VIVIO CEO, Pramod John, speaks with UK-based Consilium Scientific.
The paradox: Why can’t we reject high costs and subpar drug quality? Delve into healthcare inefficiencies driving this disparity and explore a pragmatic path to enhance outcomes and cut costs! Why can’t we say ‘No’ to high prices and low drug quality? The United States, which accounts for only 4% of the world’s population, spends as much on drugs as the rest of the world combined. Despite this, health outcomes in the US are often worse than those in developing countries. Economic inefficiencies of the healthcare system are the main drivers of these poor results. By focusing on outcomes and taking a commonsense approach, significant cost savings can be achieved.
The root cause: an anti-competitive PBM modelIn a free and fair market, the drug with the best outcomes data for each patient at the best price would win. Humira has been on the market for so long that its patents have expired and biosimilars have been available to 96% of the world’s population outside of the U.S. for years. Humira is not the best at anything; it is just one of many inflammatory drugs with average clinical data. As proven in clinical trials, different drugs work for different people. For instance, in rheumatoid arthritis (RA) trials, only 10% of those taking Humira achieved a great response (ACR 70 score), while 76% achieved a mediocre to no response. Fewer than 25% of patients receive a good response from the best-selling drug of all time.
Read the full article at: https://www.benefitspro.com/2023/05/04/why-biosimilars-will-fail-and-what-we-can-do-about-it/
“It’s the law unintended consequences,” Pramod John, Ph.D., chief executive officer of Vivio Health. “The ACA’s intent was not that providers now can charge whatever they wanted for service, whether a drug manufacturer or hospital. It was trying to protect a member could have a million dollar out of pocket costs in a year. This is when we started to see expansion of drug pricing because now with out-of-pockets limits, it doesn’t matter whether a drug costs $6,000 or $600,000.”
Pharmaceutical manufacturers, John said, started offering copay cards after high-deductible plans were launched. “Now a drug manufacturer can arbitrarily raise the price of a drug or remove all pricing sensitivity for the cost of the drug by paying patients’ copays and deductibles.”
Ultimately, it’s a steering mechanism, he said. “Copay cards set up economic incentives that favor the wrong behavior,” John said. “We’ve removed pricing sensitivity for patients and incentivized providers to be able to jack up the price of goods and services.”Read the full article at: https://www.formularywatch.com/view/patients-often-lose-in-the-battle-between-pharma-and-pbms
San Leandro, CA – VIVIO, a public benefit corporation reinventing the use of drug trial data in care delivery, announces a relationship with Mark Cuban Cost Plus Drug Company (Cost Plus Drugs) to acquire specialty drugs for less. Since Cost Plus Drugs and VIVIO are Public Benefit Corporations (PBCs), improving public health by lowering the cost of healthcare is as important as the bottom line.
America spends $500 Billion a year on prescription drugs. Less than 2% of prescriptions are written for ‘specialty’ drugs, but these account for $250 Billion, half of America’s total drug spend. Clinical trials and real-world evidence demonstrate that suboptimal drugs are being prescribed frequently. This means we pay for drugs that often don’t work because no one is asking the question, what do these drugs do? VIVIO’s team of clinicians and researchers match drug trial evidence to individual patient data, which improves outcomes, reduces side effects, and lowers member, employer, and health plan drug costs.
“The event that led to finalizing the collaboration between VIVIO and Cost Plus Drugs is as horrific as it is incredibly uplifting,” said Mark Cuban. “Last week I was contacted by a friend from Indiana University who mentioned that a mutual friend was in a dire situation. The mutual friend was quoted a price of $3,000 per month for a generic specialty drug called droxidopa. He asked if Cost Plus Drugs could find an affordable source of the medication.”
The Cost Plus Drugs team went to work immediately, says Cuban. Within a week, Cost Plus Drugs had sourced the same medication at a price of $75 for a three-month supply, less than 1% of the cost Cuban’s friend was paying. “I mentioned this in an interview with Trevor Noah on The Daily Show and this caught the attention of Pramod John, the CEO of VIVIO. As it turns out, VIVIO also has patients taking droxidopa. I am excited to say our relationship was finalized in a matter of days,” said Cuban. “Now VIVIO patients will have access to pay far less for droxidopa and many other medications when using Cost Plus Drugs. I am so looking forward to us working together to benefit patients everywhere!”
“As a Public Benefit Corporation, the interests of VIVIO, our patients, and our employer and health plan customers must be aligned. They want better outcomes and lower costs, and so do we. Unlike PBMs, we don’t have a formulary or own any pharmacies or provider services. Instead, our sole business is to use data to ensure drugs are working for each patient and are acquired at the lowest cost,” says Pramod John, VIVIO CEO. “We seek to partner with other like-minded innovators to drive meaningful change to an industry that desperately needs it but doesn’t want it. Our relationship with Cost Plus Drugs allows our customers to stop overpaying for drugs, and that’s an important part of our mission.”
“A foundational principle for Cost Plus Drugs and VIVIO is fairness and transparency,” says Alex Oshmyansky, CEO of Cost Plus Drugs. “It is never fair to pay $3K for a drug that’s available for $21 or to pay for a drug without the data supporting its use. This causes inflation, premium increases, and a bloated, inefficient $4.2 Trillion health system.”
About VIVIO Health, a Public Benefit Corporation
VIVIO Precision Care™ uses data to fix the big unsolved problem of paying for expensive drug therapies that don’t work for members while causing side effects. VIVIO helps self-insured employers and health plans ensure their members are on the right drugs while not overpaying for them. In 2021, VIVIO customers’ specialty drug spend was 65% lower than national benchmarks.
