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Beyond the Big Three PBMs: A Conversation with Greg Baker, CEO of EmsanaRx, Part 2
Baker discusses specialty drugs and their discounting in this segment of his interview with Peter Wehrwein, managing editor of Managed Healthcare Executive.®
Everyone in the pharmacy benefit business knows about the growing number and increasingly high prices of specialty drugs. But Greg Baker says what counts as a specialty drug is ill-defined and the vagueness is a source of confusion — and added profits — between pharmacy benefit managers (PBMs) and their clients.
"There is no industry standard for what a specialty drug is," says Baker, CEO of EmsanaRx, a PBM launched by the Purchaser Business Group on Health.
Baker was a source of Managed Healthcare Executive®'s December 2022 cover story, "Beyond the Big Three: Smaller PBMs are taking on Optum Rx, CVS Caremark and Express Scripts."
In this segment of an interview with Peter Wehrwein, managing editor of MHE, Baker discusses what he desribes as "gamemanship" with generics and how categorizing a drug as a specialty can affect discounts and therefore the net price paid by the industry clients of PBMs. He gave Truvada (tenofovir disoproxil fumarate and emtricitabine), an HIV antiviral, that be classified as a specialty drug and therefore may be discounted far less by some PBMs than if those PBMs had it on their nonspecialty lists.
"Nobody's ever tried to say this is a speicalty drug, this is not. So everybody gets to create their own specialty drug lists," says Baker.
A Conversation With Greg Baker, RPh, CEO of AffirmedRx
March 31st 2024Greg Baker, CEO of AffirmedRx, describes his early career, shares some of his critical opinions about the pharmacy benefit management (PBM) industry and how, in his view, his company is offering a better alternative.
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David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
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Florida Gets the OK. But Will Drug Importation from Canada Actually Happen?
March 5th 2024Canadian health officials warn that maintaining a drug supply for Canadians is their priority. The staunch opposition of the U.S. pharmaceutical industry may also be an obstacle to imports from north of the border.
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Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
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What Payers Need to Know As Retail Pharmacies Move Into Primary Care
September 6th 2023Healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.
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