Frustrated with the lack of accountability of the pharmacy benefit manager (PBM) industry to its employer clients, the Purchaser Business Group on Health (PBGH) has launched its own PBM called EmsanaRx.
San Francisco-based PBGH is a nonprofit coalition of nearly 40 large, private employers and public healthcare purchasers. It has launched Emsana Health as an independent company to build healthcare products that meet the needs of large employers and their employees. PBGH is a majority owner of Emsana Health.
Designed to address the concerns of many U.S. employers that the healthcare services they buy are of uncertain quality and exorbitantly priced, Emsana Health will serve as an innovation studio to develop products designed with and for PBGH member organizations. Its first business unit is EmsanaRx.
“Our members have asked us to use our unique position in the market and deep expertise with large employers to help them develop solutions for the pain points that aren’t being addressed by the status quo and to reshape the healthcare market so it delivers for them and the employees they cover,” said Elizabeth Mitchell, president and CEO of PBGH and chair of the Emsana Health board, in a statement. “Emsana Health and its first business unit, EmsanaRx, are a natural outgrowth of PBGH’s 30-plus years of work redesigning healthcare markets to reflect our members’ priorities. Purchasers feel they’ve given the healthcare industry ample opportunity to reform the payment and delivery system, but it simply hasn’t happened,” Mitchell added. “Now, purchasers are taking bold action to improve healthcare value and quality. Emsana Health is here to help them make that happen.”
PBGH said that EmsanaRx is structured to address the lack of accountability of the PBM industry to its employer clients, who largely lack access to information about drug costs, true discounts and administrative fees that contribute to huge profits — predominantly for three PBMs dominating 80 percent of the market. It said EmsanaRx’s business incentives are structured to align with the interests of the large employers paying the bills.
Emsana Health is led by Julia Hutchins, the company’s new managing director. Most recently, she was the chief strategy officer and co-founder of Apostrophe, a tech-enabled employer health plan that she started with a network of regional school districts and is now a multimillion-dollar company that administers employer health plans across the country.
Greg Baker, R.Ph., will lead EmsanaRx, as its CEO. Baker, a clinical pharmacist by training, brings more than 25 years of pharmaceutical industry experience, most recently as a senior pharmacy consultant with Blue & Co. LLC and Vice President of Pharmacy Services at Premise Health.
“The pharmaceutical supply chain is broken. An opaque third-party payment system creates a profit haven for intermediaries whose interests are not aligned with their clients,” Baker said, in a statement. “PBMs have leveraged their solutions to weave interdependent revenue streams that are built into the price of drugs paid for by employers, employees and their families.”
The new PBM said it would offer large employers a level of transparency, flexibility and control not currently available in the market, with a fixed price per prescription and direct guidance from a dedicated clinical pharmacist account manager partnering with employers to design their own pharmacy network and modify their formulary.
