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Pharmacy Benefits Made Simple
Episode 673

Mark Campbell, Vice President of Clinical Services for RxBenefits

Pharmacy Benefits Made Simple

In this episode, our guest is an experienced health care executive with a focus on all aspects of the pharmacy benefit management programs. Mark Campbell is the VP of RxBenefits and today, he discusses how his company works with employee benefit consultants and self-funded clients who are trying to get the best price. He talks about some of the benefits of RxBenefits provides, including 15-25% yearly savings, better purchasing terms, better utilization management, and more. 

 

Mark also shares his insights on evolving as a company, looking for the 2% of members who are driving the cost, listening to the market, medication affordability and sustainability, getting personal with the employer, and more! If you are looking for an incredible opportunity for you, your business, your employees to do better, tune in to this awesome conversation with Mark Campbell!

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Pharmacy Benefits Made Simple

Episode 673

About Mark Campbell

Mark is the Vice President of Clinical Solutions at RxBenefits, a technology-enabled pharmacy benefits optimizer focused on delivering value to employee benefit consultants and their self-funded clients. 

Mark has 22 years of pharmacy career experience with a Doctor of Pharmacy degree from the University of Tennesee and a board-certified residency in Geriatrics at the Veterans Administration of Memphis.

He has held numerous positions such as President and CEO of Innoviant Prescription Benefits, Vice President of Prescription Solutions, and President of Health Information Designs. 

Pharmacy Benefits Made Simple with Mark Campbell, Vice President of Clinical Services for RxBenefits transcript powered by Sonix—easily convert your audio to text with Sonix.

Pharmacy Benefits Made Simple with Mark Campbell, Vice President of Clinical Services for RxBenefits was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2021. Our automated transcription algorithms works with many of the popular audio file formats.

Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket. Today, I have the privilege of hosting Mark Campbell, he is the Vice President of Clinical Solutions at an outstanding company called RxBenefits. They’re doing some extraordinary work in helping people get better pharmacy benefit management programs. Mark’s an experienced health care executive with a focus on all aspects of the pharmacy benefit management industry. He began his twenty-two-year pharmacy career with a doctor of pharmacy degree from the University of Tennessee and a board-certified residency in geriatrics at the Veterans Administration of Memphis. From there, Mark went on to hold numerous positions, such as President and CEO of Innoviant Prescription Benefits, Vice President of Prescription Solutions, and President of Health Information Designs. He joined RxBenefits in 2017, where he serves as the vice president of Clinical Solutions. And today he’s going to share with us what exactly they’re doing there to provide that expert advice to help people get those savings that they’re looking for. It’s a really out of control area of health care. So it’s such a privilege to have you here with us. Mark, can’t thank you enough for making the time.

Mark Campbell:
Well, thank you very much for having me. I’m looking forward to it.

Saul Marquez:
Likewise. So before we dive into our RxBenefits and all the things that you guys do to make health care better for us, tell us a little bit about you, Mark, and what inspired your really just long career in health care? What lights the fire for you.

Mark Campbell:
Thank you very much. I got into managed care in the late 90s and I began working with self-funded employer groups. And the prescription benefits industry can be a bit daunting. It can be complex at times and there’s a lot of drugs out there. So it’s very difficult for the average human resources person to really spend the time and focus in a way that’s going to help them maximize the quality and the cost of care. So I found a role for myself in helping to give them an education, advise them, giving them some direction so that they could feel good, that what they were doing was really the best thing for their members clinically, but also helping them to balance the costs associated with prescription benefits. Back then, it was six percent of the total health care dollar, and today for many as well, over 20 percent. So it’s been a very satisfying career because I think we’ve been able to help a lot of people along the way bridge that gap and manage their costs and feel good about what they’re doing.

Saul Marquez:
Yeah, that’s I mean, your purpose is so clear, Mark. And I’m a firm believer in following one course until successful. And you’ve been doing it for so long in the same area, I’m sure you have seen a lot. And yet you call out from six percent to 20 percent. It’s egregious what’s happening right now and in health care for a lot of employers and individuals. Talk to us exactly about what RXBenefits is doing to help in the health care ecosystem.

Mark Campbell:
Sure. So, as I mentioned, the prescription benefits industry can be relatively complex. And so there’s all these new drugs, some of them very, very expensive, tens of thousands of dollars, and some are less expensive. So for an employer who has five hundred thousand or more people that they’re responsible for, those people on average are using 10 prescriptions a year and many of them are generic, very good value, very helpful at sustaining a much better outcome to lower incidence of heart disease and strokes. But for them, many of the newer drugs are a bit of a question mark. So a lot of the drugs and treat rheumatoid arthritis and chronic conditions for gastrointestinal issues or some of the new cancer therapies. These are drugs that can cost anywhere between fifty thousand and a million dollars a year until they find themselves in a very different situation. Now, really trying to understand the cost-efficacy associated with such a small number of their members. So our ability to come in and help give them some guidance, some reassurance and help them navigate that process can be particularly useful, not just from an economic standpoint, but just to make sure that they feel like they’re doing the right thing for their members. Most every employer I’ve ever met wants to make sure that they give full access to their members the things they need. But at the same time, they’re trying to balance the cost of this new world against the realities that they have to live in today’s economic environment.

