Podcasts about pbms

Disease-modifying therapies are the cornerstone of MS treatment, but they're not the only piece of the puzzle. Beyond prescription medications, self-care that includes making healthy lifestyle choices can significantly improve your quality of life with MS.  Julie Polisena knows this firsthand. Julie lives with MS, and in a recent blog post, she shared a comprehensive list of the lifestyle changes that have improved her quality of life with MS. Julie joins us today to discuss some of the most impactful changes you can make to start your own journey toward better health and wellness.   We're also diving into the science behind some of the most talked-about diets for MS. We're breaking down the research on the Mediterranean diet, the Keto diet, the Wahls Diet, the Swank Diet, a gluten-free diet, and intermittent fasting, giving you an overview of the studies that have measured their impact on MS. We're discussing the latest developments in the ongoing scrutiny of pharmacy benefit managers (PBMs). There's significant pending legal action and a congressional investigation targeting PBMs, the powerful and secretive middlemen in the prescription drug supply chain. And we'll tell you how they've profited at the expense of millions of people with chronic illnesses, including people living with MS. We'll tell you about a clinical trial that's testing an injectable formulation of Briumvi. You'll hear about a promising new strategy for myelin repair. And we'll remind you about a warning from the FDA and Health Canada about glatiramer acetate (Copaxone). We have a lot to talk about! Are you ready for RealTalk MS??! This Week: A DIY approach to improving your MS journey  :22 A roundup of studies that focused on popular diets for people with MS  1:53 Congress and the FTC have pharmacy benefit managers in their sites  7:32 TG Therapeutics is testing an injectable form of Briumvi   9:32 A research team has developed a novel remyelination strategy  11:03 A warning about glatiramer acetate has been issued  14:08 Julie Polisena discusses lifestyle changes that can make a difference in your quality of life  16:58 Share this episode  33:24 Next week's episode   33:43 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/420 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com PARTICIPATE: Take the Shaping Tomorrow Together Survey https://s.alchemer.com/s3/Perspectives-on-MS REGISTER: Attend the virtual Shaping Tomorrow Together meeting with the FDA https://nmss.quorum.us/event/25463 SIGN UP: Become an MS Activist https://nationalmssociety.org/advocacy READ: Small Changes, Big Impact: Managing My MS Through Lifestyle Changes https://mscanada.ca/find-support/blog/small-changes-big-impact-managing-my-ms-through-lifestyle-change STUDY: The Role of Nutrition and Physical Activity in Modulating Disease Progression and Quality of Life in Multiple Sclerosis https://mdpi.com/2072-6643/17/16/2713 STUDY: Transient Gene Melting Governs the Timing of Oligodendrocyte Maturation https://sciencedirect.com/science/article/abs/pii/S009286742500861X REVIEW: Copaxone, Glatopa (Glatiramer Acetate) FDA Drug Safety Communication https://www.fda.gov/safety/medical-product-safety-information/copaxone-glatopa-glatiramer-acetate-drug-safety-communication-fda-adds-boxed-warning-about-rare JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms DOWNLOAD: The RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 DOWNLOAD: The RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 420 Guest: Julie Polisena Privacy Policy

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

This special episode of the Astonishing Healthcare podcast features Congressman Jake Auchincloss, who discusses his efforts to reform pharmacy benefit managers (PBMs) and address systemic issues in the U.S. healthcare system to bring down costs. Representing Massachusetts' 4th district and growing up in a family of medical professionals and scientists, Rep. Auchincloss draws on his experience to advocate for policies that promote competition, innovation, and improved access to affordable care. He highlights his Pharmacists Fight Back Act (H.R.9096), noting that he looks forward to reintroducing the widely supported, bipartisan bill that aims to protect independent pharmacies, employers, and plan members, and he shares optimism about the potential for meaningful PBM reform to become law.Auchincloss stresses the importance of challenging entrenched corporate practices to create a healthcare system that prioritizes price transparency, patients, and encourages technological innovation - such as new drug development or medical devices - in key areas affecting millions of Americans. For example, why not make curing Alzheimer's, which is expected to impact upward of 60 million people by 2025, our 'moonshot'?HighlightsMandatory NADAC reporting (cost-plus, with a fair dispensing fee) and banning spread pricing, steering, and other traditional PBM business practices will help stabilize retail pharmacies and protect payers and patients from misaligned incentives.The federal government should promote competition in areas where there's an obvious and immediate positive impact, such as the development of generic and biosimilar drugs.Improving technology for "hospital at home" and long-term care for the elderly should be a focus.Price controls won't work for drugs, and there's more work to do on price transparency for medical care.Value-based contracts make sense - GLP-1s are a good example/potential application. We should be paying for performance.Congress should promote community health centers more because "they are really meeting people where they're at with the services that they need."Related ContentThe Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability (Rep. Auchincloss at 4:31:00)AH052 - ERISA Insights: Challenges & Compliance in Modern Healthcare, with Nick WelleRELEASE: AUCHINCLOSS INTRODUCES BIPARTISAN PHARMACISTS FIGHT BACK ACT TO CRACK DOWN ON PREDATORY DRUG PRICINGWhat is NADAC & How Does It Differ From AWP?For more information about Capital Rx and this episode, please visit Capital Rx Insights.

