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Reforming PBM practices

Danny Sanchez, CEO of EmpiRx Health, discusses how the time has come for traditional PBMs to change practices that hurt patients and pharmacies.

The leaders of the nation’s retail pharmacy industry recently gathered in Florida to take part in the National Association of Chain Drug Stores’ Annual Meeting, which was held April 22-25 in Palm Beach. Representing national, regional and statewide pharmacy and grocery chains, these senior executives came together to discuss major issues and opportunities facing the pharmacy industry as it emerges strongly from the challenges posed by the COVID-19 pandemic.

At this year’s NACDS meeting, we expected intense conversations about the pharmacy industry’s increasingly fraught relationship with the largest pharmacy benefits management companies. In fact, the NACDS recently published a very direct video exposing how traditional PBM business practices negatively impact patients and their pharmacies.

The fact is, the largest PBMs continue to operate using a fundamentally flawed and disingenuous business model that prioritizes drug volume to fuel profits. It’s a model that is totally misaligned between the interests of the PBMs and the stakeholders they claim to serve, and pays short shrift to what truly matters, the health outcomes of patients and the long-term success of plan sponsors.

There is a better way. PBMs can and should align their goals and interests with their clients, many of whom include the leading retail pharmacy organizations that particpated in the NACDS meetings. That’s why I am so puzzled by the fact that many retail pharmacy companies continue to work with the largest PBMs, whose business practices are fundamentally opposed to how retail pharmacy companies see the world and their employees and patients.

I have had the great pleasure of working closely with many of the top pharmacy organizations in the United States. They are justly proud of how the retail pharmacy industry has achieved significant new recognition, respect and growth. During the COVID-19 pandemic, trusted, hard-working pharmacists and techs demonstrated the strong values that have made the neighborhood pharmacy an increasingly important part of the healthcare system. Those values are anchored on
patient trust, accessibility and value.

I joined EmpiRx Health earlier this year because I was so impressed with how they transformed the PBM business model by focusing on those same values and prioritizing patient health outcomes and client success. Operating more like a healthcare company than a traditional PBM, EmpiRx Health has redefined the conventional volume-oriented PBM model. For example, unlike legacy PBM companies, our Population Health Management solution centers pharmacists within patient care teams to optimize health and financial outcomes.

As I speak with my pharmacy colleagues who attended the NACDS meeting in Florida, I intend to ask them the following question: Why do you continue to partner with a PBM company operating at cross-purposes with your core business and healthcare values and goals?

As the famed French poet Victor Hugo said: “Nothing is more powerful than an idea whose time has come.” The time has come for the largest PBMs to join EmpiRx Health in revolutionizing our industry by focusing on what matters most: client value and patient health outcomes.

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