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In this week's episode of Medicine: The Truth, hosts Jeremy Corr and Dr. Robert Pearl unpack a wide range of developments shaping healthcare in America today, including the TrumpRx drug discount program. From new legislation affecting telehealth and pharmacy benefit managers (PBMs) to the rapid spread of measles and growing public concern about vaccine policy, this month's discussion highlights the policy decisions and scientific debates influencing medicine right now. The episode opens with the latest federal legislation passed to avert a government shutdown. While healthcare was not the central focus of this particular political battle, the bill contains several provisions that affect medical practice. These include extensions for telehealth coverage and hospital-at-home programs, reforms targeting PBM transparency and new requirements designed to address “ghost networks” in Medicare Advantage provider directories. Dr. Pearl explains that while these provisions represent incremental progress, they are unlikely to solve the larger problems driving healthcare costs and access challenges in the United States. Here are the other major storylines from episode 104: Healthcare costs remain nation's top concern: A new KFF poll finds that healthcare expenses rank above food, housing and utilities as the economic issue Americans worry about most. Prior authorization frustrations grow: Many patients report delays or denials of care due to insurance requirements, highlighting persistent tension between insurers, physicians and patients. Drug pricing debates continue: Pearl examines a new prescription drug website initiative and explains why it may have limited impact compared with broader policy proposals such as “most favored nation” pricing. Telehealth's uncertain future: Although the latest legislation extends certain pandemic-era flexibilities, the lack of a permanent solution leaves virtual care programs in limbo. PBM reforms move forward slowly: New policies aim to increase transparency and reduce incentives tied to drug list prices, though Pearl notes that meaningful change will depend on future implementation. Site-neutral payment gains attention: A provision requiring unique identifiers for outpatient services could pave the way for policies that eliminate higher reimbursement for hospital-owned facilities providing identical care. Measles outbreaks surge: Nearly a thousand cases have already been reported in 2026, with the overwhelming majority occurring among unvaccinated children. Trust in the CDC declines: Polling shows confidence in the agency has dropped significantly following changes to vaccine recommendations. Independent vaccine review groups emerge: Medical organizations and states are forming new committees to evaluate vaccine evidence as federal guidance becomes more contested. Early colon cancer deaths rise: The death of actor James Van Der Beek at age 48 highlights the growing incidence of colorectal cancer among younger adults and the importance of earlier screening. FDA confusion over a new flu vaccine: The agency initially declined to review Moderna's mRNA-based flu vaccine before reversing course and agreeing to evaluate it ahead of the next flu season. Younger Americans face worsening health trends: New claims data suggest chronic disease is appearing earlier among millennials and Gen Z, driven by lifestyle factors and reduced connection to primary care. Wearable data reveal health disparities: Apple Watch data show significant differences in resting heart rates across states, reflecting variations in lifestyle, access to care and public health conditions. As the episode concludes, Dr. Pearl warns that growing political conflict around vaccines and biomedical research risks undermining public trust in science. The consequences, he argues, could shape American medicine for decades to come. Tune in for more fact-based analysis and discussion of the biggest stories in healthcare. * * * Dr. Robert Pearl is the author of the new book “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn The post MTT #104: TrumpRx, rising measles cases & the politics of vaccine science appeared first on Fixing Healthcare.
“We should all be able to look at the numbers and agree that this is not sustainable and that whatever we've been doing is not working. Democrats have had their chance, and Republicans have had their chance, and it's only gotten worse.” — Halle TeccoWarren Buffett called America's healthcare costs “a hungry tapeworm on the American economy.” That tapeworm now devours nearly a fifth of the nation's GDP—and the patient, as always, is on the table. We dedicate today's show to this most perennial of all America's problems, with two guests and two new books that approach the tragi-comedy from different angles.Self-styled innovation wonk Halle Tecco—founder of Rock Health, investor in over fifty digital health companies, professor at Columbia Business School—argues in Massively Better Healthcare that the system is both excessively public and excessively private, a Kafkaesque bureaucracy in which verticalized health plans now own the PBMs, the pharmacies, and increasingly the doctors. The result is monopoly medicine on a scale that would have appalled the original trust-busters.This is ultimately an antitrust story. As we've discussed on the show with Tim Wu, Biden's chief antitrust enforcer, the concentration of corporate power is the great unfinished business of American democracy. Tecco makes the case that Big Med is where the trust busters should go next after Big Tech. UnitedHealth is now one of the largest employers of doctors in the country. So it wasn't exactly shocking when the UnitedHealth CEO was assassinated two years ago. The system isn't broken, Tecco suggests. It's working exactly as designed—just not for patients.Surgeon Robin Blackstone, MD, author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0, joins us in the second half of the show to offer a view from the front lines. After 30 years as a surgeon, Blackstone confirms everything Tecco diagnoses—and adds a chilling detail of her own: the system is priced entirely for fixing illness, not preventing it. Her prescription is a “triangle of trust” between patient, physician, and AI—with the patient finally owning their own data.Both agree on one thing: every dollar spent on public health saves $14.30 in medical and societal costs. We are all already paying for all the waste. We just need to fix Big Med. But who's going to do it? Tecco says that America is ready for another round of Obamacare politics. But I'm not so sure. Five Takeaways• Healthcare Is a Tale of Two Civilizations: If you're wealthy, you go to UCSF and get the best care in the world. If you're not, you're one of the 100 million Americans without a regular primary care provider. Healthcare debt is the number one cause of bankruptcy. A person earning $30,000 in a rural county can expect to live a full decade less than someone earning $100,000 in an affluent suburb.• The Real Winners Are Monopoly Medicine: Verticalized health plans now own the PBMs, the pharmacies, and increasingly the providers. The ACA's profit cap forced them to grow the pie instead of getting more efficient. United is now one of the largest employers of doctors in the country. Independent pharmacies are closing at the rate of one per day. Rite Aid is bankrupt—the only major chain not owned by a health plan.• Every $1 in Public Health Saves $14.30: We're already paying for the crisis—in emergency room visits, lost productivity, and disability. We just need to move the safety net upstream. Public health is the only part of the system designed for prevention, yet its share of total health spending has dropped 25% in two decades. The economic case is overwhelming. The political will is not.• AI Could Break the Information Asymmetry: Patients are already using ChatGPT to diagnose themselves—and sometimes it's saving their lives. One woman caught her own pneumonia because her doctor couldn't see her for a week. But some doctors want to keep the paternalism: one AI tool built on medical journals is restricted to clinicians only because making it available to patients would “piss off the doctors.”• The System Is Priced for Rescue, Not Health: Everything is loaded to the moment your gallbladder goes bad or your heart gets a blockage. Prevention doesn't get paid for. Both guests agree: we need a massive re-pricing that rewards keeping people healthy, not just treating them when they're sick. That means paying doctors to prevent strokes, not just to fix them. About the GuestsHalle Tecco is the founder of the venture fund Rock Health and an investor in more than fifty digital health companies. She is an adjunct professor at Columbia Business School and a course director at Harvard Medical School. Her new book is Massively Better Healthcare: The Innovator's Guide to Tackling Healthcare's Biggest Challenges (Columbia University Press).Robin Blackstone, MD, is a physician, health systems architect, and founder of Blackstone Health. A surgeon by training with 30 years of clinical experience, she is the author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0.ReferencesPrevious Keen On episodes and authors mentioned:• Robert Pearl on how AI will be monetized in the healthcare industry• Tim Wu on the extractive economics of platform capitalism• Zeke Emanuel on which country has the world's best healthcare• Warren Buffett on healthcare costs as “a hungry tapeworm on the American economy”About Keen On AmericaNobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.WebsiteSubstackYouTubeApple Podcasts