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

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

Drug pricing in America is a shell game where patients always lose. Healthcare Bridge host Nathan Kaufman and his guest Richard Helppie pull back the curtain on why Americans pay drastically more for the same medications than patients anywhere else in the world.At the heart of this problem lies a fragmented system where the United States—effectively operating the world's largest health insurance company—somehow lacks the ability to negotiate bulk purchasing deals. While pharmaceutical companies claim high prices fund critical research, the conversation reveals how your money primarily finances the endless parade of drug advertisements dominating television commercial breaks.The journey of a pill from factory to patient passes through multiple profit-extracting entities: manufacturers, wholesalers, and pharmacy benefit managers (PBMs). With three PBMs controlling 80% of drug distribution—all owned by insurance companies—conflicts of interest are baked into the system. Through revealing personal anecdotes, the hosts demonstrate how the same medication can cost $5 with one insurer, $330 with another, yet only $20 through Mark Cuban's pharmacy. Many Americans find it cheaper to purchase medications from Canadian pharmacies despite industry warnings about "dangerous" reimported drugs—even when those medications come from identical manufacturing facilities.Recent policy proposals offer potential paths forward. The Biden administration's efforts to cap Medicare drug expenses met immediate legal challenges from pharmaceutical companies, while Trump's "most favored nation" pricing concept aims to standardize global medication costs. Medicare Part D represents a partial success story by forcing drug companies to negotiate with insurers, maintaining 95% subscriber satisfaction while running 40% below projected costs.Healthcare policy requires informed leadership, but few politicians truly understand the system's complexities. If you or someone you love needs medical care, finding an insider who understands healthcare's nuances isn't just helpful—it could save your life. Subscribe to the Healthcare Bridge for more conversations that bridge gaps in our healthcare system and work toward solutions that benefit patients first.Support the showEngage the conversation on Substack at The Common Bridge!

Health Affairs' Jeff Byers welcomes Andrew Twinamatsiko of O'Neill Institute for National and Global Health Law back to the program to discuss pharmacy benefit managers, the laws around PBMs, the statutes in place from the Express Scripts Inc. v. Richmond case, and more.Next week, Health Affairs will be releasing a new theme issue focusing on insights from the opioids crisis. Subscribe to the journal to never miss out on an upcoming issue.Join us for these upcoming events:9/3: Theme Issue Briefing: Insights About The Opioid Crisis (FREE TO ALL)9/17: Lunch & Learn: The Current Opioids Policy Landscape & What's Ahead (FREE TO ALL)Related Articles:Arkansas PBM law could spur lookalike restrictions (Axios)Express Scripts Inc et al v. Richmond et al (Judicial Publications)PBM lobby sues Arkansas over law requiring drug middlemen to sell pharmacies (Healthcare Dive)

Right up front here, let me just state loudly that there are some amazing independent TPAs (third-party administrators) out there who have the expertise, the scrappy willfulness, and the deep desire to do right by their clients, their self-insured employer clients. 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. And look, they may be facing some of the same headwinds that plan sponsors themselves face, like anticompetitive contracts, brokers who are up to no good, etc. So, just keep that in mind as you listen. And the main point of all of this if you are a plan sponsor is, find a good TPA partner, which, as Bryce Platt has said about consultants but same rules apply about TPAs here, the difficulty is being informed enough to tell the difference. So, the goal of this show is to help with that, the “be informed enough to tell the difference.” All of this being said, this is technically a Take Two; but we trimmed it down and welcome to a whole new intro. So, call this a refresher and an update about a really, really important topic from last year that is becoming extremely (maybe even more) relevant this year. Really relevant. Consider, for example, the show with Claire Brockbank (EP453) about carrier/TPA RFPs (requests for proposal) and all of the landmines that are really expensive, that are buried in some of these contracts. Then there was the Cynthia Fisher show (EP457) from last year about the millions, maybe billions of dollars in aggregate going missing in medical (ie, TPA or ASO [administrative services only]) spread pricing. We had “The Mystery of the Weekly Claims Wire” show with Justin Leader (EP433), again, revealing money that's being disappeared when the TPA is withdrawing dollars from plan sponsor checking accounts. And then there's the payment integrity episode with Kimberly Carleson (EP480) from a few weeks ago with just another wrinkle on this, namely TPAs or ASOs who insist on auditing themselves and how that turns out for members and plan sponsors. Oh, and last, but certainly not least, is the whistleblower show with Ann Lewandowski (EP476) on how a TPA arm of an EBC (employee benefit consultant) allegedly pocketed $20 million—$20 million of their client's pharma rebates—and used that $20 million to fund their executive bonus pool. What a time to be alive! All of this just highlights the huge stakes for plan sponsors to really understand what their TPA is all about. And when I say high stakes, I mean from both a legal standpoint and also just vast dollars in play here. But this episode with Elizabeth Mitchell is also, I'm gonna say, extremely relevant given just a few ripped from the headlines and news articles such as these. I'm gonna start actually with a post from Kimberly Carleson, and I like the comment by Jeff Evans, who wrote, “How does $8,710 equal $104,266?” Spoiler alert, it doesn't. Lots of missing dollars there. Someone's hands are in the cookie jar. Oh, look, the TPA has entered the chat. In a nutshell, and I'm quoting something Peter Hayes wrote, he wrote, “TPAs have received relatively little public attention. [There's an article in Health Affairs] that describes how TPAs impose hidden fees, benefit from their own form of spread pricing, and otherwise prioritize their own financial interests over those of their plan clients.” Also, here's a totally other issue. Let me quote Luke Prettol highlighting something Jason Shafrin had written about a paper by Jeff Marr, Daniel Polsky, and Mark Meiselbach. Let me slightly rephrase what Luke said. He wrote, “Employers pay, on average, a 4.7% [so almost 5%] price markup when hospitals are in their TPA's [Medicare