Business Insider and the Wisconsin State Journal recently featured Navitus and how its alternative PBM business model is gaining attention among employers.
As the pharmacy benefit landscape continues to evolve, plan sponsors must keep pace to ensure they can control the costs of their drug benefit and improve health outcomes for their employees. Plan sponsors are not only challenged with a shifting pharmacy landscape but also its increasing complexity. As they work hard to improve the quality of their drug benefit programs, they expect their pharmacy benefit managers (PBMs) to provide them with cost-effective strategies to manage their drug benefit and maximize plan savings.
This blog summarizes highlights from both Business Insider and the Wisconsin State Journal articles.
Navitus Health Solutions, started in 2003, has about 950 employees, including more than 200 at its Madison, WI headquarters and more than 600 in Appleton, WI its operations center.2
PBM Practices Under the Microscope
Although PBMs are an integral part of the supply chain, employers are frustrated with the lack of insight into their financials. And their practices have come under the microscope and PBM regulation.1,2 This year Wisconsin passed a law requiring PBMs to be licensed and report on rebate retention.2 Because of Navitus’ transparent, pass-through business model, “There were very few, if any, business practices we needed to change as a result of the legislation,"2 said Brent Eberle, Senior Vice President and Chief Pharmacy Officer of Navitus.
More Savings With a Transparent, Pass-Through PBM
Traditional PBMs gain revenue from spread pricing, rebates and fees. Although some traditional PBMs may pass through a portion of the rebates, plan sponsors question whether they are getting maximum savings.1 When plan sponsors work with Navitus, they benefit from a fully transparent, pass-through business model whereby they pay a single administrative fee. All rebates, discounts and fees are passed along to the plan sponsor. Navitus offers a lowest-net-cost approach and saves clients on average 15% “because the company doesn’t take spread or chase high rebates.”1
"There’s a coming recognition among plan sponsors … that this transparent, pass-through model is really the optimum model,”2 said David Fields, President and CEO of Navitus.
Specialty clients also benefit from the administrative fee model.2 Through Lumicera®, Navitus' specialty pharmacy, clients recognized significant savings. An example, monthly costs were reduced from $7,000 a month to $300 a month when members quickly switched to the generic version of Tecfidera®, a multiple sclerosis drug.2 “If we were getting a percentage of a higher-cost product, we may not be incentivized as the pharmacy to move people to the generic as quickly,"2 said Eberle.
Commitment to Better Serve Clients
The future for Navitus is full of growth potential and capabilities for its clients. Navitus provides pharmacy benefit management services to over 7 million lives and over the next five years plans to increase this to 15 million lives.1 In addition to the partnership with Costco to lower costs, Navitus is also expanding its specialty pharmacies by purchasing CareMetx Health, located in Gaithersburg, Maryland, and plans to add another in Southern California.2 “We have an exceptionally aggressive growth goal. We are not looking to acquire market share. What we’re looking to do is acquire capabilities,”2 said Fields.
Read the original Business Insider article here and the Wisconsin State Journal article here.
1 Livingston, S. Companies are Ditching Massive Drug-Industry Middlemen in Favor of Smaller Competitors Reimagining How We Pay for Drugs. Business Insider. https://www.businessinsider.com/companies-are-starting-to-work-with-transparent-pharmacy-benefit-managers-2021-6. Published July 1, 2021. Accessed July 23, 2021.
2Wahlberg, D. Madison-based Navitus, with Costco as part owner, expands its drug benefit business. Wisconsin State Journal. https://madison.com/wsj/news/local/health-med-fit/madison-based-navitus-with-costco-as-part-owner-expands-its-drug-benefit-business/article/_c4350902-f798-5191-855c-862f30b6f4e4.html. Published June 7, 2021. Accessed July 23, 2021.
