The next generation of PBMs?Healthcare Navigation Businesses Pivot Right – Healthcare Blog

The next generation of PBMs?Healthcare Navigation Businesses Pivot Right – Healthcare Blog

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By JESS DaMASSA, WTF Health

Pharmacy benefit management (PBM) innovation is even more compelling, this time from Care Navigator plus PBM startup Rightway. CEO Jordan Feldman and Chief Pharmacy Officer Scott Musial (who Jordan calls the “Godfather of PBM”) come to talk about their 1,500 employer customer base and how the business is now winning over health plans tired of working with the “big” three PBM.

The NextGen PBM story is the headliner here, with Rightway customers saving an average of 18% in their first year using the company’s “new PBM.”

what’s the difference? Two big things. First, the pay structure of PBM to employers. Jordan shares how these are often rebate-driven or priced based on spreads; Rightway is actually innovative, offering PBM benefits on a per-member-monthly basis.

This leads to a second twist, which is based on cost savings for employers by pairing PBM with navigation. According to Scott, this shifts the conversation from just focusing on managing drug prices to managing how employees use formularies — creating an opportunity for lower-priced generics or alternatives that Rightway is happy to point out, since it doesn’t do deals with rebates or distributions.

So, who does Rightway compete with? Navigator like Accolade, Inc. or Included Health? PBM like CVS/Caremark, Optum or Express Scripts? Or other emerging “portfolio” businesses like Transcarent?

We enter the competitive landscape with more information on PBM than you can imagine, and what Jordan and Scott hear from hard-hit employers looking to recruit and retain employees amid mass quits.




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