Advantage] network.” Right? Dr. Eric Bricker talked about this in that episode (EP472) just how TPAs with MA (Medicare Advantage) business negotiate their commercial clients to pay higher rates so that then they can pay lower rates for their own MA members. As Luke wrote, “On its face, this overpayment does not appear to be solely in the interest of participants.” No kidding. Now, let's spin the wheel here. There are barriers for TPAs themselves, even the ones who have a deep desire to do the right thing. As Patrick Moore wrote, “Most TPAs still can't do [many of the things that employers might want because there are] PPO contracts.” So, is it a rock in a hard place situation? I mean, if the TPA has no other options than using a carrier's PPO (preferred provider organization) network with all its attendant contractual issues, then yeah, that is one definite challenge. Along these lines, let me read a post by Rina Tikia, because I think she sums up this really well. “When independent TPAs … push for transparency, they're blocked under the banner of ‘fiduciary risk.' “Meanwhile, the largest carriers and PBMs, with Cayman shell subsidiaries, DOJ kickback probes, [huge] hedge fund ties, [$10 million-plus] lobbying budgets, and antitrust violations continue unchecked. They are not only allowed to operate but celebrated as mainstream options. “Why the double standard? Political donations? Foundation smokescreens? Nonprofit status as a PR shield?” These are excellent questions. And here's another challenge: brokers. Ramesh Kumar Budhani wrote about this one, just how hard it is sometimes to find—for TPA, an independent TPA, trying to do the right thing—to find brokers who prioritize doing the right thing for employers and helping their clients save money. The summary of all of this: There are TPAs and there are ASOs who aren't even trying. They are going to ride the flywheel, the gravy train, and catch all of the dollars flying off of it for as long as they can manage to cling to it with all 10 of their fingers. Then there are TPAs, mostly indies, trying super hard to do the right thing. But how successful they are is going to depend on how boxed in they are by the PPO networks or the carriers that the brokers or even plan sponsors may insist on. Just how courageous they are and just how smart they are and experienced they are about the market and how it actually operates. So, the show that follows is about all of this, including how we can inspire TPAs, which, in the show that follows, subsumes ASOs kind of into it. But in the show that follows, I hope it's inspiring to create an environment so that the market demands TPAs that do all of the things, and we make inertia not a viable business strategy. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. Also mentioned in this episode are Purchaser Business Group on Health; Bryce Platt; Claire Brockbank; Cynthia Fisher; Justin Leader; Kimberly Carleson; Ann Lewandowski; Jeff Evans; Peter Hayes; Luke Prettol; Jason Shafrin; Jeff Marr; Daniel Polsky; Mark Meiselbach; Eric Bricker, MD; Tom Nash; Patrick Moore; Rina Tikia; Ramesh Kumar Budhani; Mark Cuban; Harold Miller; Chris Deacon; Moby Parsons, MD; Benjamin Schwartz, MD, MBA; Mishe Health; Rik Renard; and Cora Opsahl. You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), advances its strategic focus areas of advanced primary care, functional markets, and purchasing value. She leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability. At PBGH, Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health (the Maine Health Management Coalition), worked within an integrated delivery system (MaineHealth), and was elected to the Maine State Legislature, serving as a State Representative. Elizabeth served as vice chairperson of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a guiding committee member for the Health Care Payment Learning & Action Network. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics.   08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What's missing from the conversation on changing health plans?   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan vs. #jumboemployer inertia 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! Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts)  

In the inaugural episode of Benefits Bites, hosts Mike Stull and Madison Connor discuss the current landscape of Pharmacy Benefit Managers (PBMs), focusing on the dynamics of the big three PBMs, the role of mid-market PBMs and the impact of disruptors in the marketplace. They emphasize the importance of transparency in drug pricing and the need for employers to stay informed and adaptable in a rapidly changing industry. Register for upcoming Employers Health webinars or watch on demand at https://www.employershealthco.com/resource-center/events/ Sign up for our monthly newsletter here. Find additional helpful benefits strategies and resources at https://www.employershealthco.com/resource-center/articles/   

T.J. Woodard didn't set out to become a voice for pharmacy reform. But from his base in Baton Rouge, LA, he's helped lead the charge against PBMs and protect independent pharmacies across Louisiana. T.J. joins us to share how his career has evolved from filling scripts to shaping state policy and how he sees the industry moving forward. He offers us a front-row view of Louisiana's recent PBM victories, the behind-the-scenes negotiations that made them possible, and how other states can follow suit. 00:00 - Welcome and guest introduction  01:44 – T.J.'s unexpected journey into pharmacy  06:19 - Lessons from chain pharmacy to independence  14:07 - Opening a downtown Baton Rouge pharmacy  18:42 - Provider relationships that drive growth  28:18 - Stepping into state pharmacy advocacy  31:02 - Louisiana's big PBM reform wins  42:46 - Pushback from PBMs and rallying support  46:01 - What's next: Enforcing the new laws  Hosted By: Johnathon Duhon | Director of Sales, PioneerRxGuest: T.J. Woodard | Co-Owner, Prescriptions to Geaux  Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com 

Where else are you going to get PBM lore? After 3 bite-sized episodes with John C. Tackman, Director of Strategic Partnerships at MedOne, we've reached the big conclusion of our PBM mini-series!In Part 1, we broke down what a Pharmacy Benefit Manager (PBM) actually is.In Part 2, we dove into the fascinating world of formularies.Now, in Part 3, we tackle the ALL-IMPORTANT conversation on rebates—what they are, how they work, and the impact they have on employers, employees, and the entire benefits ecosystem.With 15+ years in the pharmacy space, John brings a wealth of knowledge—and we cover:The truth about rebates & transparencyHow PBMs differ (and why it matters)What employers don't know they don't know The future of pharmacy benefitsIf you've ever felt PBMs were opaque or confusing, this series will clear it up—and give you the tools to ask the right questions.

