Digital Health Heavyweights Episode 9: Mark Mincy, Chief Commercial Officer at US-RX Care
13 snips
Mar 9, 2026 Mark Mincy, Chief Commercial Officer at USRX Care and a pharmacist with decades in pharmacy benefits, explains why PBM structures can drive up drug costs. He discusses fiduciary risk, transparency, conflicts of interest, specialty drug drivers, legislative shifts, and how employers can reclaim control with fiduciary-aligned strategies and alternative PBM models.
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Carve Out Utilization Management For Safety And Cost
- Do carve out formulary and utilization management so prescribing is guided by safety, effectiveness, and low net cost.
- USRX Care applies specialty guidelines from medical societies to prevent approving 10th-line expensive agents when cheaper options exist.
Enforce Biosimilar First And Open Pharmacy Access
- Require biosimilar-first policies and open access to independent pharmacies and cost-plus models.
- USRX cites House Oversight findings that big PBMs exclude cheaper biosimilars and generics, costing employers roughly $500 more per claim.
Competition Can Make Drug Prices Higher
- PBM competition paradoxically inflates prices because manufacturers must increase list prices to pay prescribers and PBMs to get formulary placement.
- New high-cost winners like Skyrizi rose as manufacturers outbid with higher rebates and payments.