Peter Wehrwein, Managing Editor

In this month’s episode of Tuning In to the C-Suite, Managing Editor Peter Wehrwein talks with Rick Bates, MBA, president and CEO of RxSense. In his conversation with Wehrwein, Bates described RxSense as a “technology platform company that has expertise in the direct-to-consumer business.” He emphasized that RxSense is not a pharmacy benefit manager (PBM) — but, rather, a company that supplies PBMs with technology, including some of the up-and-coming PBMs, such as EmsanaRx and Vivid Clear Rx. Bates and Wehrwein also discussed the Mark Cuban Cost Plus Drug and RxSense launching a standalone business intelligence product called Rx IQ.

Larger payers have plenty of cash on hand to do deals but will look for “adjacencies” rather than merger and acquisition with other payers because of the regulatory environment, say Bain experts.

Amgen says it will sell the first biosimilar to Humira on the U.S. market at two prices.

The Risk Adjustment Data Validation (RADV) rule was finalized today. The new rule for governing how CMS audits Medicare Advantage plans for overpayment due to inflated risk adjustment could cost insurers billions of dollars.

How successful accountable care organizations (ACOs) have been in bringing about value-based care hinges, of course, on how success is defined. CMS’ comprehensive end-stage renal disease (ESRD) care model is a good example.