Podcasts about PBM

Renzo Luzzatti, Founder and CEO of US-Rx Care, discusses the role and practice of the Pharmacy Benefits Managers and the advantages of working with a company that uses a fiduciary model. Inherent conflicts of interest in the traditional PBM model, such as manufacturer rebates and requirements to use PBM-owned pharmacies, drive up prescription drug costs. US-Rx Care eliminates these conflicts by charging a flat administrative fee with its sole incentive to lower drug costs for the plan and its members. Renxo explains, "We've been around since 2007. We do have about 5 million lives under management, both self-funded employers, which is the bulk of our business. Then we also tap into Medicare health plans and have some programs and offerings that we assist there to lower costs and improve the quality of care. Our approach is unique in that we've taken a fiduciary stance from day one. We can talk about that in a little bit. It is a legal term. It's defined under ERISA, which governs health plans. They have a fiduciary duty to the plan, the members, and the management of the plan assets. And the industry as a whole has shied away from any fiduciary obligation whatsoever, in part because it's rife with conflicts of interest, and you cannot have conflicts of interest as a fiduciary."   "That is really at the core of all of the issues and complaints that we're hearing about PBMs - they're driving up the cost of prescriptions rather than having the intended effect, which is to reduce the cost of prescriptions. And I would say in the last four or five years, employers have really started to ask the right questions because they're becoming more and more educated."   "For folks like us, we're growing like crazy because the industry finally gets that. The deal that they were getting through their traditional model is not so good. The other thing is when we move to a fiduciary model, savings are typically in the realm of 30% to 50% in the first year, and then we typically see additional savings in year two and three, and then after that, the goal and the intent, which we've been successful at, is to keep costs stable."  #USRxCare #PBM #PharmacyBenefits #EmployeeBenefits #HealthcareCosts #FiduciaryResponsibility #BenefitsConsulting #HealthcareTransparency #CostContainment #SelfFundedEmployers #HealthcareReform usrxcare.com Download the transcript here 

Renzo Luzzatti, Founder and CEO of US-Rx Care, discusses the role and practice of the Pharmacy Benefits Managers and the advantages of working with a company that uses a fiduciary model. Inherent conflicts of interest in the traditional PBM model, such as manufacturer rebates and requirements to use PBM-owned pharmacies, drive up prescription drug costs. US-Rx Care eliminates these conflicts by charging a flat administrative fee, with its sole incentive to lower drug costs for the plan and its members. Renxo explains, "We've been around since 2007. We do have about 5 million lives under management, both self-funded employers, which is the bulk of our business. Then we also tap into Medicare health plans and have some programs and offerings that we assist there to lower costs and improve the quality of care. Our approach is unique in that we've taken a fiduciary stance from day one. We can talk about that in a little bit. It is a legal term. It's defined under ERISA, which governs health plans. They have a fiduciary duty to the plan, the members, and the management of the plan assets. And the industry as a whole has shied away from any fiduciary obligation whatsoever, in part because it's rife with conflicts of interest, and you cannot have conflicts of interest as a fiduciary."   "That is really at the core of all of the issues and complaints that we're hearing about PBMs - they're driving up the cost of prescriptions rather than having the intended effect, which is to reduce the cost of prescriptions. And I would say in the last four or five years, employers have really started to ask the right questions because they're becoming more and more educated."   "For folks like us, we're growing like crazy because the industry finally gets that. The deal that they were getting through their traditional model is not so good. The other thing is when we move to a fiduciary model, savings are typically in the realm of 30% to 50% in the first year, and then we typically see additional savings in year two and three, and then after that, the goal and the intent, which we've been successful at, is to keep costs stable."  #USRxCare #PBM #PharmacyBenefits #EmployeeBenefits #HealthcareCosts #FiduciaryResponsibility #BenefitsConsulting #HealthcareTransparency #CostContainment #SelfFundedEmployers #HealthcareReform usrxcare.com Listen to the podcast here 

In this episode of Prescription for Better Access, we're joined by William (Bill) Sarraille, a legal expert on drug access and reimbursement. He discusses two developments shaping the pharmacy benefit landscape: the FTC's enforcement action involving Express Scripts and PBM reforms in the Consolidated Appropriations Act of 2026. Bill explains what these policy changes could mean for benefit design, drug coverage, employer-sponsored plans, and transparency in the PBM market. We also explore potential impacts on formularies, utilization management, contracting practices, and patient out-of-pocket costs, along with possible unintended consequences for employers, manufacturers, and patients seeking timely and affordable access to medicines. William (Bill) Sarraille, University of Maryland School of Law LinkedIn Pharmacy Benefit Managers (PBMs) FTC Settlement 2024 Administrative Complaint Cigna Healthcare Fair Market Value in Healthcare Consolidated Appropriations Act of 2026 Part D Plan PBMs No Longer Profit From Rebates But Plans Benefit – Pink Sheet TPA (Third Party Administrators) DOL Proposal Copay Accumulators and Maximizers Amicus Brief, HIV and Hepatitis Institute Questions or comments? Email us at comments@prescriptionforbetteraccess.com. Follow us on X, LinkedIn, YouTube, and Threads.

Jeffrey Mosher welcomed Miguel Rodriguez of American Pharmacies, a national organization testifying in Lansing this month about the rapid closure of local, independent pharmacies that serve Michigan patients in the healthcare system. Miguel Rodriquez, Executive Vice President & General Counsel with American Pharmacies Re: Michigan legislative hearings on rapidly closing local independent pharmacies Q1: Miguel Rodriguez, Executive Vice President & General Counsel with American Pharmacies, is here to talk about the loss of local independent pharmacies taking place across Michigan and how state lawmakers are now looking at the reasons why this is happening. Miguel, thanks for joining us today. Tell us about the American Pharmacies organization? Q2: Families in rural and urban communities rely on their neighborhood pharmacists for prescriptions, medical advice, and personal support. Unfortunately, we're seeing more pharmacies closing their doors, especially local independent pharmacies. What is the situation here for independent pharmacies? Is this a Michigan or a national problem? Q3: We're seeing many communities being called “pharmacy deserts” due to closings. What does that mean? Q4: Why are independent pharmacies struggling? Q5. We are hearing a lot about PBM's these days. Can you briefly explain what PBMs do? Q6: At the Capitol Building, the closure of independent pharmacies is being reviewed by the Michigan House Oversight Committee's Public Health and Food Security Subcommittee. The first of several hearings was held earlier this week. What is being looked at, to better understand the cause of closings of community independent pharmacies? Q7: What do independent pharmacists need from this legislative review? Q8: What is next in this process?

Washington ignores you—until you get loud. In this clip, Larry O’Connor sits down with AMAC’s Andy Mangione to break down two huge fights: lower prescription drug costs through PBM reform (including “delinking” profits from inflated list prices) and the SAVE Act’s stalled path in the U.S. Senate. They explain how grassroots pressure, voter accountability, and a “talking filibuster” strategy could force action—proving your voice still matters in Washington. SHOP OUR MERCH: https://store.townhallmedia.com/ BUY A LARRY MUG: https://store.townhallmedia.com/products/larry-mug Watch LARRY with Larry O'Connor LIVE — Monday-Thursday at 12PM Eastern on YouTube, Facebook, & Rumble! Find LARRY with Larry O'Connor wherever you get your podcasts! SPOTIFY: https://open.spotify.com/show/7i8F7K4fqIDmqZSIHJNhMh?si=814ce2f8478944c0&nd=1&dlsi=e799ca22e81b456f APPLE: https://podcasts.apple.com/us/podcast/larry/id1730596733 Become a Townhall VIP Member today and use promo code LARRY for 50% off: https://townhall.com/subscribe?tpcc=poddescription https://townhall.com/ https://rumble.com/c/c-5769468 https://www.facebook.com/townhallcom/ https://www.instagram.com/townhallmedia/ https://twitter.com/townhallcomBecome a Townhall VIP member with promo code "LARRY": https://townhall.com/subscribeSee omnystudio.com/listener for privacy information.

Welcome to another episode of TWIRx – This Week in Pharmacy, where we break down the most important developments impacting the pharmacy profession. This week's show features leaders from across community pharmacy, health systems, healthcare advocacy, and international patient engagement. From PBM reform to patient-centered care and health system growth in Western Pennsylvania, this episode brings together voices shaping the future of pharmacy. Sponsored by Sykes & Company, P.A. Accounting, tax strategy, and advisory services dedicated exclusively to independent pharmacy operators. Segment 1 Austin Murray Communications and Marketing Director – Sykes & Company, P.A. We kick off TWIRx with Austin Murray from Sykes & Company, discussing the NCPA Consumer Marketing Campaign designed to educate the public about the value of community pharmacies. Austin shares insights on: • The importance of telling the community pharmacy story directly to consumers • Why independent pharmacies remain essential healthcare access points • The evolving state of independent pharmacy nationwide • Continued momentum around PBM Reform • Strategic accounting and tax advantages pharmacy operators should understand in today's challenging reimbursement environment Austin also explains how pharmacy-focused accounting firms like Sykes & Company help owners navigate reimbursement pressure, tax planning, and business strategy. Segment 2 Mark Duman Pharmacy 50 Award Winner – United Kingdom International healthcare thought leader Mark Duman joins TWIRx to discuss one of the most important principles in healthcare transformation: The patient must come first. Mark shares his perspective on: • Why healthcare systems must remain patient-centered • How pharmacy can lead the way in improving patient outcomes • Lessons learned from patient engagement initiatives in the UK healthcare system • Why meaningful healthcare innovation always begins by focusing on the patient experience Mark emphasizes that when healthcare professionals keep the patient as the constant focus, better pharmacy care and stronger health systems follow. Segment 3 Dr. Laura Mark, PharmD Vice President of Pharmacy – Allegheny Health Network Next, we welcome Dr. Laura Mark, Vice President of Pharmacy at Allegheny Health Network (AHN), who shares exciting news about new pharmacy operations facilities recently built in Butler County, Pennsylvania. Todd and Laura also reflect on their shared roots growing up in Butler County, while discussing how AHN is investing in the future of pharmacy. Topics include: • The new pharmacy operations infrastructure in Western Pennsylvania • How AHN is expanding pharmacy services across the Greater Pittsburgh region • The role of health system pharmacy in improving access to care • Strategic positioning for future healthcare growth and integration AHN continues to strengthen its pharmacy operations as a key component of coordinated patient care throughout the region. Segment 4 Eric Pusey Independent Pharmacy Owner – Pennsylvania Closing out this week's episode, pharmacy owner Eric Pusey joins TWIRx to discuss the latest updates on PBM Reform in Pennsylvania. In 2024, Pennsylvania enacted Act 77, a landmark law aimed at increasing oversight and fairness in pharmacy benefit management. Eric explains how the law: • Grants new regulatory authority to the Pennsylvania Insurance Department • Restricts PBM patient steering to pharmacies owned or affiliated with benefit managers • Improves transparency requirements for PBM operations • Establishes payment protections intended to level the playing field for community pharmacies Patient steering practices have long limited competition and reduced patient choice. Eric shares why these reforms represent an important step toward protecting both patients and independent pharmacy providers across the Commonwealth. Listen & Subscribe Stay informed on the business, policy, and innovation shaping the pharmacy profession. Follow TWIRx – This Week in Pharmacy on the Pharmacy Podcast Network, featuring conversations with the leaders and advocates advancing pharmacy practice.

