D
Don Anderson
Don Anderson, Pharm.D., is Vice President of Pharmacy at OrionRx (Pinnacle Rx Solutions), a pharmacy benefit manager focused on pharmacy cost containment for employers and health plans.
1
APPEARANCES
1
PODCASTS
012
DEC 30
JAN 6
JAN 13
JAN 20
JAN 27
FEB 3
FEB 10
FEB 17
FEB 24
MAR 3
MAR 10
MAR 17
MAR 24
MAR 31
APR 7
APR 14
APR 21
APR 28
MAY 5
MAY 12
MAY 19
MAY 26
JUN 2
JUN 9
JUN 16
JUN 23
JUN 30
JUL 7
JUL 14
JUL 21
JUL 28
AUG 4
AUG 11
AUG 18
AUG 25
SEP 1
SEP 8
SEP 15
SEP 22
SEP 29
OCT 6
OCT 13
OCT 20
OCT 27
NOV 3
NOV 10
NOV 17
NOV 24
DEC 1
DEC 8
DEC 15
DEC 22
DEC 29
JAN 5
JAN 12
JAN 19
JAN 26
FEB 2
FEB 9
FEB 16
FEB 23
MAR 2
MAR 9
MAR 16
MAR 23
MAR 30
APR 6
APR 13
APR 20
APR 27
MAY 4
MAY 11
MAY 18
MAY 25
JUN 1
JUN 8
JUN 15
JUN 22
JUN 29
JUL 6
JUL 13
JUL 20
JUL 27
AUG 3
AUG 10
AUG 17
AUG 24
AUG 31
SEP 7
SEP 14
SEP 21
SEP 28
OCT 5
OCT 12
Oct 6, 2026
S8E3 - Health Plan Cost Containment Part 1 - Medical Plan and Rx Spend Cost Containment
37:00
42:20

Dorothy CociuHOST
And I think that people don't really understand that they have choices to make in a pharmacy plan because they just kind of a lot of times buy what was presented to them, right? So what can you do to contain costs? How can you kind of dig into that and try to save some money?
D
37:14Don AndersonGUEST
Yeah, so on the plan sponsor side, one of the things that we find a lot of success with is our clinical intervention program.
D
37:21Don AndersonGUEST
So I've got a team of pharmacists and nurses that are looking at high-cost claims coming through, and we set that threshold differently depending on the plan themselves.
D
37:29Don AndersonGUEST
But anything that's in excess of $5,000 or $6,000, we're looking at pretty closely.
D
37:35Don AndersonGUEST
Is that claim the right claim in that member's health profile? Does it make sense right now? And if it doesn't, what can we do with a provider to come up with a better solution? Um, and a lot of that, I'll call it academic detailing, right? Pharmaceutical reps are detailing doctors to prescribe certain things.
D
37:51Don AndersonGUEST
We're going back and behind them, reeducating that provider onto a less costly alternative with similar likely outcomes.
D
37:58Don AndersonGUEST
Um, I've taken a plan in from a large PDM competitor and we've shaved anywhere from 15 to 17 points right off of the drug spend in the first 12 months, just doing that alone.

Dorothy CociuHOST
But the drug costs... have come down on glp-1 drugs in in 2026 i've noticed tell me about this are plans covering it now in your perspective are more plans covering it than maybe even a year ago and if so are they building in requirements criteria such as you know body mass obesity that sort of thing or are they just letting people that anybody that wants to get skinny get skinny