VENTEGRA ANNOUNCES ITS MEDICAL BENEFIT MANAGER (MBM) PHARMACY SERVICES ADMINISTRATION (PSA) CONTRACTS TOP 100; HELPS CLIENTS GAIN EFFICIENCIES, IMPROVE QUALITY OF CARE, AND LOWER COSTS
Ventegra Celebrates 7 Years as the First New Class-of-Trade Created in the Last 40 Years - Designation Recognized by Pharma
GLENDALE, CA –Ventegra, Inc., a Medical Benefit Manager (MBM), which includes a Pharmacy Services Administration (PSA) program, today announces that its roster of MBM clients has topped 100, greatly fortifying Ventegra leadership as both the first and largest U.S.-based, legally recognized and configured MBM in the nation.
Ventegra CEO Robert T. Taketomo, Pharm D, MBA, says, "We are proud that Ventegra
is recognized by the pharmaceutical industry as the first entity operating with an MBM
business model. Ventegra's MBM new class-of-trade designation allows the industry to
work with Ventegra in ways that are separate and distinct from traditional PBMs and
GPOs and consistent with various regulatory safe harbors."
A crucial cornerstone of this industry shift is that the MBM business model enables all
drugs to be covered under a single integrated healthcare benefit vs separate billing for
medical drugs and pharmacy drugs. As a result, the model reduces fragmentation,
increases integrity, integrates population health, and improves utilization management.
Ventegra's MBM status ensures the delivery of innovative solutions for cost-efficient
pharmaceutical services that maximize benefits for payors, providers, and patients,
unlike Pharmacy Benefit Managers (PBMs) and Group Purchasing Organizations
(GPOs). By using the MBM model, payors of healthcare in all market segments reap
benefits that include administrative simplification, efficiencies, and increased quality of
care fueled by the highest integrity and transparency standards in the marketplace.
Explaining Ventegra's Medical Benefit Manager "difference," Dr. Taketomo says, "We
have zero conflicts of interest unlike many PBMs that require members to use PBMowned
mail order or specialty pharmacies or that move their rebate contracting
operations offshore to other countries. The tremendous recognition and support by the
industry and our clients to this new discount channel continues to fuel Ventegra's
passion for making a meaningful difference in the health of the community that we
In 2014, after extensive legal review, Ventegra received contractual designation from
one of the largest pharmaceutical companies in the world as the first entity operating as
an MBM, making it a new class-of-trade. The significance of this recognition is
underscored by the fact that the last new class-of-trade in the industry was created over
40 years ago with the introduction of the Pharmacy Benefit Manager (PBM) class-oftrade.
By December 2019, almost all Ventegra agreements had placed Ventegra into
this new class-of-trade, thus representing a significant milestone in the continued
evolution of healthcare delivery in the United States.
With the MBM model, clients have the assurance that they will have access to discounts
that may be unavailable to other current classes-of-trade such as PBMs and GPOs. The
MBM PSA solution can deliver all the functionality of a PBM with more integrity,
transparency, and significant cost savings, while improving overall quality of care. For
instance, with our patented Acquisition Cost Index, the amount billed by pharmacies is
reflected and verifiable in the invoice detail paid by the payor, rather than being simply
'passed through' before adding ancillary charges.
Dr. Taketomo uses the analogy of an electric car to illustrate the MBM model. "Like the
comparison between an electric engine and a traditional gas engine, Ventegra can
power the same solution as a PBM, but we do it more efficiently and ethically by being
patient-focused rather than being driven by fiduciary obligations to shareholders."
About Ventegra, Inc.
Ventegra uses innovative and proprietary programs and products to ensure appropriate
use of prescription drugs while lowering our clients' costs. As a Medical Benefit
Manager (MBM), Ventegra is a new class-of-trade healthcare model that helps clients
gain efficiencies, lower expenditures, and improve the overall quality of care.
Ventegra's offerings include innovative, cost-saving solutions designed for medical
groups, health systems, self-insured plans, TPAs, government entities, brokers,
consultants, and nonprofits. www.ventegra.com
Our drug list and formularies are designed to provide our clients with a choice of pharmacy products that meet all of the essential clinical conditions while addressing economic needs, and providing quality of care, affordability and choice.
Ventegra was founded to create balance between profitability and affordable patient care in an industry burdened by misplaced priorities. Our team applies our core values of integrity and transparency to create new healthcare delivery channels that are more consolidated and efficient. We channel our resources to positively impact the lives of others and create value for society as a whole.
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What are Fraud, Waste, and Abuse?
FRAUD is generally defined as knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. (18 U.S.C. § 1347)
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ABUSE includes any action(s) that may, directly or indirectly, result in one or more of the following:
Unnecessary costs to the health care system, including the Medicare and Medicaid programs
Improper payment for services
Payment for services that fail to meet professionally recognized standards of care
Services that are medically unnecessary
Abuse involves payment for items or services when there is no legal entitlement to that payment.
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