“Show me an incentive structure and I'll show you human behavior... until employers realize they have more power than they give themselves credit for, this can't continue."My guest this week is Norm Volsky, Managing Partner at DRI and Founder of MVP Growth Partners. Norm has spent the last decade as one of the top executive recruiters in the digital health and employer benefits space - placing the commercial teams that helped build unicorns like Livongo and Hinge Health.In this episode, Norm explains why the next wave of healthcare innovation isn't about adding more "point solutions" to an already fatigued market. Instead, smart money is betting on companies that carve out high-margin, inefficient services directly from the major insurance carriers - like radiology, fertility, and specialty infusion.We discuss how Norm built an "army" of over 500 industry executives to crowdsource due diligence, why the traditional VC model fails in healthcare, and why employers and their benefits leaders are finally at a watershed moment where they must demand true fiduciary alignment from their vendors.If you want to know where the smart money is moving in employer healthcare, and why the "BUCA" carriers should be worried, this episode is a must-listen.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:[00:00:00] Intro: Recruiting in the Early Days of Digital Health[00:04:12] The Livongo Story: Selling Healthcare Direct to Employers[00:08:44] What Makes a Great Salesperson in Healthcare?[00:11:46] Spotting the Next Unicorn: The Hinge Health Experience[00:17:28] Private Equity vs. Venture Capital[00:20:00] Using Recruitment Data to Drive VC Investments[00:23:41] The "One Imaging" Pitch & Carving Out Radiology[00:30:40] Building an Army: Crowdsourcing VC Due Diligence[00:36:26] Why MVP Growth Partners Only Invests in "At-Risk" Pricing[00:41:40] Point Solution Fatigue & Identifying the "Good Actors"[00:46:17] Why Employers Must Demand Fiduciary Responsibility[00:50:41] The Future: The Erosion of the Big 3 PBMs and CarriersKey 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/
Your benefits plan may be getting more expensive for reasons unrelated to better care. In this episode of Sharkpreneur, Seth Greene interviews Chris Hamilton, Partner at Hotchkiss Insurance and a healthcare industry expert, who explains why employer health costs keep skyrocketing. He breaks down how misaligned incentives in traditional plans drive inflation and why mid-market employers often have far more control than they realize. You'll hear practical, modern strategies such as self-funding, direct agreements, and transparency tools that can improve coverage while reducing total costs for both companies and employees. Key Takeaways:→ Traditional compensation structures can incentivize higher premiums rather than better outcomes for employers and employees.→ When insurers own PBMs and other components, pricing can become a circular profit engine that justifies ongoing rate hikes. → If you reduce the underlying cost of care, the premium required to fund the plan naturally drops.→ The same procedure can vary dramatically in price across facilities, with no reliable correlation to quality. → Employers can contract directly with hospitals and concierge physicians to simplify access, improve care, and reduce both company and employee financial burdens. Chris Hamilton is a Partner at Hotchkiss Insurance in Texas, where he leads the employee benefits consulting practice. He specializes in managing healthcare and insurance costs to improve benefits coverage, reduce expenses, and enhance employee health outcomes. With over a decade of experience in corporate finance, Chris has advised clients across various industries, including private equity and oil & gas. In his free time, he enjoys traveling, working out, attending live music events, and spending time with family. Connect With Chris:Website: https://hotchkissinsurance.com/YouTube: https://www.youtube.com/@chrishamiltonbenefitsinsiderLinkedIn: https://www.linkedin.com/in/chamilton/
Send a textThis episode unpacks Novo's aggressive price cuts, Lilly's head to head trial win, and the emerging triple agonist race, revealing how pricing strategy and next generation data are colliding in a full scale GLP-1 market war.00:00 – Cold Open: Lilly vs Novo Shock TimingDave opens with the bombshell that Novo funded a tirzepatide trial while simultaneously announcing major price cuts to Wegovy and Ozempic, setting up a strategic chess match.03:20 – Novo Nordisk Price Cuts ExplainedDeep dive into Novo's plan to cut list prices by up to 50% and what that actually means for formulary power, PBMs, and competitive positioning.07:25 – Tirzepatide vs Semaglutide Head to Head TrialBreakdown of the direct comparison study showing stronger weight loss with tirzepatide and what that means clinically and commercially.11:55 – Market Reaction and Strategic ImplicationsDiscussion of stock movement, competitive signaling, and how Novo's pricing move may blunt Lilly's trial victory.14:25 – Novo Triple Agonist Data DropsShift into Novo's early phase data on its triple agonist candidate and how it compares conceptually to existing dual agonists.16:00 – Comparing Novo's Triple to RetatrutideAnalysis of weight loss percentages versus Lilly's retatrutide data and the caution required when comparing across trials.18:15 – The Triple Agonist EraBroader conversation about whether triple agonism consistently pushes weight loss higher and what durability may look like long term.20:00 – Clinical Trial Results vs Real World RealityReminder that clinical trial outcomes do not automatically translate to everyday patient experience.22:30 – Data Refresher on Allurion Ballon ApprovalQuick recap of the headline numbers and strategic landscape as innovation and pricing Visit TRYSHED.COM to learn more today! Use CODE OTP25 to save 25%!
"Why are we paying $10,000 for a $30 drug?"My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives.In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J.Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games. Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why We Talk About Cost Instead of Quality (00:02:42) From Silicon Valley & Defense Tech to McKesson (00:10:43) Why Healthcare is NOT a Technology Problem (00:15:53) Fiduciary Responsibility & The J&J Lawsuit (00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend (00:23:54) Building an "Open Market" Alternative to PBMs (00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies (00:35:42) FDA Approval vs. Real-World Efficacy (00:45:44) How to Actually Fix the Model: The Real-Time "Pause" (00:58:36) Why International Sourcing & PAPs Aren't the Fix (01:11:00) Replacing PBMs with Simple Transaction SoftwareKey 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/
"Why are we paying $10,000 for a $30 drug?"My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives.In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J.Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games. Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why We Talk About Cost Instead of Quality (00:02:42) From Silicon Valley & Defense Tech to McKesson (00:10:43) Why Healthcare is NOT a Technology Problem (00:15:53) Fiduciary Responsibility & The J&J Lawsuit (00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend (00:23:54) Building an "Open Market" Alternative to PBMs (00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies (00:35:42) FDA Approval vs. Real-World Efficacy (00:45:44) How to Actually Fix the Model: The Real-Time "Pause" (00:58:36) Why International Sourcing & PAPs Aren't the Fix (01:11:00) Replacing PBMs with Simple Transaction SoftwareKey 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/
In this episode of HR Benecast, host Mike Stull welcomes back Kevin Wenceslao, director of clinical solutions at Employers Health, to discuss how a clinical-first approach strengthens pharmacy plan performance. Kevin explains how the Employers Health clinical team works with clients and PBMs to deliver meaningful clinical insights and strategies. Watch or listen to Benefits Bites and Health Care Headlines. 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.
