Podcasts about PBM

American Pharmacy Cooperative, Inc. (APCI) called on Congress on Thursday, December 11, 2025 to pass the reintroduced Pharmacists Fight Back Act, two coordinated pieces of federal legislation designed to reform pharmacy benefit manager (PBM) practices. The Pharmacy Podcast Network provides exclusive coverage of the event held on Capitol Hill.

Pošaljite nam SMS poruku.Anemija i transfuzija krvi i dalje se u svakodnevnoj kliničkoj praksi često posmatraju kao izolovani problemi i „nužna rješenja“. Međutim, savremeni dokazi jasno pokazuju da su i anemija i transfuzija povezane sa značajnim kratkoročnim i dugoročnim rizicima, uključujući poremećaje oksigenacije, imunološke i protrombotske učinke, infekcije, povećanu stopu komplikacija, mortalitet te nepovoljne onkološke ishode. Posebno je važno razumjeti da alogena pohranjena krv ne predstavlja adekvatnu zamjenu za pacijentovu vlastitu krv.Ovaj CME.ba tečaj fokusira se na ključno pitanje: koji rizik zapravo želimo izbjeći – anemiju, transfuziju ili oboje?Kroz jasno strukturiran i klinički orijentiran pristup, tečaj obrađuje patofiziologiju anemije, promjene koje nastaju u pohranjenim eritrocitima, kliničke posljedice transfuzije te koncept krvi kao „tekućeg organa“, čija se transplantacija ne bi trebala primjenjivati bez jasne indikacije i iscrpljenih alternativnih mjera.Centralni dio edukacije posvećen je Patient Blood Management (PBM) konceptu – interdisciplinarnom, dokazima utemeljenom programu usmjerenom na prevenciju i liječenje anemije, smanjenje krvarenja i racionalnu primjenu transfuzije. PBM se pokazao kao efikasan alat za poboljšanje kliničkih ishoda, smanjenje komplikacija i optimizaciju troškova, te se danas uspješno primjenjuje širom svijeta.----------Ukoliko želite postati partner portala CME.ba ili želite da se Vaš brand ili audio poruke pojave na našim podcastima, mollimo da se javite na email info@cme.ba. Više informacija za potencijalne partnere potražite na OVOM LINKU. Portal CME.ba je najbogatija platforma za medicinsko usavršavanje u regionu. Sve komentare ili prijedloge možete poslati na: Facebook Instagram Twitter LinkedIn Email na info@cme.ba Hvala na slušanju!

This week on the PBM Reform Podcast, Breck L. Rice takes listeners inside a major new software upgrade designed to integrate directly with state-level PBM complaint and reporting systems. Breck also recounts his recent meetings with state Insurance Commissioners—where he presented this breakthrough technology while PBM lobbyists pushed back in real time, leaving community pharmacy with only one voice in the room standing up for them. He underscores a critical issue that often goes unaddressed: while states continue to pass legislation aimed at PBM accountability, the real failures are happening in execution and enforcement. Without meaningful oversight, even the strongest laws fall short, and independent pharmacies continue to bear the consequences.  

Send us a textSchedule an Rx AssessmentWhat happens when GLP-1 compounding, TrumpRx, and PBM audits all collide in your pharmacy?In this episode of the Bottom Line Pharmacy Podcast, hosts Austin Murray and Bonnie Bond, CPA, are joined by healthcare attorney Dae Lee of Buchanan Ingersoll to unpack the fast-moving legal and regulatory landscape around GLP-1s, PBMs, and audits—and what independent owners need to be doing right now to protect their businesses.We cover: - The vertical integration behind the “big three” PBMs and their rebate aggregators- Why PBM audit triggers and the realities of today's audit tactics- A practical roadmap for responding to an audit- What “recredentialing season” really means- TrumpRx And more!More About Our Guest:Dae Y. Lee, Pharm.D., Esq., CPBS focuses on representing pharmacies in their dealings against Pharmacy Benefit Managers (PBMs). With extensive experience in the intricacies of PBM audits, investigations, network enrollment, network suspension, network terminations, reimbursement disputes, and DEA as well as other governmental investigations, Dae has become a trusted advisor to a broad cross-section of pharmacies and pharmacy providers, including community retail pharmacies, chain pharmacies, compounding pharmacies, specialty pharmacies, mail order pharmacies, home infusion providers, and dispensing physician practices.. His practice also extends to assisting other stakeholders in the pharmacy industry such as wholesalers, manufacturers, and other healthcare providers. In addition to his PBM-focused work, Dae represents entities in pharmacy-related transactions and assists clients with corporate formation, due diligence, licensing, change-of-ownership requirements and credentialing, providing comprehensive legal support throughout the transaction process. Dae is a Certified Pharmacy Benefits Specialist™ (CPBS™). Offered through TransparentRx and accredited by the University of Kentucky School of Pharmacy, the CPBS program is designed to cover complex topics of pharmacy benefit management in order to provide a foundational knowledge required for higher-level evaluation of PBM business operations, fundamentals of PBM pricing, plan design, cost-containment strategies, PBM contracts, PBM procurement, Specialty Pharmacy benefits management, and overall PBM performance with emphasis on cost effectiveness.Stay connected with Dae and Buchanan, Ingersoll, & Rand: Dae Lee LinkedInBuchanan, Ingersoll, & Rand WebsiteBuchanan, Ingersoll, & Rand LinkedInBuchanan, Ingersoll, & Rand TwitterBuchanan, Ingersoll, & Rand FacebookStay connected with us on social media:FacebookTwitterLinkedInMore on this topic:Podcast: The Startup Compounding Pharmacy PlaybookPodcast: The Trusted Pharmacist: Advocacy and Building a Resilient PharmacyPodcast: From Counter to Capitol

In this special edition of Independent Rx Forum, NCPA General Counsel Matt Seiler is joined by Arkansas Supreme Court Justice Hon. Nicholas Bronni, Robert T. Smith, a partner the law firm Katten and a specialist in PBM litigation, and Arkansas Pharmacists Association CEO John Vinson to commemorate the fifth anniversary of the landmark U.S. Supreme Court Case Rutledge v. PCMA. Listen now to find out how the case affected PBM regulation nationwide, and how it will affect future cases.

Jennifer Shannon, PharmD shares one of the most inspiring journeys in independent pharmacy. From opening Lily's Pharmacy with no patients, to building a pioneering transitions-of-care program, to fighting PBM patient steering at the state level, Jennifer has pushed for better care at every turn. She walks through how FairRx saved their business, how her community rallied behind her, how her kids supported seniors during COVID, and how she and her husband now run a 39-stall equine farm. It's a story of advocacy, resilience, and redefining what pharmacy can be. This episode also marks a special moment for our team — a heartfelt farewell to Mark Bivins, whose presence, leadership, and passion helped shape so much of what this podcast has become.  00:00 — Jennifer Shannon's Origin Story & Why She Opened Lily's Pharmacy 03:42 — Building a Pharmacy With No Patients: Community, Cupcakes & Persistence 08:55 — The Transitions-of-Care Program That Changed Everything 14:12 — Taking on CVS/Caremark & Testifying Against PBM Abuse 21:40 — The Birth of FairRx and Fighting to Save Their Pharmacy 29:03 — Kids Helping Seniors During COVID: A Community Moment 34:28 — How Jennifer Became an “Accidental” Equine Pharmacist 41:10 — A Heartfelt Farewell to Mark Bivins  Hosted By: Mark Bivins Guest: Jennifer Shannon | Owner of Lily's Pharmacy  Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com

Not gonna give much of an introduction here because this is a short bonus level set, but I did just wanna call everyone's attention to the "arms race" created by our status quo purchasing and selling of many things, pharmaceuticals included. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. For example, raise the list price of a drug to maximize rebates, because the higher the list, the bigger the discount you can give, which then exacerbates patient affordability because coinsurance is often based on list price. But then Pharma starts offering co-pay cards, which messes up the whole PBM (pharmacy benefit manager) plan to drive patients to their highest-rebate products (ie, the most profitable products). So then maximizers and accumulators enter the chat, and prior auths ramp up because plans start having to raise premiums after enough 340B drugs with high lists and no rebates, and then there's no cost containment and raise deductibles and around and around we go. Meanwhile, is this drug fundamentally worth the list price or even the net price? Is it an effective drug? What's the right price to be paying for this drug? Should be the operative question, right? Just like what's the quality and appropriateness of any medical service? Maybe we should just quit it and just pay for value. And with that, let me introduce Sarah Emond, CEO of ICER (Institute for Clinical and Economic Review), and I will let Sarah tell the rest of the story. Also mentioned in this episode are Institute for Clinical and Economic Review (ICER); Cora Opsahl; 32 BJ Health Fund; Payerset; Aventria Health Group; Dea Belazi, PharmD, MPH; and Tom Nash. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.   You can learn more at ICER.org and follow Sarah on LinkedIn.   Sarah K. Emond, MPP, is president and chief executive officer of the Institute for Clinical and Economic Review (ICER), a leading nonprofit health policy research organization, with 25 years of experience in the business and policy of healthcare. She joined ICER in 2009 as its first chief operating officer and third employee and has worked to grow the organization's approach, scope, and impact over the years. Prior to joining ICER, Sarah spent time as a communications consultant, with six years in the corporate communications and investor relations department at a commercial-stage biopharmaceutical company and several years with a healthcare communications firm. Sarah began her healthcare career in clinical research at Beth Israel Deaconess Medical Center in Boston. A graduate of the Heller School for Social Policy and Management at Brandeis University, Sarah holds a Master of Public Policy degree with a concentration in health policy. Sarah also received a bachelor's degree in biological sciences from Smith College. Sarah speaks frequently at national conferences on the topics of prescription drug pricing policy, comparative effectiveness research, and value-based healthcare.   02:28 What is ICER? 02:47 What does the Institute for Clinical and Economic Review do? 05:09 The importance of still showing up, even when others don't understand or disagree. 06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH. 09:04 Why it's important to think about population health and how our choices impact affordability for everyone.   You can learn more at ICER.org and follow Sarah on LinkedIn.   @sarahkemond discusses #ICER and the status quo of #pharmaceuticaldrug #pricing on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW43), Olivia Ross (Take Two: EP240), John Quinn, Dr Sam Flanders and Shane Cerone (EP492), Elizabeth Mitchell (EP491), Shane Cerone and Dr Sam Flanders (Part 1), Dan Greenleaf (Part 2), Dan Greenleaf (Part 1), Mark Cuban and Cora Opsahl  