On this episode of Astonishing Healthcare, Lloyd Fiorini, General Counsel & Chief Compliance Officer at Judi Health, returns to the studio for a discussion about the barrage of regulatory changes shaping the pharmacy benefit manager (PBM) landscape in early 2026. Within just two weeks, the Department of Labor announced new proposed rules, the Consolidated Appropriations Act of 2026 became law, and the FTC's announced a settlement with Express Scripts. Then, to top it all off, TrumpRx went live.Lloyd offers clear, helpful explanations of the key takeaways from each of these concurrent reforms aimed at improving transparency and how PBMs operate and interact with the other stakeholders in the supply chain, from independent pharmacies to patients and plan sponsors (employers). Whether you're responsible for a self-funded plan or overseeing a Medicare Part D plan, this episode provides the detail and insights about where the puck is going that you need. As Lloyd said, "I think we've made a great step forward, but the work isn't done."It's also worth giving a shoutout to previous guest Jim Winkler, as "Change is Imminent" is in the title of AH090!Episode HighlightsThe Department of Labor's historic proposed rules on PBM disclosures fills a gap left by the CAA of 2021The Consolidated Appropriations Act of 2026 redefines the financial alignment of pharmacy benefits beyond just Medicare Part Patient/plan member protection seems to be what the FTC's recent settlement was all aboutTrumpRx signals a broader shift toward transparent, cost-plus pricing models, but it's just for cash-paying customers, at least for nowDelinking and efforts to block vertical integration are hotly contestedRelated ContentAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHow to obtain Rx data and what to do with itAH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason BarrettoSigns it is time to change your PBM vendor, and how to overcome common hesitationsReference LinksUS Department of Labor proposes historic pharmacy benefit manager fee disclosure rule (January 29)PBM Reforms Signed Into Law, Reshaping Medicare Part D Drug Pricing Transparency (February 3)FTC Secures Landmark Settlement with Express Scripts to Lower Drug Costs for American Patients (February 4)TrumpRx Launches (February 6)For more information about Judi Health and this episode, please visit Judi Health - Insights.

In this episode, listeners get to know the leadership of the California Pharmacists Association (CPhA), exploring their professional journeys, personal backgrounds, and the experiences that shaped their commitment to advancing the pharmacy profession. Susan Bonilla, CEO of the California Pharmacists Association, joins Dr. Sean Kim, PharmD, Vice President of Practice & Professional Development at CPhA, to discuss California's progress in pharmacy benefit manager (PBM) reform. As the largest state in the nation, California continues to play a significant role in shaping policies that strengthen patient access to pharmacy care and improve transparency within the prescription drug supply chain. Bonilla and Kim share insights into the reforms California has achieved, the legislative and regulatory priorities currently underway, and how these efforts may influence PBM reform conversations across the country. The PBM Reform Podcast is sponsored by the American Pharmacy Cooperative, Inc. (APCI). APCI's sponsorship supports the production of this program but does not imply affiliation with the individual guests, nor endorsement of the views, opinions, or insights shared by podcast hosts or guests. APCI does not endorse any statements or content discussed on the PBM Reform Podcast or across the Pharmacy Podcast Network. Please reach out to the APCI Communication's team for additional information. 

In this episode, listeners get to know the leadership of the California Pharmacists Association (CPhA), exploring their professional journeys, personal backgrounds, and the experiences that shaped their commitment to advancing the pharmacy profession. Susan Bonilla, CEO of the California Pharmacists Association, joins Dr. Sean Kim, PharmD, Vice President of Practice & Professional Development at CPhA, to discuss California's progress in pharmacy benefit manager (PBM) reform. As the largest state in the nation, California continues to play a significant role in shaping policies that strengthen patient access to pharmacy care and improve transparency within the prescription drug supply chain. Bonilla and Kim share insights into the reforms California has achieved, the legislative and regulatory priorities currently underway, and how these efforts may influence PBM reform conversations across the country. The PBM Reform Podcast is sponsored by the American Pharmacy Cooperative, Inc. (APCI). APCI's sponsorship supports the production of this program but does not imply affiliation with the individual guests, nor endorsement of the views, opinions, or insights shared by podcast hosts or guests. APCI does not endorse any statements or content discussed on the PBM Reform Podcast or across the Pharmacy Podcast Network. Please reach out to the APCI Communication's team for additional information. 

In this week's episode of Medicine: The Truth, hosts Jeremy Corr and Dr. Robert Pearl unpack a wide range of developments shaping healthcare in America today, including the TrumpRx drug discount program. From new legislation affecting telehealth and pharmacy benefit managers (PBMs) to the rapid spread of measles and growing public concern about vaccine policy, this month's discussion highlights the policy decisions and scientific debates influencing medicine right now. The episode opens with the latest federal legislation passed to avert a government shutdown. While healthcare was not the central focus of this particular political battle, the bill contains several provisions that affect medical practice. These include extensions for telehealth coverage and hospital-at-home programs, reforms targeting PBM transparency and new requirements designed to address “ghost networks” in Medicare Advantage provider directories. Dr. Pearl explains that while these provisions represent incremental progress, they are unlikely to solve the larger problems driving healthcare costs and access challenges in the United States. Here are the other major storylines from episode 104: Healthcare costs remain nation's top concern: A new KFF poll finds that healthcare expenses rank above food, housing and utilities as the economic issue Americans worry about most. Prior authorization frustrations grow: Many patients report delays or denials of care due to insurance requirements, highlighting persistent tension between insurers, physicians and patients. Drug pricing debates continue: Pearl examines a new prescription drug website initiative and explains why it may have limited impact compared with broader policy proposals such as “most favored nation” pricing. Telehealth's uncertain future: Although the latest legislation extends certain pandemic-era flexibilities, the lack of a permanent solution leaves virtual care programs in limbo. PBM reforms move forward slowly: New policies aim to increase transparency and reduce incentives tied to drug list prices, though Pearl notes that meaningful change will depend on future implementation. Site-neutral payment gains attention: A provision requiring unique identifiers for outpatient services could pave the way for policies that eliminate higher reimbursement for hospital-owned facilities providing identical care. Measles outbreaks surge: Nearly a thousand cases have already been reported in 2026, with the overwhelming majority occurring among unvaccinated children. Trust in the CDC declines: Polling shows confidence in the agency has dropped significantly following changes to vaccine recommendations. Independent vaccine review groups emerge: Medical organizations and states are forming new committees to evaluate vaccine evidence as federal guidance becomes more contested. Early colon cancer deaths rise: The death of actor James Van Der Beek at age 48 highlights the growing incidence of colorectal cancer among younger adults and the importance of earlier screening. FDA confusion over a new flu vaccine: The agency initially declined to review Moderna's mRNA-based flu vaccine before reversing course and agreeing to evaluate it ahead of the next flu season. Younger Americans face worsening health trends: New claims data suggest chronic disease is appearing earlier among millennials and Gen Z, driven by lifestyle factors and reduced connection to primary care. Wearable data reveal health disparities: Apple Watch data show significant differences in resting heart rates across states, reflecting variations in lifestyle, access to care and public health conditions. As the episode concludes, Dr. Pearl warns that growing political conflict around vaccines and biomedical research risks undermining public trust in science. The consequences, he argues, could shape American medicine for decades to come. Tune in for more fact-based analysis and discussion of the biggest stories in healthcare. * * * Dr. Robert Pearl is the author of the new book “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn The post MTT #104: TrumpRx, rising measles cases & the politics of vaccine science appeared first on Fixing Healthcare.

PainExam Podcast Show Notes Red Light Therapy (Photobiomodulation) for Pain Evidence, Mechanisms, and Clinical Applications Host: Dr. David Rosenblum Red light therapy, also known as photobiomodulation (PBM) or low-level laser therapy (LLLT), is an emerging non-invasive treatment modality increasingly used in pain medicine, rehabilitation, and regenerative medicine practices. In this episode of the PainExam Podcast, Dr. Rosenblum reviews the mechanisms, clinical evidence, indications, and safety considerations surrounding photobiomodulation therapy for pain. Red and near-infrared wavelengths stimulate mitochondrial activity, increase ATP production, reduce inflammatory mediators, and promote tissue healing. These physiologic effects may translate into analgesic benefits for a variety of musculoskeletal and neuropathic pain conditions. Clinical research suggests potential benefit in temporomandibular disorders, chronic neck pain, and inflammatory oral conditions, though results vary due to differences in dosing parameters and treatment protocols. Despite these limitations, PBM has a favorable safety profile and is increasingly being integrated into multimodal pain management strategies. Key Topics Covered • What is photobiomodulation therapy (PBM) • How red and near-infrared light interact with mitochondria • Mechanisms of analgesia and tissue repair • Evidence from clinical trials in TMD, neck pain, and oral inflammatory pain • The biphasic dose response (Arndt-Schulz law) • Safety profile and contraindications • How PBM may integrate with regenerative pain medicine Mechanism of Action Photobiomodulation works primarily through stimulation of mitochondrial chromophores, particularly cytochrome c oxidase. This leads to: • Increased ATP production • Modulation of inflammatory cytokines • Increased angiogenesis and tissue repair • Reduced oxidative stress These effects may improve pain, inflammation, and healing in certain musculoskeletal conditions. Evidence Discussed in This Episode Temporomandibular Disorders Randomized trial demonstrating improvements in pain and mandibular function with red light therapy. De Carvalho et al., Pain Research and Treatment (2019) https://onlinelibrary.wiley.com/doi/full/10.1155/2019/8578703 Chronic Neck Pain Clinical trial demonstrating improvements in pain scores and pressure pain thresholds after photobiomodulation therapy. Chen et al., Lasers in Medical Science (2022) https://link.springer.com/article/10.1007/s10103-022-03540-0 Oral Pain and Dental Inflammation Randomized study demonstrating reduced pain and improved healing following PBM treatment. Almeida et al., BMC Oral Health (2023) https://link.springer.com/article/10.1186/s12903-023-02784-8 Who May Benefit From Photobiomodulation? Red light therapy may be considered as an adjunct treatment for: • myofascial pain • cervical spine pain • temporomandibular disorder • tendinopathy • peripheral neuropathy • musculoskeletal injury recovery Safety and Contraindications Photobiomodulation has a very favorable safety profile. Reported adverse effects are rare and usually mild: • transient erythema • warmth at treatment site • headache • eye irritation without proper protection Precautions include: • avoiding direct retinal exposure • avoiding treatment over malignancy • avoiding application over the uterus during pregnancy • caution in photosensitive disorders Resources For Patients Seeking Treatment Learn more about integrative and regenerative pain treatments including PRP, ultrasound-guided injections, and advanced pain therapies: AABP Integrative Pain Care & Wellness https://www.AABPpain.com For Pain Physicians and Advanced Practice Providers Training in ultrasound, interventional pain procedures, and pain board preparation: NRAP Academy CME Education https://www.NRAPpain.org

