How One Company is Using Transparency to Streamline the PBM Industry

A co-founder of RxAdvance explains how it is trying to help pharmacy benefit managers tap the market’s full monetary potential. 

Another RXAdvance co-founder, Barry Katz, will be speaking at Privcap Game Change: Healthcare 2016, Nov 17 in NYC.

Pharmacy benefit management (PBM) and associated medical costs is a $850B market opportunity. Yet, according to Ravi Ika, co-founder and CEO of the PBM company RxAdvance, says technology limitations mean that companies are leaving more than half that amount on the table.

“It’s inadequately addressed,” Ika says.

RxAdvance is a national, full-service PBM. Their Collaborative PBM Cloud platform promises to deliver integrated services that reduce overall pharmacy costs, optimize specialty spend by converting from “buy and bill” to “authorize and manage”, and reduce avoidable drug-impacted medical costs while improving a patient’s quality of life through regulatory compliance and transparency.

“Twenty-five to 30 percent of medical costs are avoidable; half of those avoidable medical costs are physician or hospital abuse or overuse, Ika says. “The other half stems from ‘avoidable drug-impacted medical costs’—costs that would not have arisen had the drug benefit been administered correctly and comprehensively.” Having a PBM provider that understands the costs on the medical and pharmacy side can then lead to comprehensive solutions to address overall pharmacy cost reduction, and a significant reduction in avoidable drug-impacted medical costs, he explains.

RxAdvance is addressing the PBM market with three solutions: nirvanaRxCloud, which reduces the overall pharmacy costs through gains in efficiency; nirvanaAccountableCare, which aims to reduce avoidable drug-impacted medical costs; and nirvanaSpecialty, which aims to substantially reduce specialty medical costs while improving outcomes.

“These solutions are designed to improve transparency and relative value so everyone has the playing field to take their respective market share, financially, based on relative value and equal compensation,” says Ika.

He says that RxAdvance is leading the industry through system-driven compliance.

“We have the know-how, the platform, and the business model to transform [the industry],” he says. “In turn, if we can realize even half of the [untapped] savings that we have identified, that’s more than enough to cover the uninsured and underinsured, while also decreasing premiums for all Americans.”