I was out drinking martinis with Cora Opsahl, director of 32BJ Health Fund, and Cora said, "Look, most plan sponsors' biggest expense is health system spend, hospital spend." I know this is an unexpected start to an episode about pharmaceutical pricing and value featuring Sarah Emond, CEO of ICER (Institute for Clinical and Economic Review). But yeah, 50% of most plan sponsors' spend these days goes to health systems. Fifty percent! One half! For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, if a patient who is adherent to a drug and that drug keeps that patient out of the hospital, why do I want to make a patient have excessive skin in the game to get that drug, which everybody knows at this point this "skin in the game" can cause said patient to not be adherent in many cases, cost being a very big reason patients give for not taking medications as prescribed. So then we have this not adherent patient who winds up in the hospital, via the ER often enough. The core issue here that surfaced, bottom line—and I'm not sure if this was in spite of the martinis or as a result of them—but while hospital spend is the largest health expense, high-value drugs that prevent hospitalization often face patient cost sharing and access restrictions, which leads to poor patient adherence and ultimately higher system cost potentially. So then Cora and I spent the next half hour debating when the statement is empirically true and when it's not. And you know what it all boils down to? What's the value of the drug? Do we even know what that means to start? But if it's determined that the drug is relatively high value, then the plan desperately should want to do everything possible to keep that patient on that medication, and cost sharing is a huge barrier to adherence. Today, as I said, I'm speaking with Sarah Emond, CEO over at ICER, and we get into all of this in the conversation that follows. In fact, most of the conversation that follows explores the tensions that exist in the current way that we sell and buy pharmaceutical products. I'm just gonna sum up these tensions in a list here at the top of this show. There's six of them that Sarah Emond and I discussed today by my counting, and each of these we explore in some depth. So, here's the list. Tension 1: The value of any given drug (in other words, what is the fair price for that drug considering the health gains that it delivers) versus the total cost to the plan for the total population taking that drug. GLP-1s have entered the chat. GLP-1s (by ICER's analysis, at least) are super high-value drugs that also can bankrupt plans due to the number of folks who may benefit from taking the drug. Definitely a tense tension to kick off our list here. Tension 2: The list or net price of a drug versus patient access and affordability. Again, this can be tense in an area of much misalignment. You can have a great well-priced drug with huge patient affordability and access challenges because drug net price and coinsurance amounts often have nothing to do with each other. Tension 3: Lifetime value of a drug versus a 3-, 2.5-year, whatever time horizon that many plan sponsor actuaries use in their value assessment. We discussed this today, but there's a Summer Short (SUMS7) on actuarial value horizons with Keith Passwater and JR Clark if you wanna dig in on this further. Tension 4: The tension between the societal value of a drug or even the patient's perceived value of a drug versus what an employer plan sponsor might perceive as the value. What is the formula used to determine value? What's in and what's out? So, that's a bigger conversation just beyond the time horizon for what's included in this calculation. Tension 5: Exacerbating the what's included in the value contemplation beyond just what you include in there is the tension between what is hypothetically of value and what is possible to measure. If you have pharma datasets and medical datasets separate in silos, who knows how many hospital readmissions were prevented by whatever drug? And how much presenteeism or absenteeism exists. I mean, it is an outlier, again, if anyone even knows the net price they paid for a drug, just to level set context here. Tension 6: Lowering financial barriers for patients to take drugs that are of value versus status quo goals and incentives. Like, for example, PBMs (pharmacy benefit managers) are often told that their goal is to reduce drug spend. Okay … so, how do I do that? Oh, reduce access either by prior auths or delay tactics or really high coinsurance, which is gonna reduce adherence by design. And it's someone else's problem—if I'm just thinking like a status quo PBM—if medical spend goes up, right? So, that's our last and not insignificant tension. And look, who comes out the loser in all of these tensions when they get tense? Patients. Not pricing based on value and not buying and setting up cost sharing based on value punishes patients and also plan sponsors or any other ultimate purchaser in the long term, given that the plan is but a population of patients if you start thinking about it in that context. Here is Sarah's advice in a nutshell: Pharma, sell. Pick your price based on something other than market power. And some pharma companies are actually dipping their toe into these waters and doing it. But then PBMs and plan sponsors have to hold up their end of the bargain here and buy drugs based on their value, not just the size of their rebates or some other discounting promise. And then we gotta continue the through line through to member affordability and access. High-value drugs should get preferred. So, right, do a high-value formulary. Listen to the show with Nina Lathia, RPh, MSc, PhD (EP426) on high-value formularies and then listen (after you're done with that one) to episode 435 with Dan Mendelson entitled "Optimized Pharmacy Benefits Are Required if You Want to Do or Buy Value-Based Care." Also, as I said, GLP-1s come up in this conversation, so … yeah, buckle up. One last thing, besides my normal thank you to Aventria Health Group for sponsoring this episode, I am so pleased to thank Payerset for donating to help Relentless Health Value stay on the air. Payerset is a price transparency company with a mission to create fair and equitable healthcare for everyone. Love that. Payerset empowers healthcare organizations, employers, and patients with the most complete set of healthcare price transparency data. They benchmark every negotiated rate and claim and delivering the actionable insights needed for smarter contract negotiations and a more transparent healthcare system. As I have said several times today, my conversation is with Sarah Emond, CEO of ICER. Also mentioned in this episode are Institute for Clinical and Economic Review (ICER); Cora Opsahl; 32 BJ Health Fund; Keith Passwater; JR Clark; Nina Lathia, RPh, MSc, PhD; Dan Mendelson; Aventria Health Group; Payerset; Antonio Ciaccia; Elizabeth Mitchell; Purchaser Business Group on Health (PBGH); Shane Cerone; Sam Flanders, MD; Mark Cuban; Morgan Health; and Tom Nash. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here. You can learn more at ICER.org and follow Sarah on LinkedIn.   Sarah K. Emond, MPP, is president and chief executive officer of the Institute for Clinical and Economic Review (ICER), a leading nonprofit health policy research organization, with 25 years of experience in the business and policy of healthcare. She joined ICER in 2009 as its first chief operating officer and third employee and has worked to grow the organization's approach, scope, and impact over the years. Prior to joining ICER, Sarah spent time as a communications consultant, with six years in the corporate communications and investor relations department at a commercial-stage biopharmaceutical company and several years with a healthcare communications firm. Sarah began her healthcare career in clinical research at Beth Israel Deaconess Medical Center in Boston. A graduate of the Heller School for Social Policy and Management at Brandeis University, Sarah holds a Master of Public Policy degree with a concentration in health policy. Sarah also received a bachelor's degree in biological sciences from Smith College. Sarah speaks frequently at national conferences on the topics of prescription drug pricing policy, comparative effectiveness research, and value-based healthcare.   08:18 Why list prices are a lie. 10:59 How does the rebate model sometimes get in the way of paying for value? 12:50 Bonus clip with Sarah Emond. 13:14 EP491 with Elizabeth Mitchell. 13:20 EP490 and EP492 with Shane Cerone and Sam Flanders, MD. 14:37 The tension that is created between affordability and adherence. 15:03 When cost sharing makes sense in pharmaceutical drug pricing. 17:26 INBW42 with Stacey on moral hazard. 18:53 How GLP-1s are "wildly cost effective." 21:32 Why the sticker shock on cost-effective drugs is a failure in the system for paying for value. 22:38 ICER's report on GLP-1s. 26:59 EP385 with Dan Mendelson. 28:57 How employers and payers can have a value assessment approach and a health insurance system that allows access to cost-effective drugs. 29:48 How cost-effective prices are calculated. 31:55 One of the core value underpinnings for value assessment of drugs. 34:54 Why manufacturers and pharmacy benefit managers should work together more by referencing something like an ICER report. 36:55 EP426 with Nina Lathia, RPh, MSc, PhD. 38:21 "We can make different choices."   You can learn more at ICER.org and follow Sarah on LinkedIn.   @sarahkemond discusses #pharmaceutical #drugpricing on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW43), Olivia Ross (Take Two: EP240), John Quinn, Dr Sam Flanders and Shane Cerone (EP492), Elizabeth Mitchell (EP491), Shane Cerone and Dr Sam Flanders (Part 1), Dan Greenleaf (Part 2), Dan Greenleaf (Part 1), Mark Cuban and Cora Opsahl

Pharmacy benefits shouldn't feel like a black box. We sit down with Susan Thomas, Chief Commercial Officer at Lucy Rx, to unpack why drug costs keep rising and what it takes to build a benefit that serves patients and plans—not middlemen. Susan started as an oncology nurse and moved into PBM leadership, and that dual lens shows up in everything we cover: from the real-world stress of waiting days for an oral chemo to the hidden economics of rebate chains and vertically integrated networks.We dig into the two biggest levers for change. First, formulary autonomy: instead of being locked to a single, opaque GPO, a marketplace approach lets employers compare multiple rebate contracts, see drug-level net cost, and choose the best path for categories like Humira biosimilars or GLP-1s. That shift enables utilization management that protects value without opening the floodgates. Second, network independence: when PBMs own specialty and mail, steering is inevitable. By contracting with integrated health systems for specialty and modern mail partners for home delivery, plans can speed therapy, reduce waste from 30-day auto-ships, and improve member experience at a lower overall cost.We also talk fiduciary duty, policy momentum, and technology. Employers need verifiable net-cost math—not averages—to defend decisions in a post–J&J lawsuit world. Washington's scrutiny is rising, and incumbents are signaling changes, but structural misalignments remain. On the tech front, AI-driven reporting and specialty navigation are already here, while precision medicine and pharmacogenomics promise to target high-cost drugs to the patients who will benefit most. The question is whether the industry will embrace smaller, smarter populations when volume shrinks and outcomes improve.If you care about cutting pharmacy spend without compromising care, this conversation is a practical roadmap: ask for drug-level net cost, insist on formulary choice across GPOs, require independent specialty and mail, and set utilization criteria that put patients first. Subscribe, share this episode with a colleague who manages pharmacy benefits, and leave a review with the one PBM metric you wish you'd had sooner.This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