Saul Marquez:
Well said. I’ve even heard of you mentioned it, right. Complexity, complexity, complexity, complexity, and there’s so much that we don’t know and that we could learn from a company like yours. I’ve heard from folks that oftentimes for one therapy, there could be six solutions. You know, the form is different. It’s in the tablet, it’s in a powder, it’s in a syringe. There’s a lot there that we don’t know. And so talk to us a little bit about that and what you believe makes what RxBenefits provides different and better than what’s available there.

Mark Campbell:
Sure, and it’s a great question. I think I have a pretty good example for you to illustrate. There are a lot of parties that are involved in the health care delivery model. You have patients who are inherently very good people trying to do the right thing, you have doctors again, inherently good people, really trying to do the right thing. Manufacturers who develop new therapies and bring them to market, which can be very good for us in general. We have PBM’s that help to connect to pharmacies and the manufacturers and all these parties together. And so all of those entities and individuals are inherently trying to do the right thing. But there are gaps that can occur as those parties try to come together. And I’ll give you an example. A patient may go to see a physician and the doctor may prescribe medication. Some medications are what’s called parity prices. So you can have the same price regardless of the strength of the medication. And while that may not sound like very much, in the case of certain medications, that could be the difference between paying two hundred forty thousand dollars a year for a patient who is taking a medication for a particular type of cancer and paying nine hundred and sixty thousand dollars a year.

Mark Campbell:
So because the one-milligram tablet for milligram tablet costs the same for one-milligram tablets, it cost four times as much as a one-milligram tablet.

Saul Marquez:
So, my goodness.

Mark Campbell:
In a sense, what you really need is somebody who understands these complexities, is watching out for these things, who can step in. And we’ve done that on many cases where we reach out to the doctor who’s not particularly aware that this exists and affect change, which has a substantial impact on the employer financially. There’s no negative impact on the member, no negative impact on the provider. So it’s really just a way of trying to find those opportunities where things can be done that are going to drive better clinical and economic outcomes. And that’s not a role that any one of those individuals in and of their own right can play. So having someone who can kind of sit on top of that can be very, very useful.

Saul Marquez:
Absolutely. Wow. That’s a different angle. I never heard that one before, Mark. It’s surprising. And, you know, again, it’s a testament to how valuable having a partner like RxBenefits could be for self-funded employers. But you guys help more people. I mean, I feel like this is typically the crowd that could benefit most from this type of health care navigation. But maybe you want to share a little bit more about how you’re helping serve others.

Mark Campbell:
Sure. So we really focus on working with employee benefits consultant and their self-funded employer clients. And so our customers range on the small end from one hundred or even below one hundred up to tens of thousands of lives. And so with these employers, again, they’re trying to navigate a system where they’re trying to get the best price, make sure that they’re doing the best to help manage the utilization so that they get that balance that we talked about earlier. So we have nearly two thousand clients and roughly two and a half million, soon to be three million members that we take care of. And the intent is really to create that experience that for the individual member is exactly what they need at that point in time. And for the employer making sure that we’re doing that, a holistic umbrella plan that is going to give the right solution to all of their members. And so it’s a very effective model that we work with the three largest PBM in the industry. But then we put into that our own member services, our own customer service, our own clinical program management to create that unique circumstance and benefit for the employer.

Saul Marquez:
So you don’t necessarily have to throw the PBM out with the bathwater.

Mark Campbell:
That’s a good way to say it. No PBM’s bring a lot of things to the marketplace, and so they have systems that can help to manage claims for all types of benefit designs, and they have the volume that can help to drive better purchasing through manufacturers. They have pharmacy networks that can provide access from border to border and coast to coast. So those things can be remarkably valuable. But if you think about a PBM servicing federal programs and commercial programs and groups as small as, you know, very small, 10, 12, 15 people all the way up to groups that serve hundreds of thousands of people, you can imagine that there can be some complexity behind the walls. So for us to be able to do a lot of that for the employer provides a more tailored experience for them. And then we can leverage those things that the PBM’s bring to the table that is good and can be very valuable to a self-funded employer.

