A Higher Standard

Abarca CEO Wins Florida EY Entrepreneur of the Year Award

Orlando, FLAbarca, a pharmacy benefit manager (PBM) that is disrupting the industry with an entirely new approach to technology and business practices, today announced that its CEO Jason Borschow has been recognized with an EY Entrepreneur of the Year® 2018 Award in the Florida region.

Jason Borschow founded Abarca Health shortly after graduating from Harvard University with the goal of tackling a fundamental challenge in healthcare: Pharmaceuticals cost too much, members deserve a much better experience, and the big companies that dominate the industry are more focused on profits than patients. Jason threw away the PBM playbook and committed to building something member-focused and technology-driven, using straightforward, transparent business practices.

To make his vision a reality, Jason recruited talent from across the country who shared his energy, fearlessness, and vision for healthcare, including clinicians, software engineers, and people with a deep understanding of the pharmaceutical supply chain. With an in-house, San Juan-based team of software engineers, Abarca designed a better technology platform and large health plans saw the value right away.

“Being recognized with an EY Entrepreneur of the Year Award is an incredible honor made possible by our deeply committed team and our clients who believe in us,” said Borschow. “But what makes me particularly proud is how we have found bold new ways to improve the healthcare experience for millions of families.  And we are just getting started.”

Today, Abarca manages more than $1 billion in drug costs for millions of people with levels of client and member satisfaction that are unheard of for a PBM. The company has announced innovative agreements with drug manufacturers that shift risk from payers and patients to the manufacturers and will be announcing significant partnerships in the coming months.

Now in its 32nd year, the program has expanded to recognize business leaders in more than 145 cities in more than 60 countries throughout the world.

Abarca Launches Darwin, A Smarter PBM Platform

Boston, Mass. – Abarca, a pharmacy benefit manager (PBM) that is disrupting the industry with a completely new approach to technology and business practices, today launched Darwin, a smarter PBM platform, at AMCP’s Managed Care & Specialty Pharmacy Annual Meeting. Darwin is a first-of-its kind technology built from the ground up by Abarca to be fully integrated and user friendly. This technology will be rolled out to Abarca’s PBM service customers and is available as a standalone software-as-a-service (SaaS) offering for health plans and other PBMs. Payers of any size will now be able to implement their own turnkey PBMs powered by Darwin technology, and fully supported by Abarca’s services and expertise.

“We engineered Darwin to be modern, cloud-based, secure, flexible, and unimaginably efficient. The era of navigating disconnected legacy systems, waiting years for enhancements, and building spreadsheet-based workarounds is now over.” said Jason Borschow, Abarca’s Chief Executive Officer. “It’s hard to believe, but most of the PBM platforms used today date back more than two decades and they haven’t changed fundamentally since then.”

Darwin integrates claims processing, pharmacy network, prior authorizations, clinical programs, Medicare and Medicaid compliance, rebate management, and other critical PBM work streams into a single, fast, friendly interface. Invoicing, payments, and all other financial functions can be seamlessly integrated into a PBM’s general ledger, fully automating the accounting cycle, and dramatically reducing overhead.

Users of legacy systems know the frustrations of having to toggle between programs and screens, retyping data, coding tables and drug lists, and waiting for upgrades and fixes to address basic business and compliance needs. Darwin ends these drains on accuracy, productivity, and morale. The platform is cloud-based, mobile friendly, secure, permission based, and point-and-click easy.

For Medicare and Medicaid plans, Darwin is a game changer. Clinical management tools, deep analytics, and compliance support are integrated with automated letter generation, outbound IVR, and care management workflows to increase member engagement and improve star ratings, without adding man hours. It helped one plan go from two to five stars in just two years.

At AMCP, Abarca was selected to present the results of a program in which, using Darwin, it was able to help one health plan reduce the cost and improve the effectiveness of treating Hepatitis C. Using Darwin’s advanced analytics and member and physician engagement programs – Abarca increased the percentage of people who stayed on their doctor-prescribed therapy to 94.6% and sustained virologic response, or control of the disease, to 99.4%. This also led to patients and the health plan saving over $1.3 million.