PainExam Podcast Show Notes Red Light Therapy (Photobiomodulation) for Pain Evidence, Mechanisms, and Clinical Applications Host: Dr. David Rosenblum Red light therapy, also known as photobiomodulation (PBM) or low-level laser therapy (LLLT), is an emerging non-invasive treatment modality increasingly used in pain medicine, rehabilitation, and regenerative medicine practices. In this episode of the PainExam Podcast, Dr. Rosenblum reviews the mechanisms, clinical evidence, indications, and safety considerations surrounding photobiomodulation therapy for pain. Red and near-infrared wavelengths stimulate mitochondrial activity, increase ATP production, reduce inflammatory mediators, and promote tissue healing. These physiologic effects may translate into analgesic benefits for a variety of musculoskeletal and neuropathic pain conditions. Clinical research suggests potential benefit in temporomandibular disorders, chronic neck pain, and inflammatory oral conditions, though results vary due to differences in dosing parameters and treatment protocols. Despite these limitations, PBM has a favorable safety profile and is increasingly being integrated into multimodal pain management strategies. Key Topics Covered • What is photobiomodulation therapy (PBM) • How red and near-infrared light interact with mitochondria • Mechanisms of analgesia and tissue repair • Evidence from clinical trials in TMD, neck pain, and oral inflammatory pain • The biphasic dose response (Arndt-Schulz law) • Safety profile and contraindications • How PBM may integrate with regenerative pain medicine Mechanism of Action Photobiomodulation works primarily through stimulation of mitochondrial chromophores, particularly cytochrome c oxidase. This leads to: • Increased ATP production • Modulation of inflammatory cytokines • Increased angiogenesis and tissue repair • Reduced oxidative stress These effects may improve pain, inflammation, and healing in certain musculoskeletal conditions. Evidence Discussed in This Episode Temporomandibular Disorders Randomized trial demonstrating improvements in pain and mandibular function with red light therapy. De Carvalho et al., Pain Research and Treatment (2019) https://onlinelibrary.wiley.com/doi/full/10.1155/2019/8578703 Chronic Neck Pain Clinical trial demonstrating improvements in pain scores and pressure pain thresholds after photobiomodulation therapy. Chen et al., Lasers in Medical Science (2022) https://link.springer.com/article/10.1007/s10103-022-03540-0 Oral Pain and Dental Inflammation Randomized study demonstrating reduced pain and improved healing following PBM treatment. Almeida et al., BMC Oral Health (2023) https://link.springer.com/article/10.1186/s12903-023-02784-8 Who May Benefit From Photobiomodulation? Red light therapy may be considered as an adjunct treatment for: • myofascial pain • cervical spine pain • temporomandibular disorder • tendinopathy • peripheral neuropathy • musculoskeletal injury recovery Safety and Contraindications Photobiomodulation has a very favorable safety profile. Reported adverse effects are rare and usually mild: • transient erythema • warmth at treatment site • headache • eye irritation without proper protection Precautions include: • avoiding direct retinal exposure • avoiding treatment over malignancy • avoiding application over the uterus during pregnancy • caution in photosensitive disorders Resources For Patients Seeking Treatment Learn more about integrative and regenerative pain treatments including PRP, ultrasound-guided injections, and advanced pain therapies: AABP Integrative Pain Care & Wellness https://www.AABPpain.com For Pain Physicians and Advanced Practice Providers Training in ultrasound, interventional pain procedures, and pain board preparation: NRAP Academy CME Education https://www.NRAPpain.org

PainExam Podcast Show Notes Red Light Therapy (Photobiomodulation) for Pain Evidence, Mechanisms, and Clinical Applications Host: Dr. David Rosenblum Red light therapy, also known as photobiomodulation (PBM) or low-level laser therapy (LLLT), is an emerging non-invasive treatment modality increasingly used in pain medicine, rehabilitation, and regenerative medicine practices. In this episode of the PainExam Podcast, Dr. Rosenblum reviews the mechanisms, clinical evidence, indications, and safety considerations surrounding photobiomodulation therapy for pain. Red and near-infrared wavelengths stimulate mitochondrial activity, increase ATP production, reduce inflammatory mediators, and promote tissue healing. These physiologic effects may translate into analgesic benefits for a variety of musculoskeletal and neuropathic pain conditions. Clinical research suggests potential benefit in temporomandibular disorders, chronic neck pain, and inflammatory oral conditions, though results vary due to differences in dosing parameters and treatment protocols. Despite these limitations, PBM has a favorable safety profile and is increasingly being integrated into multimodal pain management strategies. Key Topics Covered • What is photobiomodulation therapy (PBM) • How red and near-infrared light interact with mitochondria • Mechanisms of analgesia and tissue repair • Evidence from clinical trials in TMD, neck pain, and oral inflammatory pain • The biphasic dose response (Arndt-Schulz law) • Safety profile and contraindications • How PBM may integrate with regenerative pain medicine Mechanism of Action Photobiomodulation works primarily through stimulation of mitochondrial chromophores, particularly cytochrome c oxidase. This leads to: • Increased ATP production • Modulation of inflammatory cytokines • Increased angiogenesis and tissue repair • Reduced oxidative stress These effects may improve pain, inflammation, and healing in certain musculoskeletal conditions. Evidence Discussed in This Episode Temporomandibular Disorders Randomized trial demonstrating improvements in pain and mandibular function with red light therapy. De Carvalho et al., Pain Research and Treatment (2019) https://onlinelibrary.wiley.com/doi/full/10.1155/2019/8578703 Chronic Neck Pain Clinical trial demonstrating improvements in pain scores and pressure pain thresholds after photobiomodulation therapy. Chen et al., Lasers in Medical Science (2022) https://link.springer.com/article/10.1007/s10103-022-03540-0 Oral Pain and Dental Inflammation Randomized study demonstrating reduced pain and improved healing following PBM treatment. Almeida et al., BMC Oral Health (2023) https://link.springer.com/article/10.1186/s12903-023-02784-8 Who May Benefit From Photobiomodulation? Red light therapy may be considered as an adjunct treatment for: • myofascial pain • cervical spine pain • temporomandibular disorder • tendinopathy • peripheral neuropathy • musculoskeletal injury recovery Safety and Contraindications Photobiomodulation has a very favorable safety profile. Reported adverse effects are rare and usually mild: • transient erythema • warmth at treatment site • headache • eye irritation without proper protection Precautions include: • avoiding direct retinal exposure • avoiding treatment over malignancy • avoiding application over the uterus during pregnancy • caution in photosensitive disorders Resources For Patients Seeking Treatment Learn more about integrative and regenerative pain treatments including PRP, ultrasound-guided injections, and advanced pain therapies: AABP Integrative Pain Care & Wellness https://www.AABPpain.com For Pain Physicians and Advanced Practice Providers Training in ultrasound, interventional pain procedures, and pain board preparation: NRAP Academy CME Education https://www.NRAPpain.org

Episode Highlights With KatieWhat photobiomodulation (PBM) is and how red/NIR light affects cellsCore mechanism in plain English: cytochrome-c oxidase, nitric oxide displacement, ATP boost, secondary ROS and Ca² signalingWavelengths and depth: red (630–660 nm) for skin/surface; NIR (810–850 nm) for deeper tissues; why 980 nm behaves more thermallyEvidence overview: where PBM helps most (pain, recovery, tissue healing, some skin outcomes) and where data is still emerging“Free” red/NIR from sunrise and sunset: why the spectrum shifts, circadian benefits, and practical outdoor habitsDevice fundamentals: wavelength, irradiance (mW/cm²), energy dose (J/cm²), distance, and session timeBest-practice protocols: example dosing for skin vs joints/muscle; frequency and cycling (start low, titrate)Safety and cautions: eyes, heat load, photosensitizing meds, pregnancy/active cancer care, implanted electronicsHome tips: avoid staring at LEDs, position perpendicular to target, measure/estimate dose rather than chasing wattageSleep support stack: morning outdoor light + evening low-intensity red environment (not bright blue at night)Skeptic's view: helpful when wavelength/dose are right; underwhelming if misused or sold as a cure-allMy routine: sunrise/sunset outside first; add targeted device sessions for DOMS, skin, or joint recovery and track results over 4–8 weeksResources MentionedBON CHARGEJOOVV red light Red Therapy red lights use code wellnessmama for a discountMito red lightHigher DoseBONCHARGEI like so many of their products - from their red light products to their sauna blankets. Red light has been so helpful for me during my recovery from Hashimoto's. To find out more, go to boncharge.com/wellnessmama and use code wellnessmama for 20% off!