Saul Marquez:
Wow. Well said. Well said. And this is a great opportunity, right? I mean, you can’t expect your PBM to be able to offer a tailored solution. And just if that’s your expectation, you’re getting let down, as many of us are. And Mark and his team’s approach is unique and an opportunity for us to think about how we’re providing benefits and a lot of times a unique approach like this, a tailored approach not only saves you money, but it offers you an opportunity to help improve access and outcomes for your employees. So talk to us about that. Give us an example about how you guys are improving outcomes and making business better.

Mark Campbell:
Absolutely. And I appreciate the opportunity. We started some of our clinical programs in 2017 and some of our first customers adopted the programs. One of them was a school board with about twenty-five hundred members in the plan. So we brought our approach to them and they were quick to adopt it and put it into place. In the first year that this plan put the programs in place, they saved roughly two million dollars on about 15 million dollars spent. The impact on their members was almost nil. So they didn’t get any complaints from the membership for the program. So we truly impacted a pretty small number of numbers overall. But the benefit to the school system in terms of their ability to reinvest that money back into their benefits or into their salaries or their school infrastructure was particularly material. And so it makes you feel good that we’re able to do something that really didn’t alter things for anyone in a negative way, saved a lot of money, and allowed them to do some things with that money that were more beneficial for them and for their employees.

Saul Marquez:
Wow. That’s meaningful. You know, and you think about you always hear about it. You know, across the country, teachers that are struggling to get fair pay and, you know, for such an important role in our society. For you guys to come in and say, hey, here’s several million. I think that’s rewarding.

Mark Campbell:
It is that I and the truth of the matter is is that’s not an isolated account. I think on average, our groups coming to us can say between 15 and twenty-five percent in the first year by optimizing their contract, getting better purchasing terms, getting better utilization management through the clinical programs. I’ve seen savings as high as thirty-five percent, but it’s easy to find out what the potential is. Our folks are quite good at going through data and helping people get a very good understanding of what they might achieve by moving to our office.

Saul Marquez:
Yeah, it’s pretty neat. You guys have a cool little calculator. So, folks, you’re listening to this and you’re intrigued. Go to our RxBenefits dotcom. They’ve got a calculator there. It’s a very basic one. But just to give you an idea, Right. like I’m a big fan of anybody that could be transparent and for somebody to say, yeah, look, I’m going to be able to offer you X percent and just put it on the front of their Web page. I mean, that’s awesome. You know, and that little calculator, Mark, I saw it. I played with it. Significant tight., especially as you consider how much money we’re spending on health care each year. It’s impacting our global competitiveness. It’s impacting so much. You guys are making a big difference and I would say contributing to the American dream.

Mark Campbell:
Well, thank you for that. We’re very proud of what we’re doing. And I think if you in front of the trend now, you’ll feel much better about it. Two years from now or three years from now, there’ll be new drugs coming to market and they’ll be more expensive. That will incur many of those will be well justified. But just the same, if there is a way for you to reduce expenses, just not really adding anything to the solution, now’s a good time to do that.

Saul Marquez:
Love it. And so talk to us, Mark. I mean, this kind of work doesn’t come without its lumps. So talk to us about maybe one of the biggest setbacks you’ve had and maybe an experience, a key learning you got out of that.

Mark Campbell:
So if we’ve got about four or five hours, I could probably give you a lot of examples. But I think you only have a few minutes. But this industry has evolved and changed a lot since I got into it. And so I’ve had to constantly kind of reassess where we’re at and what my approach is for what we do. And so there have been times with some of the clinical programs where I feel like our intent was the right thing and maybe even at the time it was a good solution. But we do have to grow and evolve. So if we look at some of the things like step therapies, those were programs that were really designed to help promote the use of the lower-cost brands to generic medications 10, 15 years ago. But the absolute necessity for those types of programs aren’t what they once were so we’ve got a lot of people. Eighty-seven eighty-eight percent of the people on generics now. So going out and pushing that type of a solution is disruptive, but doesn’t really create a lot of savings for employers. So we’ve had to kind of refocus ourselves and look at those one or two percent of members who are really driving 60 percent of the cost and find a way to integrate with them and with their providers so that we can have a more meaningful impact and really reduce our footprint and not have a negative experience for a member. So you kind of go until you get some feedback from members, from employers, and then you modify your approach, but it’s constant listening and adapting to what our customers of the market are telling us.

Saul Marquez:
Yeah, some great lessons there. And yeah, you know, it’s you take deeper dives, you learn a little bit more and you uncover new opportunities sometimes. So. So what would you say, Mark, you’re most excited about today?