Abarca is a different kind of company and a different kind of PBM. It focuses on delivering a better experience for members and plans, and every single employee is committed to a higher standard of business practices. Abarca was founded more than a decade ago, many PBMs are still using technologies that were already aging when they got into business. They designed their technology from scratch and built it in-house. It is modern, flexible, intuitive, and powerful, and the perfect solution for a PBM or health insurer that wants its own customizable platform but doesn’t have the time, appetite, or expertise to develop one themselves.

“No plan or PBM should endure legacy systems anymore,” concluded Borschow. “It’s time for a better way.”

Abarca’s Chief Legal Officer to speak at the 2018 PR Health & Insurance Conference

San Juan, PR – Adriana Ramirez, Abarca’s Chief Legal & Compliance Officer, was featured as a panelist at the Puerto Rico Health & Insurance Conference. This year’s conference focused on the opportunities for growth and change as Puerto Rico recovers from Hurricane María.

Adriana was a featured speaker on the panel titled “Battling Fraud, Waste, and Abuse,” where she discussed challenges and opportunities to improving quality and reducing the cost of healthcare in Puerto Rico.

“Hurricane Maria impacted every aspect of life in Puerto Rico, and the island faces both challenges and opportunities as we look to regrow,” said Adriana. “At Abarca, our members are always our first consideration. And, as we face this critical time of recovery, that focus has never been more important.”

Other featured panelists at the event include the Honorable Jennifer A. González Colón, Puerto Rico Resident Commissioner to the U.S. Congress, the Honorable Rafael Rodríguez Mercado, MD, Secretary of the P.R. Department of Health, and the Honorable Alex M. Azar II, Secretary of the U.S. Department of Health & Human Services.

Adriana is a frequent panelist at industry events across the island. Last year, she participated in the 6th Annual Cyber Forum, where she discussed best practices for reacting to a cyber breach.

Abarca Receives PBMI Excellence Award for Quality Improvement Strategies

Palm Springs, CA – Abarca today announced that it was awarded the Pharmacy Benefit Management Institute (PBMI) Excellence Award for Quality Improvement Strategies for its groundbreaking work on medication therapy management (MTM) programs. The award was based in part on Abarca’s success in helping a Medicare Part D plan improve from 3 to 5 CMS Stars in under 2 years.

“We are thrilled to award Abarca for the dramatic improvements it helped achieve in medication therapy management and comprehensive medical reviews (CMR),” says Jane Lutz, Executive Director of PBMI. “Abarca’s work gives the industry a roadmap for how to significantly improve outcomes and the quality and value of drug benefits.”

The award was based on Abarca’s work on behalf of a Medicare Part D health plan based in Puerto Rico. Abarca implemented an integrated technical and clinical solution for the plan that included:

  • An MTM module that connected medical, clinical notes, and drug utilization data to improve reporting, analytics, resource allocation, and the user experience for clinicians.
  • Highly targeted and customized outreach programs conducted by clinician specialists to improve provider and member engagement, adherence, and outcomes.

This approach enabled the Medicare Part D health plan to achieve an 84% CMR completion rate, a 47% improvement in a little more than a year. CMR completion rates are an important metric CMS uses in awarding Stars for MTM programs.

“We knew that tweaking the MTM model PBMs have been using for years wasn’t going to yield meaningful improvements. It takes a carefully synchronized combination of the right data and expert clinical interventions,” said Jason Borschow, Abarca’s Chief Executive Officer.  “We also had the advantage of a platform that we designed from the ground up to provide the right information, and a world class team of clinicians.”

The MTM program is just one example of how, for more than a decade, Abarca has rejected traditional PBM technology and thinking. This has included launching a smarter technology platform, built from scratch to be more powerful, flexible, and user friendly; intensely focusing on providing clients and members with a better experience; and operating at a higher standard – of reliability, openness, urgency, and accountability.

“It’s an honor to be recognized for excellence by PBMI,” continued Borschow. “But what drives us is making a difference in the health and lives of members, and we couldn’t be happier in what we achieved with this program.”

To read the full case study, click here.

