#505 PBMs Are Sick: Is There A Disruptor Writing A New Prescription? With Susan Thomas The ShiftShapers podcast

#505 PBMs are Sick: Is there a disruptor writing a new prescription? with Susan Thomas

3M ago 24:11

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In this episode of Shift Shapers, Susan Thomas, Chief Commercial Officer at LucyRx, discusses how LucyRx is addressing the issues and conflicts within the traditional Pharmacy Benefit Manager (PBM) landscape. The conversation delves into the structural problems of traditional PBMs, the role of misaligned incentives, and how LucyRx aims to eliminate these conflicts to benefit plan sponsors and patients. Key topics include formulary management, specialty pharmacy networks, and the importance of transparency and true net cost evaluations.

This Episode is Sponsored by Benepower
BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.

Key Takeaways

**Misaligned Incentives in PBMs**: Traditional PBMs have misaligned incentives due to their vertical integration with large insurance companies and ownership of mail and specialty pharmacies. This drives up costs for plan sponsors.

**Transparent Formulary Management**: LucyRx offers a formulary marketplace that eliminates exclusive arrangements with Group Purchasing Organizations (GPOs), allowing plan sponsors broader access to formularies and more flexible utilization management.

**Independent Pharmacy Network**: LucyRx contracts with independent pharmacy networks, such as Amazon, to provide a more efficient and cost-effective mail delivery service, ensuring quicker access to medications.

**Educational Initiatives**: LucyRx is actively educating advisors and plan sponsors on the benefits of their new pharmacy care model through a robust roadshow and sharing real-world case studies.

**Future of Pharma**: With advancements in AI and machine learning, precision medicine can help in developing more effective targeted treatments. However, skepticism remains about whether large PBMs and pharma companies want a smaller, more precise target population.

In This Episode

00:00 Introduction to PBM Issues

00:39 Meet Susan Thomas from LucyRx

00:50 Susan's Journey into Healthcare

02:06 Problems with Traditional PBMs

02:28 LucyRx's Approach to PBM Conflicts

06:23 Formulary Management Innovations

13:55 Network and Specialty Pharmacy Solutions

16:17 Educating Advisors and Plans

20:23 Future of Pharmacy Benefits and AI

22:07 The Story Behind LucyRx

23:25 Conclusion and Farewell

Chapters

1. #505 PBMs are Sick: Is there a disruptor writing a new prescription? with Susan Thomas (00:00:00)

2. Traditional PBM Arrangements (00:00:02)

3. A New Hope: LucyRx (00:08:15)

4. Interview with Susan Thomas (00:39:23)

5. The Nursing Background (00:48:00)

6. Transparency and Ethics in PBMs (01:30:00)

7. Future of Pharmacy Benefit Management (02:00:00)

512 episodes