US-Rx Care

US-Rx Care brought fiduciary commitment to the PBM industry. Without the PBM conflicts of interest, we focus solely on delivering best clinical outcomes and lowest cost (30%-50%+ lower spend PMPM).


What is US-Rx Care?

Thank you. It's a pleasure to be here. US-Rx Care is a fiduciary PBM, and I'll come back to that in a minute. We really do lean into the word fiduciary. It's important to understand that we are not a product of the PBM industry. We came out of the health plan space. Think of director of pharmacy at Humana or Blue Cross or Centene back in the day when they had 2 million Medicare, Medicaid, commercial lives. That's where we grew up, managing pharmacy risk for at-risk health plans. It's a very different environment than the traditional PBM model where at the end of the day, they're selling drugs to members at a profit, and there's no risk management. In fact, it's the opposite in that traditional model.

How is US-Rx Care different?

Yes, and I mentioned the word fiduciary. We take that very seriously. We define what it means to be a fiduciary in our contract, and we hold ourselves to that standard. There are three core elements. Number one is no conflicts of interest. Number two, only looking out for the best interest of the plan and plan participant and number three is all utilization and financial information in full view, which is transparency. So note that transparency is one of three elements under fiduciary. I'm often asked, are you a transparent PBM? And we say that we are, and that that's one of three elements, but we don't believe that's enough. You can have a transparent PBM that's conflicted. For example, they can own the specialty pharmacy, they can own the mail order pharmacy. They can collect rebates, which is an incentive from drug manufacturers to push certain products, right? At the end of the day, the drug manufacturer, want a return on investment. And the last thing I'll say on this front is because we are fiduciary compliant, and it's in our contract, we're fully in alignment with employers fiduciary role under the CAA.

Who is a good fit for US-Rx Care?

Any employer that doesn't want to overpay for medications and doesn't want to pay for medications that are not needed, any employer that wants to reduce their drug costs by 30 to 50% without changing benefit design or disruption. I want to share just one clinical example. When you're working a health plan, you get really clinical really quickly. We've had four of these cases for this drug, Strensiq, that we have inherited from other PBMs. This is a drug that costs about $2 million a year. In each case, after our due diligence, we found out that none of these patients had the disease, not one, yet they were costing their plan over $2 million a year. It's important to understand that the PBM prior approved it and the PBM was dispensing it. There is the conflict of interest. Visit our website, usrxcare, get in touch with us, we'd love to chat.

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Duration: 02:57

Posted: Thursday, February 22, 2024

Video tags: Under 50 EEs, 51 - 100 EEs, 101 - 250 EEs, 251 - 500 EEs, 501 - 1000 EEs, 1001 - 2500 EEs, 2501 - 5000 EEs, Over 5000 EEs