LucyRx’s David Blair Pushes for Change in Pharmacy Benefits | PBMI Innovator

David Blair, founder, chairman and CEO of LucyRx, is among the winners of the inaugural PBMI Innovator Award from Managed Healthcare Executive, which honors leaders reshaping the pharmacy benefits landscape. Blair is being recognized for pushing a shift away from vertically integrated pharmacy benefit managers (PBMs)—a model he argues has long misaligned incentives.

In an interview with MHE, Blair warned that when PBMs control everything from drug manufacturing and distribution to benefit design and medical claims, financial motives can outweigh patient needs. This particular focus makes it difficult to maintain transparency and prioritize outcomes, he said

“It seems obvious that it's created misaligned incentives, right?” Blair said. “These organizations are manufacturing drugs, selling drugs, managing prescription benefits and also managing medical side, right? So they’ve got their hand in so many different profit buckets that they can't keep their priorities straight.”

Rather than waiting for federal reform, some health plans and employers are already acting. Blair mentioned Blue Shield of California’s high-profile 2023 move to unbundle its pharmacy benefit services—opting instead to contract separately for claims processing, specialty pharmacy and other components. That act has sparked a broader movement.

Blair said more organizations are choosing to “decouple” these services to avoid conflicts of interest and gain greater control.

“We’re seeing more employers say, ‘I’m not going to have the fox watch the hen house,’” he said. “They’re actively working to decouple these services to create more transparency and better outcomes.”

State policymakers are also stepping in.

For example, Arkansas passed legislation to support this approach, and more than a dozen other states are considering similar action. While Blair said progress at the federal level has been slower, the regulatory conversation is gaining momentum.

With LucyRx, Blair is helping employers and plans implement this model, offering a new path forward in pharmacy benefits—one centered on transparency, flexibility and accountability. As pressure grows to improve affordability and patient outcomes, Blair’s work is helping push the industry in a new direction.