Baker spoke with Peter Wehrwein, managing editor of Managed Healthcare Executive®, about the smaller, upstart pharmacy benefit managers (PBMs) and their role in the industry. Some are using newer technology as their calling card, he says.
"The noise of the dissatisfaction with the incumbent PBM industry continues to grow."
So says Greg Baker, CEO of EmsanaRx, in this interview with Peter Wehrwein, managing editor of Managed Healthcare Executive.®
Baker was interviewed for MHE's December 2022 cover story, "Beyond the Big Three: Small PBMs are taking on OptumRx, CVS Caremark and Express Scripts."
EmsanaRx, which started operations this year, was launched last year by the Purchaser Business Group on Health, an employer group, as an alternative to the traditional PBMs.
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In this segment of the interview, Bakers says there are about 50 to 60 smaller PBMs.
Private equity investment is flowing into the industry and to some of the insurgent PBMs, according to Baker, partly because the pharmaceutical industry (and therefore the PBM industry) is growing: "If I can grab a small piece of this really big pie, it turns into a really good thing for me."
Some of the upstarts are billing themselves as having much better technology than the stalwarts, Baker tells Wehrwein. "Fundamentally, part of what's broken is that most of the (established) PBMs are working ona 30-year-old technology stack."
Others are touting patient navigation, Baker says. Another subset are "gimmicky," in his eyes.
He talks about another group:
"I think the last bucket is peope who have tried to say,hey, holistically, let's look to see how (the PBM industry) is broken, from bad contract terms to bad formularies to bad service,and if we really want to bring a comprehensive solution to the market that makes sense, here's what it looks like."
"And your put (EmsanaRx) in that virutous bucket?" asked Wehrwein.
"Absolutely," said Baker.