MONTVALE, N.J., August 24, 2023 — EmpiRx Health, the leading value-based PBM company, applauds Blue Shield of California for joining it in implementing a value-based pharmacy care model. Building on its longstanding leadership as the value-based PBM pioneer, EmpiRx Health also announces that it is launching a Four-Point PBM Revolution Plan for customers. The new plan is designed to further transform the PBM industry by putting the needs of plan sponsors and their members first with value-driven pharmacy care.

EmpiRx Health’s “value versus volume” model is built on a clinically driven pharmacy care approach that puts a pharmacist at the center of the care model. Using AI-powered population health analytics, EmpiRx Health pharmacists work directly with prescribers, dispensing pharmacies, and members to coordinate the best pharmaceutical care. This clinically driven, customer-first approach helps to deliver better health outcomes while guaranteeing cost savings to plan-sponsors.

“We welcome this move by Blue Shield of California to put its size and influence behind the value-based pharmacy care model that EmpiRx Health has pioneered since its founding in 2014,” said Danny Sanchez, Chief Executive Officer of EmpiRx Health. “However, we view this as just a first step by a leading health plan to help advance the critical transformation of pharmacy benefits care. Much still needs to be done.”

Sanchez continued: “We invite the entire PBM industry to join with us in helping to lead this transformation. More than ever, we need bold action to radically change the current, deeply flawed pharmacy benefits system. That’s why we’re launching a Four-Point PBM Revolution Plan and encouraging our industry colleagues to embrace this customer-first operating model.”

The EmpiRx Health Four-Point PBM Revolution Plan is built on these key operating principles:

  • Embrace a ‘Value Versus Volume’ Business Model – Traditionally, PBM companies have acted more like financial or retail firms, focused on arbitrage and volume-driven trading transactions to fuel profits. This legacy model is antithetical to the goal of enabling customers to keep their members healthy, happy, and productive, while significantly reducing drug costs.
  • Put Customers and Members First – PBM companies have long been criticized for opaque and highly complex business models that are designed to maximize their profits, not prioritize the needs of customers and their members/employees. By putting the needs of customers first with value-based, clinically driven pharmacy care, everyone wins.
  • Drive Better Health Outcomes with Clinically Driven Care – Pharmacy care is healthcare. The PBM industry must recognize that fact and prioritize its strategies and operating models around clinically driven pharmacy care. At EmpiRx Health, this means analyzing the populations we serve, identifying those at risk, and engaging with prescribers to provide patients with clinically appropriate, cost-effective therapies that maximize health outcomes and reduce costs.
  • Turn Pharmacy Benefits into a Strategic Asset – Pharmacy and healthcare benefits have traditionally been viewed as complicated cost centers that need to be effectively managed, or even cut, to ensure the financial health of an organization. Here again, EmpiRx Health is revolutionizing the industry by helping clients turn pharmacy benefits into a strategic asset that drives better business and organizational results. According to a recent study by SHRM, the Society for Human Resource Management:
    • 56 percent of employees said that whether they like their health coverage is a key factor in staying at their current job.
    • 46 percent said health insurance was either the deciding factor or key influence in choosing their current job.

The rising cost of prescription drugs is a primary driver of overall healthcare spending in the US. This continuing trend is fueled by several factors, including the proliferation of high-cost specialty medications, a lack of price transparency, and the misalignment of incentives in the pharmaceutical supply chain. The Centers for Medicare and Medicaid Services project that pharmaceutical spending is rising at an average annual rate of about 6 percent, faster than other areas of healthcare.

Read the full press release HERE.