A Higher Standard

Abarca Executive Samir Mistry will be Featured Panelist at the 2018 CBI Reimbursement and Contracting Conference

Philadelphia, PA– Samir Mistry, Abarca’s Vice President of Rebates and Pricing Strategies, will be a featured panelist at the CBI Reimbursement and Contracting conference January 24-25, 2018 in Philadelphia. Samir has been selected to lead two discussions that will cover best practices in developing innovative contracting and implementing effective pricing strategies, as well as shining the spotlight on value-based contracting.

“When negotiating contracts for rebates, we start with one fundamental question: What will provide the greatest benefit to our clients?” said Samir.  “Ultimately, decisions that are good for our clients almost always turn out to be good for our business partners in pharmaceutical companies as well. Short-sighted, self-serving negotiating tactics generally lead to contracts that aren’t sustainable or profitable in the long run, and I am looking forward to sharing Abarca’s perspective at CBI’s Reimbursement and Contracting conference.”

Now in its fifth year, CBI’s Reimbursement and Contracting conference will provide insight on some pressing industry topics, including:

  • Uncovering leading contracting and pricing strategies for optimized reimbursement
  • Navigating the latest healthcare updates and implications for contracting and reimbursement
  • Aligning new technologies and treatment paradigms and AI technologies
  • Shining light on value-based contracting from a payer’s perspective
  • Overcoming key challenges for specialty products and biosimilars

Samir has been in the managed care pharmacy industry for over 20 years, and has cultivated deep experience in contract negotiations, forging strategic partnerships and understanding health plan cost drivers.

The CBI’s Reimbursement and Contracting conference will be attended by professionals from across the pharmaceutical, medical device, and biotechnology industries.


Abarca Receives URAC Reaccreditation Score of 100%

Washington, D.C.— Abarca is proud to announce it has been again awarded URAC’s Pharmacy Benefit Management (PBM) Accreditation. This designation was given in recognition of Abarca’s high clinical, quality, and service standards.

After undergoing URAC’s rigorous evaluation process, Abarca demonstrated full compliance with all URAC PBM Accreditation standards and earned a score of 100 percent from the URAC Accreditation Committee. The company also received a perfect score when it was last considered for accreditation in 2014.

“URAC is the gold standard in PBM accreditation,” said Jason Borschow, president & CEO of Abarca. “I am extremely proud to work with a team that constantly pursues a better way to conduct business and serve members. We are always holding ourselves to a higher standard, and this recognition from URAC shows the results of that commitment.”

Among other key measures of success, a URAC-accredited PBM program:

  • Meets critical benchmarks in service quality
  • Has processes to identify consumer safety issues
  • Promotes rational, clinically appropriate, safe and effective drug therapy
  • Includes review of the therapeutic advantages of drugs based on scientific evidence and standards of practice
  • Adheres to standards for P&T committee membership representation, its functions, and responsibilities
  • Provides for a formulary appeals process, including peer clinical review
  • Ensures the formulary is up to date

One example of Abarca’s high clinical and service standards can be seen in the Hepatitis C care management program it developed for five health insurance plans. This program focused on monitoring adherence, addressing gaps in care coordination, and providing high levels of patient and provider engagement. The program realized an overall medication adherence rate of 94.6% and $1.3 million in savings by switching patients to lower cost — but equally effective — therapies.

What Amazon Can Really Deliver

The healthcare news has been abuzz with reports that Amazon, the company that upended the retail, publishing, movies, groceries, and countless other industries is now taking on the drug distribution channel. Think of the companies that Amazon has disrupted out of business (remember Borders? Blockbuster? Record stores?). Could drug stores and even PBMs?

At Abarca, we think that if Amazon becomes the next drug mail order and pharmacy services company, and if they bring the smarts they showed in other lines of business, consumers will stand to gain tremendously.

Prices could fall and pharmacy benefits could be more transparent for members. There could be fewer middlemen between the manufacturer and the patient taking a cut. Great. But we believe the biggest gains could be in the member experience. In fact, the change in the way Americans buy prescriptions could be so profound, it could improve health and healthcare in ways that are hard to imagine.

Amazon redefined home delivery and we love it. Families today rely on Amazon mail order so much that, in a growing economy, the brick and mortar retail employment is actually shrinking. Home delivery has never taken hold for prescriptions in this way. For the relatively few people who get their scripts by mail, home delivery is something that their plans require, and not something they choose to do.

