As founder and CEO, Mindi Fynke leads one of the fastest growing, independently owned Pharmacy Benefit Managers in the country. Dedicated to innovative plan design, cost containment, and excellent customer service, EHIM, Inc. will continue to grow and evolve while making healthcare options affordable for its members. Ms. Fynke recently sat down for a Q&A session that may provide insight into the company's business philosophy and success story. The questions and her answers are listed below.

Q: Refusing to accept rebates from drug manufacturers is a somewhat unusual and provocative stance. Explain the rationale behind that.
    A: I have never believed in rebates. When I first began building my pharmacy network over 23 years ago to establish EHIM as a PBM, I was approached by a formulary management firm who was willing to give me $1.00 for every transaction we processed. I hadn’t even filled one script yet! When I learned I would have to relinquish control of my formulary and share my claim data in exchange for the $1.00 rebate, it reaffirmed my belief that the practice of rebates was unethical. It was upsetting that they were willing to give me a $1.00 per transaction to manage my formulary and steer a patient’s medication choice. I would much rather they reduce the cost of medication to make it more affordable.

    I believe rebates are a complete conflict of interest for a PBM to accept. Over the last 2 decades, rebates have resulted in pushed market share for products that are often not only the most expensive ones out there – but sometimes have been products that are not the most effective. Or, in recent years – the most safe!

    You may remember well when Vioxx – a very rebatable product at the time - - was pulled from the shelf. It would have been heartbreaking to me if I had somehow influenced even more distribution of this product because it meant more dollars in my pocket.

    It has not always been easy to explain my strong stance against rebates. For years, we had to show how there was not money left on the table. Rebates are intended to push market share – not cut costs to medication. This does not parallel with what I view a PBM’s primary responsibility is: To manage pharmacy benefits. To help affordability, patient compliance, safety and wellness while controlling the payment channel for this care.

    What will be interesting is where the rebate industry goes in the future. We are operating in an era where the Generic Utilization Rate is climbing higher and higher. At EHIM, we are seeing nearly 80% GUR averages – with many clients nearing 90%! With such a high GUR possible across the entire PBM industry – the rebates are going to begin to diminish.

    Being free of the whole rebate game has allowed EHIM to stay true to my passion of care, and commitment to our customers. We can design any formulary, any program – and never worry about preferring one drug over another because I am obligated by contract to do so.

    It’s also allowed us to have some of the lowest trend in the country – I am very proud to say we have maintained a less than 5% trend for over 6 years.

    Q: Since you don’t pass along rebates, what other methods, strategies or principles do you use to provide savings and value to your customers?

    A: See, this question is written a little backwards! We don’t feel passing along rebates are a strategy to provide true “savings” and “value” to our customers. Rebates are paid for high cost medication; if a client yields a high rebate check at the end of a time period, they spent this up front to begin with. We consult our clients on strategies that include plan design, formulary control, and medication adherence. In fact, sometimes our programs provide savings on medical plans as well.

    As a strategic partner for clients, a PBM should reduce costs in any area possible. This can be achieved through value-based plan designs, $0 copay Over-the-Counter initiatives, or compliance monitoring, for example.

    Our true value to our clients is data analytics – not just providing lists of top 100 medications, or therapeutic class performance. Any PBM can do that. It’s what you advise your client to do with that data that provides true value; being able to design a custom formulary with past performance in mind.

    We view each client as the driver of their own plan design. We work with members to educate them on their options with their own program. We reach out to physicians to provide them what medications are in their own patients’ formulary, so they can help achieve savings to the member.

    Q: What are the important considerations when you devise a customized plan for a specific population? What are the benefits of a customized plan for the client?

    Being headquartered in Detroit, we see so many extremes that mirror what is going on throughout the country. We see heavily bargained contracts with low out-of-pocket costs for members (we still see the $2 copay plan, believe it or not!) – to the exact other extreme with companies who are laying off and fighting to keep their doors open.

    Those considerations need to be taken with each group. In all environments, flexibility is paramount to achieving the goals of any client. That’s truly the best part of this company – being able to address challenges, and continue access to care all while having complete freedom from the Rebate industry. It lets us help our clients control their own destiny and trend.

    Every group is examined from various angles. We look at demographics, historic performance – and, most importantly, we identify what the group’s own goals are. Today, it’s no longer just about saving the dollars. It’s making those savings translate into health, and a future of continued care.

    My favorite example of a recent specific population that approached EHIM to work with them was a non-profit organization who built a network of physicians and hospitals to provide free access to care to an uninsured population. They looked to EHIM to develop a platform for pharmacy benefits – a key component to keeping this population healthy. Their goal was unique: They needed to maximize the benefits to the fullest, so they could continue to increase the number of people who could be recipients of this free healthcare.

