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Raulo S. Frear, PharmD, Says How PBMs Are Aligning Benefit Designs for Delivery System Reform
Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways. With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs, Dr Frear says. They're still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.
Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways.
“With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs,” Dr Frear says. “They’re still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.”
He adds that over time, as various programs are put into place, and as evidence of these programs affecting cost emerge, reform will naturally lead to different types of designs in benefits, formulary, or utilization management tools.
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Safety and Efficacy Updates for Asthma and Urticaria Therapies
April 5th 2025The long-term safety and efficacy of omalizumab, alongside promising phase 3 trial results that demonstrated the efficacy and favorable hematological safety profile of remibrutinib, were highlighted at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
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High-Impact Trials at ACC.25 Signal Shift in Chronic Disease Treatment
April 4th 2025Experts highlight groundbreaking research presented at the American College of Cardiology Annual Scientific Session (ACC.25), which emphasized a shift toward more personalized, evidence-based treatment strategies.
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