We Give Thanks to You in Pharmacy | TWIRx  Welcome to This Week in Pharmacy for November 28th! We hope you all had a wonderful Thanksgiving, and as we roll into Black Friday, we want to take a moment to express something truly important: our gratitude. At the Pharmacy Podcast Network, we are incredibly thankful for the pharmacists, pharmacy technicians, and pharmacy teams who show up every day for their communities. You are the medication experts, the problem-solvers, the late-night troubleshooters, the vaccine champions, the trusted faces behind the counter, and the advocates who keep patient care moving—often without enough recognition. To every pharmacist and pharmacy technician working long hours, covering holiday shifts, managing medication shortages, answering tough questions, and supporting patients with compassion: Thank you. Your commitment keeps the healthcare system steady, especially during the busiest times of the year. From all of us at the Pharmacy Podcast Network, we appreciate you, we support you, and we're honored to share your stories. Happy Thanksgiving—and welcome to This Week in Pharmacy. TWIRx News November 28, 2025 Pharmacy Times  Fun Fact: Coffee Could Reduce Feelings of Depression https://www.pharmacytimes.com/view/fun-fact-coffee-could-reduce-feelings-of-depression Saving Advice article “Unmask The Lie: The Reason Your Local Pharmacy Always Runs Out Of Meds” https://www.savingadvice.com/articles/2025/11/28/10442667_unmask-the-lie-the-reason-your-local-pharmacy-always-runs-out-of-meds.html  Could dedicated pharmacists help improve neonatal care's medicines safety problem? https://pharmaceutical-journal.com/article/feature/could-dedicated-pharmacists-help-improve-neonatal-cares-medicines-safety-problem    On Today's "This Week in Pharmacy" we're welcoming back Pharmacist and Kelli Stovall, RPh EMBA, Vice President of Pharmacy Services and Clinical Programs with IPC. Kelli and I talk about preparing for a more profitable 2026 with several ideas to build new non-PBM revenues with patient services needed throughout communities threatened by 'pharmacy deserts'.  Next, a special feature interview with Myra Ahmad, MD. CEO & Founder of Mochi Health. Mochi Health is a telehealth company offering comprehensive virtual obesity and weight-management services. Through its platform, patients connect with board-certified physicians, nurse practitioners, and registered dietitians to receive personalized treatment plans tailored to their unique body, lifestyle, and health goals.  Mochi Health emphasizes that weight is not a moral failing, but a complex health issue — and their care is non-judgmental and supportive.  Clients can access evidence-based medication options (including GLP-1 receptor agonists), nutrition guidance, and ongoing support — often virtually from home.  The company aims to make obesity care more accessible, affordable, and personalized than traditional in-person clinics.    SPECIAL ANNOUNCEMENT on "This Week in Pharmacy" November 28th 2025, the Legacy Pharmacy Group (LPG) has announced that CEO Ritesh Shah, RPh has been appointed to Governor-Elect Mikie Sherrill's Transition Task Force in New Jersey. This appointment highlights Shah's longstanding leadership in independent pharmacy and his commitment to strengthening community-based healthcare across the state. Shah will focus on advocating for independent pharmacies, improving transparency in Pharmacy Benefit Manager (PBM) operations, and promoting policies that ensure community pharmacies remain viable, accessible healthcare resources. His priorities on the task force include: Protecting and strengthening independent pharmacies statewide Ensuring fairness, transparency, and accountability in PBM practices Expanding access and reducing barriers to care, particularly for underserved populations Legacy Pharmacy Group Founder and Pharmacist, Jay Dhaduk, emphasized the importance of having informed pharmacy leadership at the policy level and celebrated Shah's appointment as critical to the long-term sustainability of independent pharmacies. The release also highlights LPG's role as the tri-state area's largest group purchasing organization, supporting more than 720 independent pharmacy members with programs, services, and advocacy to help them thrive.   Thank you to IPC and YARAL Pharma for sponsoring today's TWIRx 

The level of interest in Episode 84 of Astonishing Healthcare made this one an easy choice to lift it to "best of" status. We'll be back with fresh new episodes in early December, and then we'll close out the year with two more Best of '25s. For those of you who didn't check this one out, Josh Golden, SVP of Strategy, and RFP Content Manager, Nic Bolitho, joined host Justin Venneri in the studio for a discussion about trends they're seeing in the market and how to run a better request for proposal (RFP) process to select a pharmacy benefit management (PBM) partner. Long story short, the "old way" of running a PBM RFP is broken, but, as Josh describes, there are some "tectonic shifts" happening as plan sponsors demand to see more options (i.e., transparent PBMs) and benefits brokers and consultants upgrade the questions and scoring used to force accountability and drive meaningful results for plans and plan members.HighlightsUnit-cost-based spreadsheet comparisons and marketing fluff are "out;" evaluating drug mix and how the PBM manages the plan (the 'M' in PBM) or makes money off of the plan are "in."Plan sponsors and benefits consultants must demand flexibility - the PBM contract should not be a "house of cards." For example, agreements should provide the freedom to add new vendors or carve out services without collapsing your financial arrangement.Legacy tech platforms are a barrier to innovation; ask potential partners if their technology can handle customizations and integrations with agility to avoid being told, "We just can't do that."Precise questions about member experience are a must; RFPs should move beyond open-ended questions that invite marketing fluff. Use specific, binary questions to obtain an accurate measure of the member experience and the effectiveness of clinical programs (e.g., NPS, turnaround times for prior authorizations, etc.).Related ContentReplay: PBM Procurement Decoded: Insights from a Pharmacist and an Actuary Why Savings Don't Materialize: The Truth About Pharmacy Benefit Procurement eBook AH034 - Customer Care in Healthcare: Setting a Higher Bar, with Will TafoyaAH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD5 ways to improve PBM procurement (EBN) For more information about Capital Rx and this episode, please visit Judi Health - Insights.

If you're wondering which therapies may influence care delivery, budgets, and decision making in 2026, the pipeline offers an early preview and it points to a year defined by innovation. We're seeing new first in class treatments, thoughtful next generation agents, and a biosimilar market where fewer launches are offset by important competitive shifts driven by recent approvals. John Schoen and Heather Pace from the Center for Pharmacy Practice Excellence join Stacy Lauderdale, Associate Vice President of Evidence-Based Medicine and Drug Information and your Verified RX program host to highlight pipeline agents worth watching and discuss what they may mean for care delivery and spend management in the year ahead.   Guest speakers:  John Schoen, PharmD, BCPS   Senior Clinical Manager of Drug Information    Vizient Center for Pharmacy Practice Excellence    Heather Pace, PharmD Senior Clinical Manager of Drug Information    Vizient Center for Pharmacy Practice Excellence      Host:   Stacy Lauderdale, PharmD, BCPS   Associate Vice President  Vizient Center for Pharmacy Practice Excellence   Show Notes: 01:01 — Episode Scope The focus is non-CGT therapies; CGT pipeline will be covered in Part 2. 01:50 — Therapeutic Areas With the Most Approvals Oncology leads the pipeline. Others include infectious disease, neurology, rare disease, endocrine, hepatology, dermatology, and rheumatology. 02:37 — Biosimilars in 2026: Momentum or Headwinds? Discussion of potential “biosimilar void”—only 10% of expiring biologic patents have biosimilars in development. Emerging role of PBM private-label biosimilars. 03:51 — FDA Draft Guidance on Interchangeability FDA exploring interchangeable designation for all biosimilars. Potential shift away from clinical efficacy studies in favor of analytical comparisons. Guidance still in draft and open for public comment. 05:34 — John's Top Picks for First-in-Class Agents 06:11 — Orviglance First manganese-based, oral MRI contrast agent. Advantages for patients with kidney impairment. Used for liver imaging. 06:20 — Why Non-Gadolinium Matters Lower risk of nephrogenic systemic fibrosis. 06:46 — Tabelecleucel First allogeneic EBV-specific T-cell therapy. For EBV-positive PTLD post-transplant. Could become new standard of care. 07:42 — Tanruprubart First therapy specifically for severe Guillain-Barré Syndrome (GBS). Shows improved outcomes over IVIG and plasma exchange. 08:20 — Comparing to Standard of Care Review of improved real-world data outcomes. 09:03 — Therapies That May Shift Care Delivery 09:32 — Icotrokinra: First oral IL-23 antagonist for plaque psoriasis. 10:00 — Insulin Icodec First once-weekly basal insulin for type 2 diabetes. Resubmitted after safety concerns in type 1 diabetes. 10:59 — Honorable Mentions Camizestrant SERD for ER+/HER2– metastatic breast cancer. Ensitrelvir (COVID-19) Oral option for pre-exposure prophylaxis. Also being evaluated for treatment. Doravirine + Islatravir (HIV) Introduces new NRTTI class. Cefepime + Zidebactam Active against metallo-β-lactamase–producing organisms. 14:05 — Key Biosimilar Launches Omalizumab (Xolair) First biosimilars in asthma/allergy space. Aflibercept (Eylea) High competition expected pending litigation. Pertuzumab (Perjeta) First biosimilar anticipated in oncology. 15:31 — Biosimilars Approved in 2025, Impacting 2026 Ustekinumab (Stelara): first full year of competition Denosumab (Prolia/Xgeva): 10–15 biosimilars expected Eculizumab (Soliris): notable for rare disease market entry 17:17 — John's Closing Thoughts Strong mix of first-in-class advances and next-gen convenience therapies. 17:36 — Heather's Closing Thoughts 2026 will focus on speed and scale after the 2025 biosimilar wave. Pharmacists pivotal in ensuring smooth patient transitions.   VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed

Welcome to The ASHHRA Podcast! In this episode, hosts Bo Brabo and Luke Carignan sit down with Keith Sorgius, a dedicated hospital advisor at RxBenefits, to dive deep into the world of pharmacy benefits and cost management for hospitals and health systems. With a rich background in pharmacy analytics, PBM consulting, and 340B in-house pharmacy management, Keith Sorgius shares his practical insights on using data-driven strategies to identify savings opportunities and maximize the value of in-house pharmacy operations.Together, the trio explores the role of predictive analytics in pharmacy plan management, the critical relationship between HR and pharmacy teams, and the importance of transparent communication when rolling out new benefits strategies. You'll learn why benchmarks can be tricky to rely on, how leveraging your own hospital pharmacy can be a game-changer for costs and patient care, and best practices for getting buy-in from employees and their families.Whether you're in HR, pharmacy operations, or just passionate about controlling healthcare costs, this episode is packed with actionable advice and real-world stories to help you navigate the ever-evolving pharmacy benefits landscape. Let's get started! From Our Sponsors...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/3ZaurZNStreamline HR Compliance with oneBADGEhealthcareSimplify screening, credentialing, and compliance for healthcare HR. oneBADGEhealthcare from ISB Global offers a tailored solution to keep your workforce compliant and efficient. Built for healthcare leaders, it's your all-in-one compliance tool.Get Started here - https://isbglobalservices.com/onebadgeunitedstates/ashhra/ Support the show

Send us a textSchedule an Rx AssessmentSubscribe to Master The MarginCompounding Pharmacies are under a lot of fire but through advocacy, the future is bright!So, what does it really take to protect, grow, and advocate for compounding pharmacies in today's changing landscape?In this episode, Scotty Sykes, CPA, CFP®, and Austin Murray sit down with Scott Brunner, CEO of the Alliance for Pharmacy Compounding (APC), to unpack the realities of advocacy, access, and opportunity in the compounding space.We cover:- How GLP-1 shortages spotlighted the critical role of compounding pharmacies- The advocacy battles shaping patient access and prescriber freedom- Why cash-pay compounding is helping hybrids survive PBM reimbursement cuts- The rise of telehealth and private equity in personalized medicine- And more!More About Our Guest:Scott Brunner, CAE, is CEO of the Alliance for Pharmacy Compounding. APC is the industry trade association and the voice for pharmacy compounding, representing compounding pharmacists and technicians in both 503A and 503B settings, as well as prescribers, educators, researchers, and suppliers. APC works to preserve patient access to compounded drugs and the essential role of compounded medications in the American healthcare system.Brunner was formerly the senior vice president communications and external relations for the National Community Pharmacists Association and CEO of the Georgia Pharmacy Association. In his 30+year career in association management, he has also led statewide trade associations in Mississippi and Virginia.As you'll hear in his drawl, he is an Alabama native. He earned his BBA at the University of Montevallo and MPS from Auburn University Montgomery. He earned the prestigious Certified Association Executive designation in 1997.Stay connected with Scott and Alliance for Pharmacy Compounding: Scott Brunner LinkedIn APC WebsiteAPC LinkedInAPC FacebookAPC InstagramStay connected with us on social media:FacebookTwitterLinkedInScotty Sykes – CPA, CFP® LinkedInMore on this topic:Podcast: The Trusted Pharmacist: Advocacy and Building a Resilient PharmacyPodcast: From Counter to Capitol

On this 3d long-form edition of #TheShot of #DigitalHealth Therapy, Jim Joyce and I had the privilege of sitting down for an unforgettable deep dive with Tim Wentworth, the candid, thoughtful, fiercely grounded and recently retired CEO of Walgreens (previously CEO of Evernorth Health Services). Tim's story reads like a masterclass in leadership and life itself - from sweeping parking lots in Rochester to leading global healthcare giants like Cigna's Evernorth and Walgreens. Across nearly two hours (and honestly, we could've gone four), Tim brought raw honesty, wisdom, and humor to every story - from his early scholarship thanks to a teacher who believed in him, to leading multi-billion dollar companies but always defining what it means to lead with heart. This is not just a leadership interview - it's a living case study in resilience, humility, and purpose.

