Specialty Exceeds Traditional in Drug Spend

Greg 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.

In 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.

Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.

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.

In this second part of a video series, AMCP CEO Susan Cantrell addressed the impact of high prescription drug prices on underserved communities, highlighting disparities in access caused by the pandemic's effects on minority populations. On the industry blame debate, she urged collaborative solutions, mentioning AMCP's engagement with diverse stakeholders to find comprehensive, patient-centric solutions and advocate for policy changes like the MVP Act to address rising costs and access challenges.

In this first part of a video series, Susan Cantrell, CEO of AMCP, discussed root causes of high drug prices, its impact on underserved communities and Medicare price negotiation, emphasizing AMCP's actions and the role of decreasing drug prices for equity.