Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep176: Cutting the PBM out of your patient's GLP-1, with Jay Bregman of Andel
Transcript
- Speaker 1 0:00 I think less than 2% of of people actually in any given plan get access to the job you want because there's massive utilization management, there's massive prior authorizations. People just give up. I mean, nobody gets access to these drugs. Oh, and by the way, even if you do manage to get your plan to cover it, just wait until next year because maybe, maybe not. Right? It's a real, it's a real crapshoot. Austin Littrell 0:31 Welcome to Off the Chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, I sat down with Jay Bregman, founder and CEO of Andel, one of a growing number of companies trying to route around the pharmacy benefit entirely. Andl buys brand-name drugs straight from the manufacturer and sells them to employers, who pass the discount on to their workers with no insurer, no pharmacy benefit manager, and no prior authorization in between. The company launched its platform in March with ZepBound, and it isn't alone. Eli Lilly and Novo Nordisk have each opened direct channels of their own, and the field of benefit vendors has grown up around the same idea. The pitch to physicians is that nothing changes at the point of prescribing, and everything downstream just gets easier. So we get into whether that actually holds up, what happens to a patient's access when they leave the job, or the employer stops contributing, and where a benefit build on employer contributions leaves the patients that it doesn't reach. With all that said, Jay Bregman, thank you for joining us. Let's get into the episode. Jay Bregman, thank you so much for joining me today. Speaker 1 1:40 Yes, it's great to be here. Really excited. Thank you. Austin Littrell 1:44 Before we get started, could you introduce yourself and Andel? Speaker 1 1:47 Sure. I'm Jay Bregman. I'm the founder and CEO of Andel. We are a cooperative marketplace putting together plans, pharma, and participants on the same network with maximum efficiency and minimum corporate overhead, all in an attempt to reduce drug prices for plans and members. Austin Littrell 2:06 For physicians who are hearing about a direct-to-employer drug purchasing for the first time, I guess could you kind of walk through what it is and what gap it's trying to fill? Speaker 1 2:16 Yeah, sure. So Andel's model, and we really pioneered the direct-to-employer category is that we acquire the rights to expensive brand drugs directly from the manufacturer at a significantly lower price, and we earn that price because on our marketplace there's no utilization management, no prior authorizations, no formularies, and no rebates. We then contract with employers directly, who pay us a cash contribution, as little as $100 per fill, as much as 100% of the fill, and then carve out their drugs from their traditional plan. Let the members know that they're contributing to the medications, but not in the traditional way. Members send their scripts to the Andal Pharmacy. We process them. We basically manage eligibility. We send a message to the member once the prescription is confirmed, and the member downloads one of our apps, they pay net of all of the discounts and contributions, and the medication gets shipped to them the next day at a massively lower price. Austin Littrell 3:37 Why GLP wanton? I mean, why have they in particular become the entry point for this kind of model. Speaker 1 3:42 Well, I think there's there's a couple of different you know phenotypes that are appropriate to the direct to or more appropriate to direct to employer. Ultimately, we think it's applicable to almost anything. I think you know GLP ones are have such high utilization that they have really broken the traditional model for coverage. They're just it's sort of like the wildfires and hurricanes of you know a pharmacy. They're just it's just impossible to cover them because so many people want them at almost any cost, and so they they sort of have you know almost fundamentally come into this category where if you want to provide some form of benefit, it has to be a different type of benefit than the traditional pharmacy benefit, and so that's why they've been carved out, and that's why they've been effective you know, effectively a good candidate for direct to employer, and because so many plans now are exploring and implementing direct to employer for GLP ones, they're effectively putting in place the scaffolding for many other drugs to be. Ah, put under this alternative direct-to-employer benefit as well. Austin Littrell 5:06 So we kind of got into it a little bit, but could you walk me through the process? You know what actually happens when an employee gets a medication like ZepBound through Andal, from the prescription to actually having the drug in their hands? Speaker 1 5:17 Yeah, sure. So I mean, with Andal, it is extremely seamless, right? So they keep that the members keep their own trusted doctors, their own trusted providers. They don't have to change. There's no telehealth, limited networks, etc. So their existing provider sends the script to the Andal Pharmacy. The Andel Pharmacy is a non-dispensing pharmacy. We're on the SureScripts network. We're in every EMR in the country, so it's really easy. Doctors don't have to do anything differently. And then once we get the script, everything is completely automated. The eligibility management, the the communication to the member, the member downloading the the the app, the fact that the member can pay via HSA, FSA, or just credit card or debit card, and then they just receive the the medication conveniently in the mail the next day as soon as the next day. Austin Littrell 6:15 Where does the treating physician fit in this process? Does the prescription still start with the patient's doctor? Speaker 1 6:21 Well, what's so great about the Endel model is we are really just reempowering the prescriber. I mean, in the in this day and age, so much, so many forces have acted to take away, basically, and to provide administrative burden to prescribers prior authorizations, utilization management-they don't add any clinical value. Let's face it; they're really designed to just protect formularies and you know costs and other kinds of things. So, so what we've done is we've chosen a different model where the provider makes the decision about what drug to prescribe, and once that drug is prescribed, there is a contribution level that is set by the plan that is fair and consistent. The member pays that contribution level, and then they're dispensed the drug. There's no other admin in between. So all of the costs that the plans have been paying for prior authorizations and utilization management-they're gone. Austin Littrell 7:26 Does a physician need to do anything differently under this model? I know you mentioned their prior authorization documentation, or just down to how they prescribe. Speaker 1 7:35 Well, you know what-that's the great thing. So we've chosen to do the extra hard work to build our own pharmacy, to build our own MPI, our own SureScripts integration because we're integrated into the SureScripts network, which has 100% of U.S. U.S. prescribers, you know, present on the network. They don't need to do anything differently. Any EMR