County alleges unlawful price inflation.
Pharmacy benefit managers' business practices are under attack from multiple directions. David W. Johnson and Julie Murchinson debate whether the new legislative and regulatory actions on pharmacy benefit managers' business practices will make a difference in how much consumers pay for drugs on “Breaking PBMs' Hold Over Drug Prices,” the new episode of the 4sight Health Roundup podcast, moderated by David Burda. Listen.
Think ownership requires slow growth? Think again. Independent pharmacy owner Kyle Beyer joins us to discuss how he went from chain pharmacist to multi-location owner of North Shore Pharmacy in only five years. He talks about the opportunities and obstacles of ownership: from buying during COVID, building a compounding hub, scaling through partner networks, and navigating the changing landscape of PBMs. If you're wondering what it really takes to grow in today's industry, Kyle's is the success story you need to hear. 00:00 – Welcome & Guest Introduction 01:30 – The North Shore Expansion Story (3 Locations & Growing) 07:54 – Buying a Pharmacy Right Before COVID Hit 11:14 – Building a Compounding Hub & New Revenue Streams 13:19 – Partner Network Success & the Rise of the “Sticky Patient” 17:26 – Supplements, DME & Front-End Profit Strategies 23:29 – Scaling With Technology: Processes, Staff & Pioneer Features 33:15 – Medicare True-Ups & What Pharmacy Owners Should Watch Hosted By: Johnathon Duhon | VP of PMS Sales, RedSail Technologies Guest: Kyle Beyer | Owner, North Shore Pharmacy Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com
This week, we discuss the Department of Labor's (DOL's) new compliance tools, its proposed pharmacy benefits manager (PBM) transparency regulation, and updated enforcement priorities from the DOL's Employee Benefits Security Administration. We also cover the National Labor Relations Board's (NLRB's) revamped case intake process. DOL Releases Compliance Tools The DOL has introduced new resources—including interactive toolkits, industry-specific guidance, updated fact sheets, and self-audit checklists—to help employers avoid wage-and-hour violations. DOL Issues Proposed Regulation for PBMs The DOL has issued a proposed regulation, now open for comment, aimed at increasing transparency from PBMs. The proposal would mandate PBMs to disclose the full scope of fees, rebates, and compensation. Additionally, the DOL's Employee Benefits Security Administration has unveiled a significant overhaul of its enforcement priorities for 2026. NLRB Adjusts Intake Procedure Faced with a significant number of pending cases due to the government shutdown and staffing issues, the NLRB has instituted a new intake procedure for unfair labor practice charges. - Visit our site for this week's Other Highlights and links: https://www.ebglaw.com/eltw421 Subscribe to #WorkforceWednesday: https://www.ebglaw.com/eltw-subscribe Visit http://www.EmploymentLawThisWeek.com - Epstein Becker Green is a national law firm that focuses its resources on health care, life sciences, and workforce management solutions, coupled with powerful litigation strategies. These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. EMPLOYMENT LAW THIS WEEK® and #WorkforceWednesday® are registered trademarks of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Steve Moore engages in a wide-ranging discussion primarily focused on economic prosperity and the policy shifts occurring under the Trump administration. A significant portion of the program features an interview with Steve Forbes, where the two celebrate the Dow reaching 50,000 and advocate for a supply-side agenda characterized by aggressive tax cuts, deregulation, and the potential privatization of Social Security. The dialogue shifts toward healthcare with Dr. Mike Ybarra, who critiques middleman PBMs and warns that price controls could stifle life-saving pharmaceutical innovation. Throughout the broadcast, Moore also offers sharp commentary on fiscal responsibility, the necessity of voter ID laws, and the appointment of Kevin Warsh to lead the Federal Reserve to ensure a stable dollar. Interspersed with nostalgic tributes to Buddy Holly, the show serves as a platform for promoting free-market principles as the essential engine for American wealth creation. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today on The Gist Healthcare Podcast, negotiations to reinstate the Affordable Care Act's enhanced premium tax credits stall in the Senate. Express Scripts reaches a landmark settlement with the FTC in the agency's lawsuit against PBMs. Plus, a new report shows healthcare bankruptcies declined last year, even as financial pressure across the industry remains high. These stories and more, coming up. Hosted on Acast. See acast.com/privacy for more information.
In this episode of Friday Fiduciary Five, Eric Dyson talks about the Employee Benefit Security Administration's January 29, 2026, proposal to enhance transparency into pharmacy benefit manager (PBM) fee disclosures. The proposal aims to provide ERISA plan fiduciaries with clearer information on PBM compensation, including direct and indirect revenue streams. If finalized, PBMs and associated brokers must disclose detailed compensation at regular intervals for the benefit of plan sponsors. Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information contained herein is general in nature and is provided solely for educational and informational purposes.It is not intended to provide a specific recommendation of any type of product or service discussed in this presentation or to provide any warranties, financial advice, or legal advice.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan specific circumstances.The opinions expressed by guests are not necessarily agreed by, or the same opinions of 90 North Consulting or of Eric Dyson.
For the 100th episode of Astonishing Healthcare, we welcomed AJ Loiacono, our co-founder and CEO, back to the show for a lively discussion about the evolution of our industry and business. What started as a transparent pharmacy benefits manager (PBM) in the "age of indifference" is now a more comprehensive health benefits manager (HBM), and we've entered the "era of acceptance." It's been an incredible 8+ years of growth, fueled by innovation and an unwavering commitment to our clients and delivering on our mission: to build the infrastructure our country needs to deliver the healthcare we deserve. But we had to endure an "age of confusion" to get here!AJ explains why traditional healthcare giants are facing a "BlackBerry moment" - trying to emulate a conflict-free challenger when "it's already too late." The balance of power is shifting away from the traditional PBMs, as the industry now demands full transparency - buyers of health benefits today are smarter than ever before. We also discuss how and why the U.S. wastes [at least] a trillion dollars annually by trying to deliver care using inefficient, fragmented systems; we built the infrastructure to stop it. This episode isn't just a retrospective; it's a blueprint of sorts, and we've got the cultural DNA required to bring about sustainable change (vs. just daydreaming about it). Related ContentReplay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health's Capital Rx Surpasses Five Million Contracted PBM Lives as America's Largest Employers, Unions, and Leading Health Systems Evolve Their Health Benefits StrategiesAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.