    With limited funds and a growing number of recipients, EHIM developed an evolving formulary that is one of the most evidence-based cost efficient programs offered in the country.

    Essentially – we stretched the dollar as far as it can go. This program, which also heavily integrates Patient Assistance Programs for continued payment options for the group – has received national acclaim for its success, and I am so proud we were able to be a part of it.

    It’s part of the uniqueness of EHIM – meeting the needs of our clients, and feeling like we did something good at the end of the day.
    Q: What are some of the primary differences in working with the public sector? What makes EHiM attractive to government clients?

    A: EHIM is attractive to government clients because of our highly customized plan designs. Our clients may be a bargained group with a union contract in place that is very specific in describing the benefit level that is to be administered or a federal government client that has a very defined program. Because EHIM’s system platform is proprietary and in-house, we can accommodate highly complex plans or plans that do not follow the traditional menu of what is available today.

    We have groups that have anywhere from a flat one tier program to five tier copay plans and everything in between. We support program designs that have $0 copays, deductibles, and percentage copayments.

    With our proprietary systems, we provide the detailed reporting to support these plan designs and give our clients the data, the feedback and tools necessary to analyze and manage their plan. Reports to track performance, utilization, formulary management, channel utilization, compliance, and adherence are all part of our standard reporting.

    Additionally, EHIM truly remains attractive to all of our clients because of our hands-on, high touch customer service. Our program is easy to use for both our client and our members. Our pharmacy help desk is open 24 hours a day, 365 days a year so if a member or their pharmacy has a question about a prescription, we are available. They call us and someone answers the phone. Callers don’t have to go through an automated phone maze that can be confusing and frustrating; they dial and we answer, it’s very simple for the member. The feedback we continue to receive from our clients is that our customer service is second to none and I think the longevity of the relationships we have with our clients’ prove this. I am proud to say many of my clients are clients that have been with EHIM for over 20 years!

    Q: Tell us about the hurricane relief prescription drug program you worked on for the VA. What was your role in that?

    A: EHIM had been providing initial fill pharmacy services to the veterans in Florida since 2004. When Hurricane Wilma hit the Miami area in 2005, it was devastating and initially a lot of chaos because much of the area had no phones, no power, nothing. The VA wasn’t even sure which of their clinics had been affected and to what extreme. We made contact with the VA and offered our services in any way we could. The order of business was trying to determine which of the VA clinics had been affected by the hurricane. EHIM assisted the VA by contacting our participating pharmacies that were in closest proximity to each VA clinic to help determine the extent of damage felt by each location. We were figuring out which ones (if any) were fully operable, partially operable, or completely inoperable. Once we determined the clinics that could not support their veterans in need of urgent health services, we immediately put into place a temporary program to service over 250,000 veterans who needed immediate access to care and prescription refills. We opened our initial fill program to cover up to a 90 day supply of medication at any of our participating pharmacies for veterans who were unable to receive their prescriptions from the VA mail order service. We truly had the program in place and were filling our first prescription within 48 hours of the initial phone call. As the clinics were able to rebuild and function at full capacity, then the temporary 90-day program we had put in place was phased out.

    It was truly a feeling of being able to give back and take care of others. I was really proud of my organization for being able to rise to the occasion, and assemble our portion of the Relief program so quickly.

    Q: This year you were named 2010 Entrepreneur of the Year by Ernst & Young, a fairly high-profile award for individual business excellence. In your estimate (or the award citation) what are the best practices, traits, accomplishments, etc. that earned you the award?

    It is amazing to think that the business idea I had over twenty years ago which I started in my one bedroom apartment is a reality that services over 2 million lives across the country and was recognized with the E&Y Award. It is truly amazing, incredible and unbelievable.

    It’s hard to answer the question of what earned us the award. As I built my business, I was never focused on winning awards. I am passionate about taking care of our clients, our members and committed to doing the right thing and what is in their best interest. I am dedicated to educating our clients and members in how both employer and employee can contribute to keeping costs down. We help our clients manage their pharmacy costs which in turn contribute to cost containment of their entire medical plan. This means that a client doesn’t have to take away or reduce benefits, or raise copays. These are the driving forces and beliefs that initiated EHIM’s business model which broke the mold in our industry and proves to be successful. The greatest reward is knowing that our commitment to managing pharmacy benefits doesn’t compromise care, rather it enables members to receive the care they need at costs that are affordable.