in funding — has its work cut out as it sets out for new clients, but we think its disruptive approach positions the startup for success.Capital Rx is setting its new pricing model afloat in a convoluted PBM market rife with headaches for payer clients.
Long-standing PBMs have been placed under the government's microscope for controversial pricing strategies — some of which could be draining payers' pockets. PBMs have in the crosshairs of the US government's mission to deflate astronomical drug costs over the last couple of years.in July on a proposed rebate rule that could have significantly cut PBMs' margins, it's likely scrutiny of PBMs won't let up entirely — from not only the government, but also the independent payers they contract with, which could be losing cash as PBMs take a larger cut from the sum they reel in from drugmakers.
But Capital Rx is looking to shine a light on the opacity of PBMs: It wants to boost cost transparency and consistency for its clients by using the government-maintained National Average Drug Acquisition Cost database, which aims to provide accurate, upfront costs of drugs across pharmacies to health plans.Though deeply entrenched, the PBM space is primed for disruption — and it's likely independent payers will embrace new players catalyzing the changes.
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