1. What do you think is broken about the PBM business model, and how is your approach different?
At Abarca, we think there is a lot that is broken with the PBM model. For example, many PBMs use outdated technology which hinders innovation and contributes to a poor customer experience. A lack of transparency in the industry deprives many payers of basic information about the true cost of services. And vertical integration has left many health plans in a position where they are relying on a large competitor for essential services. Our entire company is built on three foundational principles: Delivering a smarter platform, providing a better experience, and operating with a higher standard. This guides everything we do.
2. I am concerned about my drug spend spiking next year, what can you do to help?
Unlike other PBMs, Abarca’s incentives and business model are always aligned with those of our clients: healthier members and lower drug spend. We provide several programs that enable us to achieve these goals, including innovative clinical programs and drug contracts, and user-friendly digital tools for members—all powered by modern technology. We also guarantee the net cost of drugs, including specialty medications, by offering an annual fixed per claim cost for an entire population. And we are constantly developing new ways to go even further.
3. How does your PBM technology provide me with a competitive advantage?
The PBM industry relies on inflexible and unfriendly legacy platforms that confuse and constrain plan sponsors. These outdated platforms are a drag on productivity and don’t offer plans a competitive advantage. We built Darwin™, our technology platform, from scratch, to be modern, intuitive, and powerful. Darwin™ fully integrates PBM and business functions into a single interface, such as claims adjudication, network, clinical and financial management, compliance, and rebate information. It also empowers payers with greater control over their pharmacy benefits and better tools to serve members and compete for new business.
4. We are growing rapidly, how will I know you can keep up?
Darwin™ is infinitely and immediately scalable and has the capability to process as many claims as the largest PBMs in the industry. We also provide a dedicated team for each of our clients to ensure a smooth transition. Recently, we were able to implement Darwin™ for 11 health plans that serve millions of lives in just 18 months with minimal disruption.
5. The current “Pay for Volume” paradigm costs too much and delivers too little value. What will you do about it?
While other PBMs are still debating value-based agreements, Abarca is delivering on them. We currently have contracts in place whereby the plan receives a discount or rebate if a member discontinues the therapy due to adverse effects or because the medication is ineffective. We also have contracts with some of the nation’s biggest drugmakers, including the first publicly disclosed outcomes-based agreement to apply to a Medicaid population.