Abarca & Amgen Enter Outcomes-Based Agreement for Repatha® (evolocumab)

Miami, FL – Abarca, a pharmacy benefit manager that is disrupting the industry with smarter technology and innovative strategies, today announced it has signed an outcomes-based contract with Amgen for the cholesterol-lowering drug, Repatha® (evolocumab). This agreement is the first of its kind involving Amgen’s Repatha and a standalone PBM.

“In the future, our payers and members will only pay for therapies that deliver expected outcomes and provide meaningful clinical value,” said Jason Borschow, Abarca’s Chief Executive Officer. “We are proud to partner with Amgen, a company that stands by its products, to make this a reality today for the clients and members we serve.”

Repatha is a PCSK9 inhibitor indicated to reduce the risk of myocardial infarction, stroke, and coronary revascularization in adults with established cardiovascular disease. Recently, Abarca also announced an outcomes-based contract with Biogen for medications used to treat multiple sclerosis. Abarca is currently collaborating with several drug manufacturers for similar agreements.

Abarca is a different kind of company that rejects traditional PBM thinking, and its aggressive push for outcomes-based contracts is just one example. Abarca’s smarter technology platform focuses on delivering a better experience for members and plans, and its higher standard of business practices also set it apart from the industry. Founded more than a decade ago, today Abarca serves more than two million members and manages more than a billion dollars in drug spend.

“Our business philosophy is simple: Put our clients and members first in everything we do,” concluded Borschow. “When that is your priority, the decision to pursue value-based agreements suddenly becomes an obvious one.”

Abarca Brings Together Business Leaders to Exchange Ideas on Managing in Times of Change

On February 9th, Puerto Rico’s most influential and inspiring business leaders came together to share ideas and hear from international business visionary Anthony Iannarino. The event brought together leaders from different organizations, industries, and expertise, but at the end of the day we all shared the same goals: learning, exchanging ideas, and developing meaningful connections.  

Relationships really do matter, and this was an opportunity for members of our business community to establish even stronger bonds.

The event, hosted by Abarca, consisted of two sessions. The first, a luncheon for CEOs from around the island, discussed Anthony Iannarino’s “10 Rules for Transforming Organizations In a World of Constant, Accelerating, Disruptive Change.” The business community of Puerto Rico continues to be a shining example of how to navigate change, and we enjoyed a lively exchange of experiences.

Later, Anthony and Abarca CEO Jason Borschow were joined by business leaders to discuss the importance of establishing more meaningful connections and building lifetime relationships based on value and trust.

The event concluded with lively break-out sessions and a networking cocktail reception.

We look forward to our building on the momentum of this meeting and look forward to moving forward together to create the brightest and most promising future for our families, for our organizations and for our Island. Check out or photos from the event:


Anthony Iannario shares his signature tactics for business

During break-out sessions, attendees discussed the day’s sessions and shared ideas for success

Abarca CEO Jason Borschow kicks off the day by introducing Anthony Iannarino

Business leaders take the stage to discuss their experiences

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.

Abarca’s Continues to Strengthen their Commitment to Cyber Security Preparedness

San Juan, PR – Adriana Ramirez, Abarca’s Chief Legal and Compliance Officer, participated in the 6th Annual Cyber Forum: Cyber ​​Risks … Meeting the Challenges, Monitoring Risks hosted by the Association of Certified Public Accountants of Puerto Rico. Adriana was a featured speaker on the panel titled “We have been breached …. Now, what?” where she discussed best practices for responding when an organization is compromised.

Earlier in the day, the panelists participated in a tabletop exercise that tested their responses to a cyber crisis. Among other takeaways, Adriana stressed the importance of teamwork and clear communication when responding to a breach.

“Responding to a breach is like putting together a puzzle, and everyone is responsible for a piece,” said Adriana. “At Abarca, our process and preparedness plans are very clear, allowing us to resolve and report on issues quickly while staying open with our clients. We know that incidents happen, and we believe that they must be addressed head-on.”

For Abarca, staying on the cutting edge of compliance and incident preparation and management is imperative. In participating in this event, Adriana was able to share her broad experience in the area, part of having a higher standard, and learn from what others have experienced as well.

“Data security and compliance are a very fast-moving field,” said Adriana. “You can never stop learning.”

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