in America has the Endel Pharmacy. They search for it. They send the prescription as they would any other pharmacy, and that's it. We handle the rest. Keith A. Reynolds 8:16 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60 seconds, we deliver proven, real-world tactics you can plug into your practice today. Whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way-I want to feature it. Shoot me an email at k. Reynolds at mjhlifesciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. Austin Littrell 9:07 Will the medication still show up in the patient's records the way a normal prescription would, so the physician has a full picture of what the patient's taking? Speaker 1 9:14 Well, again, absolutely, because this is being sent from the prescriber's EMR via SureScripts. All of the data is there, but it gets better. Not only that, we provide a free data exchange API to plans and PBMs and carriers, so that actually the plan itself can maintain information about anything the out of pocket that's being paid by the member they can reconcile accumulators or deductibles and the plan will retain a complete picture of the health of the member even though this is kind of provided under a non traditional means which is something you don't get with direct to consumer direct to consumer everybody. On their own, there's no data. Deductibles aren't counted. It's really the wild, wild west. Austin Littrell 10:06 From the patient side of things, how does the cost and the overall experience compare to getting a GLP one through the regular pharmacy benefit? Speaker 1 10:14 Yes. Well, first of all, let's just be clear. I think less than 2% of people actually, in any given plan, are getting access even when when they do cover GLP ones, actually get access to the GP one because there's massive utilization management, there's massive prior authorizations. People just give up. I mean, nobody gets access to these drugs. Oh, and by the way, even if you do manage to get your plan to cover it, just wait until next year because maybe, maybe not. Right? It's a real, it's a real crapshoot. You know, with with our platform, the member gets a predictable, transparent price that they're paying their out of pocket on. It's going to be the same or lower out of pocket each month, and basically, they're going to be be getting it through a consistent system and and platform, so the member is getting just a much better consistent experience than they're getting with the traditional you know reimbursement system or the traditional insurance system, which let's face it you know just just isn't reliable for these kind of drugs. Austin Littrell 11:20 What happens to a patient's access if they leave the job or the employer drops the benefit? And is there anything a physician should keep in mind about about that process? Speaker 1 11:29 So you know, at Andal, we think about this. We are working on this. There's there's a couple of different things that we should know. One is Cobra. So if somebody leaves their job and they're eligible for Cobra, we have confirmed that with our providers, with our the medicines on our network, that the plan may choose to continue giving them the benefit under Cobra, which is a huge deal, right? That's that's a you know huge huge I think undertaking. The the second is we are trying to develop in the future ways that you can port your Andal membership from one employer to the next, and even see which employers actually support Andel and would go. So that basically that might be a factor that you might use in deciding whether to choose one employer over the next, but anyway, for for now, for for certain drugs, depending on the drug and the manufacturer, unfortunately, once the contribution from the plan runs out, you are not able to access that price anymore. But like I said, that's something that we don't believe is currently fair, and we absolutely want to change. Austin Littrell 12:49 So Medicare just launched its own $50 GLP-1 program for some older patients through 2027, but it doesn't reach working-age commercially insured patients. So where does Andel's model fit relative to that. Speaker 1 13:03 Look, you know, I think Medicare has always been its own thing. None of the Andel products currently are designed to be sold on Medicare. I think we should celebrate all of the access that is going on in Medicare. It is a separate government-funded program, so let's let's kind of you know let's celebrate everything that's being being done there, but we're we're focused on the mainstay of the market, which is the commercial market, which is effectively everybody else. And how do you improve that for for the hundreds of millions of people that that are not in Medicare. Austin Littrell 13:42 As more employers look at this and models like this, what's one thing you want physicians to understand about this process? Speaker 1 13:50 I think one of the things I want them to understand is that help is coming. For you know, my father was a heart surgeon, right, and he lamented about this. But every but every physician laments about the increasing amount of admin that is being forced on them by insurance companies, by PBMs, etc. I mean, adds no clinical value at all. Right? They're just gatekeeping after gatekeeping, roadblock after roadblock. What they need to know is that help is on the way. The Andel platform, one of its tenets, key tenets, is that the prescriber knows best, and so we respect the prescriber's decision. We don't challenge it with a prior authorization. We don't challenge it with utilization management because what do we know? And frankly, what does the insurance company know either? Austin Littrell 14:37 Well, is there anything that we we didn't talk about today that you think is important for physicians or the audience to keep in mind. Speaker 1 14:43 I think the main thing is Andel is not just a service for GLP ones. We have signed agreements yesterday for our first non-GLP one medication that'll be announced in the coming weeks, and ultimately, I think in the next six. Months you're likely to see dozens of new medications come onto the Andal platform. What we really would like is to build a dialog and a relationship with prescribers, so that we know what they like about the Andal platform, what they don't, and how we can make it better and easier, quicker for them. Austin Littrell 15:19 Well, Jay Bregman, thank you so much again for taking the time today. Speaker 1 15:22 I really appreciate this, Austin. Great to meet you. Austin Littrell 15:24 Great to you as well. Once again, that was a conversation I had with Jay Bregman, founder and CEO of Andal. My name is Austin Latrell, and on behalf of the whole Medical Economics and Physicians Practice Team, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories, and solutions for your practice. You can find us by searching "off the chart" wherever you get your podcasts. Also, if you like the best stories that Medical Economics and Physicians Practice publish, delivered straight to your email six eighths of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the chart, a business and medicine podcast, is executive produced by Chris Masolini and Keith Reynolds, and produced by Austin Latrell, medical economics and physicians practice are both members of the MJH Life Sciences family. Thank you.