About Mark Cuban Cost Plus Drug Company, a Public Benefit Corporation
Cost Plus Drugs aims to change the way the pharmaceutical industry operates. As a public-benefit corporation, its social mission of improving public health is just as important as the bottom line. Cost Plus Drugs transparently charges a standard markup on every drug it sells. The costplusdrugs.com online pharmacy launched in January 2022 now carries nearly 1,000 prescription products, delivered by mail to thousands of happy customers every day. Cost Plus Drugs works with health plans, managed-care organizations, pharmacy benefits managers (PBMs), and self-insured employers to bring these same savings to employer-sponsored benefit plans nationwide.
The original press release can be found at: http://www.prweb.com/releases/2022/10/prweb18961234.htm
Advancing principles for value in addressing inflammatory bowel disease As the Center for Medicare and Medicaid Innovation (CMMI) continues to advance value-based payment (VBP) models to address quality and total cost of care in primary care and large-scale populations, many stakeholders are grappling with how to build VBP models for chronic specialty and subspecialty conditions for smaller populations, such as inflammatory bowel disease (IBD).1 Some believe that VBP models have the potential to improve patient and cost related outcomes in IBD, and while some commercial payers and practice partners are experimenting with such models, most of these efforts remain nascent.
Beginning in 2021, Tapestry Networks engaged a diverse group of stakeholders—including payers, self-insured employers, gastroenterologists and clinical specialists, patient advocacy organizations, industry representatives, and others—in its IBD Shared Value Initiative to address the challenges and opportunities surrounding value-based care (VBC)2 and VBP models in IBD. The initiative culminated in the May 2021 Progress Summit. 3 Following the summit, many stakeholders noted that establishing consensus-based principles for value in IBD could help guide those looking to pilot new approaches. Therefore, throughout 2021 and early 2022, Tapestry continued discussions with key stakeholders to consider what those principles might be. From this broader group, a small subset of payers and providers, chosen for their roles and leadership in care delivery and contracting, collaborated to draft a publication on the topic. In June 2022, the draft framework publication was presented to the larger stakeholder group for further insights. Meeting participants also discussed considerations for practical implementation of the framework, including the incentives and resources necessary to advance the principles proposed in the draft. The meeting also provided a forum for candid discussion among stakeholders for continuous learning, and more such meetings may be convened in the future.
The original PDF can be found at: https://viviohealth.com/inflammatory-bowel-disease-shared-value-initiative/
San Leandro, CA – VIVIO, a leading specialty drug management company, announced today that Chris Crawford has joined the company as Chief Growth Officer.
Chris is leveraging almost 20 years of employee benefits consulting and leadership experience to drive new client acquisition and build a sales organization. Chris’ relevant experience includes Mercer, where he was the US Sales & Client Management Leader, before founding a benefits consulting firm, CMC Advisory Group, which was later acquired by Cottingham & Butler. Most recently, Chris was the Chief Growth Officer at Health Strategy which is recognized as one of the premier pharmacy benefit consulting firms in the industry.
“The rising cost of specialty drugs is the most significant challenge facing employee benefit plans,” said Chris. “Employers struggle with where to turn for help as the PBM industry is known for misaligned incentives, hidden vendor revenue streams and complex contracts.”
“We are excited to have Chris join our leadership team,” said Pramod John, VIVIO CEO. “His deep industry experience will greatly benefit our current and future clients, stakeholders and the specialty drug industry as a whole.”
“I am proud to join the VIVIO team as I believe employers are looking for a specialty drug management solution that they can understand and trust.” said Crawford. “VIVIO’S drug coverage decisions are driven by science and clinical data, rather than by supply chain profit motivation. VIVIO also provides employers with a solution that is free from the conflicts of interest that exist when traditional PBMs are responsible for authorizing drug therapies that are then sold from their own specialty pharmacies. Finally, employers and Plan Fiduciaries are looking for partners that charge a fair and transparent administration fee, while never receiving any other compensation or profiting from either drug cost inflation or an increase in utilization.”
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About VIVIO: VIVIO Precision Care™ fixes the following system problems: identifying expensive drug therapies that don’t work even though they have FDA approval; not knowing if a member is responding adequately to the therapy; doctors not reading the clinical trials themselves; the arbitrary line between pharmacy and medical benefit; and, egregious supply chain waste. VIVIO uses clinical trial, patient, and financial data to drive better patient outcomes while eliminating wasted spend. The company’s carve-out program plugs into an employer’s current carriers and PBMs. 2020 net savings for VIVIO customers was 37%, while both outcomes and member experience significantly improved. In 2020, on average, VIVIO customers experienced a 7.5X ROI on program fees.
For more information or a higher res image, contact T. J. Tedesco at [email protected]
Minneapolis, MN, October 2019 – VIVIO, a specialty drug management company, won one of two innovator awards offered by Employer Health Innovation Roundtable.
EHIR’s mission is to accelerate the adoption of innovation to improve health, wellness and productivity. EHIR provides objective support in identifying and assessing emerging solutions to sift through the noise and stay ahead of the curve amid a rapidly changing competitive landscape. EHIR has provided a streamlined process and valuable insights to leading employers for the last 5 years.
What is the EHIR Traction Award?
The Traction Award is a semi-annual award (Spring/Fall) recognizing the innovator, among these selected by our members to present, with the most employer interest through the EHIR matchmaking process. This award recognizes the importance of work in partnering with EHIR members to drive impact through action.
Why did EHIR create this award?
EHIR’s mission is to accelerate the adoption of innovation to improve the health, wellness, and productivity of employees and plan members. EHIR does this through a matchmaking process and it is through this commitment to action that innovation truly happens. The Traction Award was created to recognize the innovators who help EHIR deliver on its mission.
How are award winners determined?
The innovators with the greatest number of matches (between employer/innovator) during individual cohort meetings (Spring/Fall) is recognized as the winner. There are 4 winners each season as we have 4 employer cohorts.