The world of pharmacy benefits management (PBM) is on the verge of a massive shift, one that could redefine how employers, patients, and pharmacies interact. As pharmacy costs rise and transparency becomes a priority, companies like Capital Rx are pioneering a new path. I sat down with Bridget Mulvenna, a seasoned pharmacy industry expert and VP of Business Development at Capital Rx, to uncover the complexities of PBM 2.0, the nuances of GLP-1 drugs, and the urgent need for transparency in drug pricing.
The Importance of Transparency in PBMOne of the biggest challenges facing the pharmacy industry is the lack of clarity around drug pricing and rebates. Traditional PBMs often operate in a “black box” model, where costs and savings are not fully disclosed to plan sponsors. Bridget explains how Capital Rx’s approach is different. Using a single ledger model, they prioritize transparency, giving plan sponsors direct insight into how and where their money is spent. This model eliminates hidden fees and puts power back into the hands of plan sponsors, ensuring they get a fair deal.
How GLP-1 Drugs Are Shaping Healthcare CostsGLP-1 drugs like Ozempic and Wegovy are transforming diabetes and weight loss treatment, but they come at a high cost. With the surge in popularity among celebrities and everyday users alike, these drugs have put a financial strain on both insurers and patients. Bridget provides insights into the risks of using these drugs, especially when patients purchase them from less-regulated compounding pharmacies. These pharmacies often offer lower prices but lack the stringent oversight that ensures the drug’s quality and efficacy.
Embracing PBM 2.0 for a Sustainable FuturePharmacy costs are no longer just a healthcare issue—they’re a national financial concern, accounting for nearly 30% of healthcare spending. Bridget emphasizes that PBM 2.0 isn’t just about managing claims; it’s about a comprehensive approach to cost management and oversight. By focusing on the “rebate yield” instead of total rebate dollars, Capital Rx aims to give plan sponsors a clearer understanding of where savings can truly be made, allowing them to reinvest those savings into employee benefits, wage increases, or other business initiatives.
Why Employers Should Pay AttentionWith the Consolidated Appropriations Act and other legislative actions on the horizon, employers are facing new responsibilities as plan fiduciaries. Bridget encourages them to be proactive in understanding their PBM contracts and the true costs associated with drug coverage. She advises employers to look beyond surface-level rebates and prioritize models that bring clarity and fairness to drug pricing.
As healthcare continues to evolve, so too must the systems that support it. Bridget’s insights reveal a vision of pharmacy benefits management that is transparent, cost-effective, and focused on patient outcomes. For employers and plan sponsors, the rise of PBM 2.0 is an opportunity to rethink how they approach healthcare benefits—one that could transform the future of employee well-being and organizational health.To get in touch with Bridget and learn more from her and Capital Rx on managing pharmacy costs and GLP-1 spend:
* Bridget Mulvenna on LinkedIn
* The Astonishing Healthcare Podcast
* AH002 - A Former Pharmacy Program Director's View on Controlling Pharmacy Costs
* AH021 - Managing Pharmacy Costs in a GLP-1 World, with Bridget Mulvenna
* Replay - Innovative partnerships for GLP-1 management, with Vida Health
Additional Note: Find Jerry Schlichter at: https://uselaws.com/
