Wiley's Health Care Contracting Chronicles
Contracting for Success: Key Legal Considerations When Segmenting Pharmacy Benefit Programs
April 22, 2025In this episode of The Wiley Contracting Chronicles, co-hosts Jordan Ross and Brooke DeLoatch take a deeper dive into program segmentation within pharmacy benefit programs. After outlining the concept in their previous episode, they now explore the contractual implications that follow a health plan’s decision to segment services among multiple PBMs or service providers. Throughout the episode, they stress one essential takeaway: involve legal counsel early and often to lay the groundwork for a smooth and strategic transition to a segmented model.
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Wiley's Health Care Team
Dorthula H. Powell-Woodson; Brooke M. DeLoatch; Jordan Ross; Lukman Azeez; Kathryn Bucher; Kathleen E. Scott; Tatiana Sainati; Kathleen Cooperstein; Rebecca J. Fiebig; Melany Birdsong; Kelly Baugh; Kirsten C. Hines
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Pharmacy Benefit Segmentation: Emerging Models for Health Plans
March 18, 2025In this episode of The Wiley Contracting Chronicles, hosts Jordan Ross and Brooke DeLoatch discuss the growing trend of pharmacy benefit segmentation among health plans. They outline three emerging models identified at Wiley: Product Service Disaggregation, Program Segmentation, and Industry Disruption—each offering varying levels of complexity and control. The hosts highlight key considerations for implementing these models, including resource commitment, clear contracting terms, and ensuring service provider capabilities. With careful planning and strategic contract management, health plans can leverage segmentation to foster competition, improve efficiency, and lower drug costs.
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Transforming PBM Contracting: The Wiley Approach
December 16, 2024
In this episode of Wiley’s Health Care Contracting Chronicles, hosts Jordan Ross and Brooke DeLoatch share how Wiley’s innovative PBM contracting process helps health plans achieve better pricing, transparency, and efficiency. They outline the five key stages of the Wiley Competitive Contracting process, explain why early legal involvement is a game-changer, and discuss how this method drives meaningful negotiations. Tune in for actionable insights into mastering PBM contracts in a rapidly evolving marketplace.
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Understanding Pharmacy Benefit Managers: The PBM Landscape Explained
September 23, 2024In this episode of Wiley’s Health Care Contracting Chronicles, hosts Jordan Ross and Brooke DeLoach introduce the complex world of Pharmacy Benefit Managers (PBMs) and their pivotal role in the healthcare industry. They explore the functions of PBMs as intermediaries between insurers, pharmaceutical companies, and pharmacies, detailing their responsibilities in managing drug benefits and negotiating prices. The discussion also addresses the growing concerns around transparency and regulatory oversight, highlighting recent legislative efforts aimed at reforming PBM practices. Tune in to gain foundational insights into the PBM landscape and what it means for healthcare contracting in the future.
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