Adding a new associate sounds cut and dry. After all, they're there to treat patients, for which they have the training to do so. Easy, right? Not so fast. There's more to it. My guest today advises his clients on numerous accounting and operational issues, including hiring, and he'll share his experience with us.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 discussThe office cultural considerations, for example, the mission, values, and accepted and not-accepted behaviorsThe operational considerations, for example, credentialing, scheduling, etcThe marketing considerations, for example, the associate's role in attracting patientsOther considerationsWant 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

On Episode 91 of Astonishing Healthcare, we dove into the Workplace Intelligence Forecast for 2026 - The 10 Trends Businesses Need to Focus On! Here at Judi Health, we obviously live in the health benefits world and generally focus on content revolving around the pharmaceutical supply chain (i.e., PBM), health tech, and the administration of employee benefits, more broadly... but there is A LOT more going on our there that impacts America's workforce. Our guest, Dan Schawbel, Managing Partner of Workplace Intelligence (links below), has been tracking and publishing research on workplace trends for well over 15 years, and he unpacks the forces shaping the future of work, today. Aside from rising healthcare costs, how are employers - and their benefits leaders - thinking about remote work vs. returning to the office (and the impact on working mothers), the use of AI and a widening skills gaps, and the shift from white-collar to blue-collar jobs? Dan paints a picture of a market where employer leverage has returned amidst hiring freezes and layoffs. This newer dynamic intensifies the pressure on benefits teams, who are on the front lines, grappling with the complexities of GLP-1 drug coverage, and the critical need for mental health support, for example. Other highlights of the discussion include:AI is widening the skills gap, and many companies are failing to provide adequate training, leaving employees feeling unprepared; this is fundamentally reshaping learning and development needs for 2026.The era of the "Great Resignation" is over - employers now have leverage, driving return-to-office mandates and changing the power dynamic.Amidst rising costs, a comprehensive and affordable healthcare plan has become a powerful tool for employers - sometimes valued even more than a salary increase.Unsustainable healthcare cost increases are reaching a boiling point. Dan predicts 2026 will be the year the system either breaks or fundamentally changes, driven by extreme cost pressures on both employers and employees.The gap between what the C-suite thinks about AI and what the workforce says is extraordinarily wide: "We found that 96% of the C-suite expect AI to boost worker productivity... But when we asked employees, 77% of them say that AI has increased their workload. So it's done the exact opposite."Additional Resources/LinksConnect with Dan Schawbel on LinkedInWorkplace Intelligence Weekly (Free Newsletter - LinkedIn)Join Dan Schawbel and Claude Silver, Chief Heart Officer at VaynerX and author of Be Yourself At Work, for an exclusive webinar to look at the Workplace Trends 2026 Forecast: Click Here to RegisterRelated ContentAH072 - The Benefits You Probably Didn't Know You Have, with Marsha PerryReplay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive ImpactAH086 - Balancing Technology and a Human Touch in Member Service, with Lisa Ellerhorst and Sonia PettisHealth Benefits 101: The Importance of a Transparent PBM ModelFor more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

In this week's Energy Code episode, Dr. Mike Belkowski breaks down three of the latest and most fascinating studies on photobiomodulation (PBM), revealing how red and near-infrared light impact spinal cord recovery, vision health, and traumatic brain injury. He also introduces BioLight's newest innovations in skincare — the BioMinerals Mist and BioMinerals Platinum Mist — merging light, minerals, and structured water into a next-generation skincare technology that enhances hydration, energy, and cellular vitality.   Dr. Belkowski explores how standardization in PBM research is key to making red light therapy mainstream and clinically validated — and how these findings reinforce the power of light to heal and energize, from skin to nervous system. Stay tuned through the episode for exclusive details on BioLight's Pre–Black Friday sale, including early access for loyal Energy Code listeners. In This Episode, Dr. Belkowski Covers:

In this episode of Disruption/Interruption, host KJ interviews Mark Mincy, Chief Commercial Officer at US RX Care, about the hidden complexities and conflicts of interest in the pharmacy benefits industry. Mark shares how his company is disrupting the status quo by demanding transparency, eliminating conflicts, and helping employers reclaim millions in savings. The conversation uncovers the tangled web of PBMs, rebates, and the urgent need for legislative and technological change. Key Takeaways: The PBM System is Riddled with Conflicts of Interest [2:34]Mark explains how pharmacy benefit managers (PBMs) and consultants often act in their own financial interest, not the employer’s or patient’s, leading to inflated drug costs. Rebates and Purchasing Contributions Inflate Drug Prices [8:59]The system of rebates and retrospective payments to PBMs can account for up to 80% of a drug’s cost, forcing manufacturers to raise prices and employers to pay more. Transparency and Fiduciary Duty are Essential for Reform [21:37]Mark’s company, US RX Care, operates with complete transparency, passes back all rebates, and offers per-member-per-month guarantees to eliminate guesswork and conflicts. Employers and Consumers Can Take Action [33:34]Mark recommends joining healthcare purchaser coalitions, hiring ERISA attorneys, and demanding non-conflicted consultants to protect interests and drive industry change. Quote of the Show [31:27]:"Everything's intertwined. You want to move and do the right thing. These employers are between a rock and a hard place, so I do think some legislative action needs to occur." – Mark Mincy Join our Anti-PR newsletter where we’re keeping a watchful and clever eye on PR trends, PR fails, and interesting news in tech so you don't have to. You're welcome. Want PR that actually matters? Get 30 minutes of expert advice in a fast-paced, zero-nonsense session from Karla Jo Helms, a veteran Crisis PR and Anti-PR Strategist who knows how to tell your story in the best possible light and get the exposure you need to disrupt your industry. Click here to book your call: https://info.jotopr.com/free-anti-pr-eval Ways to connect with Mark Mincy: LinkedIn: http://www.linkedin.com/in/mark-mincy-a185497 Company Website: https://us-rxcare.com How to get more Disruption/Interruption: Amazon Music - https://music.amazon.com/podcasts/eccda84d-4d5b-4c52-ba54-7fd8af3cbe87/disruption-interruption Apple Podcast - https://podcasts.apple.com/us/podcast/disruption-interruption/id1581985755 Spotify - https://open.spotify.com/show/6yGSwcSp8J354awJkCmJlDSee omnystudio.com/listener for privacy information.

Dae Lee, PharmD, Esq, CPBS, and Lucas Morgan, Esq, joined Over the Counter to discuss both state and federal PBM reform heading into the new year.

Host Mike Stull is joined by MedImpact's Aprit Patel and Zach Johnson to discuss how this independent PBM is reshaping the landscape. They delve into MedImpact's history, unique approach to drug pricing and new GLP-1 and biosimilar offerings available for MedImpact clients. Register for upcoming Employers Health webinars or watch on demand at Events - Employers Health. Sign up for our monthly newsletter here. Find additional helpful benefits strategies and resources at Articles | Employers Health.

For Episode 90 of Astonishing Healthcare, Jim Winkler, Chief Strategy Officer at Business Group on Health, joins us in the studio for a lively discussion about the results of their 2026 Employer Health Care Strategy Survey! This annual study is packed with qualitative and quantitative information and highlights the top trends in employer-sponsored health care. Jim brings decades of experience to the table and puts helpful context around the headline data and employers' expectation for a ~9% year-over-year health care cost increase. He also shares his perspective on the evolution of the role benefits brokers and consultants play, how employers can navigate the rapidly evolving market and inflationary storm, vendor accountability, and how to position difficult decisions around making big changes. Discussion HighlightsCosts are expected to rise 9% in 2026, marking the worst multi-year surge in over a decade; it's another year of healthcare costs rising by more than benefits teams forecasted.Pharmacy's share of the total cost has jumped to 24%, driven by expensive GLP-1 and cancer drugs, and some other new cost drivers include mental health and autoimmune conditions.Proactive employers have been reviewing their data and are optimizing their programs, cutting underused solutions, investing where there's a tangible return, and tightening controls on high-cost treatments.Employers are aggressively scrutinizing partners and exploring alternative PBM and health plan models, as they should be (vendor accountability has become increasingly important over the years) - change is imminent (i.e., expect an acceleration of RFP activity).Additional Resources2025 Employer Well-being Strategy Survey: Executive SummaryBusiness Group on Health - Resources (Surveys, Data, etc.)Related ContentHow employers can take back control of unnecessary pharmacy spendingReplay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive ImpactSigns it is time to change your PBM vendor, and how to overcome common hesitationsHealth Benefits 101: The Importance of a Transparent PBM ModelFor more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

In this eye-opening episode of The ASHHRA Podcast, hosts Bo Brabo and Luke Carignan welcome Kinjal Patel and Brady Heiner from RxBenefits to demystify the complex world of pharmacy benefit management (PBMs). As costs skyrocket, driven by specialty drugs accounting for 50% of spend from just 2% of prescriptions, HR leaders face fiduciary risks, hidden contract clauses, and potential class-action lawsuits. Kinjal and Brady reveal how transparent PBMs differ from traditional models, why "transparency" claims often fall short, and how RxBenefits operates as a client-aligned Pharmacy Benefits Optimizer with 3 million members' negotiating power.Discover actionable strategies for hospitals and health systems to leverage in-house pharmacies, avoid rebate pitfalls, and conduct essential market checks and audits. The duo emphasizes the critical fine print in PBM contracts (e.g., CVS, Express Scripts, OptumRx) that can erode savings if overlooked. RxBenefits offers free, comprehensive contract analyses to uncover hidden opportunities and protect your organization.Key takeaways for healthcare HR professionals:Understand true PBM transparency vs. marketing hype… demand bias-free alignment.Specialty drugs dominate costs; optimize high-dollar prescriptions for massive savings.Hospital pharmacies are goldmines; structure contracts to maximize rebates and utilization.Fiduciary duty demands expertise; avoid legal risks with proactive audits.Don't DIY pharmacy benefits; partner with consultants for smarter plan design and pricing.A must-listen for HR managing escalating drug spend and compliance. Take control… request your free RxBenefits analysis today!From Our Sponsors...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/3ZaurZNStreamline HR Compliance with oneBADGEhealthcareSimplify screening, credentialing, and compliance for healthcare HR. oneBADGEhealthcare from ISB Global offers a tailored solution to keep your workforce compliant and efficient. Built for healthcare leaders, it's your all-in-one compliance tool.Get Started here - https://isbglobalservices.com/onebadgeunitedstates/ashhra/ Support the show

In this lively and thought-provoking episode, co-hosts Bo Brabo and Luke Carignan sit down with Elizabeth Babb, System Director of Human Resources at Spartanburg Regional Healthcare System, for a conversation that blends humor, heart, and hard-hitting insights about modern HR leadership.Elizabeth, a lifelong Spartanburg native and self-proclaimed “hilarious dog mom,” brings her infectious energy and wealth of experience across industries to the table as she dives into the art and science of total rewards. From introducing paid parental leave to strengthening benefits education and employee engagement, Elizabeth reveals how communication, not cost, is often the secret ingredient to driving employee satisfaction and retention.