But efficient home and same-day delivery on Amazon’s scale could make getting prescriptions faster, cheaper and easier for consumers. Think of what this could mean to people in rural areas, the home bound and the elderly. This could drive medication adherence up dramatically, something the public health community has wrestled with for decades.

Could Amazon be having an impact on the pharmacy marketplace even before it enters it? CVS just announced same day home delivery in some big cities. This and the company’s decision to acquire Aetna are more than likely spurred, at least in part, by the Amazon threat. CVS isn’t the only one rethinking business models and girding for battle with potentially the biggest pharmacy competitor ever.

At Abarca, we believe that improving the member experience is everything, and we have been quietly disrupting the industry to do just that. For example, we have been working with manufacturers to provide members and payers with money back guarantees if medications have side effects or don’t work as intended. We’re rethinking member engagement by partnering with the pharmacists who know them and connecting with consumers in ways that are far less frustrating and more effective. Approaches like these have enabled us to help one Medicare plan jump from 2 stars to 5 in just 2 years, and deliver the lowest PMPM drug costs to the most underfunded Medicaid plan in the nation. We have ambitious plans, but we know that we are just scratching the surface.

We are committed to a smarter platform, higher standard and better experience for payers, providers and plans, and we agree that the drug dispensing experience is in need of serious disruption. The key to getting people fully engaged in their healthcare is to make it simple and affordable. When this happens, adherence goes up, people manage their chronic diseases better, and the skyrocketing cost of our nation’s healthcare system will begin to slow.

If Amazon can deliver that and help us change healthcare, sign us up for Prime

Health Sector Alliance Launches Effort to Drive Patient Visits to Doctors

San Juan, Puerto Rico (November 13)– An unprecedented alliance comprised of multiple health insurers, service providers, industry associations and the government of Puerto Rico announced the start of an advertising, public relations and outreach campaign titled “Visit Your Doctor Today,” which aims to help patients seek preventive care and better manage existing health conditions through regular visits to their primary medical doctors and specialists.

Puerto Rico Health Insurance Administration (ASES for its Spanish acronym) Executive Director Ángela Ávila and Health Department Secretary Dr. Rafael Rodríguez Mercado in a joint press conference with the sponsoring companies and professional associations issued an urgent call for citizens to resume medical care through their doctors.

“The ‘Visit Your Doctor Today’ campaign seeks to normalize the procurement of health services by our citizens as soon as possible. To that end, we will inform the population about which medical facilities and health service providers are operating and how to contact them. We are asking our citizens to visit their primary and specialist doctors in order to resume the adequate care of medical conditions”, said Ávila, campaign spokesperson. “If you are unable to contact your primary doctor please contact your health insurer or refer to the provider directory that we have prepared to help patients in the process.”

“This initiative represents a singular event and a historic precedent that evidences what can be accomplished when the private and public sector come together for the benefit of our citizens. This effort is also consistent with Governor Ricardo Rosselló’s vision to advance the recovery process of the island after the passage of hurricane Maria,” added Secretary Rodríguez. “Having our citizens visit their doctors regularly to maintain adequate health care is important to prevent the spread of disease and ensure that patients don’t neglect the treatment of existing medical conditions.”

Ávila announced that ASES has developed a health service provider directory (also available in Spanish) using information provided by health insurers for digital and print distribution as a complement to the media campaign. The directory, available for digital download at www.asespr.org, includes contact and working hour information for primary medical groups, specialists, pharmacies, hospitals, laboratories, diagnostic and treatment centers (CDT’s for their Spanish acronym), dialysis clinics and radiology services centers.

The alliance behind the “Visit Your Doctor Today” initiative includes ten health insurance companies – Constellation Health, CMC Care, First Medical Health Plan, Inc., Humana, MAPFRE, MCS, Molina Healthcare, MMM, Plan de Salud Menonita and Triple-S –, as well as ASES, the Puerto Rico Health Department, the Office of the Insurance Commissioner, Best Option Healthcare, Redes del Sureste, the Insurance Companies’ Association of Puerto Rico (ACODESE for its Spanish acronym), the Pharmaceutical Industry Association (PIA), the Independent Providers Association de PR (AIPR for its Spanish acronym), Primary Healthcare Association (FQHC’s), COOPHARMA, the College of Medical Doctors and Surgeons, the Puerto Rico Pharmacist Association, Abarca and MC-21.

