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Regional pharmacy benefit manager is on a growth curve
While the biggest PBMs, such as Medco and Express Scripts, look to merge and consolidate more of the drug spend through their systems, other PBMs are tacking in their own direction—and apparently making headway. Navitus Health Solutions (Madison, WI) has recently established a new corporate identity, but its business model remains the same: a “zero-spread, full pass-through model, which focuses on high-touch service” and “lowest-net drug cost,” according to the company. Translation: unlike other PBMs, Navitus says it passes all rebates or discounts directly to its health-plan clients, charging only an administrative fee for the PBM service. Differential pricing for preferred placement on formularies is less feasible; and patient discounts such as coupons (which can sometimes thwart the goal of using lower cost, equivalent drugs) are more exposed to plan operators.
“Our new logo and tagline—‘Share a Clear View’—emphasize transparency and openness,” says Terry Seligman, president, adding that with one million covered lives today, and an expectation of two million by 2012, “our clients ‘get it.’” It’s not that the company is hostile toward pharma marketing efforts, but that it puts a primary emphasis on clinical outcomes combined with price transparency, a sort of “what you see is what you get” approach. Brett Kelly, RPh, who is senior director for industry relations and contracting, notes that other PBMs are telling Wall Street that their financial performance will be improved in the next few years with the slew of patent expiries. “They call their higher profitability from new generics ‘spread revenue,’ and I ask you—where do you think that spread is coming from?”
Seligman adds that the company encourages pharma involvement in improving health outcomes, and will be receptive to the evidence-based research that pharma companies might bring to the table.