I was pleased to attend the White House roundtable on the importance of ensuring all Americans have access to the medications they need, and the ways pharmacy benefits and technology can better address the needs of health consumers. 

It might surprise you, but I believe the world needs Pharmacy Benefit Management (PBM). More than half of all Americans take at least one prescription drug¹ as part of their health and care, and pharmacy represents $405 billion² of our healthcare spend overall. Something that big and important needs dedicated support. But we also need to evolve and change alongside health consumers. In all aspects of our lives, we expect information, access, and transparency before making purchasing decisions. Why should our prescriptions be any different?

We see that happening at new, innovative companies like Mark Cuban’s Cost Plus, GoodRx, and many others. Additionally, many larger health plans are seeking partnerships with innovators, like Transcarent, to deliver these new models at scale.   

With our transparent PBM partner, Prescryptive, self-insured employers and their employees access a network of more than 60,000 retail, home delivery and specialty pharmacies. They can transparently see all their options – whether it’s cash, coupon, or insurance prices. 

Given the size of this industry, we simply can’t rip and replace overnight, nor will the shift happen fast enough if we try to replace the existing providers. To move forward, we will need everyone in the industry to begin to embrace what will bring about a more equitable and affordable pharmaceutical system. This includes making information available 24x7x365 at people’s fingertips, which today means on their phones; providing easy access, including home delivery and mail order; sharing insurance claims data; and offering full transparency on price and cost.    

We should also note that this is not simply about the lowest cost, but it’s about appropriate use, safety, and counseling when and where necessary. One very important example: GLP-1 class drugs are an amazing breakthrough in the weight health space, but only if coupled with lifestyle changes. 

At Transcarent, we believe:  

• Consumers should have easy, affordable access to the highest-quality medications they need – directly through their choice of retail pharmacies or mail order pharmacies. 

• Costs to consumers should be clear and unambiguous, and be available to them in advance of purchase. 

• Complexity in the medication authorization process should be reduced, recognizing that some medications may not be appropriate in all circumstances. 

• Availability of medications should not be based on a “pay to play” formulary positioning, but rather based on efficacy and standards of care.   

• Rebates should reduce the cost of medications for the individual health consumer and employers should have a line of sight into these rebates. 

• Patient education and counseling are necessary and valuable in delivery of pharmaceutical care. 

• Administrative services such as claims processing and data sharing must be done transparently and efficiently. 

As the One Place for Health and Care, at Transcarent, our intention is to work with all of the players in the ecosystem who embrace digital innovation, transparency, interoperability, and provide people with information that puts them back in charge of their health and care.   

¹ Ashley Kirzinger, Alex Montero, Grace Sparks, Isabelle Valdes, and Liz Hamel, Polling, KFF, “Public Opinion on Prescription Drugs and Their Prices” Aug 21, 2023

² CMS Newsroom, "National Health Expenditures 2022 Highlights" Dec 13, 2023