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we delve into a dynamic landscape of scientific breakthroughs, regulatory shifts, and strategic maneuvers reshaping the industry.BioMarin's recent decision to divest from its hemophilia A gene therapy, Roctavian, has garnered significant attention. Despite being the sole approved gene therapy for hemophilia A, Roctavian has struggled with sales since its launch two years ago. This move underscores the complex challenges in commercializing gene therapies, highlighting that even groundbreaking treatments can face hurdles in market penetration. It reflects broader implications for the commercialization strategies of innovative therapies and emphasizes that market acceptance is as crucial as clinical efficacy.In manufacturing and regulatory affairs, Regeneron is navigating hurdles with its Eylea HD due to persistent manufacturing issues. The FDA's complete response letter points to ongoing problems at a Novo Nordisk plant. This situation illustrates the critical role of manufacturing standards in securing regulatory approvals and ensuring consistent product availability. Regeneron's efforts to seek alternative manufacturing solutions emphasize the importance of compliance and quality assurance in the pharmaceutical landscape.Roche is advancing its kidney disease portfolio with a Phase 3 trial success for Gazyva against idiopathic nephrotic syndrome. Building on previous approvals for lupus nephritis, this achievement underscores Roche's strategic focus on expanding indications for existing biologics. It highlights the value of lifecycle management strategies in maximizing therapeutic potentials and extending the reach of established drugs.A significant shift in pharmacy benefit management is underway as Cigna's Evernorth division moves away from PBM rebates through Express Scripts. This transition towards a rebate-free model may influence industry-wide practices, addressing growing scrutiny over rebate structures criticized for their lack of transparency and their impact on drug pricing.CSL's decision to delay the spinoff of its flu vaccine unit amid declining U.S. immunization rates illustrates market challenges in vaccine uptake. The anticipated drop, particularly among older populations, raises public health concerns and underscores the necessity for enhanced outreach and education to improve immunization coverage.On the investment front, AbbVie, Regeneron, and Sanofi have collectively invested $80 million in ZAG Bio's Series A funding round. This company is developing thymus-targeted medicines for autoimmune diseases, reflecting continued interest in novel therapeutic approaches addressing unmet medical needs within the biotech space.Catalent's rebranding initiative signifies a strategic effort to align corporate identity with mission-driven objectives, emphasizing "missions that matter" as it approaches an anniversary milestone with Novo Nordisk's acquisition. Such rebranding efforts are critical for differentiating service offerings and reinforcing corporate values within competitive markets.The competitive landscape within diabetes and obesity treatment markets is experiencing a potential paradigm shift following the results from Innovent and Eli Lilly's Phase 3 trial of mazdutide. This dual GLP-1/glucagon receptor agonist outperformed Novo Nordisk's semaglutide, offering improved outcomes in weight reduction and glycemic control. Mazdutide's dual mechanism could redefine treatment protocols, offering patients enhanced therapeutic benefits.MapLight Therapeutics has successfully raised $250 million through an IPO to advance its schizophrenia treatment candidate, Cobenfy. This funding supports further clinical development and potential commercialization efforts, reflecting investor confidence in innovative neurologSupport the show

PODCAST LAS NOTICIAS CON CALLE DE 27 DE OCTUBRE DE 2025 - Jamaica ahora mismo bajo vientos de huracán, todavía no entra el ojo - NWS - Plantean posible aumento del café para pagar a los caficultores más por el alud - Primera Hora - Gobierno jura que tiene dinero para los cupones, por ahora - Primera Hora - Cigna anunció que va a cambiar el modelo de PBM para que los rebates de las farmacéuticas pasen directo a los clientes - Axios - DACO gana caso ante jueza Swain contra LUMA  - Cuarto Poder - Se vuelven a atrasar las entregas de Gas Natural, ahora por Melissa - El Vocero - Consiguen 50 millones para los cupones en PR - El Vocero - Se están matando los jóvenes y la policía advierte de preocupación - El Vocero - Más joven el cáncer de próstata - El Vocero - Son ilegales las casas de la Parguera, pero… ¿quién las tumba? - El Vocero - Hay vista hoy en el caso de asesinato de Gabriela Nicole, Anthonieska vuelve al tribunal - Cuarto Poder - Se está perdiendo el café a pesar de aumento en precio - Primera Hora - Ganan los Dodgers en 18 entradas tras HR de Freeman - MLB- La Junta jura que ni LUMA ni Genera, ni la AEE han entregado los datos solicitados - El Nuevo Día - Alcaldes dicen que buscarían cómo sustituir el impuesto de inventario - El Nuevo Día - AAFAF dice que no admitió deuda con LUMA, juran los mal interpretaron en tribunal federal - Metro - Amazon despedirá a 30 mil empleados, arrancan con 14 mil - Metro - Asesinan 3 en cancha de residencial - Policía- Jueza federal da guiñada a posible cancelación de contrato de LUMA en caso DACO - Noticel - Trump vuelve a coquetear con tener un tercer término - NYT- Trump sigue soltando la guardia nacional en diferentes estados sin restricciones, senador republicano en contra de ataques contra barcos en el Caribe - WSJ- Qualcomm entra a competir en microchips con Nvidia y otros - CNBC- Mandani bien al frente en NYC para alcalde - NYT - Incluye auspicio

Justin, a PBM industry insider, pulls back the curtain on the complex games that drive up pharmacy spend. He explains the critical difference between a PBM that claims to be “transparent” and one that is a true fiduciary, contractually bound to act in your best interest. This conversation moves beyond the misleading “spreadsheet game” of chasing rebates to focus on the one metric that actually matters: lowest net cost.Tune in to understand:The key questions you must ask to determine if your PBM is truly aligned with your plan.Why the highest rebate almost never equals the lowest cost.The “product hopping” tactic that's costing your health plan millions on specialty drugs.How to leverage your own data and focus on PMPM (per member per month) spend to achieve real, measurable savings.LEARN MOREServe You RX: https://serveyourx.com/Heads Up Adviser: https://virtuealliance.com/heads-up-adviser/Show Sponsor Virtue Health: https://virtuealliance.com/CONNECT ON LINKEDINJustin Jasniewski: https://www.linkedin.com/in/justin-jasniewski/John W. Sbrocco: https://www.linkedin.com/in/johnwsbrocco/

“Just because someone hasn't gone to the doctor in four years does not mean they're not a walking time bomb." - Garrett JerueMy guest this week, Garrett Jerue, argues that the key to solving our healthcare crisis is to think differently and build a truly cohesive healthcare ecosystem. Driven by his personal experience battling cancer and navigating a fragmented system, Garrett has dedicated his career to designing benefits strategies that actually work for people.In this episode, Garrett shares his playbook for building this ecosystem. We discuss the "Ticket Health" model he developed, which integrates direct primary care, transparent PBM partnerships, and robust care navigation into a seamless experience. He explains why treating members with dignity and choice, focusing on proactive care, and challenging the status quo are essential ingredients for success.We also dive into the critical importance of mental health support and why employers need to view their health plan not just as an expense, but as a living, breathing organism that requires constant care and innovation.Tune in to get Garrett and I's insight on building a healthcare ecosystem that truly serves people.Chapters:(00:00:00) Building A Cohesive Healthcare Ecosystem (00:10:24) How a $600k Cancer Bill Changed Garrett's Life(00:17:22) Why Healthcare Financing Needs a Rethink (00:25:28) Treating Members with Dignity & Choice (00:38:11) The Keys to a Transparent PBM Partnership (00:43:45) Direct Primary Care: The Foundation of the Ecosystem (00:50:26) Care Navigation: The Glue That Holds It Together (00:59:07) Making Mental Health a Priority in the Ecosystem (01:12:32) The "Think Different" Mindset for Healthcare InnovationKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

“Just because someone hasn't gone to the doctor in four years does not mean they're not a walking time bomb." - Garrett JerueMy guest this week, Garrett Jerue, argues that the key to solving our healthcare crisis is to think differently and build a truly cohesive healthcare ecosystem. Driven by his personal experience battling cancer and navigating a fragmented system, Garrett has dedicated his career to designing benefits strategies that actually work for people.In this episode, Garrett shares his playbook for building this ecosystem. We discuss the "Ticket Health" model he developed, which integrates direct primary care, transparent PBM partnerships, and robust care navigation into a seamless experience. He explains why treating members with dignity and choice, focusing on proactive care, and challenging the status quo are essential ingredients for success.We also dive into the critical importance of mental health support and why employers need to view their health plan not just as an expense, but as a living, breathing organism that requires constant care and innovation.Tune in to get Garrett and I's insight on building a healthcare ecosystem that truly serves people.Chapters:(00:00:00) Building A Cohesive Healthcare Ecosystem (00:10:24) How a $600k Cancer Bill Changed Garrett's Life(00:17:22) Why Healthcare Financing Needs a Rethink (00:25:28) Treating Members with Dignity & Choice (00:38:11) The Keys to a Transparent PBM Partnership (00:43:45) Direct Primary Care: The Foundation of the Ecosystem (00:50:26) Care Navigation: The Glue That Holds It Together (00:59:07) Making Mental Health a Priority in the Ecosystem (01:12:32) The "Think Different" Mindset for Healthcare InnovationKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