In this episode, we sit down with Fair Jones, Owner of Sav‑Mor Drugs & Gifts in Grenada, Mississippi, to talk all things ownership and advocacy. Fair shares her experiences stepping into pharmacy ownership in 2019, navigating curbside-only operations during COVID, and why reimbursement/PBM pressures pushed her to start speaking up online — including the moment she realized she made $0.88 on six prescriptions. In doing so, Fair shows how to balance meeting margins and pushing for reform in the industry. Follow Fair's Facebook Page here: https://www.facebook.com/fairpenderjones 00:00 – Welcome & Episode Intro 00:23 – Fair's Early Path Into Pharmacy 04:55 – Retail Burnout & the Push Toward Ownership 08:16 – Taking Ownership of Sav‑Mor in 2019 11:53 – Six Months of Curbside‑Only During COVID 17:21 – Med Sync, Inventory Control & Staying Afloat 23:30 – The $0.88 Reimbursement Story 29:17 – Becoming a Voice for Pharmacy Advocacy 33:33 – Full‑Circle Moment at Ole Miss 38:09 – Tech, Tools & Pioneer‑Driven Efficiency Hosted By: Johnathon Duhon | VP of PMS Sales, RedSail Technologies Guest: Fair Jones | Owner, Sav-Mor Drugs and Gifts Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com
In this episode, Luke discusses all things "vendor stack". Why you need one, how to build one, and how to deploy without overwhelming clients. Luke also touches on recent regulatory changes affecting pharmacy benefit managers (PBMs) and the implications for your clients....
In this eye-opening interview, Clay sits down with Michael Jones, owner of Helping Hand Family Pharmacy in Vicksburg, to expose the pharmacy benefit manager (PBM) "racket" that's devastating independent pharmacies across Mississippi. Michael breaks down how PBMs—middlemen like Express Scripts (Cigna), CVS Caremark, and Optum (UnitedHealth)—started as claim consolidators but evolved into profit machines through spread pricing, manufacturer rebates, and vertical integration, forcing locals to sell meds below cost and leading to widespread closures. He shares his fight's origin: Post-COVID reimbursement drops hit hard, shuttering stores like People's Drugstore, creating "drug deserts." Michael dug into campaign finances, uncovering PBM-linked donors influencing lawmakers, and went public—posting at his store and on social media—to rally customers. A Mississippi audit revealed Optum paying affiliates 20x more than independents, while PBM profits soar into billions. Urgent action: Support House Bill 1672 (State Affairs Committee) and Senate Bill 2575 (Public Health and Welfare)—bills must exit committee by February 3. Michael urges calls to the Capitol switchboard at (601) 359-3770 to demand fair reforms. Last year's near-win died at the eleventh hour; don't let it happen again. This is a battle for community businesses—stand up before independents vanish!
LucyRx & Veltris on vertical AI for PBMs—omnichannel member experience, specialty savings, faster time-to-therapy, net-cost wins.Key points discussed include:Vertical AI is the key to unlocking speed-to-market in a PBM industry dominated by heavyweights.Omnichannel, human-first member experience reduces friction and operating load.Measure what matters and moves from rebate dynamics to net-cost and specialty affordability at scale.Modernize PBM prescription workflows now using “vertical AI” and a services-as-software approach.
For Episode 99 of Astonishing Healthcare, we welcome Hannan Allen, SVP of Consultant Relations to the company and show! The discussion builds on Episodes 90 and 93, with Jim Winkler of Business Group on Health and Susana Villegas Spillman, respectively, by explaining why "pharmacy benefit consultants have a really tough job right now" and tackling some timely questions, including how has the role of the benefits broker or consultant evolved? What's making the job so complex lately? And, are plan sponsors' primary needs changing? We cover these questions and many more - including who will win Super Bowl LX. - with Hannan, so if you're working in the pharmacy and health benefits space, you won't want to miss this one. Tune in to hear about:Biosimilars - the big opportunity and challenges PBMs have createdThe push for transparency, and what it means for consultantsHow to weigh price/cost, and why drug mix is so importantPrioritizing member care and programs that benefit membersThe opportunity cost of sticking with the status quo (is astonishing)Related ContentHow employers can take back control of unnecessary pharmacy spendingJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM ReformReplay: PBM Procurement Decoded: Insights from a Pharmacist and an ActuaryHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.
If you've ever wondered why your deductible feels like a brick wall while insurers tout “savings,” this conversation goes straight to the source. Nathan Kaufman sits down with Mark Cuban to pull apart how PBMs and insurers shape drug prices, hide rebates, and use denials as financial float—while patients and providers pay the price. It's a rare, unfiltered tour through the pharmacy supply chain, medical loss ratio math, and the perverse incentives that keep care costly and complicated.We dig into the real-world fallout for physicians and hospitals: Medicare's stagnant updates, shadow-priced commercial contracts, and the administrative churn that drives independent practices into the arms of health systems or private equity. Mark challenges the industry to think like a startup—publish prices, strip out unnecessary vendors, and pay clinicians more with transparent, fixed margins. He shares why GPOs often inflate costs, how a virtual wholesaler model can save millions on injectables and specialty meds, and what happens when leadership manages silos instead of the whole enterprise.Then we get tactical. Imagine a standardized claim process across payers and a new financing model that replaces premium fights with unlimited HSAs plus government-backed medical loans pegged to Medicare rates. Pair that with direct contracts that pay providers quickly, no prior auth, no denials, and zero out-of-pocket for employees using posted agreements. Add agentic AI to audit thousands of contracts, verify invoices, and stop leakage dimes at a time—and a clearer path emerges: fewer middlemen, faster pay, better outcomes. Along the way, we confront uncomfortable truths about facility fees, subprime patient financing, and why breaking up insurance conglomerates or forcing divestiture of non-insurance assets could restore real competition.If you care about practical reform—transparent pricing, direct contracting, real outcomes data, and technology that kills waste—this is your playbook. Listen, share with a colleague who manages benefits or a hospital P&L, and tell us: where should transparency and direct contracts start in your market? Subscribe for more unscripted conversations that push healthcare toward simpler, fairer, and smarter.Support the showEngage the conversation on Substack at The Common Bridge!