Mark Campbell:
So I think there is an enormous amount of potential on the horizon. Employers, we’re going to see a lot of new drugs come to market and many of those new drugs can be particularly valuable to them and to the employees that are covered under their benefit. And if you look at certain types of cancers were 20 years ago we might have said, well, we’ve done all we can. We know how people who’ve been living with chronic myelogenous leukemia for 20 plus years and that would have been unheard of a long time ago. We have people with rheumatoid arthritis and other conditions that really do have a therapy that has made a material difference not only in their daily lives but in their life expectancy. And I think we’ll continue to see much more of that. What we have to do, though, is make sure that it’s sustainable for employers, that it’s affordable for employers. And that’s where I get very excited about what we’re doing because I think we’re helping them really match up the accountability for both making sure that things are as clinically appropriate and economically practical as possible. So we have some new programs that we’re working on right now that would provide protection for employers, that the cost goes above two hundred fifty thousand for an individual member, something that’s truly necessary, but at the same time could be a catastrophic expense for them. And to me, that’s very, very exciting.

Saul Marquez:
Totally. Yeah. And, you know, I can’t imagine that it’s easy. I mean, for an employer that has a focus on driving their business outside of health care, call it, they still have a health care business if 20 percent of their money is going there. Right. So for you, Mark, and your team who are solely focused on this, I’m sure it’s still hard for you guys to see and know what those new medications are. How do you guys do it and how do you stay ahead of it?

Mark Campbell:
Well, it’s a great question. I have a wonderful team of pharmacists who work for our company and they work with our clients, with our employee benefit consultant, and really get into the weeds and help them understand. So we’re dealing with a small employer who has one individual, a chronic condition that’s driving 40 percent of their cost. We can really dig into that with one of our clinicians. And it really gets down to a very personal level with the employer and with Broecker many times just to talk through what’s going on. Not everyone has someone who’s costing them two hundred and three hundred four hundred thousand dollars or more. But right now I’d say about one in 10 employers are going to see an expense like that. So we have to guide them and give them their options and help them understand how they can maximize value. For those that aren’t there, it’s preparing for the future. And how do you make sure that you take care of things so that you can afford that expensive patient when you give further down the line, make sure that you don’t leave the door open to pay for something like the example I gave earlier, where you’re going to pay four times more for something than you could or should. So it’s, you know, it’s a balancing act because not every employer has all day, every day to spend thinking about pharmacy benefits. But it’s definitely a big concern for them for sure.

Saul Marquez:
Thanks for that. You know, it’s really valuable to have, you know, pharmacists on the team and obviously credentials as a pharm d it speaks to how deep you guys get in the weeds and how important it is to have a partner that really understands the intricacies of the drugs, you know, their effects, the chemical composition, etc. So really, really an awesome conversation today. Mark, I love it if you could just leave us with the closing thought, leave the listeners and leave us all thinking about something. And then the best place where they could get a hold of you and your team to learn more.

Mark Campbell:
So thank you. And I enjoyed the discussion as well. As you think about prescription benefits and where we’re at today and where we’re going to be five years from now or 10 years from now, there’s going to be a lot of good and there’ll be some challenges that come along with it. Just kind of think about that, that goal line manufacturers, PBM doctors, patients, a lot of different parties. And so it’s very important to make sure that you have a seat where you can take a look and make sure that the goals of all of those individuals and institutions are aligned for the benefit of the employer. Very, very important. And it can mean the difference between having really optimal care and cost and not so at our expense. If that’s what we do. We’re proud of what we do and we’re happy to spend the time with anyone who might be interested to help. Figure out where their opportunities are today and if you take care of those opportunities today, I think you’ll be in a far, far better place two years from now, three years from now, or four years from now, and managing your cost and maintaining a sustainable benefit.

Saul Marquez:
Well said, Mark. And so the website is RxBenefits.com Would that be the place they reach out to, Mark, or is there anywhere else?

Mark Campbell:
Yes. And so we have a content hub there. There are all kinds of information. We can certainly facilitate a number of connections through that Web address and make sure that we get you what you need.

Saul Marquez:
Love it. Yeah, folks, go to RxB benefits.com. There’s a content hub right in the middle. Tons of great stuff, videos, and blogs, all kinds of great stuff. So make sure you check that out. Now’s the time. You start now. It could be an incredible opportunity for you, your business, your employees, to do better. So, Mark, just want to thank you again for sharing your wisdom with us today, and certainly looking forward to staying in touch with you guys.

Mark Campbell:
Well, thank you very much. Appreciate it.

Saul Marquez:
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Things You’ll Learn

  • We’re going to see a lot of new drugs come to market and many of those new drugs can be particularly valuable to them and to the employees that are covered under their benefit.
  • Make sure that you have a seat where you can take a look and make sure that the goals of all of those individuals and institutions are aligned for the benefit of the employer.
  • Figure out where their opportunities are today and if you take care of those opportunities today,  you’ll be in far, far better place years from now, and managing your cost and maintaining a sustainable benefit.

 

Resource

https://www.rxbenefits.com/