In this episode of Framework Focus, Dr. Dae Lee breaks down the regulatory and reimbursement shifts reshaping long-term care (LTC) pharmacy. With the Inflation Reduction Act (IRA) moving from policy theory to operational reality, Medicare's Maximum Fair Price (MFP) program, Part D redesign, and inflation rebate enforcement are now active forces that LTC operators must navigate. This conversation moves beyond headlines and into real-world implications: cash flow risk, administrative burden, contracting exposure, and strategic readiness for closed-door and combo LTC pharmacies. Key Discussion Points Medicare Drug Price Negotiation Is Now Operational  The IRA authorizes Medicare to negotiate prices for certain high-spend Part D drugs, with the first 10 Maximum Fair Prices (MFPs) effective January 1, 2026. This marks a structural shift in federal drug pricing and directly impacts LTC dispensing economics. Maximum Fair Price and LTC Reimbursement Compression  MFP caps reimbursement on selected drugs, creating potential margin compression if acquisition costs and payment timing are misaligned. For LTC pharmacies operating on tight spreads and high-volume chronic utilization, even small deltas can materially affect profitability. Medicare Transaction Facilitator (MTF) and Payment Timing Risk  The MTF system introduces new payment mechanics between manufacturers, plans, and pharmacies. LTC pharmacies must understand how effectuation and reconciliation work, particularly if payment timing differs from traditional Part D adjudication flows. Cash flow modeling becomes essential. Administrative Complexity and Claims Reconciliation  Identifying which NDCs are subject to MFP, managing claim reversals, handling price disputes, and monitoring plan-level compliance will increase administrative workload. LTC pharmacies will need structured internal workflows to prevent reimbursement leakage. Dispensing Fees and the LTC Service Intensity Problem  Unlike retail, LTC pharmacy includes compliance packaging, emergency kits, cycle fills, consultant pharmacist oversight, and regulatory documentation. Current IRA implementation does not automatically adjust dispensing or supply fees to reflect this complexity, raising sustainability concerns. Congressional Efforts to Stabilize LTC Pharmacy  Legislative proposals such as the Preserving Patient Access to LTC Pharmacies Act aim to create supply fee protections tied to MFP drugs. The episode explores whether policy corrections are likely — and how quickly DC can realistically respond. Expansion of Negotiated Drug Lists  The initial 10 negotiated drugs are only the beginning. Additional rounds of negotiation are underway, expanding exposure across more therapeutic classes. LTC pharmacies must treat MFP as a growing structural feature — not a limited pilot. Part D Redesign and the $2,100 Out-of-Pocket Cap  Beginning in 2026, the redesigned Part D benefit changes liability distribution among plans, manufacturers, and CMS. The new out-of-pocket cap alters plan incentives and may lead to tighter utilization management, formulary shifts, and network recalibration — all of which LTC pharmacies must monitor closely. Inflation Rebates and Market Distortion  The IRA's inflation rebate provisions penalize manufacturers for price increases above inflation benchmarks. While not directly adjudicated at the pharmacy counter, these provisions influence manufacturer pricing strategy, launch pricing behavior, and downstream PBM negotiations — indirectly affecting LTC acquisition costs. Strategic Readiness as a Competitive Advantage  The episode concludes with practical recommendations:  • Conduct an MFP exposure audit across top-dispensed NDCs  • Reassess PBM contracts and network participation clauses  • Model cash flow under delayed reimbursement scenarios  • Educate facility partners on regulatory changes  • Build internal compliance tracking specific to negotiated drugs Why This Matters Now For LTC pharmacies, this is not simply a policy conversation — it is a structural shift in reimbursement architecture. As federal oversight expands and pricing authority evolves, operational precision and legal literacy will define which organizations adapt successfully. About our guest:  Dr. Dae Lee, Pharm.D, Esq., CPBS  Shareholder - Buchanan Ingersoll & Rooney PC  Email: dae.lee@bipc.com  Dae Y. Lee is a pharmacist-attorney and Certified Pharmacy Benefits Specialist™ (CPBS™) who represents pharmacies, healthcare stakeholders, and plan sponsors in high-stakes disputes and regulatory matters involving Pharmacy Benefit Managers (PBMs) and government payors. Drawing on his dual training as a pharmacist and attorney, Dae focuses his practice on defending clients in audits, investigations, enforcement actions and complex reimbursement and compliance matters. Dae routinely represents pharmacies nationwide in PBM and payor audits, including Fraud, Waste and Abuse (FWA) investigations, extrapolation disputes, overpayment recoupments, credentialing denials, network suspensions and terminations. He advises pharmacies on compliance with applicable state pharmacy fair audit laws, PBM provider manuals, and reimbursement standards, with the goal of minimizing financial exposure while preserving network participation and business continuity.

Believe it or not, marketing strategies other than going online not only exist, but are alive and well. The trick, just like with any other strategy, is to make sure it fits the goal. My guest today helps his private practice clients grow profitably, and we'll have a good rap session on this one.Joe Lessard is a partner at Professional Business Management, a healthcare practice management and accounting firm in the northwest Chicago suburbs. Joe has been with PBM since 2009 and a Principal since 2020. He has attained designations as a Certified Public Accountant (CPA), Health Practice Advisor (HPA), and as a Certified Healthcare Business Consultant (CHBC). He believes in rolling up his sleeves and is usually on site visiting his clients' operations first-hand. Joe is responsible for all accounting and payroll services as well as personal and business tax returns for his clients. He helps them review operations and day-to-day aspects such as HR, employee benefits, retirement plans, collections, billing, and patient interactions. Every client has different needs and that's why Joe's commitment to his clients' needs and his customer service is what he prides himself on.In this episode Carl White and Joe Lessard discussSome of the more common offline marketing strategies he sees workingExamples of uncommon offline marketing strategies he sees workingHow he recommends that his clients think through their offline marketing strategiesWant to be a guest on PracticeCare®?Have an experience with a business issue you think others will benefit from? Come on PracticeCare® and tell the world! Here's the link where you can get the process started.Connect with Joe Lessardhttps://www.linkedin.com/in/joelessardpbm/https://www.instagram.com/thedoctorscpa/For more depth on this episode, read Understanding and Managing Overhead Costs in Your Practice, a blog this guest wrote about it. Connect with Carl WhiteWebsite: http://www.marketvisorygroup.comEmail:  whitec@marketvisorygroup.comFacebook:  https://www.facebook.com/marketvisorygroupYouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmigLinkedIn: http://www.linkedin.com/in/healthcaremktg

How Kroger does PBM and the future of community pharmacy is clinical encounters.   

In this episode of The Syneos Health Podcast, Conversations on Commercialization, Tyler Cowan, VP, Commercial speaks with Paul Rittman, President and General Manager of Almirall US, about how payer consolidation and PBM influence are reshaping dermatology commercialization.   They discuss how pharmaceutical companies must adapt launch strategy, market access planning and clinical differentiation to succeed in today's competitive specialty landscape. The conversation explores the growing role of digital engagement, direct-to-consumer (DTC) strategy, telehealth and cash-pay models in improving patient access.   Listeners will gain practical insights into how innovation, payer strategy and patient-centric commercialization drive success in dermatology and specialty pharma.  The views expressed in this podcast belong solely to the speakers and do not represent those of their organization. If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision-making and investment. You can find it all at https://www.syneoshealth.com/insights-hub. Like what you're hearing? Be sure to rate and review us! We want to hear from you! If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com.

In this episode, Paul Markovich, President and CEO of Ascendiun, discusses his testimony before Congress, the push to eliminate PBM spread pricing and rebates, and why he believes the healthcare industry must confront its cost problem head on. He also shares how Ascendiun's new structure, digital health record ambitions, and unbundled PBM model aim to build a system that is sustainably affordable and worthy of patients and families.

Photobiomodulation (PBM) is a light-based therapy that uses specific wavelengths to interact with body tissues, influencing cellular activity without heat and supporting recovery across both medical and general wellness settings Europe recently released its first formal clinical guide for PBM in oncology, marking a shift toward standardized use of light-based supportive care across cancer treatment centers Clinical research shows PBM is most strongly supported for managing oral mucositis and radiation-related skin damage, two common cancer complications that can interfere with eating, speaking, and treatment continuity Beyond cancer care, PBM has been studied for wound healing, nerve pain, musculoskeletal recovery, skin health, and hair loss, with consensus reviews supporting its safety when properly applied Effective PBM depends on correct wavelength selection, dosing, and device quality, with red and near-infrared light delivering biologically active energy when used within established therapeutic ranges

In this installment of The Phia Group's “Empowering Plans” podcast, attorneys Bryan Dunton and Cindy Merrell discuss what happens when laws evolve faster than contracts, and how many compliance failures live in old documents. This episode breaks down how legacy contract language creates modern risk under HIPAA Part 2 and emerging PBM transparency reforms, particularly where downstream data sharing and compensation disclosures are involved. Brokers, TPAs, and plan fiduciaries will want to tune in and find out how these changes will impact their groups.

In this episode, Paul Markovich, President and CEO of Ascendiun, discusses his testimony before Congress, the push to eliminate PBM spread pricing and rebates, and why he believes the healthcare industry must confront its cost problem head on. He also shares how Ascendiun's new structure, digital health record ambitions, and unbundled PBM model aim to build a system that is sustainably affordable and worthy of patients and families.

This week, we discuss the Department of Labor's (DOL's) new compliance tools, its proposed pharmacy benefits manager (PBM) transparency regulation, and updated enforcement priorities from the DOL's Employee Benefits Security Administration. We also cover the National Labor Relations Board's (NLRB's) revamped case intake process. DOL Releases Compliance Tools The DOL has introduced new resources—including interactive toolkits, industry-specific guidance, updated fact sheets, and self-audit checklists—to help employers avoid wage-and-hour violations. DOL Issues Proposed Regulation for PBMs The DOL has issued a proposed regulation, now open for comment, aimed at increasing transparency from PBMs. The proposal would mandate PBMs to disclose the full scope of fees, rebates, and compensation.  Additionally, the DOL's Employee Benefits Security Administration has unveiled a significant overhaul of its enforcement priorities for 2026. NLRB Adjusts Intake Procedure  Faced with a significant number of pending cases due to the government shutdown and staffing issues, the NLRB has instituted a new intake procedure for unfair labor practice charges. - Visit our site for this week's Other Highlights and links: https://www.ebglaw.com/eltw421 Subscribe to #WorkforceWednesday: https://www.ebglaw.com/eltw-subscribe Visit http://www.EmploymentLawThisWeek.com - Epstein Becker Green is a national law firm that focuses its resources on health care, life sciences, and workforce management solutions, coupled with powerful litigation strategies. These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. EMPLOYMENT LAW THIS WEEK® and #WorkforceWednesday® are registered trademarks of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.