SummaryIn this episode, Sean M Weiss interviews Katie Tolento, CEO of All Better Health, discussing her journey in healthcare policy reform, the challenges of navigating the healthcare system, and the importance of price transparency. Katie shares insights from her time in the White House, her approach to firing PBMs to reduce drug spending, and her optimistic outlook on future healthcare reforms.TakeawaysAll Better Health focuses on building health plans for self-funded employers.Prior authorizations can be waived for urgent care needs.Firing PBMs can significantly reduce drug spending for employers.Price transparency is crucial for competitive healthcare pricing.Katie Tolento emphasizes the need for fearlessness in healthcare policy.The current administration is showing some commitment to price transparency.Healthcare legislation is complicated and often misunderstood by lawmakers.Katie's experience in the White House provided unique insights into healthcare policy.The importance of patient advocacy in navigating healthcare challenges.Optimism exists for future healthcare reforms despite current challenges.Website: https://allbetter.health/ About Katy Tolento: Katy is a licensed health benefits consultant, veteran health care reformer, epidemiologist and thought leader. As the top health advisor at the White House Domestic Policy Council, Katy spearheaded transformative policies to end secret health care prices across the United States, end predatory medical collections practices, lower prescription drug prices, guarantee health records access and interoperability for patients and their care teams, combat the opioid addiction crisis and eliminate domestic HIV/AIDS. She first developed her take-no-prisoners approach to waste and corruption as an oversight investigator and legislative director on Capitol Hill, born of love and duty toward the hardworking American taxpayers.Katy has traveled the world, holding U.S. foreign aid programs accountable for results, as well as protecting the workforce of multinational energy companies from infectious disease threats. On the faculty of Georgetown University Medical School, Katy managed the school's participation in a multi-site NIH study. She founded a mentorship program for junior high girls in inner city DC and even served two years as a Catholic nun! Katy earned her graduate degree in Epidemiology from Harvard School of Public Health and an undergraduate degree from the University of Virginia.Based in northern Virginia, Katy quarterbacks AllBetter's nationwide, custom-curated partnerships of advisors, actuaries, member services teams and analytics gurus to deliver on the AllBetter client promise: significant savings, more generous benefits, and happier employees.
In Episode 123 of DC EKG, Joe Grogan sits down with Jackson Hammond (Senior Policy Analyst, Paragon Health Institute) to unpack what the latest CMS National Health Expenditure (NHE) data says about where U.S. health care is headed. They break down the June 2025 NHE release, compare it to Jackson's earlier “Paragon Prognosis” analysis, and explain what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. They also connect the spending outlook to Jackson's paper, “How to Reform the CMS Innovation Center with a Choice and Competition Approach,” and debate whether CMMI is bending the cost curve or just adding bureaucracy without accountability. Jackson argues we should aim for health care so affordable you barely need insurance. Chapters / Timestamps 00:00 – Intro + welcome 00:55 – Jackson's background: how he got into health policy 03:39 – Focus areas: Medicare, hospitals, drug pricing, PBMs, 340B 05:14 – What the NHE report is showing 06:14 – $5.2T → $5.6T → $8.6T: why the trajectory matters 08:00 – Why health spending isn't really “optional” 10:11 – Where the money is going: payer mix + per-enrollee costs 12:23 – Medicaid costs, provider taxes, and state financing tactics 15:58 – Medicare spending pressure and fiscal risk 21:06 – Misconception: “coverage = care” 26:18 – Why provider payments keep rising (post-COVID demand + consolidation) 33:01 – Rural care, consolidation, and the REH / hub-and-spoke model 40:08 – Drug pricing: retrospective vs prospective MFN 49:20 – 2026 outlook + closing thanks In This Conversation • NHE 2025: what the June 2025 data confirms about spending growth and the federal share. • Rising prices, flat health: why prices climb while outcomes lag. • Medicare and Medicaid: why they remain major budget drivers. • Coverage vs access: why an insurance card doesn't guarantee care or better health. • Hospitals and consolidation: what's driving higher payments and fewer choices. • Rural vs urban: why patients bypass local hospitals and what a better model could look like. • Drug pricing: what MFN approaches might mean for costs and innovation. • 2026: what Jackson expects next and what reform could realistically look like. Key Takeaways • NHE data points to continued, unsustainable spending growth. • Medicare and Medicaid drive long-term budget pressure. • Consolidation and payment incentives shape prices as much as utilization. • CMMI reform hinges on accountability, choice, and competition. • Smarter drug pricing policy should lower costs without undermining innovation. About Our Guest Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's “Paragon Prognosis” analyses and wrote “How to Reform the CMS Innovation Center with a Choice and Competition Approach.”
On Thursday, January 15, President Donald Trump announced several proposals to lower health insurance costs, which he called “The Great Healthcare Plan.” The healthcare-reform framework focuses on four broad initiatives: lowering drug prices, lowering insurance premiums, holding big insurance companies accountable, and maximizing price transparency. Although the White House has not announced specific legislative proposals to enact the policy, Trump specified he would seek to make more medications available over the counter, regulate pharmacy benefit managers (PBMs), and require insurance companies to explain their costs in simple and clear language.Ad-free podcasts are here!To listen to this podcast ad-free, and to enjoy our subscriber only premium content, go to ReadTangle.com to sign up!Want to get texts from Tangle?Since October, over 13,000 Tangle readers have joined us on Subtext, our free SMS messaging service that lets us connect directly with readers. Subtext subscribers can weigh in on our coverage through topic polls, receive analysis on developing stories straight from Isaac, and get occasional peeks behind the scenes at Tangle's operations. You can sign up for Subtext here!(Note: Subtext is currently only available for subscribers based in the U.S. and Canada.)You can read today's podcast here, our “Under the Radar” story here and today's “Have a nice day” story here.You can subscribe to Tangle by clicking here or drop something in our tip jar by clicking here. Take the survey: Which healthcare reforms would you support? Let us know.Our Executive Editor and Founder is Isaac Saul. Our Executive Producer is Jon Lall.This podcast was written by: Will Kaback and audio edited and mixed by Dewey Thomas. Music for the podcast was produced by Diet 75.Our newsletter is edited by Managing Editor Ari Weitzman, Senior Editor Will Kaback, Lindsey Knuth, Bailey Saul, and Audrey Moorehead. Hosted on Acast. See acast.com/privacy for more information.
