, say they reduce those costs but Navitus takes it further by passing along to employers all rebates and discounts.

The Slow Reveal

  • 9/18/2019
  • Managed Care Magazine

Rebates have created pay-to-play dynamics. Employers facing high drug costs have “rebate addiction.” And the impressive “rebate guarantees” are hard to resist. But at least the process of how drugs get formulary placement is becoming clearer, and some PBMs have moved to charging administrative fees only.

Small PBMs Urge Congress: Don't Kill Rebates

  • 5/16/2019
  • Healthcare Dive

Smaller pharmacy benefit management companies, rarely in the spotlight, are urging Congress not to fundamentally alter the way prescription drugs are paid for in the U.S. As the Trump administration advocates banning rebates under Medicare and Medicaid, these lower-profile PBMs aim to convince lawmakers not to junk the entire system. They say Congress should start by examining business models other than just of the nation's largest PBM players.

Policy Makers Seek Answers for High Costs of Prescription Drugs

  • 5/10/2019
  • Pharmacy Times

Members of Congress sought to deconstruct the drug supply chain Thursday in an effort to find ways to lower prescription drug prices. Hosted by the House Committee on Energy & Commerce, the investigational hearing drew testimony from health care industry experts representing drug companies, insurers, and patient advocacy groups.

PBM executive: Industry has been discussing end of rebates for a 'long, long time'

  • 4/30/2019
  • FierceHealthcare

Though the Trump administration’s steps to end drug rebates have been met with outrage from pharmacy benefit managers (PBMs), these companies have been talking about a future without rebates for a long time, experts say.

Wisconsin Pharmacy Benefits Combination Challenges National Giants

  • 4/9/2019
  • Milwaukee Business Journal

A “significant number” of southeast Wisconsin employers are in the pipeline to enroll in a new local pharmacy benefits program that promises savings and a departure from the much-maligned large national pharmacy benefits firms.

Wrapping up 2018 and Looking Forward to the New Year

  • 12/20/2018
  • Business Health Care Group - The Catalyst

Throughout 2019 we expect more BHCG member employers and non-members will move to Navitus as their pharmacy benefit management solution.

Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

  • 11/16/2018
  • Health Payer Intelligence

Surescripts Prescription Price Transparency Tool Realizes Massive Provider Adoption, Achieves Break

  • 11/14/2018
  • Surescripts

The Surescripts Network Alliance™ is experiencing one of its fastest health information technology adoption curves to date as it transforms the prescription decision process, with a fortyfold increase in the number of prescribers utilizing its Real-Time Prescription Benefit tool since it launched last year. To date, prescribers have used the tool 30 million times to view patient-specific prescription price and therapeutic alternative information, integrated with their electronic health record (EHR) software, at the point of care.

A Tough Negotiator Proves Employers Can Bargain Down Health Care Prices

  • 10/2/2018
  • NPR / ProPublica

One woman found a way to attack high health insurance prices. And that's news because it's hard for any one person to do. If you go to the hospital, the hospital charges your insurer, which passes the cost on to you. And it's hard to negotiate a better price in that system. Marshall Allen of the nonprofit newsroom ProPublica has been investigating high health insurance costs. And he has the story of a woman who used her power to hold them down.

Navitus Builds New Headquarters, Keeps Distance from Big Drug Benefit Managers

  • 7/6/2018
  • Wisconsin State Journal

With a new headquarters going up at a prominent intersection on Madison’s West Side, Navitus Health Solutions is gaining visibility at a time when some of its competitors are trying to avoid attention.

Managed Care Pharmacy Leaders Are Honored at the Academy of Managed Care Pharmacy/AMCP Foundation

  • 4/26/2018
  • Academy of Managed Care Pharmacy

The Academy of Managed Care Pharmacy and AMCP Foundation recognized a group of leaders who have contributed significantly to the profession of managed care pharmacy. Eight awards were presented at a gala Awards Dinner held April 25 as part of the AMCP Managed Care & Specialty Pharmacy Annual Meeting in Boston, Mass.

Managed Care Pharmacy Residency Director/Preceptor Award Recipient Marnie Wickizer, PharmD, is the Residency Program Director at Navitus Health Solutions.

Combating Fraud, Waste and Abuse: Trends and Intervention

  • 10/19/2017
  • ACAP Webinar

Join Navitus Health Solutions as we explore the latest trends and best practices in combating fraud, waste and abuse on this educational webinar as part of the ACAP Vendor Education Series. From evaluating pharmacy behaviors to the growth of telemedicine prescribers, we will cover the newest factors impacting fraud and actions that can work for you.

Episode 13: Navitus Health Solutions, Gary Hattendorf & Byron Mickle

  • 7/7/2017
  • Reconstructing Healthcare Podcast

In this podcast, Gary Hattendorf, Western Regional Sales Vice President, and Byron Mickle, Senior Vice President at Navitus Health Solutions discuss the differences in PBM models, formulary management and how Navitus helps manage pharmacy costs with a low net cost approach.

What They're Watching: Byron Mickle

  • 6/14/2017
  • State of Reform

Byron Mickle, Senior Vice President of Navitus Health Solutions, joins the State of Reform in this edition of What They’re Watching to discuss transparency in pharmaceutical costs.

Care Management Vital in Tackling Specialty Pharmacy Costs

  • 2/9/2017
  • Society for Human Resource Management

Managing specialty drug benefits is becoming an increasingly critical, and increasingly frustrating, task for HR managers. While the number of employees and their dependents who may need high-cost specialty drugs—typically for diseases such as multiple sclerosis, rheumatoid arthritis, hepatitis C and cancer—is usually very small, the percentage of total drug spending on these types of medications is disproportionately driving overall pharmacy and medical spending higher.

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