On Episode 88 of Astonishing Healthcare, we're celebrating Women Pharmacist Day (#WPD2025) and sharing stories from four of our amazing team members: Allison Gallant, PharmD (Sr. Strategic Account Executive), Cindy Strassner, RPh (Customer Success Pharmacist), Lorece Shaw, PharmD (Sr. Director of Prior Authorization and Clinical Care), and Hope Nakazato, PharmD (VP of National Business Development). These women aren't just talking about improving healthcare or celebrating one day - they're actively promoting and implementing change, mentoring the next generation of pharmacists, and building systems to improve clinical workflows and member care.Lorece, Allison, Hope, and Cindy highlight their career journeys, insights on leadership, and the importance of mentorship to their personal and professional development throughout the discussion. They offer unfiltered advice on career growth, overcoming obstacles, staying resilient and expressing confidence in yourself, and how to work together to fix what's broken in pharmacy and health benefits. Whether you're interested in "non-traditional" career paths for pharmacists, curious about how pharmacists work in managed care, or just need some motivation to go for the next big opportunity and a reminder that you've got to be prepared and show up with confidence, per Allison and Lorece, respectively, this episode is for you!Related ContentSigns it is time to change your PBM vendor, and how to overcome common hesitations (by Hope Nakazato, PharmD, MBA)AH018 - What's the Right Path? Post-grad Options for PharmacistsPharmacy Benefits 101: Prior AuthorizationsHealth Benefits 101: The Importance of Clinical ProgramsAH040 - Celebrating Women Pharmacist Day 2024For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

Did you know that one in five adults skip filling their prescriptions because of cost, and many may be missing out on valuable savings and benefits they didn't even know they had? Tune in for an inspiring discussion with Pharmacist Joshua Fredell, Senior Vice President, Head of PBM and Specialty Product Innovation at CVS Health. Moments with Marianne Radio Show airs in the Southern California area on KMET1490AM & 98.1 FM, an ABC Talk News Radio Affiliate!  https://www.kmet1490am.comJoshua Fredell, a pharmacist and Senior Vice President, serves as Head of PBM and Specialty Product Innovation at CVS Health. He oversees ideation, commercialization, and management of the company's pharmacy benefit and specialty management products, including formulary design, network products, specialty cost management, clinical solutions, and medical benefit management. Joshua joined the legacy Caremark Rx corporation in 2003. Currently, Joshua and his team are focused on developing strategies that help create best-in-class savings while supporting clinically robust decision making including targeted formulary approaches for high-cost therapy classes, better control of specialty spend within the medical benefit, and improving the patient/provider experience while lowering overall cost. His team is also focused on continuing to innovate and enhance plan design solutions to help clients stay ahead of emerging market trends in a changing pharmaceutical landscape. Prior to CVS Health, Joshua was part of the pharmacy department of UPMC Health Plan, Joshua holds a Pharm.D. from the University of Pittsburgh.  www.cvshealth.comFor more show information visit: https://www.mariannepestana.com/

In this episode of Astonishing Healthcare, return guest Libbi Green, PharmD (Manager, Formulary Operations) joins Justin Venneri for a discussion about the 2025 flu season, including the latest vaccine-related updates that employer plan sponsors and plan members need to know. We discuss the effectiveness of last year's flu vaccines, factors influencing the rates, vaccination timing, and how there can be differences in state vs. federal guidelines, among other topics!HighlightsLarger employers may need to tailor flu programs across different states due to varying regulations.Federal agencies - ACIP and the CDC - are recommending the annual flu vaccine but are emphasizing single dose formulations that are free of preservatives.For people who regularly get or would like to get the flu vaccine, the timing is good now, before the end of October. For other vaccines - COVID, etc. - it's important to discuss timing and need with providers to reach a "shared decision."For plan sponsors, working with a PBM partner "to ensure patients have the access that they need and that you're meeting all regulatory compliance" is crucial.Judi®'s flexibility helps allow plan sponsors to react quickly and ensure vaccine-related claims are appropriately processed for their populations.Related ContentWhat employers need to know about federal vaccine policy changes (Mercer)AH072 - The Benefits You Probably Didn't Know You Have, with Marsha PerryAH071 - A Look at What's Really Driving Drug Spend, and How it Impacts Us, with IQVIA's Michael Kleinrock12 New Judi® Features Innovating Pharmacy Benefit AdministrationReference MaterialsInterim Estimates of 2024–2025 Seasonal Influenza Vaccine Effectiveness — Four Vaccine Effectiveness Networks, United States, October 2024–February 2025RSV monoclonal antibody nirsevimab 83% effective in babies, data revealBEYFORTUS® reduced hospital and doctor visits for RSV disease in babies by 87%, according to largest US real-world studyFor more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

Send us a textSchedule an Rx AssessmentSubscribe to Master The MarginAs a pharmacist, serving your community means putting your advocacy hat on and stepping into unfamiliar territory. One of the largest untapped resources that can really drive change towards PBM reform is using your existing patient base to show legislators the importance of PBM legislation.In this episode, Scotty Sykes, CPA, CFP®, Bonnie Bond, CPA, MBA, and Austin Murray, sit down with pharmacist and owner of Table Rock Pharmacy, Jessi Stout, to explore the grassroots advocacy efforts driving Pharmacy Benefit Manager (PBM) reform in North Carolina.We cover:How to engage customers in advocacyWhy local advocacy is critical for independent pharmaciesReal-world stories that bring the PBM issue to life for legislatorsMore About Our Guest:Jessi Stout is the owner of Table Rock Pharmacy in Morganton, North Carolina and winner of the 2025 Cardinal Health's Community Leadership Award which celebrates independent pharmacists going above and beyond for their community.A dedicated advocate for independent pharmacy, Jessi was once uninvolved in politics, has become a strong leader in the fight for PBM reform and combines her role as a local pharmacist with her passion for patient care, ensuring her voice and the voices of her patients are heard in legislative conversations that shape the future of pharmacy.Table Rock Pharmacy was one of the first pharmacies in North Carolina to offer the yellow fever vaccine and was the only pharmacy in the region offering the REGEN-COV and EVUSHELD injections while they were authorized to treat COVID-19.Additionally, during Hurricane Helene, Table Rock Pharmacy remained open, despite power outages and fallen trees. Transactions were recorded by hand to ensure patients could still get their prescriptions. At one point, they transported a generator by wheelbarrow to keep critical medication frozen. During this time, Stout also spoke out against audits being performed by Optum Rx. A social media post went viral, and this attention resulted in audits being paused for hurricane-affected areas.Learn more about Jessi and Table Rock Pharmacy:Table Rock Pharmacy FacebookTable Rock Pharmacy InstagramTable Rock Pharmacy WebsiteTable Rock Pharmacy TikTokTable Rock Pharmacy YouTubeStay connected with us on social media:FacebookTwitterLinkedInScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP TwitterBonnie Bond – CPA LinkedInBonnie Bond – CPA TwitterMore on this topic:Podcast: Becoming a Pharmacy GladiatorPodcast: Pharmacy's Never Ending StoryPodcast: Pharmacy O

Send us a textSchedule an Rx AssessmentSubscribe to Master The MarginAs a pharmacy owner, it often feels like you're fighting battles against systems designed to work against you.Few battles loom larger than the fight against Pharmacy Benefit Managers whose opaque practices have chipped away at margins, patient trust, and sustainability for independents.In this episode, we have two very special guests on the front lines of PBM reform: Dared Price, President of OreadRx and Price Pharmacies and Mark Cuban, legendary entrepreneur and co-founder of Cost Plus Drugs.Scotty Sykes, CPA, CFP®, Bonnie Bond, CPA, MBA, and Austin Murray sit down with Mark Cuban and Dared Price to explore how transparent models are reshaping the future of drug pricing and pharmacy benefit management.We cover:The real impact of spread pricing, rebates, and hidden contracts on pharmacy ownersHow Cost Plus Drugs is cutting out middlemen to bring transparency to patients and pharmaciesWhy OreadRx's transparent PBM model could change the game for independentsWhat a fair reimbursement ecosystem might look like and how owners can prepareAnd more!Stay connected with Dared Price, OreadRx, Mark Cuban and Cost Plus Drugs:  Dared Price LinkedInOreadRx WebsiteOreadRx FacebookCost Plus Drugs WebsiteCost Plus Drugs LinkedInCost Plus Drugs FacebookStay connected with us on social mediaFacebookTwitter (X)LinkedInInstagramScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP TwitterBonnie Bond - CPA, MBA LinkedInMore resources about this topic:Podcast - Pharmacy's Never Ending Story: PBM Reform Act and Medicare Drug Pricing ChangesPodcast - Pharmacy Ownership Through TimePodcast – The State of PBM Reform

Should you add a new service to your practice? That depends on the answers to a few important questions, which unfortunately, we don't see enough practices asking and answering before they do. My guest today helps his clients develop informed answers, and he'll share his thinking with us.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 discussWhy the most important question is: “does the market I serve need this service?” Additional important questions, such as who the competition is, why you think you can deliver the service better, and how you'd deliver the service day to dayExamples Joe has of success stories and failure storiesWant 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

In this special RxBenefits-sponsored episode of The ASHHRA Podcast, hosts Bo Brabo and Luke Carignan explore the dynamic pharmacy benefits landscape with experts Sarah Hearn and Wes Hill (Director of Compliance & Legal Operations). Amid the busiest legislative season yet—over 1,500 bills—they discuss PBM reforms, ERISA challenges, compounding alternatives for GLP-1 drugs like Ozempic, 340B pricing, and emerging lawsuits. Gain insights on transparency, cost savings, and compliance for healthcare HR pros navigating employee benefits.Key takeaways for healthcare HR leaders:Legislative Surge: 1,500+ state bills target PBMs, carriers, and more; expect increased reporting burdens but better data for informed decisions.ERISA Erosion Risks: States challenge federal uniformity—multi-state plans face conflicting laws; monitor for compliance headaches.Positive Reforms: New mandates empower plan sponsors with PBM data; leverage 340B and coupons to cut costs (e.g., Wegovy from $1,000 to $100/month).Compounding & Innovation: Affordable GLP-1 alternatives via telehealth, but ensure safety and avoid controlled substance pitfalls.Lawsuits to Watch: Oklahoma ERISA win; Arkansas PBM permit ban challenges interstate commerce—outcomes could reshape operations.Action Steps: Demand vendor transparency; align with ERISA; educate teams on benefits to prevent misuse and optimize savings.Essential listening for HR managing rising pharmacy costs and regulations. Spark curiosity—reach out to RxBenefits for guidance!From Our Sponsors...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/3ZaurZNStreamline HR Compliance with oneBADGEhealthcareSimplify screening, credentialing, and compliance for healthcare HR. oneBADGEhealthcare from ISB Global offers a tailored solution to keep your workforce compliant and efficient. Built for healthcare leaders, it's your all-in-one compliance tool.Get Started here - https://isbglobalservices.com/onebadgeunitedstates/ashhra/ Support the show

Bill Wolfe, COO of WriteWise, joined Over the Counter to discuss the current turning point in the PBM industry and how his company is leveraging technology to lower costs and improve care.