PBM Problems, Self-Insured Contracts, & Taking Back Control of Independent PharmacyIn this blockbuster episode of PBM on the Rocks, we're thrilled to welcome a special guest who needs no introduction: Mark Cuban.Known for shaking up industries and challenging the status quo, Mark joins our Cocktail Crew for a candid conversation about the opaque world of PBMs. The conversation dives deep into how PBM practices are hurting employers, back office challenges facing independent pharmacies, and the potential of artificial intelligence to streamline operations and cut costs for small businesses.Music by JuliusH | Production & Editing by Shannon Wightman-Girard
"I asked him, 'What is it that you're teaching undergraduate students about benefits?''…Just two slides. That blew me away." - Kyle MinickMy guest this week is Kyle Minick, Vice President of Employee Benefits at Summit Financial Group. Kyle returns to the show to expose a massive systemic failure: Universities are not teaching HR professionals how to manage their second-largest expense.Kyle shares the shocking story of how he discovered that major university HR programs dedicate almost zero curriculum to healthcare strategy. Instead of complaining about it, he decided to fix it. We discuss the 6-week accredited college course he built from scratch to teach the next generation of buyers about Stop-Loss, PBMs, and TPA contracts before they enter the workforce.But before we dive into the classroom, we dissect the broken market they are inheriting. We debate why Reference-Based Pricing (RBP) is failing in hospital-dominated markets like Texas, why relating prices to Medicare might be backfiring, and whether the government should step in to establish a "median price" for care.Tune in to see how we can bridge the education gap and finally train buyers to demand better.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Why RBP Struggles in Texas Monopolies (00:03:30) The "Medicare Price" Fallacy (00:11:00) Should the Government Set a Median Price? (00:25:00) The Education Gap: How Universities Failed HR (00:29:25) The "Two Slide" Curriculum Problem (00:33:00) Kyle's Solution: Building an Accredited Benefits Course (00:43:00) Teaching HR to Audit Their Consultants (00:54:30) The Syllabus: Stop-Loss, PBMs, and Contracts (01:07:00) How to Enroll & The Future of Benefits EducationKey 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/
"I asked him, 'What is it that you're teaching undergraduate students about benefits?''…Just two slides. That blew me away." - Kyle MinickMy guest this week is Kyle Minick, Vice President of Employee Benefits at Summit Financial Group. Kyle returns to the show to expose a massive systemic failure: Universities are not teaching HR professionals how to manage their second-largest expense.Kyle shares the shocking story of how he discovered that major university HR programs dedicate almost zero curriculum to healthcare strategy. Instead of complaining about it, he decided to fix it. We discuss the 6-week accredited college course he built from scratch to teach the next generation of buyers about Stop-Loss, PBMs, and TPA contracts before they enter the workforce.But before we dive into the classroom, we dissect the broken market they are inheriting. We debate why Reference-Based Pricing (RBP) is failing in hospital-dominated markets like Texas, why relating prices to Medicare might be backfiring, and whether the government should step in to establish a "median price" for care.Tune in to see how we can bridge the education gap and finally train buyers to demand better.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Why RBP Struggles in Texas Monopolies (00:03:30) The "Medicare Price" Fallacy (00:11:00) Should the Government Set a Median Price? (00:25:00) The Education Gap: How Universities Failed HR (00:29:25) The "Two Slide" Curriculum Problem (00:33:00) Kyle's Solution: Building an Accredited Benefits Course (00:43:00) Teaching HR to Audit Their Consultants (00:54:30) The Syllabus: Stop-Loss, PBMs, and Contracts (01:07:00) How to Enroll & The Future of Benefits EducationKey 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/
This episode of The Jim Stroud Podcast is brought to you by ProvenBase - an AI-powered talent acquisition and Deep Search sourcing platform that helps organizations find, engage, and hire hard-to-find candidates from thousands of real-time online sources. See it in action for yourself by visiting - https://provenbase.com ... In this episode: Are pharmacy benefits actually helping employers and employees—or has the system become a costly black box? Jim Stroud sits down with Alan Pannier, Chief Strategy Officer at SmithRx, to unpack how the U.S. pharmacy benefit ecosystem really works and why it can feel “scammy” even when it's legal. Alan explains how PBMs were originally built to simplify pharmacy access, and how the model evolved into opaque pricing practices that can drive costs higher. In this episode, we break down spread pricing, rebate incentives, and why the “middle layer” of healthcare may be the biggest winner when no one can see the real numbers. Jim also presses for practical guidance: what HR leaders should ask their PBM, how to evaluate vendors using net cost vs. discount math, and what “fiduciary alignment” should look like in a contract. If you're an employer, HR leader, or benefits decision-maker wondering why drug costs keep climbing—and what you can do about it—this conversation is your cheat sheet. Contact our guest: Alan Pannier - https://www.linkedin.com/in/alan-pannier SmithRx - http://www.smithrx.com/ Learn more about your ad choices. Visit megaphone.fm/adchoices
Susan Thomas, RN, joined Over the Counter to discuss women's health, the pharmacist's role, and her organization's newly launched program designed to benefit both patients and providers.
On this episode of the podcast, Army Col. Vic Suarez (RET.) and Oxford Pharmaceuticals Chairman Tom Neely expose a quiet but dangerous vulnerability in America's healthcare system: the offshore manufacturing of generic medications relied upon by U.S. families and service members alike. With more than 90% of prescriptions filled by generics sourced largely from China and India, they break down how regulatory loopholes, price manipulation, and weak reimbursement structures have undercut American manufacturers while compromising quality and safety. Drawing on Senate testimony, defense procurement concerns and real-world manufacturing challenges, Suarez and Neely make the case for reshoring active pharmaceutical ingredient production, closing exploitative loopholes, reforming PBMs and distributors, and treating drug manufacturing as the national security priority it has become.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Alec Ginsberg, COO of C.O. Bigelow, takes us inside America's oldest pharmacy to share its 187-year history (and why it's still thriving today). From celebrity customers to the fight against PBMs, Alec shows how independent pharmacies can survive and why he launched Drugstore Cowboy to educate consumers and push for change. If you care about the future of healthcare, this is a conversation worth hearing. Subscribe to Drugstore Cowboy here: https://drugstorecowboy.com/ 01:50 - Inside America's Oldest Pharmacy 06:37 - Celebrities Need Pharmacists Too 11:07 - Why I Chose the Counter Over the Stage 18:10 - Staffing Like Service Actually Matters 20:51 - The Business Beyond the Counter: Cosmetics & Hotels 25:36 - Drugstore Cowboy: Why I'm Poking the Bull 40:30 - The $80K Patient: What PBMs Do to Real People 52:38 - The Mom Test: Why Service Still Wins Hosted By: Johnathon Duhon | VP of PMS Sales, RedSail Technologies Guest: Alec Ginsberg | COO, C.O. Bigelow Apothecaries Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com
Episode 95 of Astonishing Healthcare features six previous guests on the show who share astonishing observations from 2025 and some bold predictions for the New Year! Industry veteran Jeffrey Hogan, our General Counsel and Chief Compliance Officer, Lloyd Fiorini, ERISA law expert Nick Welle, two of our clinical leaders – Sarra Izadi, PharmD, Chief Clinical Officer, and Bonnie Hui-Callahan, PharmD, CDCES, Sr. Director, Clinical Programs, and our Chief Technology Officer and Co-Founder, Ryan Kelly, joined us for this round-robin discussion that's packed with insightful reflections and optimism about the future. We won't ruin it in the show notes, but based on what we saw in 2025: Everyone has finally had enough of the costs and opacity of the U.S. healthcare system – a $70k family premium is truly astonishing It's surprising that, despite the lawsuits, warnings, and reform efforts, the proverbial hammer didn't drop on anyone for not being a good health plan fiduciary The speed and impact of AI have broadly been more positive than expected The rise of cardio-diabesity How GLP-1s helped shift the balance of power in the pharmaceutical supply chain And in 2026, we may see: Employers fight back – they take agency over their plans, and for first movers that started with transitioning to aligned PBMs, it's “game on” for the rest of their health plans The cash price – or acquisition cost – of drugs in the U.S. becomes the baseline – i.e., we finally see a real change in how drugs are priced ICHRAs and other alternative models become more popular Employers look to new clinical programs and models that demonstrate a return on their spending AI become more important for clinical workflows (not decision-making, at least not yet) Pharmaceutical manufacturers find themselves with increasing bargaining power vs. traditional PBMs A new Stanley Cup champion, and a Super Bowl ring for… Related Content Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness AH094 - How Unified Claims Processing Evolved from Pharmacy: Improving Member Care & Operating Efficiency Health Benefits 101: The Importance of Clinical Programs How to obtain Rx data and what to do with it For more information about Capital Rx and this episode, please visit Judi Health - Insights.