The public communications effort includes public relations, advertising and outreach events. The advertising campaign will require an investment of less than $150,000 and will be funded in its entirety by insurers and the private sector. Furthermore, members of the alliance will actively distribute communication materials and the provider directory. Health fairs will also be held across the island to connect beneficiaries with their doctors and other health professionals.

“This campaign is critically important to prevent the spread of diseases and support easy access to medical care in the face of the serious public health emergency created in the wake of hurricanes Irma and Maria,” said Ávila.

The campaign starts on November 13 and ends in December 2017.

AMCP Nexus Recap

Last month, members of the Abarca team attended AMCP Nexus. We spent three exhilarating days meeting with attendees, conducting demos, and sharing the Abarca story with the best and brightest in the industry.

Didn’t have a chance to stop by our booth? Check out our video and photos from the event:


Abarca home base at AMCP Nexus, ready for the conference to begin


Call him a CEO for discussion purposes, but Jason Borschow does it all


When we say we’re coming out swinging, we mean it!


VP, Client & Pharmacy Partnerships, Rebecca Sabnani: “When you view your clients as partners and consider their success your own, you can accomplish unimaginable things together. It’s all about commitment.”


The revolution starts here.


Samir Mistry leveraged his pharmacy industry experience to make meaningful connections with AMCP Nexus attendees


Lissette Lorenzo makes innovative clinical operations a real treat


Thanks to our Abarca team for a great conference!


The Academy of Managed Care Pharmacy (AMCP) is the nation’s leading professional association dedicated to increasing patient access to affordable medicines, improving health outcomes and ensuring the wise use of health care dollars. This year’s AMCP Nexus explored perhaps the most transformative change taking place in health care: how we pay for health care – and the emergence of value as the defining factor and goal.

Keeping it Simple

At Abarca, we don’t believe in making simple things complicated. Here’s a perfect example: Consumers should be charged the lowest available cost for their medications. Although this may sound straightforward, somehow it is at the center of a heated debate.

You may have seen one of the press accounts recently that some consumers are being charged a copay that is higher than the cash price of their prescription, and other PBMs are pocketing the difference.

This practice is referred to as “PBM Clawbacks”, and it’s one we don’t take part in.

Abarca is a different kind of PBM and a different kind of company.  We believe that putting the member first is always the right thing to do.  It is also good for our client’s business and ours in the long run.  Pretty simple, we think.

Abarca Announces Innovative Value-Based Contract with Biogen For Multiple Sclerosis

SAN JUAN, PR — Abarca, a pharmacy benefit management (PBM) and technology company that serves more than two million lives across the nation, has signed a value-based reimbursement contract with Biogen Inc. (NASDAQ: BIIB) for select products in Biogen’s leading multiple sclerosis (MS) portfolio. This first-of-its-kind agreement between the companies offers an innovative approach to connecting outcomes with the effective net cost of the products. The agreement places accountability on Biogen to deliver safety, efficacy, and value for the patients who receive these life-impacting therapies and for the payers who finance them.

“We are excited to partner with Biogen in implementing this innovative, data-driven, and outcomes-based pricing program for MS drug therapies.  We believe this program is a significant milestone in our efforts to collaborate with pharmaceutical manufacturers to find a better way to guide patients and payers down the path to value, especially in high impact disease categories,” stated Javier Gonzalez, Chief Operating Officer of Abarca.

This contract builds on Abarca’s ongoing work with Biogen to find better ways to collaborate in the treatment of patients afflicted with complex, high-cost conditions.

“We believe that contracting approaches like this will help expand access for patients. We are excited to work with an innovative partner like Abarca and lead the way for MS care,” said Jean-Paul Kress, Executive Vice President and President, International and Head of Global Therapeutic Operations of Biogen.

Outcomes-based contracting is an important part of the future of healthcare. By partnering with manufacturers such as Biogen, Abarca is ensuring greater accountability around the investments made by payers and patients in high cost treatments, which leads to better access and better outcomes for patients.

Jason Borschow receives the Teodoro Moscoso Award from the PR Chamber of Commerce

San Juan, PR -The Puerto Rico Chamber of Commerce announced this year’s awarded entrepreneurs at their annual convention. Jason Borschow, chief executive officer for Abarca, was recognized with the Teodoro Moscoso Award which in the past has been handed to top entrepreneurs who have made an impact on the economic development of Puerto Rico.

“We receive this distinction with great honor and accept the challenge of serving as an example to emerging new companies on the island,” stated Borschow about the distinction. The award is named in honor of Teodoro Moscoso, the first administrator of the Economic Development Administration of Puerto Rico, known in Spanish as Fomento.

