EmpiRx Announces New AI-Powered Platform as Part of Push to Change PBMs

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The relationship between the pharma industry, pharmacists, and customers continues to evolve.

EmpiRx Health, a PBM company headquartered in NJ, announced that it is launching a new AI-powered platform.¹ The new platform is called Clinically, and it will use AI technology to help pharmacists with claims adjudication, clinical reviews, and other features that EmpiRx says will put the pharmacists at the center of the PBM model.

In a press release, EmpiRx’s CEO Danny Sanchez said, “Our new Clinically platform clearly demonstrates EmpiRx Health's strong commitment to transforming the pharmacy care industry by creating the PBM of the future – one that's already providing the highest quality service to customers, patients, and advisor partners. This PBM revolution was long overdue. Far from helping plan sponsors to manage and lower drug costs, the traditional PBM model, which prioritizes drug volumes and rebates, leads to a vicious cycle of rising prescription drug costs without the promise of improved patient health outcomes."

In the same press release, Silvana Stankus, executive director for the New England Health Care Employees Welfare Fund 1199NE discussed how the platform will impact the roles that PBMs play in the pharmacy.

"I've been in the health business for many years and have seen the direct impact of managing patient health from a multi-benefit, holistic view,” Stankus said. “As such, I see an incredible amount of potential in embracing a clinically driven PBM model vs the traditional volume-driven model. I believe clinically based pharmacy care platforms play a key role in advancing this holistic approach to patient care."

This platform is just the latest example of EmpiRx’s efforts to improve the PBM model in the healthcare industry. In October of last year, the company announced that it had added to Humira biosimilars to its preferred products.² According to the company, the move is part of its initiative to push a value-based, clinically driven pharmacy care approach.

In a press release issued at the time, EmpiRx’s chief pharmacy officer Polina Kogan, RPh, PharmD, said, “Rather than the broken PBM model of maximizing drug rebates at the expense of plan sponsors and their members, we opted for the significantly lower priced biosimilars that not only help to improve patient care but also reduce costs for plan sponsors. At EmpiRx Health, our frontline pharmacists support and collaborate closely with physicians to ensure clinically appropriate care that helps to keep patients healthy while lowering overall drug costs. Lower priced biosimilars are a key component of that value-based pharmacy care approach."

In the same press release, Sanchez said, “As the nation has been celebrating the essential role of pharmacists during American Pharmacists Month, our prioritization of lower cost biosimilars demonstrates yet again how EmpiRx Health is helping to transform pharmacy care. At the heart of that transformation is our unique pharmacist-centric, customer-first business model that is diametrically opposed to the old, volume-driven PBM business approach."

Also, in August of last year, the company announced that it had launched a four-point plant to accelerate PBM transformation in response to Blue Shield of California for supporting a value-based prescription drug model.³

At the time, Sanchez said, “We welcome this move by Blue Shield of California to put its size and influence behind the value-based pharmacy care model that EmpiRx Health has pioneered since its founding in 2014. However, we view this as just a first step by a leading health plan to help advance the critical transformation of pharmacy benefits care. Much still needs to be done."

Sources

1. EmpiRx Health Launches AI-Powered Technology Platform to Expand Clinically-Driven Pharmacy Care and Drive Innovative, Customer-First Solutions. EmpiRx. May 15, 2024. https://www.prnewswire.com/news-releases/empirx-health-launches-ai-powered-technology-platform-to-expand-clinically-driven-pharmacy-care-and-drive-innovative-customer-first-solutions-302146427.html
2. EmpiRx Health Expands Value-Based PBM Leadership by Prioritizing Lower-Priced Biosimilar Medications. EmpiRx. October 31, 2023. Accessed May 15, 2024. https://www.prnewswire.com/news-releases/empirx-health-expands-value-based-pbm-leadership-by-prioritizing-lower-priced-biosimilar-medications-301973036.html
3. EmpiRx Health Applauds Blue Shield of California for Embracing a Value-based Prescription Drug Model, Announces Four-Point Plan to Accelerate PBM Transformation. EmpirRx. August 24, 2023. Accessed May 15, 2024. https://www.prnewswire.com/news-releases/empirx-health-applauds-blue-shield-of-california-for-embracing-a-value-based-prescription-drug-model-announces-four-point-plan-to-accelerate-pbm-transformation-301909192.html