Choosing a PBM Partner: What Self-Funded Employers Need to Know (Part 1)

In this episode of Captivating Health Insights, host Maddison Bezdicek speaks with Kevin Kobielski, President and Founder of Navion, to explore the complexities of pharmacy benefit management (PBM) for self-funded employers.

The conversation unpacks how pharmacy spend has evolved to represent more than half of total healthcare costs and why choosing the right PBM partner is critical. Kobielski explains the differences between transparent and traditional PBM models, how specialty drugs and rebates influence costs, and why employers must consider clinical oversight, contract flexibility, and utilization trends when selecting a PBM. This is Part 1 of a two-part discussion.

Chapters

• (00:00:00) - Introduction & navigating the pharmacy benefits landscape
• (00:01:03) - How Kevin got into the world of pharmacy
• (00:03:23) - What is a pharmacy consultant?
• (00:05:15) - Choosing the right PBM for your organization
• (00:10:33) - The difference between a transparent vs traditional PBM
• (00:13:36) - What is a specialty pharmacy?
• (00:17:40) - Transparent PBM vs Traditional PBM: Best Fit
• (00:20:13) - Reasons Why the utilization of a PBM matters
• (00:21:47) - Biosimilars
• (00:23:51) - Components of a PBBM evaluation?
• (00:26:56) - Clinical management strategies
• (00:30:13) - MAP and PAP Programs
• (00:36:14) - International specialty programs & wrap up