Segment 1: Hormone Imbalances May Be Causing Your Mental And Physical Issues Hormones regulate nearly every function in the body, yet their role in women's health is often overlooked in conventional medicine. Misdiagnosis of hormone imbalances can lead to physical and emotional suffering. Dr. Julie Taylor explains the proper tests and education that can help women find the root cause of many different symptoms, empowering them to better understand and manage their health. Segment 2: Are Pharmacy Benefit Managers To Blame For Your Massive Health Bills? Last week we discussed how PBMs operate within healthcare, including negotiating drug prices and operating clinical programs. And though PBMs are under increasing scrutiny from lawmakers and the FTC, experts argue that reform – not removal – is key to creating a more transparent and efficient system. Medical Notes: The Best Alcohol For Minimal Hangovers, The Impact Of Color Additives, And Is One Brand Of Water Healthier Than The Rest? Is your gut making you sick? Should you be drinking one type of water over all the others? Does vibrant food make us eat more? If you're sick of hangovers, we may have a solution. Learn more about your ad choices. Visit megaphone.fm/adchoices

According to Dave Chase, Co-Founder at Health Rosetta, “every dysfunction in health care is codified in health care plans.” His company investigates every corner of employer and union health care plans—which cover 54% of Americans—to make them more efficient and serve their employees better.In this video, Chase explains some of the ways that payers, PBMs, third-party administrators (TPAs) and other institutions pad costs. He also describes the collaborations among people throughout health care to create a set of standards for contract language and for measuring the performance of a health care plan.Learn more about Health Rosetta: https://healthrosetta.org/Healthcare IT Community: https://www.healthcareittoday.com/

Last week we discussed how PBMs operate within healthcare, including negotiating drug prices and operating clinical programs. And though PBMs are under increasing scrutiny from lawmakers and the FTC, experts argue that reform – not removal – is key to creating a more transparent and efficient system. Learn More: https://radiohealthjournal.org/are-pharmacy-benefit-managers-to-blame-for-your-massive-health-bills Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of "The Founder's Sandbox", Brenda speaks with Donovan Ryckis; CEO of Ethos Benefits, the nation's leading fiduciary benefits consultant in mid- -large market employers. Ethos Benefits was founded in 2016, after a chance request from a client of Donovan when he operated as a financial advisor--the client was faced with an increase in the companies' health insurance bill for the companies' employee plan that would have had a financial burden that threatened the sustainability of the company.   ‘Ethos' represents the guiding principle, character, or spirit of a person or organization. It's the ‘why' that drives decision-making and fuel's purpose.   Through Donovan's origin story we will have our eyes opened as business owners to the potential risks of employer sponsored healthcare plans and how to mitigate these risks. You can find out more about Donovan and Ethos at: www.linkedin.com/in/donovanryckis Upcoming master class on August 14th https://ethosbenefits.com/ https://businessofbenefitspodcast.com/ For a limited time only access the documentary: It's not personal, it's just  healthcare. https://ethosbenefits.com/documentary/     Transcript:  00:04 Welcome back to the Founder's Sandbox. I am Brenda McCabe, your host on this monthly podcast. It reaches  business owners and entrepreneurs who learn about building resilient, scalable, and 00:32 purpose-driven companies, all with great corporate governance. I am Brenda McCabe, and I am your host. And the guests that come to the podcast are not only those founders and business owners who are sharing their experiences, but also corporate directors,  investors,  and professional service providers who, like me, want to use the power of the private enterprise, small, medium, and large, to create change for a better world. 01:00 Through storytelling here and a recreated  sandbox,  my goal is to equip  one startup founder or one business owner at a time to build a better world through great corporate governance. Today, my guest is Donovan Rikas.  He is joining the podcast as CEO of Ethos Benefits, the nation's leading fiduciary benefits consultant in the mid to large market employer space. 01:29 So I'm absolutely delighted to bring in a professional service provider in  the employer benefits area, which  we're going to  unpeel  this  sector  today in the podcast. it's fascinating. So thank you, Donovan, for joining me today. Thank you, Brenda. Thanks for having me. Excellent. So  the company you and Chelsea, your wife and president of Ethos Benefits, 01:59 was founded in 2016, which wasn't that  long ago.  But it happened serendipitously.  You got a chance request because at that time, you were a financial advisor, right? Yes. When  your client was faced with an increase  in the company's health insurance bill for their employee plan,  pardon me, that would have had such a financial burden,  it would have threatened the sustainability of 02:27 the company and that's your client. So what did you do Donovan? What was the origin  of Ethos Benefits? Thank you. Yeah, so that's exactly right. I started as a financial advisor.  So Ethos Benefits was formerly a registered investment advisory, which was Jay Donovan Financial.  And one of the interesting things that are a little bit different on the security side versus the insurance world is 02:56 the ability to  license and designate yourself as a fiduciary advisor to your clients.  So that's really important and that's kind of where we started as financial advisors. So that essentially means that you're not gonna be commission-based with variable commissions based on what you wanna sell and the client doesn't really understand, right? You're gonna be  transparent with how you earn any compensation. 03:23 and you're not gonna have any conflicts of interest that might change  the recommendations or advice that you're giving them. So it's gonna be flat fee and you get to work with them directly instead of working for the financial institutions and the insurance companies kind of in the background that are actually the ones incentivizing. Cause  it's this odd relationship where it's like you think the financial advisor is working for you but they're actually incentivized by the institutions  that they're representing. Very important clarification because we do have a question 03:53 further on, which is, you know, what, what, how does the 401k management, right about employers 401 plan, mirror that of healthcare benefits? Yeah, for sure. You'll start to see some of those. So that's how we're working as financial advisors. And that's an important distinction as we get into an explanation of 04:22 the whole healthcare industry and how that works. So you're exactly right. I was working as a financial advisor, working with business owners  because they had more kind of complicated planning and tax structures and things that I could do to really make a difference.  