In this throwback episode Zach and Kevin feature Dr. Bob Convissar, a pioneer in laser dentistry with over 32 years of experience. He's a prolific author, lecturer, and practitioner who began his career after graduating from NYU in 1980 and acquiring a unique, century-old dental practice in New York City The main topic is the ABC's of Laser Dentistry, starting with a critical distinction between true lasers (like CO2​ and Erbium) and devices often called lasers but primarily used as hot glass tips (like diodes). Bob explains that diodes, which can operate at extremely high temperatures (750∘C to 1500∘C), work thermally, creating a burn, while CO2​ and Erbium lasers are absorbed by the water in soft tissue and vaporize it at 100∘C. He emphasizes that the CO2​ laser is the best option for general dentists doing soft tissue work, as it creates a much smaller zone of necrosis (thermal damage) than ElectroSurge or diode lasers, leading to better healing. He also offers a crucial financial perspective, arguing that while a CO2​ laser may have a higher initial purchase price (around $30,000), its lack of expensive disposable tips makes it a more cost-effective long-term investment than a cheaper diode laser (like a Picasso) with high operating expenses (potentially $18,000 in tips per year). For a multi-faceted approach, he recommends dentists invest in a CO2​ laser, a modern air abrasion unit, and a Photobiomodulation (PBM) laser (around $2,000 to $3,000). PBM lasers are purely palliative and can be used for pain management, like treating TMJ issues or for analgesia on deciduous teeth, and for promoting healing after invasive procedures. Finally, Bob stresses that the most crucial factor in laser dentistry is training, advising listeners that any course focusing on only one manufacturer or wavelength is likely a sales pitch, not a comprehensive educational seminar. He promotes his widely used textbook, Principles and Practice of Laser Dentistry   Join the Very Dental Facebook group using the password "Timmerman," Hornbrook" or "McWethy," "Papa Randy," "Lipscomb" or "Gary!" The Very Dental Podcast network is and will remain free to download. If you'd like to support the shows you love at Very Dental then show a little love to the people that support us! -- Crazy Dental has everything you need from cotton rolls to equipment and everything in between and the best prices you'll find anywhere! If you head over to verydentalpodcast.com/crazy and use coupon code “VERYDENTAL10” you'll get another 10% off your order! Go save yourself some money and support the show all at the same time! -- The Wonderist Agency is basically a one stop shop for marketing your practice and your brand. From logo redesign to a full service marketing plan, the folks at Wonderist have you covered! Go check them out at verydentalpodcast.com/wonderist! -- Enova Illumination makes the very best in loupes and headlights, including their new ergonomic angled prism loupes! They also distribute loupe mounted cameras and even the amazing line of Zumax microscopes! If you want to help out the podcast while upping your magnification and headlight game, you need to head over to verydentalpodcast.com/enova to see their whole line of products! -- CAD-Ray offers the best service on a wide variety of digital scanners, printers, mills and even  their very own browser based design software, Clinux! CAD-Ray has been a huge supporter of the Very Dental Podcast Network and I can tell you that you'll get no better service on everything digital dentistry than the folks from CAD-Ray. Go check them out at verydentalpodcast.com/CADRay!      

(0:00) Introducing Eli Lilly CEO Dave Ricks (1:43) How Eli Lilly discovered the GLP-1 impact on weight loss, counterfeit products from China (7:08) GLP-1 pricing and capital allocation after a breakout pharma product (12:56) Why Biotech VC has plummeted, “patent hacking” in China (15:32) Dave's health regimen: good sleep, movement, healthy diet, social relationships, reading (18:32) Unexpected impacts of GLP-1s, helping with addictions, potential mental health use cases (21:16) Thoughts on RFK Jr, Big Pharma's influence on the media, how AI empowers patients (25:27) Impact of proposed NIH cuts, explaining the “PBM boogeyman”, next major pharma breakthrough Thanks to our partners for making this happen! Solana - Solana is the high performance network powering internet capital markets, payments, and crypto applications. Connect with investors, crypto founders, and entrepreneurs at Solana's global flagship event during Abu Dhabi Finance Week & F1: https://solana.com/breakpoint OKX - The new way to build your crypto portfolio and use it in daily life. We call it the new money app. https://www.okx.com/ Google Cloud - The next generation of unicorns is building on Google Cloud's industry-leading, fully integrated AI stack: infrastructure, platform, models, agents, and data. https://cloud.google.com/ IREN - IREN AI Cloud, powered by NVIDIA GPUs, provides the scale, performance, and reliability to accelerate your AI journey. https://iren.com/ Oracle - Step into the future of enterprise productivity at Oracle AI Experience Live. https://www.oracle.com/artificial-intelligence/data-ai-events/ Circle - The America-based company behind USDC — a fully-reserved, enterprise-grade stablecoin at the core of the emerging internet financial system. https://www.circle.com/ BVNK - Building stablecoin-powered financial infrastructure that helps businesses send, store, and spend value instantly, anywhere in the world. https://www.bvnk.com/ Polymarket: https://www.polymarket.com/ Follow the besties: https://x.com/chamath https://x.com/Jason https://x.com/DavidSacks https://x.com/friedberg Follow on X: https://x.com/theallinpod Follow on Instagram: https://www.instagram.com/theallinpod Follow on TikTok: https://www.tiktok.com/@theallinpod Follow on LinkedIn: https://www.linkedin.com/company/allinpod Intro Music Credit: https://rb.gy/tppkzl https://x.com/yung_spielburg

In this episode of the Astonishing Healthcare podcast, host Justin Venneri is joined by Josh Golden, SVP of Strategy, and RFP Content Manager, Nic Bolitho, for a timely discussion about trends they're seeing in the market and how to run a better request for proposal (RFP) process to select a pharmacy benefit management (PBM) partner. Long story short, the "old way" of running a PBM RFP is broken, but, as Josh describes, there are some "tectonic shifts" happening as plan sponsors demand to see more options (i.e., transparent PBMs) and benefits brokers and consultants upgrade the questions and scoring used to force accountability and drive meaningful results for plans and plan members.HighlightsUnit-cost-based spreadsheet comparisons and marketing fluff are "out;" evaluating drug mix and how the PBM manages the plan (the 'M' in PBM) or makes money off of the plan are "in."Plan sponsors and benefits consultants must demand flexibility - the PBM contract should not be a "house of cards." For example, agreements should provide the freedom to add new vendors or carve out services without collapsing your financial arrangement.Legacy tech platforms are a barrier to innovation; ask potential partners if their technology can handle customizations and integrations with agility to avoid being told, "We just can't do that."Precise questions about member experience are a must; RFPs should move beyond open-ended questions that invite marketing fluff. Use specific, binary questions to obtain an accurate measure of the member experience and the effectiveness of clinical programs (e.g., NPS, turnaround times for prior authorizations, etc.).Related ContentReplay: PBM Procurement Decoded: Insights from a Pharmacist and an Actuary Why Savings Don't Materialize: The Truth About Pharmacy Benefit Procurement eBook AH034 - Customer Care in Healthcare: Setting a Higher Bar, with Will TafoyaAH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD5 ways to improve PBM procurement (EBN) For more information about Capital Rx and this episode, please visit Judi Health - Insights.

Resources for the Community:___________________________________________________________________https://linktr.ee/theplussidezpodcast Ro - Telehealth for GLP1 weight management https://ro.co/weight-loss/?utm_source=plussidez&utm_medium=partnership&utm_campaign=comms_yt&utm_content=45497&utm_term=55Find Your US Representatives https://www.usa.gov/elected-officials ______________________________________________________________________Join us as we talk with the founder of Claimable, a startup fighting to simplify the confusing world of health insurance. We'll uncover why health insurance is so complicated and whether that confusion is by design. The episode will focus on the challenge of getting GLP-1 medications covered, offering a step-by-step guide to prior authorization and the appeals process. We'll also explain the role of Pharmacy Benefit Managers (PBMs) and what PBM reform could mean for patients. This is a must-listen for anyone struggling with insurance denials, providing the knowledge to confidently advocate for your health.GetClaimable.com/PlusSideZ to save  ______________________________________________________________________⭐️Mounjaro Stanley⭐️griffintumblerco.Etsy.comUse code PODCAST10 for $ OFF______________________________________________________________________Join this channel to get access to perks:   / @theplussidez______________________________________________________________________#Mounjaro #MounjaroJourney #Ozempic #Semaglutide #tirzepatide  #GLP1 #Obesity #zepbound #wegovy Send us Fan Mail! GetClaimable.com/PlusSideZ to appeal your GLP-1 Insurance Denails and use code PlusSideZ to save! Support the showKim Carlos, Executive Producer TikTok https://www.tiktok.com/@dmfkim?is_from_webapp=1&sender_device=pc Instagram https://www.instagram.com/dmfkimonmounjaro?igsh=aDF6dnlmbHBoYmJn&utm_source=qr Kat Carter, Associate Producer TikTok https://www.tiktok.com/@katcarter7?is_from_webapp=1&sender_device=pc Instagram https://www.instagram.com/mrskatcarter?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==

Episode 83 of the Astonishing Healthcare podcast features returning guest, Bridget Mulvenna (VP, National Business Development at Capital Rx)! We discuss specialty drugs, pharmaceutical manufacturer rebates, and the shift to biosimilars. Yes, GLP-1s come up as well (how could they not?), and Bridget explains how employer plan sponsors can consider opportunities to provide access to these medications while not ignoring their inflationary potential and the economic impact on the plan - i.e., how to pivot from a rebate-driven models to a net-cost approach, facilitating more accurate cost management and budgeting.HighlightsTraditional PBMs remain focused on rebate value, which doesn't always mean the lowest net cost for the plan sponsor.Biosimilar adoption and precision formularies/benefits are a threat to old models.Plan sponsors must get [and use] their data - without detailed information, it's impossible to determine the true net cost or implement effective communication and education strategies.GLP-1s should be supported by wellness programs, and respecting FDA labeling is crucial.Surprisingly, many plan sponsors still choose the PBM that offers the highest rebates.Related ContentWill Biosimilar Rebates Pass-Through?Health Benefits 101: The Importance of a Transparent PBM ModelHow to Manage Pharmacy Benefit Spend in a GLP-1 WorldPharmacy Benefits 101: What is a Formulary?Pharmacy Benefits 101: Pharmaceutical RebatesFor more on the importance of access to plan data:

Send us a textHealthcare spending continues to surge, with pharmacy costs now representing 30-40% of total healthcare spend.   In this episode of CareTalk Executive Features, David Williams speaks with Dr. Alan Pannier, SVP of Product Strategy at SmithRx, about how legacy PBMs' misaligned incentives drive up costs, the toll on patients, employers, and independent pharmacies, and how a modern PBM model focused on transparency, fair reimbursement, and aligned incentives could finally fix what's broken in pharmacy benefits.

