This episode of The ShiftShapers Podcast is called “New Developments In Pharmacy Cost” with Garrett D’Antoni of NavRx, a prescription benefit manager (PBM) with a commitment to transparency.
Garrett begins by defining companion diagnostics then breaks down the confusing nature of NDC codes and why some PBM’s can charge astonishing amounts for prescribed medications. He also goes into detail about the increasing popularity of pharmacy tourism and the significant cost savings it offers.
What You’ll Learn From this Episode:
- 02:50 Providing expensive drugs with companion diagnostics
- 06:15 NDC codes explained
- 13:00 Generating massive savings with pharmacy tourism & prescription care coordination
- 18:20 The future of pharmacogenomic testing & PBM’s
05:17 “There’s not enough drugs that are mapped genetically that says okay, this is how you’re going to metabolize it. And so, as we move towards that, you’re right, it comes down to do I take it or do I not take it?”
08:24 “This is where the spread pricing comes in. So a pharmacy could submit one NDC, the PBM can charge a client on a different NDC, so you’re basically switching the NDC from one price to another.”
09:21 “You have to get the information. That’s the most difficult part when you go to a PBM and say, well, let me see what you actually paid the pharmacy. Is that what you billed me? And so that’s when they’re saying it’s proprietary information.”
11:35 “You have the polytherapy problem where the one drug causes your stomach ache so they put you on another drug. And before you know it, you’re on five different medications.”
15:55 “You have these countries that you’re getting up to 50, 70 percent discount on the medication. You’re traveling there three to four times a year. You’re bringing back basically 90 days supply. And you’re able to keep some coordination or continuity of care.”