Send a textSchedule an Rx AssessmentWith TrumpRx officially live, the first major PBM reform in decades signed into law, and the FTC squeezing historic concessions out of Cigna/Express Scripts…Did independent pharmacy just have its “Super Bowl week?”In this bonus episode, Scotty Sykes, CPA, CFP®, Bonnie Bond, CPA, MBA, and Austin Murray break down what these rapid-fire developments actually mean for pharmacy owners.We cover:MFP UpdatesTrumpRx going liveFTC + Cigna/Express Scripts settlementWhat new CMS transparency could mean for pharmacy reimbursementAnd more!Stay connected with us on social media:FacebookTwitterLinkedInScotty Sykes – CPA, CFP® LinkedInMore on this topic:Podcast: Business As Usual...Until It Isn't: MDPNP's Impact on 340BPodcast: Driving Independent Pharmacy Profitability in 2026Podcast - Maximizing Med Sync

On this fiery Friday episode, Clay dives into the chaos shaking Central Mississippi. From back-to-back bomb threats at Madison Station Elementary—leading to school closures and federal involvement—to a mass shooting threat at Hillcrest Christian School, where 38-year-old Abby Nicole Taylor was arrested and charged with terrorist threats on a shockingly low $75,000 bond. Clay breaks down the stupidity behind these acts and questions the low stakes for such serious crimes.   Hear the frustrating story of parent Shane Saxton, who defied school admins to get his kids off a bus during the lockdown, only to get pulled over by police afterward for "causing a disturbance." Clay shares Shane's viral video and opens the lines for listener reactions—was it overreach or necessary protocol? Plus, a shoutout to local heroes like the Flora Police Department keeping things safe.   Sports fans, celebrate with Clay as he congratulates New Orleans Saints legend Drew Brees on his Hall of Fame induction, reminiscing about epic moments like the Superdome's post-Katrina return game.   In hour two, State Auditor Shad White joins to expose a nonprofit focused on human trafficking that's funneling hundreds of thousands of taxpayer dollars to anti-ICE protests—liberal logic at its finest. Then, State Rep. Fred Shanks drops in for the weekly "Under the Dome" segment, covering bills like mobile sports betting, teacher pay raises, and PBM reform moving through the legislature.   Clay also touches on local media outrage over changes to a Medgar Evers pamphlet and calls for better parental communication during crises. Packed with texts, calls, and live reactions, this episode fights for the soul of America and demands positive solutions in a broken system.   Tune in for raw takes on Jackson's real issues—no holds barred. Listen now and join the conversation!

Strap in for raw Mississippi politics as Clay Edwards chats with State Rep. Fred Shanks from Brandon in this no-holds-barred "Under the Dome" segment from Episode #1150. Fred breaks down the week's big moves in the House: Mobile sports betting passing (potentially raking in $80-100 million for the state—third time's the charm?), PBM reform to support independent pharmacies, and teacher pay raises to boost education. They dive into the ballot initiative bill finally out of committee, requiring around 170,000 signatures, and Fred's push for a castration bill as a deterrent against pedophiles (it died this year, but it's coming back).   Clay and Fred call out the Epstein files as a massive distraction—why obsess over dead billionaires when immigration enforcement is the real fight tearing up the country? They slam hypocritical politicians dodging ICE support and urge listeners: If you care about these bills, call your senators now and push hard. Plus, insights on California's meddling in Southern states and why mobile betting won't hurt casinos—it's untapped revenue from folks who'd never hit the slots anyway.   If you're tired of distractions and ready for real action on teacher pay, betting, and accountability, this interview demands solutions and exposes the games in Jackson. Listen now and get in the fight!

In this episode of Friday Fiduciary Five, Eric Dyson talks about the Employee Benefit Security Administration's January 29, 2026, proposal to enhance transparency into pharmacy benefit manager (PBM) fee disclosures. The proposal aims to provide ERISA plan fiduciaries with clearer information on PBM compensation, including direct and indirect revenue streams. If finalized, PBMs and associated brokers must disclose detailed compensation at regular intervals for the benefit of plan sponsors. Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information contained herein is general in nature and is provided solely for educational and informational purposes.It is not intended to provide a specific recommendation of any type of product or service discussed in this presentation or to provide any warranties, financial advice, or legal advice.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan specific circumstances.The opinions expressed by guests are not necessarily agreed by, or the same opinions of 90 North Consulting or of Eric Dyson.

For the 100th episode of Astonishing Healthcare, we welcomed AJ Loiacono, our co-founder and CEO, back to the show for a lively discussion about the evolution of our industry and business. What started as a transparent pharmacy benefits manager (PBM) in the "age of indifference" is now a more comprehensive health benefits manager (HBM), and we've entered the "era of acceptance." It's been an incredible 8+ years of growth, fueled by innovation and an unwavering commitment to our clients and delivering on our mission: to build the infrastructure our country needs to deliver the healthcare we deserve. But we had to endure an "age of confusion" to get here!AJ explains why traditional healthcare giants are facing a "BlackBerry moment" - trying to emulate a conflict-free challenger when "it's already too late." The balance of power is shifting away from the traditional PBMs, as the industry now demands full transparency - buyers of health benefits today are smarter than ever before. We also discuss how and why the U.S. wastes [at least] a trillion dollars annually by trying to deliver care using inefficient, fragmented systems; we built the infrastructure to stop it. This episode isn't just a retrospective; it's a blueprint of sorts, and we've got the cultural DNA required to bring about sustainable change (vs. just daydreaming about it). Related ContentReplay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health's Capital Rx Surpasses Five Million Contracted PBM Lives as America's Largest Employers, Unions, and Leading Health Systems Evolve Their Health Benefits StrategiesAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.

Jesse Dresser, Esq, joined Over the Counter to provide necessary insights into recently signed PBM reform set to revolutionize the distribution of pharmacy benefits.

On Feb. 3, 2026, President Trump signed the first major federal PBM reform bill in history. It's the culmination of years of lobbying and grassroots activity by NCPA and its members. NCPA's dynamic duo on Capitol Hill, Kaite Krell and David Weissman, sit down with qAM editor Sam Manas to break it all down.

In this episode, we sit down with Fair Jones, Owner of Sav‑Mor Drugs & Gifts in Grenada, Mississippi, to talk all things ownership and advocacy. Fair shares her experiences stepping into pharmacy ownership in 2019, navigating curbside-only operations during COVID, and why reimbursement/PBM pressures pushed her to start speaking up online — including the moment she realized she made $0.88 on six prescriptions. In doing so, Fair shows how to balance meeting margins and pushing for reform in the industry. Follow Fair's Facebook Page here: https://www.facebook.com/fairpenderjones 00:00 – Welcome & Episode Intro 00:23 – Fair's Early Path Into Pharmacy 04:55 – Retail Burnout & the Push Toward Ownership 08:16 – Taking Ownership of Sav‑Mor in 2019 11:53 – Six Months of Curbside‑Only During COVID 17:21 – Med Sync, Inventory Control & Staying Afloat 23:30 – The $0.88 Reimbursement Story 29:17 – Becoming a Voice for Pharmacy Advocacy 33:33 – Full‑Circle Moment at Ole Miss 38:09 – Tech, Tools & Pioneer‑Driven Efficiency  Hosted By: Johnathon Duhon | VP of PMS Sales, RedSail Technologies Guest: Fair Jones | Owner, Sav-Mor Drugs and Gifts  Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com 

