There’s a new player in the pharmacy benefits management market and its origins are perhaps not what you’d think. Vivid Clear Rx launched just over one year ago with the goal of helping companies gain insights into the cost and utilization of prescription benefits. But it didn’t spring from a drug store chain, big pharma or even the insurance marketplace.
“Vivid Clear Rx is a subsidiary of Hy-Vee,” said Michael Agostino, president. “One of the things we’d talked about pre-COVID was what would be a good fit for Hy-Vee’s strategic approach to expanding into health care services. A natural next step was to develop our own pharmacy benefit manager.”
Agostino, who’s simultaneously Hy-Vee’s senior vice president of pharmacy business development, was asked to develop the startup, with a built-in first client to show proof of concept.
“Being at the time at 89,000 employees and a self-insured company on the health care side, we said let’s start taking care of our own folks and minding our own management of employees under our management model,” he said. “We formed the cultural background of the company, which falls perfectly in line with our parent company, which immediately makes us a market differentiator. It’s a very straightforward, simplistic approach in the very complicated environment that’s health care.”
Making Sense of Prescriptions
Prescription medication has become one of the more confusing elements of any benefits plan, Agostino said, making the market ripe for a company that can make sense of things and ensure plans are optimized from cost to customer service. He said current events such as COVID-19 and employee turnover have only added to the importance of this function.
“Within health care, one of the things that really stands out is companies needing to offer elevated health benefits within their employer base,” he said. “It’s tough right now to hire someone and it’s tough right now to retain somebody. So, offering the best health care benefit possible is key. But, that’s not inexpensive; in fact, it can be very expensive for companies.”
Vivid Clear Rx leverages a combination of technology and expertise behind the digital wall to provide clients with the data insights to ensure health care dollars are being spent efficiently. It also provides individual employees and dependents – “members” in Vivid Clear Rx-speak – with various resources for navigating the often-choppy pharmacy channels.
“We created a model that is very group-centric all the way down to member-centric,” Agostino said. “What that means is, not every employer group needs the same thing. What we see in the marketplace is a lot of the benefit offerings sold out there that tend to be the same ones, offered again and again.
“But if you take a good, hard look at what the employer group has experienced in the past, and then put your heads together from a financial standpoint or from a clinical standpoint, you should be able to look at what’s ahead for the year to come. To bring that planning and strategic mindset, specific to an employer group, is an immediate differentiator.”
Agostino said another major benefit applies to new drugs, which are so prohibitively expensive they can skew the cost of prescription benefits nearly out of feasibility.
“We call that market ‘specialty pharmacy’ and right now, it’s 2 to 3% of the U.S. population.” he said. “But today, we have groups where over 50% of the drug spend is coming from that 2 to 3% population. There are some groups carving this out of coverage, which is catastrophic to someone who needs these critical medications.
“Companies have to be very sensitive with this approach and they have to be smart about it. You have to be strategic and you have to have a subject matter expert. There are not a lot of PBM’s out there that have that expertise and we’ve got it. As far as a differentiator goes, that’s a big deal.”
Finally, the company helps clients make sense of the myriad regulations covering prescription medications, varying widely from state to state and only multiplying in the age of at-home drug delivery.
“The sheer understanding, or lack thereof, of [prescriptions] can be a mixed bowl, that has your head spinning,” he said. “I’m a pharmacist, I’ve been in the industry for 30 years, and sometimes even helping my parents I take a step back going, ‘This doesn’t make any sense,’
“That’s the one thing we’re very proud of with our staffing model; if any of our members call us, we leverage our channel partners and our expertise and make sure we guide them through where to get their medication, how much it’s going to cost and what is best at managing a specific condition. We’re just trying to make all that easier; that’s as simple as this model is.”