And what I realized is when most of them had commission-based advisors, they'd rush to sell a product, mutual funds  with upfront loads and REITs that had  proprietary commissions and all this kind of stuff. And then they would leave without worrying about any of the 04:52 tax consequences,  you know, islets or trusts or even wills, right? Like all these extra things that business owners needed to set up their own personal wealth, but also their company, their 401k, maybe combining a defined benefit plan. So that was kind of the niche I chose.  And it was incredibly lucrative. I loved it.  Was doing exactly what I wanted to do until that client kind of asked me for that help, like you alluded to. 05:21 And it was 40 % increase on his health insurance. He said, my broker says, this is it. There is nothing else. Can you help? And I didn't know any idea. Like I had no idea about health insurance or what I do. But yeah, just- No, no. problem. 05:39 And certainly as a financial advisor, it kind of seemed like going backwards and beneath me. didn't really want to do it, but I was like, I could hear the panic in his voice. And I was like, yeah, absolutely. Just send me everything you have. And after about three weeks, basically making as many connections in the industry and learning as much as I could and trying different things, we basically mitigated that increase entirely. 06:05 And he actually came three points under where he was currently today before that increase. And we didn't take away any benefits from employees. We didn't put them in smaller  HMO networks. We didn't increase deductibles or increase their premiums. None of the usual tricks.  So this was a like for like solution. We actually improved the plan a bit and came in under.  And it really made me realize in that moment, it wasn't my experience or my education or my smarts that 06:34 may be able to do this,  it was a lack of conflicts  in compensation and incentives,  right? Because his broker does about $7 billion a year annually.  I didn't come in with more market knowledge, leverage, or experience. I just didn't have conflicts of interest and compensation. That's what  started me down this path.  And  back then,  you hadn't yet  created Ethos Benefits with that name. 07:03 So when I did a little bit of research,  I couldn't have been more delighted that you actually reached out to to be featured on the founder sandbox because of two reasons, you the word fiduciary, right?  It was in  your basically your call to action, right? Or your or the definition of company. So,  you know, you  are  the governance of a company goes way beyond making a profit for shareholders. 07:32 the duty of care, the duty of loyalty and the duty of obedience is really the underpinning elements of  fiduciary duty. And on your website, you say our ethos is simple fiduciary first. So we're going to appeal that in here in a minute here. So act in the best interest of those we serve,  no matter the cost. You also on the website,  you you had a purpose ethos represents the guiding principle. 08:01 character or spirit of an organization or a person is the why that drives decision making and feels purpose. So I,  I looked like I was reading what next act advisors may consult a firm is about is just really finding those purpose driven. So  with that, I wanted to just, you know, ask you,  what was that you had that first client that first aha moment, and 08:29 How long did it take you and did when did you realize that this could be a a career change for you, right? Rather than a financial advisor, you were actually actually a health care benefits advisor, right? Yeah, I mean, I think I think the first moment is, you know, being being a financial advisor was very lucrative. And I like the people I was working with. I liked working with entrepreneurs and business owners and and, you know, just 08:58 I found them inspiring and I was curious about the things they're doing. And  I think that kind of lifts everybody up when you keep a circle like that, right? Like you  push yourself harder, you learn, educate and do different things.  So I love the clients I was working with. Like I said,  maybe  working on personal wealth for individuals though, isn't the most rewarding thing you could be doing. seeing that... 09:25 Don't get me wrong, I was paid well enough. It would have took me a long time to figure out that it wasn't very personally fulfilling.  But seeing that first case, mean, the first thing I did when I got that successful proposal back, before I presented it to the clients is I was looking at the math  of what does this cost? What difference does this make per paycheck to all the individuals in this planet? And then I'd look at somebody, my God, this person's got a wife and two kids. Look at the difference in premium there. 09:54 I was calculating my work in return to the average American worker and realizing like me putting myself aside to  proactively, strategically go after this problem instead of making a decision for my own personal commission, looking at how much that impacted everybody. And that was powerful. 10:20 I'm going on 20 years in financial services and every aspect of it, I've seen people who prioritize commissions over, you know, a better product, a better outcome for an individual. But the idea that that could be done on scale to where you're now making that decision for yourself over 200, 500, 2000, 3000 employees, like that's pretty disgusting, right? So seeing that that kind of impact could be made. 10:49 I mean, it was  it was really not a question after that I knew I was transitioning my business. Excellent. Excellent. So  my own path  after 25 years in Europe  was quite an eye opening experience when I came back to the United States, I am a US citizen, but I had to get you know, I've been working for myself and I had to get self insured. So  I got back this is like 11:18 12 years ago, I got the Affordable Care Act for dummies from my local library.  I had not yet transferred my tax certification to the United States takes quite a few years when you've been gone so long.  So you because you do have to sub venture tax returns and all that. And then  I ran into I met Marshall Allen, the author of never pay the first bill and the other ways to fight the healthcare system and when 11:46 Marshall Allen actually spoke at  a graduate or alumni event of University Chicago. And  I was, you know, reading these books. And you know, eventually,  I got my own broker to help me get onto the exchange. But it every year has been  an experience.  I'm fortunate to be part of a  membership organization through which  for small  and medium sized businesses and I get  PPO through 12:14 I won't mention names, but  I was  blessed because just  and I'm 12 years in the United States, you have to knock on a lot of doors to actually get health care when you are a small business  owner  and really  understand what  you are paying for,  not only your premiums of what are the services  that are provided. So can you talk about  the average 12:44 premium for a family of four and some of the  numbers that you discovered  and believe  we as a country could actually improve  on the outcomes, healthcare outcomes with the actual spend we have today, right? Yeah, we're getting the numbers are pretty wild. mean, I feel like we're really kind of getting to a breaking point with it.  