In this episode of 1st Talk Compliance, Kevin Chmura is joined by Robyn Johns, as they discuss recent updates to their November live webinar, Compliance Cliffs: Navigating Telehealth Waivers and Reimbursement Changes. Learn how the policy landscape has shifted in recent months—especially around telehealth flexibilities, controlled substance prescribing, and the 2026 CMS payment rules.   Kevin Chmura Welcome to 1st Talk Compliance. I’m Kevin Chmura, CEO of Panacea Healthcare Solutions. Today we’re bringing you a timely update on our November live webinar, Compliance Cliffs: Navigating Telehealth Waivers and Reimbursement Changes. Since that webinar, several policy changes have moved quickly, especially in telehealth flexibilities. Controlled substance prescribing and 2026 CMS payment rules. Before we jump in, just a quick note. 1st Talk Compliance is brought to you by 1st Healthcare Compliance, a part of Panacea Healthcare Solutions. We help healthcare organizations strengthen their compliance programs with practical education tools and compliance management support. So teams can reduce risk, keep pace with regulatory change and operate with confidence. Now I’m pleased to welcome back Robyn Johns from Med USA. Robyn, thanks for coming back. Robyn Johns Thanks, Kevin. I’m happy to be here. Kevin Chmura  Great. So, let’s jump in. So, in November on the webinar, we spent a lot of time on what people were calling the telehealth cliff, which was creating a tremendous amount of uncertainty on whether flexibilities would expire. Can you catch us up on what the status is now? Robyn Johns  Yeah. The major update is that the spending package released on January 20th includes extensions of the telehealth flexibilities all the way through December 31st of 2027. Kevin Chmura So that’s a pretty meaningful runway. That’s great, but I guess doesn’t eliminate compliance obligations, but it is reducing near-term uncertainty which give everybody some time to standardize workflows. So, it’s in the news, but maybe you could tell. So, what’s in the spending package at a high level and what should healthcare leaders like us be paying attention to? Robyn Johns   Right. So, it was the one from the 20th was a $1.2 trillion spending package released by the House Appropriations Committee and it was just passed yesterday on the 22nd in two separate votes by the full House. So, those bills included the remaining six of the twelve appropriations necessary to avert a government shutdown. So that’s good news for everyone. If we can get them across the finish line, they funded many of the federal government agencies such as HHS, Labor, Defense, HUD, and also Homeland Security. That was a contentious one. That’s why they had to do two separate votes. It funds them through fiscal year 2026, which ends on September 30th of this year. Kevin Chmura  So, OK, so we have a funding package with multiple healthcare policy riders. Not, I guess not too surprising in today’s day and age. So, besides the telehealth through 2027, what else is included in there that compliance and operational leaders should know about? Robyn Johns   So the writers also include PBM reform and it extends hospital at home actually through 2030, which is another one that hit a lot of facilities hard with the government shutdown. It extends Medicare dependent hospital and low volume hospital programs, which is really beneficial for our rural providers and it delays the Medicaid disproportionate share cut again until fiscal year 2028. Notably, for a lot of people, it does not include an extension of the ACA subsidies, which were such a sticking point in the government shutdown last fall. Kevin Chmura  Yeah, that that that last point is operationally really important and coverage instability often turns into eligibility churn and puts real pair mix pressures on the you know same patients, different coverage, right.? And that’s just you know probably increases downstream compliance and documentation stress. Yeah that’s a that’s a tough one. So what’s the timing of congressional action now? Robyn Johns So with the House passing all of the bills, they now send the full appropriations package to the Senate. The Senate will take all of that up when they return from recess on Monday the 26th, and will hopefully pass them all ahead of the January 30th deadline. And hopefully without any significant changes which might require them to go back to the house because the house will be on recess next week. Kevin Chmura  Wow. So split schedule, it’s why we should keep ourselves in a monitoring posture. I guess we should always be monitoring, but things are moving pretty quickly right now and you sort of get into that world of what is expected is not what’s in effect. Which is always, always a tough place to operate, but hey, that’s healthcare, isn’t it? So, given the extension to 2027, in your opinion, what should compliance teams be doing now? Like what’s some practical next steps? Robyn Johns First, you’ll want to make sure that your internal policies and educational materials reflect what’s currently in effect. No major changes since most of those telehealth things were extended, but it’s always good to double check because lots of things change around the beginning of the year. Also validate your payer specific rules. Medicare policy direction is influential, but commercial payers and state laws differ. So, you got to make sure that you are matching up with those differences. And then third, we should we talk about strengthening your auditing of documentation, the modifiers, your place of service, medical necessity, all of those things that can vary depending on the payer and the specific situation of the patient. Kevin Chmura  Yeah, that that payer variation point is where a lot of organizations end up being exposed, I guess, right? Telehealth’s not really governed by one rule. You’ve got federal policy, state overlays, and then you have commercial policy updates really coming at you a number of different ways. So, I guess a good controls to maintain maybe a payer policy matrix and try to align it into your documentation and coding guidance. Probably a solid piece of advice. Robyn Johns   Absolutely. Kevin Chmura   Yeah. So, let’s move on to probably one of the highest risk areas that we covered in the webinar, and that’s controlled substance prescribing via telehealth. What’s the latest there? Robyn Johns   Good news there as well. At the end of the year, DEA and HHS extended the telehealth flexibilities for prescribing controlled substances through this year, December 31st of 2026. There are a few rules that can apply, but because they extended the flexibilities, it’s pretty much status quo until they change it again at the end of the year. Kevin Chmura   Cool, so that’s a critical compliance area because of the high risk profile and it that really includes some regulatory scrutiny and enforcement, not really just a reimbursement issue. Robyn Johns   Yes, it’s highly watched. Kevin Chmura   Yeah. And I guess as well, it should be. So given that, what control should organizations prioritize right now to reduce risk in that area? Robyn Johns  Definitely you’ll want to have clear prescribing policies, good documentation standards, and role-based training. Also, usually they want to include identity verification and required checks when they’re applicable, and consistent auditing to ensure that your process is followed, not just written down. This is another area where state regulations can vary, so you would want to make sure that you are compliant in every state where you see patients. Kevin Chmura   Yes and you’re the expert, not me. But I guess I’d add if you expand health to if you expand the telehealth quickly, take time now to ensure your governance is mature. And I’m thinking credentialing, supervision, documentation and audit trails always the basics that can help you pulled up under scrutiny. Robyn Johns   Definitely. When you expand quickly, sometimes you sacrifice certain things for speed. So, you have a minute now to go back now that you’re sure that those policies aren’t changing anytime soon to just go back and make sure that everything’s in place, all of those areas. Kevin Chmura  Yeah, I mean like any business runs better and with certainty, but at healthcare we rarely have that. So, great. So, moving on to the 2026 CMS updates that that we talked about a little bit. So, there’s been some changes in payment policy that are driving operational changes and it’s where those operational changes come in, where we introduce compliance risks if teams can’t keep pace and often they can’t. So, what are the 2026 physician fee schedule highlights? Robyn Johns   Yeah. So, we talked about these back in November and of course they went into place at the beginning of this year. So, a little bit of good news there with the conversion factor. It included the 2.5% increase that had been mandated by Congress. It also included a .75% increase for clinicians in advanced APMs or a .25% increase for clinicians who participate in MIPS or who are exempt. And then there was also a .49 budget neutrality increase. Kevin Chmura So, so the real impact varies by payer mix, site of service and quality of participation. What about RVU related changes? Robyn Johns   So that’s kind of the devil in the details there. It also implemented a -2.5% efficiency adjustment on certain non-time based services to the physician work RVU and there is also a + or -50% practice expense RVU adjustment for facility based services. So, it’s -50% if it’s facility based services or a +50% for non-facility based services. Kevin Chmura   Wow. So site of service is increasingly strategic and it’s where we see compliance issues often arise, right? You get inconsistent documentation, coding and policy adoptions across different departments and locations. Certainly not easy. Robyn Johns   No. Something you definitely need to watch closely because it is different depending on where you are and what services you’re providing. Kevin Chmura   Yeah. So, one other hotspot or another hotspot that that we often see is incident to. What's going on there? Robyn Johns  So the physician fee schedule in that they updated the definition of direct supervision for incident to billing to permanently allow supervision through real-time audio video communication except for services that have a 10 or a 90-day global surgery period. So, the supervising physician no longer has to be physically present in the office suite, they just have to be immediately available through real time audio video communication. Kevin Chmura   OK, so that’s operationally pretty significant, right? But I guess the compliance take away is relatively simple. If you’re using remote supervision, your incident to workflows must be precise. I guess who supervises, how it’s documented, and where the exceptions apply as precise as you can make all of those, huh? Robyn Johns   Yes, absolutely. Because you are relying on remote supervision, you’ll want to make sure that that is documented very effectively. Kevin Chmura   Yeah, cool. So, what about the OPPS and ASC final rule highlights for 2026? Robyn Johns Yeah. For those that these apply to, there was a 2.6% increase as well in the payment rates. They also expanded hospital price transparency requirements and we’re seeing a lot more attention and probably enforcement in that as well. There was a three-year phase out of the inpatient only list. Site neutral payments were expanded to include Drug Administration Services and the ASC covered procedures list is expanded much in relation to the inpatient only list Phase out. Kevin Chmura Yeah, that that that that’s an interesting one. So the phase out of the inpatient only list is a real operational shift and it’s one of those opportunities for providers to move volume to better cost locations, but really your compliance needs to follow those patients, right and where you’re having them. And so, when your volume moves, audits and education have to move with it, which is probably a challenge and what we know and we at our parent company, at Panacea, price transparency just remains a compliance and reputational priority because failures lead to penalties, but bad data also leads to a lot of scrutiny. So, good that there’s some, you know some guidance there, but it’s clear that those are going to be things that really need to be paid attention to from a compliance perspective. Robyn Johns Yes, for sure. Kevin Chmura So it was hard to watch the news over the last, I don’t know, six to twelve months without talking about the One Big Beautiful Bill Act. So, we’ve been tracking it. I know you’ve been tracking it. So, what’s the timing on practice impacts that you expect? Robyn Johns So most of those One Big Beautiful Bill Act Medicaid requirements that are likely to impact practices, they don’t actually begin until January of 2027. So, practices still have some time to continue their assessment and preparation for those. The immigrant eligibility changes do take effect on October 1st of this year, 2026. So that’s a little bit shorter period of time, but you do have a little bit of time to continue to figure out how that may affect your practice if you have a high number of Medicaid patients, and prepare for the ways that you can offset those eligibility changes and payment requirements. Kevin Chmura Yeah, that clarity on the effective dates really can help teams allocate resources correctly and that’s often a challenge especially when you’re tracking proposed rules versus final rules and not sure when things will go into effect. So that’s good. So, as you’re looking out on the landscape in 2026, what are some of your top compliance priorities that you’re advising organizations to focus on? Robyn Johns Yeah, we’re currently focused on probably five or so top priorities for 2026, not in any specific order, but we are watching data privacy and security. Part of that is because HIPAA updates are underway to both the privacy and security rules, though timelines are unclear. We’re not sure when or i f we’ll see any final rules on those, but we do know that healthcare remains a prime target of cyber-attacks, so we have to constantly be vigilant to that and related to that, but also separately, is AI and other emerging technologies. AI is changing the landscape for the types of attacks we receive, but also the way we have to respond to them. It also is changing the landscape of healthcare generally, both in the provider office and at the payers and at the government. Those other emerging technologies like digital tools, those can increase the compliance risk in your environment, and we need to remember that both government and commercial payers are using AI to identify outlier claims faster and increase their auditing. Then we also have the fraud, waste and abuse enforcement. CMS we know has currently been focused a lot on Medicare Advantage, but that scrutiny can shift oversight over to providers as well because that’s where so much of the data that the Medicare Advantage plans use comes from. The OID also continues to focus on telehealth. There are other focuses are drug device and biologics and program integrity areas such as DME, Hospice and Drug Administration. So, want to make sure that you’re watching all of those if you practice there. Fourth one we have is vendor and third-party oversight. Many of the largest breaches that have we’ve seen have originated with third parties. So, organizations really need to make sure that you have careful oversight and maintain good monitoring on your third-party vendors and others who may have access to your systems and data. And finally, we know we’re going to continue to see those rapid regulatory updates. Federal and state changes often conflict. We have lots of states that are currently in their legislative period. So that will bring out some changes. And then in addition to that, commercial payers are tightening their policies and auditing in response to the pressures that are being put on that on them, whether from the government or just from a financial perspective. Kevin Chmura Yeah, it is something the pace of acceleration of some of the advances in technology and how they how they’re going to impact us. But I guess you know that’s really the reality of 2026 and beyond. You’re going to see an uptick in in in speed to policy changes, faster detection, which will be something and probably more third-party exposure as we rely on more and more vendors and others to help us do what we need to do every day, but I’m sure you know the advice I’ve heard you give many times and we have to agree with it. A strong compliance program has to be built to adapt. That means clear governance, repeatable monitoring and targeted auditing tied to the current risk with an eye on the future and where everything’s going. Robyn Johns Yeah, definitely. It’s an exciting time, lots of opportunities for improving our programs and really tightening things up to make sure that we’re protecting ourselves and all the information that we are responsible for. Kevin Chmura Yeah, great. So, Robyn, thank you for the update and for helping our listeners translate policy movement into practical compliance actions. To everyone listening, if you want the full context and deeper discussion, you can access the webinar on demand at 1st Healthcare Compliance’s website. It’s called Compliance Cliffs: Navigating Telehealth Waivers and Reimbursement Changes. Thank you for listening to 1st Talk Compliance and we’ll see you next time. Thanks, Robyn. Robyn Johns Thanks, Kevin.

