RxAdvance's Sculley: What the PBM of the future might look like

It's not a secret that the healthcare industry is slow to change. 

The traditional models for pharmacy benefit managers have been under particular scrutiny of late, with these companies seeing the revival and finalization of the dreaded "rebate rule" and a Supreme Court ruling that could open the door for greater regulation.

With these increasing calls for evolution, it begs the question: What would the PBM "of the future" look like?

For John Sculley, chairman of startup PBM RxAdvance and former CEO of Apple, it starts with starting to think about how to shake up the traditional rebate approach.

"Is there a model for the PBM of the future that is not rebate-dependent?" Sculley said during an interview with Fierce Healthcare. "It's not likely to change, but there's a huge opportunity we see at RxAdvance to bring in smart process automation."

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RxAdvance, which was founded in 2015 by physicians and health and tech entrepreneurs, is built on a collaborative cloud platform. Embracing automation, Sculley said, allows the company to streamline some of the traditional processes associated with managing prescriptions.

That documentation takes a lot of time but also includes information that has a lot of value in multiple uses. In the traditional PBM model, many of those data are siloed and hard to use, Sculley said.

"There is a hugely valuable amount of documentation that comes with each script," he said. "Platforms [like RxAdvance's] are horizontal, they aren't silos. A platform is able to take that data … across the continuum of care."

Even though giving a decades-old industry a facelift has upsides, Sculley said the only thing that will drive broad change is significant political and policy pressure, of which the Part D rebate rule is a notable example.

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Should states follow in Arkansas' footsteps in the wake of the Supreme Court's decision to uphold its law regulating PBMs, policymakers could turn up the heat even more on these firms. Sculley said part of the challenge is that the industry is heavily dominated by three large companies, so, if they're unwilling to budge, large-scale change is unlikely.

"They don't have motivation to change quickly," he said.

However, if they're really put under pressure to explain how patients benefit from the rebate model, he said, "it's a hard story to explain."

Sculley said he doesn't see the value of innovation ending with PBMs, either. Heading into 2021, he said artificial intelligence and sensors are key trends to watch in the coming year, especially around machine learning.

The Apple Watch is an example of how these platforms are evolving, he said. Early iterations of the watch had simpler sensors, which could measure steps or breathing, but they are evolving to include more features that can measure heart rate and track sleep.

And the evolution of these products is backed by heaps of data, much of them gathered through machine learning, he said.

"Sensors are just getting better and better," he said.