The Evolving Landscape Of Pharmacy Reimbursement

Recorded on 02/06/24

In this episode, we take a look at the changing landscape for pharmacy reimbursement and the push towards a cost-plus model of reimbursement. Over the last few decades, growth in pharmaceutical utilization and an increasing mix of specialty drugs has helped drive strong performance for many participants in the pharmaceutical supply chain. As the largest channel for prescriptions, retail pharmacies have been an important part of helping drive growth in the industry. However, pharmacies, having faced years of margin pressure, have not seen the same degree of benefit as others in the supply chain. For many years, pharmacies have dealt with lack of transparency in how drugs are priced, as well as uncertainty about whether reimbursement will adequately cover the cost of drugs and time associated with patient care. For more than a decade, with increasing levels of generic substitution, retail pharmacies have been able to manage their margins by cross subsidizing potential losses they would see on brand drugs with the profits they would gain on generics. But, with generics now making up more than 90% of prescriptions, the benefit from generic conversions and the ability to cross-subsidize has been maxed out and the pharmacy reimbursement model is clearly in need of change.

To help us discuss this topic, we're joined by Michael Rothrock, who brings more than 20 years of experience within Managed Care as well as the PBM industry. Before starting Allegheny Strategic Partners, Mr. Rothrock was the VP of Pharma Strategy and Contracting at Express Scripts, where he was responsible for leading Commercial and Medicare formulary contracting and strategy.

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