In this high-energy episode of the Clay Edwards Show, host Clay Edwards kicks off with a motivated Monday vibe, diving into Central Mississippi's hottest issues. He breaks down a dramatic police pursuit in Madison involving brothers Donta "Demon" Palmer and Darius Palmer, who allegedly tried to run over officers in a stolen Challenger. Clay connects the dots to a notorious local crime family, critiques Attorney General Lynn Fitch's handling of similar cases, and calls for accountability in law enforcement prosecutions.   Shifting gears, Clay spotlights the pharmacy benefit manager (PBM) "racket" that's threatening independent pharmacies. Guests Robert Jordan of Corner Pharmacy in Flowood and Michael Jones of Helping Hand Family Pharmacy in Vicksburg join to explain how big chains are squeezing out locals through unfair pricing and vertical integration. They discuss key bills—House Bill 1672 and Senate Bill 2575—and urge listeners to contact legislators before the February 3 committee deadline to support protections for community businesses.   In hour three, Clay teams up with Andrew Gasser for a deep dive into the newly released Epstein files, unpacking mentions of high-profile figures like Trump, Clinton, Gates, Musk, and others, while questioning the FBI's delays and global implications.   Tune in for unfiltered talk on corruption, justice, and standing up for Mississippi's small businesses. Call your reps at (601) 359-3770 to back independent pharmacies!  

In this eye-opening interview, Clay sits down with Michael Jones, owner of Helping Hand Family Pharmacy in Vicksburg, to expose the pharmacy benefit manager (PBM) "racket" that's devastating independent pharmacies across Mississippi. Michael breaks down how PBMs—middlemen like Express Scripts (Cigna), CVS Caremark, and Optum (UnitedHealth)—started as claim consolidators but evolved into profit machines through spread pricing, manufacturer rebates, and vertical integration, forcing locals to sell meds below cost and leading to widespread closures.   He shares his fight's origin: Post-COVID reimbursement drops hit hard, shuttering stores like People's Drugstore, creating "drug deserts." Michael dug into campaign finances, uncovering PBM-linked donors influencing lawmakers, and went public—posting at his store and on social media—to rally customers. A Mississippi audit revealed Optum paying affiliates 20x more than independents, while PBM profits soar into billions.   Urgent action: Support House Bill 1672 (State Affairs Committee) and Senate Bill 2575 (Public Health and Welfare)—bills must exit committee by February 3. Michael urges calls to the Capitol switchboard at (601) 359-3770 to demand fair reforms. Last year's near-win died at the eleventh hour; don't let it happen again. This is a battle for community businesses—stand up before independents vanish!

Today’s episode of Ask the Doctor was hosted by Dr. Michael Lange and Dr. Susan Summerton. Ask the Doctor is the longest-running live, syndicated medical talk show in the United States, broadcasting coast-to-coast for over 33 years. We opened the show discussing the massive global whey protein shortage. Whey protein is extremely difficult to obtain worldwide due to increased demand from patients using GLP-1 receptor drugs, who are being advised to consume higher protein intake to prevent muscle loss. In addition, major corporations such as Starbucks and Dunkin’ have purchased large quantities of whey protein for functional and sports drinks. Because of this shortage, Fortifeye Fit Pro is currently on backorder, though other Fortifeye whey protein products remain available, and we are actively working to secure supply. We then discussed black currant seed oil and GLA (gamma-linolenic acid) and why GLA may be a missing fatty acid in the modern diet. Fortifeye now offers Black Currant Seed Oil + GLA in a 90-count bottle. GLA helps support dry eye by stimulating Series-1 prostaglandins, which play an important role in controlling inflammation. Dr. Lange reviewed his clinical experience using Fortifeye Advanced Dry Eye Therapy, which combines: • Fortifeye Super Omega (RTG-form omega-3) • Fortifeye Focus • Fortifeye Black Currant Seed Oil + GLA This three-supplement combination has been very effective in helping reduce dry eye symptoms and improve overall ocular comfort. We also discussed the end of the BOGO on Fortifeye Vegan Super Protein. While the BOGO promotion has ended, this remains one of the top vegan proteins on the market, offering an amino acid profile comparable to whey protein, outstanding taste, and three delicious flavors. In addition, we covered exciting new research on carotenoids including lutein, zeaxanthin, and astaxanthin. These nutrients may help lower triglycerides and cholesterol, support brain health and mood, and may even help with depression. These carotenoids are beneficial for children and adults, supporting not only eye health but systemic and cognitive health as well. All three carotenoids are found together in Fortifeye Focus. We explained what photobiomodulation therapy (PBM) is and how it works. PBM uses specific wavelengths of low-level red and near-infrared light to stimulate mitochondrial function, increase cellular energy (ATP), improve circulation, and reduce inflammation. As more companies bring this technology to market, increased competition is expected to drive costs down, making this promising therapy more accessible to patients. Dr. Lange and Dr. Summerton shared their enthusiasm for photobiomodulation therapy as a supportive treatment option for macular degeneration, diabetic retinopathy, and dry eye disease. Dr. Kane has noted that when diet and supplementation are optimized, this technology may work even more effectively, reinforcing the importance of combining advanced technology with proper nutrition. Dr. Summerton also weighed in on chelation therapy, explaining how reducing toxic metal burden and oxidative stress may further support cellular health, circulation, and inflammation control. When used appropriately and combined with nutrition and lifestyle optimization, chelation therapy may enhance overall systemic and ocular health. An important discussion followed on the often-overlooked connection between dry eye disease and atrial fibrillation (AFib). Dr. Lange explained that many patients with both conditions commonly share deficiencies in: • Magnesium • Potassium • Sodium chloride • Omega-3 fatty acids • Hydration These deficiencies may contribute to inflammation, nerve dysfunction, poor tear quality, impaired circulation, and cardiac rhythm instability.

TWIRx – January 30 | Special Guest: Marc Essensa, CEO of IPC On this episode of This Week in Pharmacy, we welcome Marc Essensa, President and CEO of the Independent Pharmacy Cooperative (IPC), to discuss timely strategies and resources helping independent pharmacies strengthen their businesses in today's challenging environment. Building Your Independent Pharmacy Business Marc shares insights on navigating reimbursement pressure, improving margins, and leveraging IPC's purchasing power, data, and strategic tools to support long-term sustainability. The Payment Card Settlement: A Practical Guide We break down IPC's guidance on the Payment Card Interchange Fee Settlement, which may allow pharmacies that accepted Visa or Mastercard between 2004–2019 to recover funds. Marc explains eligibility, next steps, and how recovered dollars can support cash flow, staffing, technology, or inventory investments. IPC Member Support Services The conversation highlights IPC's expanded member support offerings, including business consulting, strategic partnerships, wholesale access, and operational resources designed to help independents stay competitive. Legislative & Advocacy Updates Marc also provides updates on IPC's advocacy efforts at both the state and federal levels, focused on protecting independent pharmacy interests and addressing ongoing policy and reimbursement challenges.

In this powerhouse segment from The Clay Edwards Show, host Clay Edwards sits down with State Rep. Fred Shanks for a no-holds-barred chat on hot Mississippi and national issues. They kick off with the "Kraken" finally unleashing in Fulton County—six years after 2020—with DNI Director Tulsi Gabbard on the ground auditing ballots amid desperate reactions from election officials that scream guilt. Clay and Fred speculate on potential foreign ties (Venezuela? China?) and celebrate the momentum, even floating a bold "Trump 2028" reclaim.   Shifting to local streets, they break down Rep. Shonda Yates' bill to seize vehicles in drag racing busts. As fellow reformed South Jackson car guys, they support hitting organized chaos—like trailer queens flipping on Medgar Evers—while protecting casual enthusiasts from overreach. No more shutting down city blocks for high-stakes bets; it's time for real teeth in enforcement, inspired by JPD and Capitol PD feedback.   Finally, Fred draws from his 30 years as a pharmacist to expose the PBM racket—pharmacy benefit managers owned by big insurers and chains like CVS, clawing back millions and forcing independents to close. They call for transparency and reform to save community lifelines that sponsor Little Leagues, deliver midnight meds, and beat big-box prices. Listeners: Contact your reps to push PBM changes before independents vanish.   Unfiltered insights on accountability, street safety, and small-business survival—straight talk from two Mississippi originals.

In this episode of The Clay Edwards Show, host Clay Edwards dives into the chaotic pulse of current events, from national political antics to local Mississippi drama. Kicking off with reflections on living in "interesting times," Clay tackles the ongoing war against cancel culture and spotlights tough conversations about Jackson's challenges, including systemic corruption and the fight for America's soul.   A major focus is Jackson State University's push for a new football stadium, with a $40 million ask from the state. Clay breaks down the debate: why JSU fans and alumni report zero donations to athletics despite high-profile seasons, comparisons to self-funded projects at Mississippi State and Ole Miss, and the case for an on-campus venue to enhance the student experience. He questions taxpayer funding without community commitment, suggesting fundraisers and master plans as alternatives.   Shifting gears, Clay discusses a proposed bill by Rep. Shonda Yates to allow law enforcement to seize vehicles involved in street drag racing. As a former street racer himself, he shares personal stories but supports cracking down on organized, dangerous events—like tube-chassis cars flipping on Medgar Evers—while emphasizing the need to protect casual car enthusiasts from overreach.   Breaking news hits mid-show: Don Lemon's arrest under the FACE Act for a church protest in Minnesota, sparking talk of "consequence culture" replacing cancel culture. Clay praises everyday black communities for steering clear of white liberal protests, avoiding manipulation, and features a caller highlighting the "paradox" black Americans face in politics—trapped between party loyalty and issues like immigration draining resources.   The episode wraps with an overnight shooting at a Jackson nightclub and a deep dive with Rep. Fred Shanks on the drag racing bill and PBM reform to protect independent pharmacies from big-chain monopolies, ensuring transparency and community access to affordable meds.   Unfiltered, no-holds-barred talk on politics, local accountability, and cultural shifts—strap in for raw insights and bold takes.