Moscoso was a former United States Ambassador to Venezuela, leader of the Alliance for Progress in the 1960’s, and the visionary official behind the economic transformation of Puerto Rico in the 1950’s as a result of his plan Operation Bootstrap. Thanks to Moscoso in just two generations Puerto Rico became a world-class location for manufacture, and the region’s hub for finance, transportation, and industry. The average per capita income in Puerto Rico was $120 per year in 1940 and is today more than $24,020 — the highest compared to Latin America. That is why the Teodoro Moscoso Award is an honorary award bestowed by the Puerto Rico Chamber of Commerce only to business leaders with outstanding contributions to the economic transformation of the island.

The Chamber of Commerce of Puerto Rico is a non-profit organization created to support the development of entrepreneurship, innovation, and business expansion throughout Puerto Rico and the U.S. mainland. It provides comprehensive resources for incubating business ideas, leveraging new markets, taking advantage of new opportunities, and advocating for policies that help the economy grow.

Abarca’s client Triple-S Advantage receives 5-stars in Part D

SAN JUAN, PR — Triple-S Management Corporation (NYSE: GTS), a leading managed care company in Puerto Rico; today announced the star ratings for its Medicare Advantage plans from the Centers for Medicare and Medicaid Services (CMS) for the payment year 2018. The purpose of this rating system is to provide Medicare beneficiaries with information to compare the quality of care across different plans. The company’s HMO offering (H5774) increased from 3 to 4 stars overall and achieved 5-stars in Part D on a 5-star rating system. Its PPO product (H4005) maintained its 3.5-star rating overall and produced 4.5 stars in Part D.

“I am delighted with the CMS ratings and recognize that this objective was achieved through the hard work of many people. Obtaining an earlier-than-anticipated 4-star designation in our HMO contract, which accounts for approximately 85% of our Medicare Advantage membership, is a testament to our dedicated team of employees and providers, as well as the significant investments we have made in technology and systems. This achievement is particularly significant in light of the reduction in Medicare Advantage funds for Puerto Rico over the last several years. Our 4-star rating is a tremendous asset that will help us further leverage the strength of the Blue Cross Blue Shield brand as we expand our footprint across the island, and it also reflects our dedication to providing the highest quality of care for our members. Accomplishing this goal, which is part of our broader corporate transformation, demonstrates that the strategy we have outlined is producing tangible results.” commented Roberto García, CEO of Triple-S Management.

Abarca, a pharmacy benefit management (PBM) and technology company that serves more than two million lives across the nation, partners with Triple-S as its official pharmacy benefit management for their Medicare Advantage plans.

The Medicare rating system ranks plans from 1 to 5 stars, with 5-stars representing the highest score. It is worth noting that no plan in Puerto Rico has achieved more than a 4-star overall rating. Star ratings are calculated annually and are subject to change each year. CMS uses data from member satisfaction surveys, health plans, and healthcare providers to arrive at a plan’s overall star rating. The rating system employs more than 40 different quality measures in five separate categories.

Abarca’s Chief Operating Officer Is Panelist at 2016 NASP Annual Meeting & Expo

Washington, DC — Javier Gonzalez, chief operating officer of Abarca, will advise specialty pharmacy leaders on “Government Funded programs and Specialty Drugs: Changing Market Controls and Future Models” as a panelist for 2016 NASP Annual Meeting & Expo, the most important specialty pharmacy conference in the United States. Moderated by Mike Agostino, Vice President of Hy‐Vee Pharmacy, the panel will also include Javier Menendez, Vice President of Virginia Premier Health Plan, Mesfin Tegenu, President of PerformRx, and Christine Strahl, Specialty Pharmacy Manager of HealthPartners.

The National Association of Specialty Pharmacy is a trade association representing all stakeholders in the specialty pharmacy industry. Their members include the nation’s leading specialty pharmacies, pharmaceutical and biotechnology manufacturers, GPOs, distributors and more. With over 1,200 members, NASP is the unified voice of specialty pharmacy in the United States.

The NASP Annual Meeting & Expo is the only comprehensive national specialty pharmacy conference in which all stakeholders can fully participate. It is the most effective way to stay abreast of rapid developments in specialty pharmacy, including national legislative and regulatory policy, which will be featured at the meeting.

Join industry leaders of specialty pharmacy as they gather for the 2016 NASP Annual Meeting, September 26-28, at the Omni Shoreham Hotel in Washington, DC.