In this special 2025 U.S. Policy Highlights edition of the Vital Health Podcast, we look back at our most important discussions on the Inflation Reduction Act (IRA) and its ripple effects across drug development, Medicare, and patient access. Over the past year, the biopharma industry and the broader healthcare system have undergone a period of rapid change as new rules surrounding drug pricing reshape how therapies are developed, financed, and delivered. In a landscape where policies are still being interpreted and adjusted, and where the long-term impact on innovation and access is far from certain, this episode serves as a year-end guide to what has changed and how to think about the road ahead. Throughout 2025, we paired our research with a series of podcast episodes where host Duane Schulthess sat down with industry leaders. In this highlights episode, we revisit several of those conversations: Donna Cryer: Advocacy, Drug Incentives & Research Crisis Barbara McAneny, Rafael Fonseca, and Steve Potts: Protecting Patients Amid the IRA Kirsten Axelsen: Part D Shift, IRA Penalties, and Access Risks Key Topics: Pill Penalty: How the shorter negotiation window for small molecule medicines relative to biologics is changing the calculus for pursuing oral therapies in areas such as cardiovascular disease, neurodegeneration, and other chronic conditions. Part D Redesign: Why moving more liability to plans is driving new premium and coverage tradeoffs, influencing which products stay on formularies, and raising questions about access in rural and underserved areas. Early Stage Investment: What our data suggest about the pullback in trial starts and funding for projects most exposed to IRA mechanics, and how that is influencing company formation, licensing strategies, and pipeline mix. PBMs, Vertical Integration, & Biosimilars: How consolidated intermediaries and payer-owned biosimilar strategies interact with IRA price setting, rebate flows, and the outlook for generic and biosimilar competition. Patient Advocacy & Real World Impact: What older adults, cancer patients, and rare disease communities are already experiencing as coverage rules change, cost-sharing is redesigned, and uncertainty grows around long-term treatment availability. Policy Paths Forward: Ideas from our guests for adjusting timelines, refining negotiation rules, and protecting incentives for follow-on and orphan indications while still improving affordability for patients. Opinions expressed are those of the speakers.See omnystudio.com/listener for privacy information.
If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we're doing something a little different to close out 2025. Instead of just looking back at December, we are ranking the biggest healthcare stories of the entire year on a Tier List, from "Not Impactful" to "Super Impactful." We cover everything from the FTC suing the Big 3 PBMs and the J&J fiduciary lawsuit dismissal to the "bloodbath" of 2026 renewals and the explosion of GLP-1 usage.Plus, we debut a new "Explain Like I'm 5" segment where I break down complex concepts like Reference-Based Pricing, Captives, and Stop-Loss using simple analogies involving candy shops and dirt bikes. Finally, we answer a listener question about building confidence as a young professional in the industry.Chapters:0:00 - Intro: Last Year in Healthcare0:51 - Tier List19:05 - Explaining Insurance To A 5-year-old24:24 - Ask Spencer Anything
If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we're doing something a little different to close out 2025. Instead of just looking back at December, we are ranking the biggest healthcare stories of the entire year on a Tier List, from "Not Impactful" to "Super Impactful." We cover everything from the FTC suing the Big 3 PBMs and the J&J fiduciary lawsuit dismissal to the "bloodbath" of 2026 renewals and the explosion of GLP-1 usage.Plus, we debut a new "Explain Like I'm 5" segment where I break down complex concepts like Reference-Based Pricing, Captives, and Stop-Loss using simple analogies involving candy shops and dirt bikes. Finally, we answer a listener question about building confidence as a young professional in the industry.Chapters:0:00 - Intro: Last Year in Healthcare0:51 - Tier List19:05 - Explaining Insurance To A 5-year-old24:24 - Ask Spencer Anything
Send us a textIn this eye-opening episode, we dive into one of America's biggest policy failures: the pricing of prescription medications like GLP-1s. While many focus on the legalization and rescheduling of cannabis, there's a far more insidious, legal, and mainstream drug policy draining your paycheck and costing countless lives. We break down the economics, the hidden players like PBMs, and the stark differences in drug pricing between the US and other countries. Learn how we can fix this broken system and why it matters for your wallet and your health.
Up first, Inspirogene-by-McKesson with Joe DePinto InspiroGene" is a dedicated business unit launched by McKesson in October 2024, focused solely on supporting the commercialization of cell and gene therapies (CGTs). It leverages McKesson's expertise in supply chain, logistics, and specialty pharmacy to help manufacturers, payers, and providers navigate the complex CGT landscape. https://www.mckesson.com/business-solutions/our-businesses/inspirogene-by-mckesson/ Our featured interview: Sponsored by MatchRX The TrumpRx Playbook for Independent Pharmacies CEO of MatchRx Johny Kello co-hosts with Todd Eury featuring our guest speaker, Dae Lee, Pharm.D., Esq., CPBS. Dae is a pharmacist-attorney and a Shareholder in the FDA & Biotechnology practice at Buchanan Ingersoll & Rooney. What makes Dae especially valuable for this conversation is that he's not just reading policy from 30,000 feet — he represents pharmacies every day in high-stakes fights with PBMs, from audits and reimbursement disputes to network suspensions and terminations. So, when we talk about TrumpRx — how it works, what it could break, and what independents should do next — Dae can translate the legal and contracting reality into real-world consequences behind the counter. Connect with MatchRX: MatchRX.com Special Message from Greg Reybold with APCI, update of the "Pharmacists Fight Back Act" Connect with Greg: https://www.apcinet.com/ Next, we talk with Dr. Jessica Daley PharmD Fractional Supply Chain and Operations Executive, with Pharma Logistics, we dicuss drug shortages and strategies for 2026. Connect with Jessica: https://www.linkedin.com/in/jessicaldaley/ Last interview, a suprise message from International Pharmacy 50 Pharmacist & Author Katrina Azer, announcing her new book https://www.katrinaazer.com/#books The TrumpRx Playbook for Independent Pharmacies - with MatchRX | TWIRx
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 episode, Jakob Emerson, Associate News Director at Becker's Healthcare, breaks down the latest debates over ACA premium tax credits, explores a potential Humana and Mark Cuban partnership, and highlights the policy and market forces reshaping the payer environment heading into the new year.
In this episode of Main Street Matters, Elaine Parker and Alfredo Ortiz sit down with former Congressman Dr. Tom Price to break down the growing healthcare crisis facing small businesses. They discuss skyrocketing health insurance premiums, the promise of association health plans, the powerful role of pharmacy benefit managers (PBMs), and why Congress must shift its focus from political gamesmanship to real solutions. Dr. Price shares his insider perspective on how market-driven healthcare reforms can lower costs, expand access, and give small business owners the relief they need.See omnystudio.com/listener for privacy information.
Send us a textHealth insurance in the United States is incredibly complex, filled with deductibles, co-pays, co-insurance, narrow networks and more. Why is our system such a maze? Is it the unintended product of decades of patchwork policies, or is the complexity intentional?In this episode of CareTalk, hosts David E. Williams and John Driscoll break down the real reasons health insurance is so hard to navigate, exploring the structural fragmentation of the system, the role of intermediaries like PBMs and brokers, the impact of convoluted billing practices, and what meaningful simplification would actually look like.