Send us a textJesse Mendelsohn and Michael Grosberg from Model N discuss why U.S. pricing complexity is spreading globally, the collapse of the PBM rebate model, what's really driving the pharmaceutical manufacturing boom, and why direct-to-consumer discount programs won't solve America's drug access problem.00:00 Introduction to Life Science Success Podcast00:34 Pressing Issues in Pharmaceutical Manufacturing00:51 Introducing the Experts from Model N03:08 Understanding International Reference Pricing04:14 Impact of US Pricing on Global Drug Launches09:26 Challenges with Pharmacy Benefit Managers16:29 Domestic Manufacturing Boom in Pharmaceuticals23:08 AI in Drug Discovery and Personalized Medicine29:03 Access and Policy Discussion30:01 Direct to Consumer Pricing31:32 TrumpRx Overview33:11 Compliance Challenges38:30 Pharmaceutical Revenue Management41:38 AI in Life Sciences48:35 Future of Life Sciences50:45 Concerns and Challenges53:52 Excitement in Current Work55:54 Conclusion and Final Thoughts

Healthcare HR leaders are heading into one of the most consequential weeks of the year. In this episode of the ASHHRA Monday News Drop, Luke Carignan, Bo Brabo, and ASHHRA President & CEO Jeremy Sadlier unpack three fast-moving developments that demand immediate attention from HR, finance, and executive teams. Segment 1: A Tale of Two Coasts While New York nurses return to work after securing historic staffing protections, the West Coast is waking up to a massive escalation. More than 31,000 healthcare workers across California and Hawaii, including nurses, pharmacists, and imaging professionals, have launched an open-ended strike over staffing ratios and wages tied to inflation. HR reality check: The contagion effect is real. Enforceable staffing guarantees are now the most powerful organizing and recruiting tool in healthcare. Union or not, organizations that fail to visibly address staffing risk becoming the next target. Segment 2: The Telehealth Hail Mary With just days remaining before the January 30 deadline, the House has passed a two-year extension of Medicare telehealth flexibilities. The Senate still must act. A lapse, even for 48 hours, could trigger denied claims and major revenue disruption. Actionable guidance: Do not dismantle telehealth infrastructure. Instruct revenue cycle teams to hold telehealth claims from February 1–3 until Senate confirmation is secured. This single step could prevent a costly billing crisis. Segment 3: The “Great Healthcare Plan” and PBM Reform The White House has released a new healthcare framework emphasizing aggressive PBM reform and price transparency, while notably stepping away from enhanced ACA subsidies. Premium pressure for employees is likely to persist. HR opportunity: PBM reform is not just a finance issue. Use this moment to demand transparency from your benefits partners, audit rebate structures, and identify savings that can help offset rising employee costs. This Week's Focus: • Monitor West Coast labor activity and prepare for patient surges • Protect telehealth revenue during legislative uncertainty • Reassess staffing strategy, benefits cost exposure, and PBM risk Healthcare HR is no longer adjacent to strategy. It is central to it.  From Our Sponsor(s)...Optimize Pharmacy Benefits with RxBenefitsElevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital's own pharmacies. Discover smarter strategies with RxBenefits.Learn More here - https://rxbene.fit/3ZaurZN  Support the show

In this episode, Heather Tamborino, Chief Financial Officer at EmblemHealth, discusses how payer provider collaboration, thoughtful use of AI, and data integration can improve outcomes while easing administrative burden. She also shares how rising pharmacy costs, PBM strategy, and transparency initiatives are shaping financial priorities for 2026.

En plena temporada de premios, llega un evento clásico de este podcast: la quinta edición de los PBM Awards, la ceremonia en la que nuestra comunidad de oyentes premia lo mejor del MCU a lo largo de 2025. Daredevil: Born Again, The Fantastic Four: First Steps, Captain America: Brave New World, Thunderbolts* y otros productos se disputan 23 premios, incluyendo el codiciado PBM de Oro. ¿Quién se llevará más estatuillas?============================================================================================================Aviso de Uso Legítimo (Copyright Disclaimer): Este episodio contiene fragmentos de audio protegidos por derechos de autor. El uso de dichos materiales se realiza exclusivamente con fines de crítica, comentario y análisis cinematográfico, enmarcándose dentro de las excepciones de uso legítimo (Fair Use). No se pretende infringir los derechos de los propietarios originales. Toda la música y sonidos pertenecen a sus respectivos autores y estudios (Marvel Studios / Disney).Copyright Disclaimer: This podcast episode features copyrighted material used for the purposes of criticism, commentary, and film analysis. This constitutes a 'Fair Use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. This content is intended for educational and entertainment purposes only. All rights and credits go directly to its rightful owners (Marvel Studios / Disney). No copyright infringement intended.

In this episode of The Health Advocates, Steven Newmark breaks down a surprising moment of bipartisan agreement in Congress: a new Health and Human Services funding bill that includes meaningful wins for patients and public health. From protecting CDC and NIH funding to extending telehealth flexibilities and hospital-at-home programs, the bill also takes historic steps to reform Pharmacy Benefit Managers (PBMs), aiming to make drug pricing more transparent and patient-centered. Steven walks through what’s in the legislation, what was left out, and why PBM reform could have a direct impact on out-of-pocket costs and medication access. Plus, what this deal signals about the power of patient advocacy in shaping policy—even in a divided political climate. Contact Our HostSteven Newmark, Chief of Policy at GHLF: snewmark@ghlf.orgA podcast episode produced by Ben Blanc, Director, Digital Production and Engagement at GHLF.We want to hear what you think. Send your comments in the form of an email, video, or audio clip of yourself to podcasts@ghlf.orgListen to all episodes of The Health Advocates on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

On this special preview episode of Voices of Self Funding, co-host Tom Testa sits down with Ron Peck, Chief Legal Officer at The Phia Group, to discuss his highly anticipated session at Executive Forum 2026: “Fiduciary Gotchas and the Company You Keep.” From revenue-sharing arrangements to PBM contracts and vendor disclosures, Ron shares what TPAs need to know now as courts and regulators sharpen their focus on fiduciary responsibilities. With plaintiff attorneys getting more creative and DOL audits on the rise, this conversation is a must-listen for anyone looking to protect their business and stay compliant. Catch the full session live at Executive Forum 2026 — register today to reserve your seat and join the industry's most important conversations. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Marty sits down with Jason Hughey of Satoshi Pacioli to discuss principal-based management (PBM), the free-market management framework developed by Koch Industries, and why its Austrian economic principles make it an ideal fit for Bitcoin companies. Jason on LinkedIn: https://www.linkedin.com/in/jasonhughey Satoshi Pacioli: https://satoshipacioli.com/ STACK SATS hat: https://tftcmerch.io/ Our newsletter: https://www.tftc.io/bitcoin-brief/ TFTC Elite (Ad-free & Discord): https://www.tftc.io/#/portal/signup/ Discord: https://discord.gg/VJ2dABShBz Opportunity Cost Extension: https://www.opportunitycost.app/ Shoutout to our sponsors: Bitkey https://bit.ly/4pOv2L4 Unchained https://unchained.com/tftc/ SLNT https://slnt.com/tftc CrowdHealth https://joincrowdhealth.com.tftc Salt of the Earth: https://drinksote.com/tftc Join the TFTC Movement: Main YT Channel https://www.youtube.com/c/TFTC21/videos Clips YT Channel https://www.youtube.com/channel/UCUQcW3jxfQfEUS8kqR5pJtQ Website https://tftc.io/ Newsletter tftc.io/bitcoin-brief/ Twitter https://twitter.com/tftc21 Instagram https://www.instagram.com/tftc.io/ Nostr https://primal.net/tftc Follow Marty Bent: Twitter https://twitter.com/martybent Nostr https://primal.net/martybent Newsletter https://tftc.io/martys-bent/ Podcast https://www.tftc.io/tag/podcasts/

In this episode, my guest is Dr. Mark Cronshaw, a scientist, a practicing physician and a highly respected expert in Photobiomodulation, the process in which different wavelengths of light affect human health. We discuss how Photobiomodulation works in a clear, scientific way, why so many people get inconsistent results, how to choose the right red light therapy device, proper dosing, intensity and session length, safety and contraindications, and its potential benefits for longevity, recovery, and healthy aging.

Desiree Chappell and Mike Grocott are joined by Klaus Gorlinger, Medical Director at TEM Innovations GmbH in Munich, Germany at ANESTHESIOLOGY® 2025. This conversation focuses on patient blood management (PBM) and viscoelastic testing (VET) delving into the significance of VET in managing bleeding during surgeries, the evolution of testing techniques, and their impact on patient outcomes. Klaus explains the importance of whole blood testing over standard coagulation tests and discusses different protocols and global practices around this technology. The conversation also highlights the economic benefits of reducing unnecessary blood transfusions and improving patient care through advanced hemostasis testing. Further reading: "Last year at the ASA, we presented a poster, about the need to analyze what does changing from just to transfuse by a goal direct approach on mortality in cardiac surgery. And it reduces mortality by 47%" Reference: Goerlinger K, Petricevic M, Lier H, Karkouti K. Effect of Viscoelastic Testing on Mortality in Cardiovascular Surgery, Lung Transplant, and ECMO: A Meta-Analysis. (Abstract 2050). The Anesthesiology Annual Meeting; Oct 19, 2024, Philadelphia, USA. https://www.abstractsonline.com/pp8/#!/20301/presentation/31677.  

In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, breaks down the latest trends in the payer landscape, including pharmacy benefit management, health system cost pressures, and Anthem's new 10% penalty on out-of-network claims. He also highlights the recent debate between Mark Cuban and PBM leaders on industry transparency and rising pharmaceutical costs.

Slow news day, but I'm slow too. Perfect fit.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Politics, AI Hype Awareness, Tesla Car Rental, Putin Residence Attack, Palmer Luckey, China Unsafe For Business, Ro Khanna, CA Wealth Tax, Gavin Newsom, Newsom CA Missing Billions, US Homicide Decrease, Anti-White Harvard, Traitor Tim, Somali Fraud, $1.5 Trillion Annual US Fraud, AG Pam Bondi, Epstein Documents, Meta Scam Ads Allegations, Climate Change Censorship, Jack Smith Deposition, 2020 Election Rigging, J6 Insurrection Hoax, Eric Swalwell, Macroharder, Elon Musk, Smart Phone's Future, Iran Street Protests, PBM, Pharmacy Benefits Manager, Scott Adams Health Update~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~If you would like to enjoy this same content plus bonus content from Scott Adams, including micro-lessons on lots of useful topics to build your talent stack, please see scottadams.locals.com for full access to that secret treasure.