Arpit Patel. Pharm.D., MedImpact

Arpit Patel, Pharm.D., was just a year and a few months out of pharmacy school when he got hired by Medco in 2006 as a “manager, retiree solutions.” Those were very early innings of Medicare Part D — plans had only begun enrolling patients in 2006 — and the group at Medco had a start-up environment with a clinical team of just three pharmacists.

“I was the newest person, sort of the junior-level person. The situation was like, ‘Hey, you guys are going to create a formulary.’ I’m like, ‘Cool, I’ve heard of this. What’s a formulary again?” says Patel with a laugh.

The naivete was short-lived. It turned out that Patel loved the challenge of putting together a formulary and the multidimensional complexities in melding financial assessment and clinical value. Healthcare in the U.S. is built on what the market will bear, Patel says. In other countries, it is based on the value that the healthcare provides.

“I always looked at the formulary as the value that healthcare can provide,” says Patel, who has now accumulated almost two decades of experience working in pharmacy benefits. “You have an opportunity to really be selective in terms of where you get the most mileage on having drugs on your formulary. Obviously, you look at it from a financial perspective. But we look at adherence, we look at discontinuation rates, we look at sort of quality of life — putting all those puzzle pieces together is really what intrigues me.”

As a senior vice president, trade relations and supply chain at MedImpact Healthcare Systems, Patel is still solving puzzles, but they are more complex these days, involving client preferences, member behavior and the labyrinthine U.S. drug supply chain. Patel’s deep knowledge of pharmacy benefits shows as he talks in rapid-fire bursts during a wide-ranging interview about his upbringing, his career, the pharmacy benefit manager (PBM) industry, and his current job at MedImpact. He doesn’t hesitate to talk up his employer. One characteristic of MedImpact that distinguishes it from other PBMs is its independence and à la carte menu of services, he says. “We were doing the DIY PBM model before the DIY PBM model became a thing with Blue Shield of California,” he says, referring to the California Blues plan’s decision three years ago to spread out the pharmacy benefit services across five companies instead of using a single PBM. Patel says his job involves talking daily to pharmaceutical manufacturers, retail pharmacies, a range of clients and “lots of consultants.”

“A lot of times I am talking to consultants and explaining, ‘Here’s the math behind this, here’s how we did this, here’s the value that you get out of it,’ because I think one of the challenges in this industry is that without that level of expertise, you tend to have a very superficial response to direct questions.”

A nudge here and influence there, and Patel’s area of expertise might have been medical, not pharmaceutical. His family emigrated from India when he was 9. His father, Harshad, had an engineering degree, and his mother, Hemanti, had an English degree. Theirs was a classic immigrant story of sacrifice, coming to this country so their children could have a better life. They ran a medium-sized grocery store. “Your parents always want you to strive for the best opportunity available for you,” says Patel. All his cousins were doctors, and Patel looked at the daunting prospect of years of education. But a pharmacist who worked at a managed care company came to speak at Patel’s high school in Nutley, New Jersey, a suburb of Newark. Patel found himself interested and disabused of the notion that the only thing pharmacists did was work behind the counter at a CVS or a Walgreens. And the Pharm.D. degree was a relative bargain.

“What sealed the deal was that it was a six-year program to a direct doctorate, and so I was, like, well, I don’t need to take the MCAT, and I don’t have to be in school for 12 years, and I walk out with a pretty great degree. So, I was sold.” Patel, 45, graduated from Rutgers University in 2005. He worked as a retail pharmacist at Walgreens for approximately a year before cutting his teeth on formulary development at Medco.

Medco was acquired by Express Scripts in 2012. When he left Express Scripts to work for the consultancy Aon in 2021, Patel said it was revealing to see the complexities of the pharmacy industry from an outsider’s perspective. “It’s a complicated decision, and it’s being put on the shoulders of HR representatives. Look, if you ask me, ‘Hey, what are the best parts to buy for a rocket ship?’ You are not going to get a great answer from me, and I am going to rely on a consultant to be able to give me that guidance and explain it to me in terms that I can understand. That was the part that I think was the eye-opening aspect.” Patel said that after working for Medco and then Express Scripts for a total of nearly 15 years, the Aon experience also made him newly aware of the “plethora of options” in pharmacy benefit management and the importance of tailoring the choice to the
clients’ needs.

