Ventegra Launches Point-of-Sale Rebate Program

Ventegra has launched the Ventegra Access Program (VAP), a point-of-sale rebate program that delivers the net contract cost to the payer at the point of adjudication. A key feature of the program is its ability to calculate any patient copayment based upon such net cost.

Ventegra, located in Glendale, Calif., provides drug benefit solutions for self-insured employers and health systems. The organization covers more than 13 million lives, with a primary focus on Texas, Washington and California.

Robert T. Taketomo, Pharm.D.

“In this model, 100% of the discount goes back to the payer, in this case the self-insured employer,” Robert T. Taketomo, Pharm.D., president and CEO of Ventegra, said in an interview. “There is no hidden margin or spread.”

Ventegra, he said, charges employers a flat fee for the management of the drug benefit. “This also supports the pharmacy since the employers are paying for the drug. That improves the profitability of the small pharmacy businesses and keeps the prescriptions local,” he said.

The new model is part of the company’s efforts to convert to a nonprofit status. Once the implementation process is complete on June 30, 2024, the organization will be called Ventegra Foundation.

Ventegra officials don’t see what they do as pharmacy benefit manager, but as a medical benefit manager. “The PBM business model is all about driving prescription drug utilization, which may not be appropriate for the member, patient or the payer. PBMs make money through all the hidden margins and spreads,” Taketomo said.

He said when PBM fees are based on a percentage of a drug's list price, this creates perverse incentives. “Also, vertical integration allows them to drive patients and prescriptions to their own pharmacies. There are conflicts of interests. They can bury discounts by moving their rebate entities to foreign countries outside of U.S. law and redefining what is called a 'rebate'.”

Taketomo, who founded Ventegra 20 years ago, said the move to nonprofit status was made to create a sustainable business model and avoid the risk of being acquired by a private equity or a venture capital group.

“It’s the employees and the clients that have made Ventegra successful,” he said. “We want to ensure continuity for the next 100 years. We call this our ‘100-year strategy.’ We’ve seen too many good companies get swallowed up by the bigger ones.”

Edward P. Kammerer, M.D.

Edward P. Kammerer, M.D., medical director, Mosaic Life Care, is a member of Ventegra’s board. Mosaic Life is a physician-led hospital system serving 35 counties in northwest Missouri, northeast Kansas, southeast Nebraska and southwest Iowa.

Mosaic Life is self-funded and self-insured for its 4,000 employees with 8,000 total lives. It has been with Ventegra for the management of its pharmacy benefits since 2017 when it switched from one of the big three PBMs. Kammerer said he made the switch after the traditional PBM would not adjust its formulary to exclude a branded drug that was a combination of two generic medications.

“At that time, we were spending $110,000 just on Vimovo, a combination of naproxen and esomeprazole,” Kammerer said. Vimovo is used to treat the pain symptoms of arthritis. Vimovo made national news then when the price was raised from $138 to almost $3,000. Vimovo has a current price of $2,623 for 60 tablets, according to Drugs.com.

“That’s when I learned about copay coupons and about the perverse incentives of PBMs,” he said. “We’re a not-for-profit hospital organization and we have a fiduciary responsibility to our employees.”

In the first year, Ventegra was able to save Mosaic Life $6 million; total savings have been about $40 million, Kammerer said. The savings, he said, come from a combination of managing utilization, compliance, and prior authorization, along with medical management. There was some disruption for employees when making the switch to Ventegra. “With cost savings, there is always disruption,” Kammerer said.