You know, 13:12 For what I work on, employer-sponsored healthcare, 186 million Americans are covered under employer-sponsored healthcare plan. These plans can average increases anywhere from seven to 10 % annually. We see a lot of reports that come out that kind of measure these things. Kaiser Family Foundation does one, Milliman Index is another one. So there's a lot of studies that kind of measure this annually and changes for employers across the board. 13:41 What we saw this year for 2025 was the average cost for a family of four under employer sponsored health care plan is $35,119, which is just an astonishing number. That is unaffordable for an employer. That's unaffordable for an employee. And it's unaffordable for them to split that cost as well, which is how these, yeah, that's how they're structured in some way or another. 14:11 And another number to know that kind of governs this is the ACA affordability percentage, which is essentially where employers have to contribute, they have to contribute enough to keep the premium under this amount, which is 9.02 % this year. So premium for one of your employees cannot exceed 9.02 % of their take-home pay. 14:39 And this is updated on an annual basis, correct? Correct. Yeah, it fluctuates a little bit, but it's always right at 9, 8.5, 9.2, it's balanced up and down. But that's a pretty astonishing number too. And I see a lot of companies that are basically designing their contribution just to stay under that. it's, obviously they'd love to do more, but with the way these costs increase annually, sooner or later, they get to that point. 15:07 where they're kind of designing it just to be under 9 % of the employee's income. Okay, that's  astonishing.  And I'm happy that you  are working nationwide now with employer benefits with companies that, what's the size of the companies that you typically sell to? So we only work with large employers these days. And if we have somebody come in a little bit under, we have some associate agencies that we can kind of refer them to. 15:36 I'd say our minimum is usually like 250 eligible employees all the way up to 5000. Yeah, so anywhere in that mix. Excellent. So when again, I first met you was unaware because you've basically become nationwide in the last what two, three years, right? I'd say around COVID. Yeah, I took off right. So when I was speaking with you spent some time on the website. 16:06 I was trying to understand the sales alignment. So how you reach customers, those employees that have 250 between 250 and 5,000 employees, right? My first reaction was, OK, Donovan, go in with either of these benefits. You do a cost down, right? You've done, you basically work yourself out of the job. You corrected me. So for my audience, so how? 16:32 does ethos benefits work for a company, right?  What is that?  Is it is it an annual  engagement  talk walk me through the work you Yeah, I mean, things are happening on a daily like when we break down our scope of services, we'll actually show them like,  these are daily, these are weekly tasks, these are monthly, quarterly and annual because there's so much happening.  So  we're talking about the employee benefit space. Yes, it's  the 17:01 kind of designing consulting for the annual premium for a 12 month period. I think that's what people first consider.  But there's also a ton of compliance factors that have to happen throughout the year that that company has to fill out, right? Could be anything from section  125s,  5,500s,  wrap documents, all kinds of notices and disclosures  that need to be done.  Also, you know, we deal with benefits administration. So that's... 17:29 How are the employees making elections, seeing premiums? Is that integrating into payroll?  So functions like that with eligibility in and out of the company  adjusting that.  But also we kind of discussed and talked about the fact that health care is incredibly complex. So all the same market influences, where the market's at, interest rates,  inflation, all that kind of stuff affects  health care rates just like any other company in the market. 17:58 but it also gets as granular as  new medical procedures, new drugs, new generic drugs that are now an option.  It can even go down, you know, locally or regionally to where we get a new CFO in a hospital group and that starts changing the reimbursement rates that they're requesting from the insurance. So we see that where kind of a CFO comes in and they start flexing, making life difficult in a particular region or with a hospital group. 18:28 So all these things are kind of coming together and changing every single day.  Also the fact of the sheer amount of bills,  claims that come through.  So what we see on average,  this is a pretty crazy number, but  what we see on average is 18 claims  per employee per year. Okay, that's a lot.  That's a lot. So if we had just a hundred employees, that'd be 1800. 18:56 basically accounts payable  into the company. And that's part of our job too, because as you might imagine, hospitals make tons of mistakes on the bills, about 80 % of the bills have mistakes.  And then we also have to make sure that those are coming in at fair reimbursement rates to the company, because what hospitals bill is a spectrum for the exact same procedure. And the only difference is the payer. It's not the patient, it's not the complexity, it's not the physician, like it's literally 19:25 just the insurance card that can affect that difference in reimbursement rates. So all these things kind of come together where, yes, it  very much is a daily  task for me and my team on different things that we're working on. And- Are you an advocate in any way for the employees? Yes,  very much. So, you know, it's two, there's two complicated ecosystems at the same time that we're trying to navigate. 19:52 One is certainly the healthcare finance, which is what we're working with the company. But healthcare delivery for employees and members is just as complicated and confusing as far as where do I go? What is this gonna cost? What's the next step? Can I get a second opinion? How would that work? Right? And also helping navigate them to their highest cost or their lowest cost, highest quality and understanding what that is and giving them options to seek care at. 20:21 at lower prices if that's available. Excellent.  So your  delivery platform, is it like a customer success team  that  is assigned solely to that client? How does it work? Yeah, so it's kind of different. every employer is starting at a different place. They also have different ideas of where their end place or where their goal is. 20:49 healthcare delivery, kind of working on some things like that, there might be a couple of different ways we handle it. One might be having a direct  primary care provider. So the idea of a direct  primary care provider is basically same day, next day appointments with your primary care physician  and 30 to 60 minute visit times, not the average, which is seven minutes with a PCP, which is what most people get across the country.  