As a Regional Sales Director at ProAct, Inc. Mike delivers a fresh perspective on pharmacy benefits. With his diverse experience in all areas of employee benefits, he understands the major roll pharmacy management plays in not only cost containment but also employee satisfaction. ProAct focuses on flexible solutions with high touch service. Working with Brokers and TPAs, they customize a PBM plan that fits an employer’s budget, and their employee’s needs.
What is your background and how did you get into the EB business?
I started in the insurance business in 1989. After college graduation, I joined Metropolitan Life as a sales representative selling individual life insurance policies at the kitchen table. It taught me the “Rule of 50” in prospecting. From there, I moved to an independent agency for 7.5 years selling employee benefits to small business employers. For the next 10 years, I moved to the health carrier side of the business working for Kaiser, Emblem Health, and United Healthcare. In the health carrier sector, I learned about large group underwriting and the complexity of provider networks and contracting.
I then chose to move back to the agency side for 14.5 years with responsibilities focused on sales and management. I managed an EB department for 5 years and doubled the revenue in the department by adding great sales talent.
Another opportunity appeared with the introduction of ACA. We built a team to help employers complete their 1095s and file their 1094s with the IRS.
Most recently, I had the opportunity to join ProAct, Inc., a 100% employee-owned Pharmacy Benefit Manager. With the complexity of employee benefits and specialty pharmacy in today’s healthcare landscape, I have the important task of helping brokers and consultants help their clients manage pharmacy cost of their employee benefit programs.
What are your leadership principals?
My core leadership principals are to lead by example; challenge the process; enable others to act; and develop future leaders.
What are you looking forward to as a BAN Partner?
I am looking forward to ProAct’s collaboration with BAN membership to provide PBM education and value.
How are you advising your clients regarding inflation, higher interest rates and a shaky economy?
All employers are feeling the pressure of inflation, higher interest rates, a shaky economy, and employee retention concerns.
Complex conditions represent significant costs within employer health plans. In 2022, specialty spend throughout the industry continued to outpace non-specialty and grew approximately 11.6% compared to non-specialty growth of 6.9%. These challenges in specialty spend are changing how brokers and consultants are helping employers manage their total spend for pharmacy benefits.
ProAct offers various solutions to assist employers (plan sponsors) in managing specialty drug spend; including percentage-based copay programs, utilization management edits, as well as funding assistance partnerships.
The introduction of biosimilars can also offer some relief. By monitoring upcoming biosimilar and generic launches, ProAct can strategize appropriately, and implement formulary changes to transition utilization toward the agent losing exclusivity or by evolving our clinical programs to increase utilization.
ProAct’s Clinical Optimization Program offers an opportunity to discuss alternative medication therapies aimed at lowering prescription drug expenditures for plan sponsors, while improving health outcomes for members.
Around the corner in 2025, there will be an introduction of many new medications for gene therapy. We work with our brokers and consultants on planning in advance for these innovations to help provide solutions in mitigating substantial increases in pharmacy spend.
Are you concerned about a recession?
A recession will greatly impact employers in operating their businesses. We will work with brokers and consultants to help mitigate excess pharmacy spend through education.
What is your outlook in 2024?
Over the past few years, we’ve seen an unprecedented level of legislation around health plans and pharmacy benefit managers, leading to over 2,800 new pieces of legislation introduced around pharmacy benefits. We look forward to being a resource for Benefit Advisors Network Partners on the changing marketplace to ensure compliance with both federal and state reporting requirements.
What is the industry’s largest challenge?
The industry’s largest challenge is innovation and the rising cost of pharmacy benefits. We look forward to developing and executing solutions to help BAN’s brokers and consultants find innovative ways to manage their employers’ total pharmacy spend.
What are two lessons that you learned during your career that you can pass along to future leaders in the insurance industry?
In sales, it took me about 20 years in my career to learn that joint team selling can generate substantially better results. As a leader, I learned the importance of taking care of my team members and showing them how important they are to the company and our goals.
Mike can be reached at mikegrinnell@proactrx.com.