Exposing What PBMs Won’t Tell You Shane | Garduno, MBA Vice President, PBM Practice at Xevant
In this episode, we dive into the hidden practices of PBMs with Shane Garduno, Vice President of PBM Practice at Xevant. Shane reveals insights into how employers can gain transparency and control prescription drug costs. Learn more about Xevant’s solutions at Xevant.com.
Expert Discusses PBM Transparency, Balancing Competition, and Real-Time Optimization
Brandon Newman, the founder and CEO of Xevant, emphasizes the importance of balanced regulation and transparency in the pharmacy industry. He cautions that proposed legislation could stifle competition and innovation if not carefully crafted, potentially leading to big PBMs exiting certain contracts. Newman argues that simply setting prices through government mandates does not necessarily achieve the desired outcomes, as manufacturers may raise prices elsewhere to compensate. Instead, he advocates for incentivizing positive behaviors and providing stakeholders, including pharmacists and pharmacies, with real-time access to claims data, rebates, and cost-saving opportunities.
Xevant: Cost-Effective Solutions in Pharmacy Benefits
The pharmaceutical benefits sector is notoriously complex yet pivotal in providing accessible and effective healthcare for millions. Characterized by a vast network of drug manufacturers, insurers, pharmacies, and patients, this intricate ecosystem comes with an overwhelming myriad of variables. Often resulting in opaque pricing structures, burdensome administrative processes, and inflated consumer costs, making it a significant challenge for healthcare providers and patients alike.
Expert Discusses Navigating Complexities of PBM Regulations
Brandon Newman, founder and CEO of Xevant, delves into the complex landscape of pharmacy benefits managers (PBMs) and the regulatory environment surrounding the industry. Newman highlights the outsized influence of the “big 3” PBMs, which control over 80% of pharmacy utilization, and how their practices impact the cost and access for both patients and pharmacies. He discusses the key legislative efforts at the state and federal levels, focusing on the push for greater transparency in reimbursement rates, business practices, and fees. He also emphasizes the role of innovative, smaller PBMs in offering unique value propositions, such as high-service models and a focus on overall therapy costs, as a counterbalance to the market dominance of the larger players.
People Spent the Most Money on These 25 Prescription Drugs Last Year
U.S. spending on prescription drugs amassed $722 billion in 2023, a nearly 14% uptick from 2022, marking the largest increase in spending in 20 years, according to a new study. The diabetes and weight loss medication semaglutide (Ozempic, Wegovy, and Rybelsus) topped the list. While drug prices did rise, the data and experts point to other, more significant factors for the national increase in spending.