And  with that DPC provider, you can also do things like 21:18 stitches,  blood work, get generic meds. So we're talking about more of a comprehensive service when you actually need it, not  the 14, 18 day  primary care. So that might be one of the ways we help with healthcare delivery.  It might be a nurse concierge where they have a nurse that they can help find providers,  navigate them. That might be a part of it.  So it kind of depends. then also  a lot of the times are 21:47 Our team will basically act as a care coach, where if they have anything going on, they can just call us. We'll help them set appointments, navigate them towards care, help them with their ID problems. Fantastic. Anything else you'd like to share or shed some light on the service offering of ETHOS benefits? So we're going to jump into a legal question in a minute here. 22:13 Yeah, I mean, it always just depends on the employer.  what I would say is generally they find everything we do to be  more comprehensive. And I think that's just the nature of the fact that we're not seeking compensation from the insurance providers or working with the client, because  it's my belief that we don't have a single thing to sell to an employer.  Employers have a health care problem. And we're here to solve that and work through that in any 22:42 way that they need at that given time.  So we're not,  you know, pushing those solutions are having those conflicts.  It's an excellent segue down into  current lawsuits  that are popping up with respect to,  first of all 401k, lawyer, and now healthcare benefits. So before we jump into that some specific cases, you know, for my listeners, what does fiduciary mean? 23:12 in your business model, right? Please. Yeah. So fiduciary for us is certainly always acting in the best interest of those that you represent. It's the highest standard of care.  So you mentioned a couple of things  earlier, loyalty, obedience. I think the biggest thing where companies may think they're acting as a fiduciary and they're not, because while we carry that duty to our employers and our clients, 23:40 Employers have that duty to all of their employees. And that's something that are kind of educating them because a lot of them don't realize it. But  I think the big duty that is  left out or misunderstood is the duty of prudence.  Okay. So did they go far enough in investigating solutions and understanding the problem and working through it and having a committee within the company to kind of help go through that? Because what I mean, in a compensation package, there is nothing more important 24:10 than the cost of health care and the options in health care, right? And how those decisions are being made.  So I see the duty of  prudence being the kind of  most 24:23 I, the duty with the most opportunity, let's say, maybe, maybe the most misunderstood because  the employer sometimes think, well, you know, the broker came in and he showed me one or two other options.  This is the least worst option. Therefore that's what we're doing. And I think that's enough. Right.  And that is not the case.  And it's only until there's a 40 % increase due, right. It doesn't employer say  my business is not sustainable. 24:51 So actually healthcare is what not the number two or number three expense  in the company's PNL today. Correct. Right. So walk me through some of these  recent lawsuits.  Yeah, I think we have companies like J &J and JP Morgan. Speak to me about that. 25:14 Yeah, J. J. J. P. Morgan, Wells Fargo. A lot of them are almost they're copied and in some parts of the complaint,  because it's very much the same thing. the first one we saw was  Lewandowski versus Johnson and Johnson. And this is for their health care plan. You know, they're a Fortune 50 company.  I think they somewhere around 160,000 employees. 25:42 and they have a benefits committee and a benefits team of 16 or 18 people. So a big team of people to help make these decisions, understand them and vet them. And the lawsuit is basically for their decision of pharmacy benefit manager. So a pharmacy benefit manager essentially sets the price for any drugs that employees could get within the plan. And it lays out 35 or so specific examples of drugs 26:12 but basically they agreed to pay  up to  13,000 times  the cost of the drug that's available, just cash pay.  employee and employer funds are agreeing to pay that kind of multiple on a drug that's available without insurance, much, much cheaper.  And the  lawsuit is brought by the plaintiffs, who are they? 26:40 am Lewandowski. So she's she's the plaintiff. And then I believe as it's developed, other employees have kind of came on. So 13,000 was it do you know, I know that you're not directly involved in this case. Nor should you speak to it if that is the case. But is the transparency of the data? Can you get that data if you were an employee to then understand the 27:09 multiples that your employer plan has agreed to pay to the pharmacy benefit. I'm aghast. 13, I think the number is 13,226. So when this came out last January, the first thing I did is I read through the whole complaint. It was like 130 pages went through all these. So for all the drugs that were mentioned, I ran 27:40 J &J's prices, again, Fortune 50, 150, 160,000 employees. So you would assume they're getting leveraged prices, they're making great decisions, all those kinds of things. I ran those prices against what my clients were paying. And in the smallest, like I think our smallest in my book of business, like 100 insured employees somewhere around there, they were paying 94 % less. 28:06 for the same, for one fill of all the same drugs. So the math worked out to be like 135,000 for J &J for one fill of each of those. And my clients were like 3000 or 4000, don't know, it's all my LinkedIn. posted the public letter as soon as it came out. But I basically price referenced them. So it's not a question of leverage or buying power, know, all the ridiculous things you hear. 28:34 when you're talking to  an insurance broker for these types of decisions,  it's literally, it comes down to that question of prudence. Like,  how did you vet these decisions?  Do you know how the pharmacy benefit manager is getting paid? Do you know what these drug benchmarks are against the cash price?  And that's  where I think this lawsuit is gonna be a slam dunk. Like, there is no reason for a company that size with that big of a benefits committee to hire such a conflicted PBM, is what they call it. 29:04 You heard it here on the founder sandbox. So stay tuned for  any other  lawsuits that are  worthy of mention. Do all of them? Are they all related to the pharmacy benefit manager conundrum?  There's there's all kinds of lawsuits. I think the PBMs are the lowest hanging fruit because it's so easy to benchmark. But certainly the same arguments exist with  hospital reimbursement rates. 29:33 And we're starting to see those as well. Excellent. Well, thank you  for sharing  a bit more  details on  the  recent,  I guess,  health care benefits in the news, right? Lawsuits.  