MINNEAPOLIS, Nov. 21, 2019 /PRNewswire/ -- Excelera®, the company behind the Excelera Network, a nationwide network of leading health systems and academic medical centers with specialty pharmacies, today announced the Excelera Pharmacy Benefit Management (PBM) Solution for health systems designed to demystify traditional PBM models and leverage the strengths of health systems: clinical care, access to care and the patient experience.
The need for a new, patient-centric PBM model is urgent. Through mega-mergers and acquisitions, the PBM industry has consolidated into an exclusive group of dominant players in the healthcare marketplace that reap profits by chasing manufacturer rebates, marking up prices to community pharmacies and forcing patients to use PBM-owned pharmacies. Further, inflexible formularies overlook the issues of total cost of care and inappropriate medication utilization. As a result, the industry has drawn attention from regulators, legislators and journalists regarding the effects of industry practices on drug prices and shortages of critical medicines.
"In theory, the idea of a PBM is a good one – there are undoubtably ample benefits to leveraging the purchasing power of a buying network to negotiate with manufacturers for rebates on prescription medications. However, lack of transparency and oversight in traditional PBM models means there's no way to ensure rebates and savings are being passed on to consumers," said Don Amorosi, Chief Operating Officer at Excelera. "A PBM entity that has 'skin in the game' and provides transparency to stakeholders, however, can truly reduce the cost of care while simultaneously improving medication access. With the Excelera PBM Solution, we have created just such a model, which brings increased drug access and additional savings to our network members and the complex patients they care for."
Three characteristics make the Excelera PBM Solution unique:
- Clinical Integration and Control: Excelera's PBM Solution enables health systems to control and manage utilization, formulary, clinical protocols and pharmacy network selection to support the unique needs of individual patients and populations in its market. Clinical excellence has come to the forefront and is incentivizing innovation, cost containment and flexibility in ways that industry-dominant PBMs currently do not.
- Cost: Excelera's PBM Solution provides cost savings through formulary control (e.g. high cost, highly rebated drugs) and utilization management, including decreased utilization of inappropriate therapies (e.g. step therapy, quantity limits, prior authorization criteria). Competitive, market-leading PBM contracting as well as control over network design and prioritization of Excelera member pharmacies will further enable reduced spending on drugs.
- Transparency: Excelera has removed the incentive misalignment associated with traditional PBM pricing, an opaque process that typically places high markups on cheaper generic drugs and demonstrates a marked preference for high-priced branded drugs with high rebates. The Excelera PBM Solution will be transparent about any manufacturer rebates. Pricing will be comparable to coalition pricing.
The new PBM Solution is one of a series of novel and innovative Excelera offerings intended to empower health systems in complex pharmacy patient care. Excelera will begin selling its PBM Solution in 2019 and is expected to be ready to deliver in the first quarter of 2020.
The Excelera Network is comprised of over 20 integrated health systems with a deep commitment to appropriate and effective pharmaceutical care for the most vulnerable complex pharmacy patients. Excelera members optimize pharmacy patient care with tools including a proprietary integrated data platform, comprehensive reporting, performance benchmarking, and education on industry best practices. Excelera also offers specialty pharmacy startup consulting, a program for gaining access to limited-distribution drugs, data analysis and reporting programs, and a payer access program.
To learn more about the Excelera Network, visit https://www.excelerarx.com/
About The Excelera® Network
The Excelera® Network is comprised of integrated delivery networks, health systems, and large academic medical centers with a deep commitment to caring for complex patients. Through national-scale collaboration, the network more efficiently gains access to limited distribution drugs, utilizes tools, technology, and best practices to deliver high quality care.
ExceleraRx Corp is a healthcare company that empowers integrated delivery networks, health systems, and large academic medical centers to provide integrated care for complex patients, leading to improved health outcomes and decreased healthcare costs. To learn more, visit https://www.excelerarx.com or follow us on LinkedIn.
SOURCE ExceleraRx Corp.