Pharmacy benefits management (PBM) is a complex and constantly evolving industry that serves as a critical component of healthcare benefits for millions of Americans. Wendy Barnes, CEO of RxBenefits, understands the challenges and pressures that employers face when navigating pharmacy benefits for their employees.
In a recent podcast interview, Barnes shared insights on the differences between PBOs (pharmacy benefits optimizers) and PBMs, the financial pressures faced by employers, and the challenges of misinformation in the industry. She also highlighted the importance of transparency and accountability in negotiations and discussed the role of pharmacists in the healthcare system.
One key challenge that Barnes emphasized is the difficulty of balancing cost control with providing adequate medication options for employees. Clients may choose a narrow benefit or carve out specialty medications, which can create tension between cost savings and employee satisfaction. Barnes stressed the need for a comprehensive approach to managing pharmacy benefits and providing a single member service center to simplify the process for employees.
In addition to managing costs, Barnes also discussed the importance of transparency and accountability in negotiations with PBMs. RxBenefits takes a one-year contract approach, as opposed to the typical three-year model, due to the difficulty of predicting market changes. Barnes also emphasized the importance of having a small team of decision-makers who engage with PBMs directly and maintain accountability on both sides of negotiations.
Barnes also discussed the role of pharmacists in the healthcare system, particularly during the COVID-19 pandemic. Pharmacy's push to practice at the top of their license has been expedited, and the key is to maintain this progress going forward. She notes that pharmacists are essential to the healthcare system and highlights their increased relevance during the pandemic.
Overall, the interview provides insights into the complexities of the healthcare industry, the importance of transparency and accountability in negotiations, and the need for a more streamlined and holistic approach to managing pharmacy benefits. By taking a comprehensive approach and emphasizing transparency and accountability, employers can navigate the complexities of pharmacy benefits and provide their employees with high-quality healthcare benefits.
The Business of Pharmacy Podcast™ is an interesting and entertaining weekly podcast discussion on the business of pharmacy. Hosted by Mike Koelzer, an independent pharmacist in Grand Rapids, Michigan, each episode covers a new topic relevant to pharmacists and pharmacy owners. In addition to hosting the podcast, Mike also enjoys improving his sight-reading at the piano.