Having that perspective made him a good fit for MedImpact, which Patel says has an array of clients ranging from health systems to smaller PBMs to employers and health plans that it matches with a like-minded array of services, some of them outside the boundaries of what a PBM traditionally does. For example, the company started a wholesale business last year to purchase biosimilars to sell to specialty pharmacies, according to Patel. MedImpact announced in March that it was purchasing MSL Captive Solutions, a medical stop-loss insurance company. Patel said the acquisition will enable them to get into a “risk-based per-member, per-month PBM model” for smaller employers that would otherwise have to turn to third-party administrators for that kind of service. He speaks enthusiastically about the advantages of MedImpact being a privately held, independent business. “We don’t have shareholders. There aren’t quarterly earnings-per-share updates. We’re not driven by that,” Patel says. Instead, he says, the focus is on driving value “to all the different players involved and making sure that you have a unique solution that makes sense for them.”

All this bespoke work — and his expertise — has shaped Patel’s role at the company. He gently jokes that his “day job” is to build out the solutions for clients, but he is also out there, speaking with consultants and clients.

“In a lot of cases, just because of the complexity of what we’re trying to put together, I am talking to consultants and explaining, ‘Here’s the math behind this. Here’s how we did this. Here’s the value that you get out of it.’ Because I think one of the challenges in this industry is that without that level of expertise, you tend to have a very superficial response to direct questions,” Patel says.

He is also helping drum up business. “I never envisioned my job going out and pitching our solutions,” says Patel. “But increasingly, it’s one of those things I think is necessary in order for us to be able to get the outcome we’re looking for.” Patel stressed that it is a team effort, “not just one guy.”

Patel says one of MedImpact’s calling cards is that all the various discounts and rebates that get passed around among the members of the drug supply chain are experienced by members and plans. “Our entire approach,” he says, “is to make sure everything we do gets the benefits of being passed down to the member as well as the plan and try to create predictable solutions that help plans take advantage of all of that value.” Patel sees the PBM reforms included in the Consolidated Appropriations Act of 2026, along with other laws and policies targeting drug pricing, as “helping members benefit from all discounts that are out there.” In his view, it is an overdue course correction.

“Essentially, we’ve created a system where PBMs and plans in general, and consultants too, have pushed for higher discounts and higher guarantees that have caused prices to go up and discounts to increase, i.e., the rebate value,” says Patel. You can argue about how much of those rebates have trickled down to payers and health plans, he says. “But the member, when you go to the retail pharmacy, your cost share is based off of that very high list price, and so you never truly benefit from all those discounts.” Patel says lower list prices are the way to go. “I think you are better off with a low list price approach because it’s simpler, it’s less opaque and, frankly, it’s more predictable.”

The Trump administration has pushed direct-to-consumer (DTC) drug sales as the way to give people access to lower-priced drugs, using the threat of tariffs to get pharmaceutical companies to start DTC programs and then aggregating them on the TrumpRx website. Patel sounds a note of caution. “I think while direct-to-consumer has obvious advantages in certain categories of drugs from a pricing perspective, you ultimately want it to be part of the benefit. Otherwise, as an employer, what are you really offering? And as an employee, what are you really getting as a benefit if certain drugs are carved out of your healthcare insurance?”

Interest in direct-to-consumer sales has been fueled by high demand for the glucagon-like peptide 1 (GLP-1) drugs for weight loss and spotty insurance coverage. Patel says MedImpact has a program that offers Zepbound (tirzepatide) at a fixed price — meeting the criterion of predictability Patel mentioned — that is below the direct-to-consumer price. People who get a prescription also have access to help from a registered dietitian at no additional cost. Patel said that feature was added after an employer said, “I hear that people stop using this drug after six months. Why should I pay for it?”

Wrapping medical services around medications — the “beyond the pill” approach — is where PBMs are headed as prices become more transparent and rebates become less central to their operations.

“That’s where I think PBMs are evolving toward a sort of care delivery model beyond just access to the drug. What other benefits come tied to that disease state, so ultimately members benefit from getting the best value that they can out of that treatment?”