If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions. This month, we're joined by Chris Hamilton! We talk about the J&J lawsuit being dismissed, Eli Lilly switching PBMs, AI in healthcare, and much more. We also play a Christmas game called Home Alone: The Wet Bandit's Bills, where Chris and I try to guess the average hospital price for the injuries incurred by the bandits from the Home Alone films.Chapters: 0:00 - Intro0:42 - J&J Lawsuit Dismissed9:20 - Eli Lily Switches PBMs11:17 - New FDA Rules On Biosimilars16:36 - AI Adoption In The Healthcare Industry25:21 - Survey On At-Home Medical Devices29:57 - Home Alone: The Wet Bandit's Bills42:32 - Ask Spencer AnythingSources: https://www.healthcaredive.com/news/fda-biosimilars-guidance-speed-development-comparative-efficacy-studies/804191/https://www.beckerspayer.com/legal/judge-dismisses-lawsuit-accusing-jj-of-mismanaging-employee-drug-benefits/?origin=PayerE&utm_source=PayerE&utm_medium=email&utm_content=newsletterhttps://www.healthcare-brew.com/stories/2025/11/25/eli-lilly-switches-big-3-pbm-alternative-transparent-rivalhttps://www.fiercehealthcare.com/health-tech/amid-shutdown-health-it-vendors-say-hospitals-are-cutting-back-spendinghttps://www.techtarget.com/virtualhealthcare/news/366633680/Survey-At-home-monitoring-devices-popular-affordablehttps://pubmed.ncbi.nlm.nih.gov/41265449/https://www.emarketer.com/content/ai-spending-healthcare-outpaces-overall-us-economy-
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
Investor and healthcare disruptor Mark Cuban joins The Other 80 to talk about his online pharmacy, Cost Plus Drugs, that is bringing affordable drugs with transparent markups to American households. Mark lays out his basic formula for taking overhead and complexity out of the US healthcare system by disaggregating huge vertical businesses and disintermediating middlemen.In this episode, Mark Cuban pitches:That direct contracting with hospitals is his next healthcare disruptionWhy he thinks medical schools should be freeHow financial audits are a first step to lowering healthcare pricesWhy price transparency is contagiousMark thinks the best way to make change is from outside the system:“What makes [Cost Plus Drugs] radical is when we started, everybody presumed and expected that we would work within the system. That we would partner with the big three wholesalers that control 98% of the sale of drugs - that we would partner with the big three PBMs that control 85% of prescriptions. And, we did the exact opposite because we knew they were the problem.”Relevant LinksThe Cost Plus Drugs mission statementRead and watch Mark Cuban testimony for the Senate Special Committee on Aging More on Mark's hospital negotiation strategyAbout Our GuestMark Cuban is an investor who lives for his family, his "Shark Tank" companies and the Dallas Mavericks. He is the owner of the 2011 World Champion Dallas Mavericks and bestselling author of "How to Win at the Sport of Business," and was an entrepreneur from the early age of 12 when he sold garbage bags door to door. Today, Cuban is the highly successful entrepreneur and investor with an ever-growing portfolio of businesses.A lifelong entrepreneur and investor, Cuban has started and built multiple industry-changing organizations including Costplusdrugs.com, which sells medications at industry low pricing with total cost transparency, which he founded with Dr. Alex Oshmansky. Named a winner of the GQ Men of the Year in 2006 and included in The New York Times Magazine's Year in Ideas, Cuban is recognized as being among the most influential people in both the cable and sports industries. He may be best known for his purchase of the Dallas Mavericks on Jan. 4, 2000. Under his leadership, the team's home games have become a total entertainment experience.Prior to his purchase of the Mavericks, Cuban co-founded the first commercial streaming company AudioNet, which became Broadcast.com, the leading provider of multimedia and streaming on the Internet. Broadcast.com was sold to Yahoo! Inc. in July 2000. MicroSolutions, a leading national systems integrator, was co-founded by Cuban and partner Martin Woodall in 1983, and later sold to CompuServe.In 2001, Cuban founded AXS TV (www.axs.tv) and sister network, HDNet Movies, the very first all high-definition TV network. He also co-owns the Landmark Theater chain, Magnolia Pictures, Magnolia Home Video and 2929 Productions along with partner Todd Wagner. With the release of the movie "Bubble" in 2005, Magnolia and Landmark Theaters pioneered the release of the movie's "day and date," meaning the
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
In this episode of Tech Trends by PrimeRx, we continue our deep dive into the evolving world of pharmacy technology. Building on the momentum from our previous discussion—where we explored the shifting landscape of pharmacy tech innovation—we now turn our focus to one of the most urgent challenges facing independent and community pharmacies: making sense of inventory and purchase data. Dr. Matthew Song joins us to break down why automation is no longer optional and how data intelligence is transforming pharmacy operations. With rising costs, shrinking margins, and increasing administrative demands, the ability to automate and optimize data workflows is becoming a competitive advantage. Dr. Song sets the stage by examining how automated systems offer unprecedented visibility into a pharmacy's financial and clinical activity. Today's modern PMS platforms, including PrimeRx, go far beyond dispensing—they automatically collect, analyze, and interpret operational data. Throughout the episode, we'll uncover how automation identifies top payers, high-impact drugs, key prescribers, patient adherence trends, and more. These insights help pharmacy leaders make informed decisions around purchasing, contracting, staffing, and patient care. Listeners will also gain actionable takeaways tied directly to real-time metrics, including dashboards that connect inventory fluctuations to financial performance. Dr. Song explains how automation eliminates manual entry errors, accelerates purchasing decisions, and helps pharmacies avoid costly stockouts or overstocking. From surfacing seasonal medication trends to pinpointing high-volume PBMs or top-referring providers, this episode demonstrates the power of transforming raw data into strategic intelligence. Stay tuned through the end as we tease what's next on the horizon—AI-driven predictive inventory management and the next evolution in pharmacy automation.
Brigham Buhler is a healthcare entrepreneur transforming America's broken system. As founder of Ways2Well, owner of Revive Rx Pharmacy, and an investor in psychedelic research, he champions a model of care that prioritizes patients over profits through preventative medicine, transparency, and innovation. His work is guided by a few core convictions: -Former insider's perspective: With deep experience navigating the corrupt systems of pharmacy benefit managers (PBMs), insurance companies, and the FDA, Brigham knows firsthand how the system is stacked against patients. -Uncompromising advocate: He pushes to expose and dismantle the corporate capture of American healthcare. -Bold truth-teller: He believes in revealing the realities of the insurance Ponzi scheme and providing practical ways to bypass outdated systems. -Relentless reformer: He is dedicated to replacing a model that profits off sickness with one centered on health, longevity, and patient empowerment. Today's Sponsors: Black Rifle Coffee: https://www.blackriflecoffee.com LMNT: https://www.drinklmnt.com/clearedhot
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