What happens when AI collides with salesmanship, streaming-era sports, and healthcare?In this episode, Erik Torenberg is joined by Mark Cuban, entrepreneur, Dallas Mavericks co-owner, and founder of Cost Plus Drugs.Topics include fiery group chats and how dissent sharpens thinking, the sales playbook of modern politics, and concrete fixes for U.S. healthcare like ending PBM opacity, publishing real prices, and government-backed patient financing. Mark also explains how AI is pushing media from “social” to algorithmic, why he expects millions of models, and why ESOPs are an underrated wealth engine. He shares what he'd build today and weighs in on NBA economics under the new collective bargaining agreement.Timecodes: 00:00 Introduction 00:47 Salesmanship, Politics, and Social Media04:05 AI, Algorithms, and the Future of Media06:29 Fragmentation of Social Platforms09:04 Political Messaging & Economic Populism12:05 Wealth, Equity, and Employee Ownership16:39 AI's Impact on Education and Healthcare21:32 Fixing the US Healthcare System29:39 Entrepreneurship in the Age of AI33:38 Business Success, Sports, and Investments35:32 NBA Economics and Team Building50:44 Personal Priorities & Closing Thoughts Resources: Find Mark on X: https://x.com/mcuban Stay Updated: Let us know what you think: https://ratethispodcast.com/a16zFind a16z on Twitter: https://twitter.com/a16zFind a16z on LinkedIn: https://www.linkedin.com/company/a16zSubscribe on your favorite podcast app: https://a16z.simplecast.com/Follow our host: https://x.com/eriktorenbergPlease note that the content here is for informational purposes only; should NOT be taken as legal, business, tax, or investment advice or be used to evaluate any investment or security; and is not directed at any investors or potential investors in any a16z fund. a16z and its affiliates may maintain investments in the companies discussed. For more details please see a16z.com/disclosures.

In this episode, we sit down with the President of the American Medical Association to discuss PBM reform and its impact on patients, physicians, and the future of healthcare. From drug pricing transparency to ensuring access to needed medications, this conversation explores why PBM reform is at the center of today's healthcare policy debates.

Join our co-hosts Todd Eury and Greg Reybold in this exclusive interview with Conor Sheehey, who most recently served as senior health policy advisor to U.S. Senate Finance Committee Chair Mike Crapo (R-ID). In this role, he advised the Committee on a range of health care policy issues, including prescription drug pricing, telehealth, AI, provider coverage and reimbursement, fraud and abuse, medical devices, and Medicare Parts B and D. Sheehey led several bipartisan legislative efforts, including the development of comprehensive PBM reforms and bipartisan proposals on clinician payment reform and drug shortages.

Today I am speaking with Dave Chase from Health Rosetta, and I'm asking Dave Chase three inferno-level burning questions—questions that, across the country, many self-insured employers are trying to find the answers to. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Now, an important underlying point that comes across loud and clear but remains unsaid, actually, in the conversation that follows is this: There are amazing brokers and EBCs (employee benefit consultants) and benefits advisors or TPAs (third-party administrators) who put their clients first and have the receipts (ie, they have data and they're willing to share it to prove this). And then there are those with the exact same titles, often enough, who are very much the opposite of this but super charming, I'm sure. I mean, it'd be a stretch to assume that the same roles don't apply to brokers or EBCs that apply for titles like hospital administrators where there's great ones and really not great ones; but everybody often gets lumped into the same category or even the term hospitals. Each of these terms is a broad stroke and contains multitudes. And do listen to the bonus clip from two weeks ago with Jonathan Baran for just more on this point. We dig into it for like 10 minutes or something. I also talk about this same concept in an upcoming episode with Mick Connors, MD. So, keep that underlying and unsaid theme in mind because a lot of these questions do boil down to, How do you figure out who's on the up-and-up and who's not? And if you need an example of the latter category, listen to the show with Ann Lewandowski (EP476) about the whistleblower lawsuit or the show with AJ Loiacono (EP379) about the myriad of brokers taking $7 or $14 per script written payable by the PBM (pharmacy benefit manager) and not reported on, as far as I know. This is very much still going on today, by the way, despite the CAA (Consolidated Appropriations Act) and the 5500 forms. Alright, so, first burning question, Question 1: After seeing J&J (Johnson & Johnson) and Wells Fargo sued for fiduciary breaches, what specific questions do I need to ask my benefits advisor to prove that my benefits advisor actually protects my interests? Okay, paraphrased, this question is employers trying to figure out what they can ask or how they can figure out if their benefits advisor or broker or employee benefit consultant is really as trustworthy as they'd like you to believe they are. There's been a whole bunch of shows that circle up on this. The thing is, though, the stakes are very, very high right now. So, yeah, I can see why this is turning into a burning question for anyone worried they might get sued personally unless they can figure out how to vet, for real in writing, who their broker, EBC, or advisor serves actually at the end of the day. Question 2 that I ask Dave Chase, and I'm not giving you the answers to these questions. You gotta listen to the show. But here's the second question I ask: How do I avoid personal liability when my TPA contract has hidden conflicts that could trigger an ERISA (Employee Retirement Income Security Act) lawsuit? Kind of a continuation of Question 1, but yeah, you can tell that self-insured employer teams are really digging in here and many, many are very aware of, first of all, the extent and depth of middle people doing things like, again, allegedly taking $20 million of employer clients' money and funding their executive bonus pool. So, yeah, definitely this is another doozy of a burning question. Also on these same topics, listen to the show with Justin Leader (EP433) and also the one with Cynthia Fisher (EP457) about spread pricing. Question 3 that I ask Dave Chase: My pharmacy costs keep climbing despite PBM guarantees. How do I tell if I am being systematically overcharged? Well, if your consultants are taking your rebates to fund their executive bonus pools, as I just mentioned there's a whole show about with Ann Lewandowski, or if they're taking $7 a script for every script that gets written for your members, which, yeah, that's afoot. I've seen the contracts and the cease and desists currently flying around our industry about that one. Or read that Osceola County lawsuit against their longtime brokers. Bottom line and end of this intro, informed employer teams are, for sure, wondering these questions. But even more than just wondering, what these questions signify to me, kind of at the macro level, they're realizing the danger of kind of sitting on that knowledge or just assuming that because everybody else is doing whatever, it's somehow safe—though status quo is getting kind of more and more dicey every single day. As some additional foreshadowing, this show finishes up with Dave Chase talking about the open-source resources that are available so that you too can create a high-performance health plan where members get higher-quality healthcare and, as Dave Chase says, the cost savings for free. There are links to many things that you can get from Health Rosetta and their sister company, Nautilus. Again, all the stuff is for free. Go to nautilushealth.org. That's their main Web site. Dave Chase, who has been on this podcast—I think this is his third time, although it has been a while—Dave Chase is co-founder and CEO of Health Rosetta. Also mentioned in this episode are Health Rosetta; Jonathan Baran; Mick Connors, MD; Ann Lewandowski; AJ Loiacono; Chris Deacon; VerSan Consulting; Justin Leader; Cynthia Fisher; Nautilus; Andreas Mang; Blackstone; Jon Camire; Claire Brockbank; Elizabeth Mitchell; Scott Haas; Paul Holmes; Chris Crawford; Luke Slindee, PharmD; Mark Cuban; Marilyn Bartlett, CPA, CGMA, CMA, CFM; Leah Binder; and Dawn Cornelis.   You can learn more at Health Rosetta and follow Dave on LinkedIn.   Dave Chase is on a mission to restore hope, health, and economic well-being to communities through healthcare transformation. As creator of the community-owned health plan (COHP) model, he is building a nationwide movement that turns health plans from drivers of wage stagnation into vessels for well-being and wealth creation. As founder of Health Rosetta, Dave has helped transform healthcare for thousands of employers covering more than five million Americans. What began with identifying just five successful health plans nationwide has grown into a movement with thousands of sustainable successes that deliver superior care at 20% to 50% lower costs. In 2024, his team launched Nautilus Health Institute, catalyzed with $4 million in Health Rosetta intellectual property and investment. Nautilus provides open-source standards, contracting templates, and technology infrastructure (including METL, an open-source healthcare data platform) that establish new market norms benefiting employers, clinicians, and communities. Dave's work in healthcare transformation has reached over 10 million people through best-selling books (The CEO's Guide to Restoring the American Dream, The Opioid Crisis Wake-up Call, Relocalizing Health), media, TED Talks, and TV/film appearances. He has received the World Health Care Congress's Lifetime Achievement Award for Health Benefits Innovation. Dave is dedicated to transforming healthcare through transparency, community ownership, and proven solutions that restore the American Dream.   06:36 What questions does a plan sponsor need to ask their consultant, EBC, or broker to ensure they are protecting the interest of the plan sponsor? 07:59 EP478 with Andreas Mang and Jon Camire. 08:49 EP453 with Claire Brockbank. 09:51 EP433 with Justin Leader. 09:53 EP436 with Elizabeth Mitchell. 11:03 How can plan sponsors avoid personal liability when their TPA has hidden conflicts of interest? 11:40 Tiara Yachts v. Blue Cross Blue Shield of Michigan lawsuit. 13:48 EP483 (Part 1) with Jonathan Baran. 14:18 EP457 with Cynthia Fisher. 16:18 The Marshall-Hickenlooper bill called the Price Tags Act. 16:50 Summer Short with Elizabeth Mitchell. 17:36 How do plan sponsors figure out if they are being overcharged for pharmacy benefits? 18:09 EP365 with Scott Haas. 20:18 EP397 with Paul Holmes. 20:22 EP465 with Chris Crawford. 20:37 EP429 with Luke Slindee, PharmD. 22:56 EP476 with Ann Lewandowski. 28:38 Where to find open-source resources to help guide plan sponsors with making better health plan decisions. 29:47 How the open-source trend is growing for health transparency. 30:48 What to look forward to at RosettaFest.   You can learn more at Health Rosetta and follow Dave on LinkedIn.   @chasedave discusses questions #plansponsors need to ask on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts), Andreas Mang and Jon Camire (EP479)

Why do drugs like Ozempic cost $1500 in the U.S., but only $147 in Canada? Most people don't know about the invisible middleman making more than 10 of the top drug companies combined.Healthcare may seem like a broken system, but it's actually not broken at all. It works great; it's just not working for you. Pharmacy benefit managers use their contracts to make massive profits off of everyone.PBMs may appear to be helpful. They negotiate lower prices for manufacturing companies, reduce out-of-pocket expenses, and handle logistics between employers and insurance companies. Pharmacy benefit managers charge the employer a very high price and pay the pharmacies a very low price, pocketing the difference. This is known as spread pricing. PBMs decide which drugs your plan covers, how much you'll pay out of pocket, which pharmacy you can use, and when or if you'll get your medication.Cheaper and better drugs are often denied if PBMs don't get a big enough rebate. They can even force you to fill your prescriptions at specific PBM pharmacies for more profit.Drug companies have to give PBMs a kickback or “rebate” to get their drugs covered by insurance companies. To afford this rebate, drug companies raise the list price, and PBMs promote the drug that gives them the most profit.Pharmacy benefit managers own insurance companies and pharmacies. Three of the largest PBMs control 80% of the medications in the U.S. Surprisingly, PBMs don't exist in other countries. Dr. Eric Berg DC Bio:Dr. Berg, age 60, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media.