Going to get a little bit technical here. 29:57 because you allowed me to.  the framework of the CAA of 2020 and 2021, that's the minimum set of standards for activities to benchmark health care plans.  And so  what are they?  Because it then leads into  some of the common sense strategies  that employers can deploy immediately.  So can you walk? Because this is just as yesterday, it's actually during the pandemic. What's the CAA? 30:27 of 2020, 2021. Thank you. Yeah. So that's the interesting part of this. So the reason I said a decade ago, over a decade ago, I was waiting for these health care lawsuits to happen. It's because Arissa has always stated that  employers have this fiduciary responsibility, just like they had with  401k. The problem has been, and the reason these lawsuits didn't come sooner, is that health insurance companies  make this data hard to access. 30:56 different carriers were released different amounts.  And there was no set of compliance standards for employers to understand this is how I go about making it, making these decisions and benchmarking these decisions, right? Like  it was all just too vague, too opaque. The data was too gagged and withheld from the employers.  So the starting point of how do I know I'm being prudent or not, that's kind of what wasn't known prior to the  CAA of 2021. 31:27 So  the CAA  basically defined a set of minimum standards  that you have to do to even pretend like you're being a prudent fiduciary for your healthcare plan. So there's four things, but there's three main things. I'll mention the fourth thing as well, because there's funny stuff about that.  So the first one  should be the most obvious, and  it's kind of our founding story, which is understanding 31:53 your broker compensation before you enter into any arrangement or agreement for your upcoming plan. So that should not only be how much,  it should be when, what type of bonus is there. If you're looking at carrier A, B, and C, really what it says is you should know what is their compensation for carrier A, B, and C before you make an arrangement, because they will be different. And that will change the recommendation, the advice, the conversation that you're having with that broker. 32:23 is critical. That is so critical. And  in reading these transparency commission  disclosures from  brokers, it is wild, the stuff that they put in there and how conflicted their advice is.  One of them that I looked at last week said, broker acknowledges that their parent company has equity in the insurance carriers that they're recommending. Oh my gosh. So they're essentially saying, 32:52 We are an insurance company that's going to bias our recommendations to the own companies we have equity in. It's like, that's no longer a party you should take advice from, right? 33:07 Okay, so that's part one.  Yeah, no, this is this is  and you know,  I without it's gonna get too technical because the gag clause and  the prescription DC reporting so that you know, basically CAA has provided the set of benchmarks, right, which  you need to at least checkmark right before you actually do. 33:35 engage or decide on your employer benefit plan.  Yeah. To be in compliance with your fiduciary duty, particularly that of prudence. Yeah.  Yeah. And I think companies shouldn't look at as a checkmark. I think if they apply it with a good faith effort, they'll see like, oh,  it's not compliance. This is a framework  for making better decisions.  Right.  And that's what it's meant to do. It's meant to say, 34:05 Know your compensation, know your drug benchmarks,  and  eliminate any gag clauses to your data because you need your data to make decisions. So I think if companies make a faith effort, they'll automatically get better outcomes. That's the way here. Excellent. Well, thank you, Donovan. I want to give me this time to actually  speak about  how to contact you,  your company. But more importantly, 34:34 There is  you're hosting a webinar on August 14, which is right around the corner. Can you  give us some more details?  The details will be in the show notes,  but speak to the event that ethos benefits is hosting on August 14 2025. Thanks. Yeah, thank  you.  Yeah. So on the 14th, we're doing a fiduciary workshop masterclass, which is basically understanding what your 35:03 what your duties are, how to get through them, how to navigate them, how to have this framework for decision making and document that process as well. And it's all geared towards just achieving those better outcomes for your company, eliminating any of these risks and really creating positive results for your people. Excellent. And any information with respect to how to reach out to you beyond the- Yeah, sorry. the registration is on a banner on the top of our 35:33 on our homepage. So ethos benefits.com. If you connect with me on LinkedIn, LinkedIn,  Donovan, ragas, you can find it there as well.  Great. Well, I'm coming to the  part of my podcast, which  brings us back to the sandbox.  In my work, I'm all about working with purpose driven, scalable, and resilient companies. 36:00 And so I ask my guest, what is the meaning of each of those terms? What does purpose mean to you? 36:08 Purpose, what does it mean to you? That's such a big question that you can go a lot away from. You know, I feel like purpose should be almost like a hidden driver. It's almost not like a well-considered thing. It's just kind of driving you forward.  I think our purpose  is progress,  right? Like if something can be done better, it should be and just kind of moving forward with that. 36:35 We're trying to move one company at a time, but also the industry and better outcomes  for the country. 36:43 And that good feel factor when you get up in the morning and know that you're doing good, right? Yeah, absolutely. Let's just sleep well at night. Right? Yes. Amazing. How about resilience? You did share with me off  camera that yeah, while you abandoned the financials,  advisory role, it took almost five years, right to really find product market fit, right  and build this because it's a very unknown right industry. 37:12 unknown service within a very, very  complex industry, right? Yeah. So resilience for you, what does that mean?  Yeah, I think you're right. You know, it took us a while because we were sharing such a wildly different message than what people were hearing from their brokers. And sometimes they look at you and be like, well, you're small, they're big, that must mean they're right, right.  So I think resilience is being able to go from 37:42 failure to failure without any loss in energy, right? So when something doesn't go your way and you have an obstacle, an outcome that is less than desired, it's about being able to push on still without losing any of your optimism or energy. And that's all we do. So. Thank you for what you do. And scalable. What does scalable mean? 38:07 Scalable is certainly about having an actual documented process. I think when you're getting into something new as a company or a new system or procedure process, if it's not something that everybody in the company could repeat in the same way that I do, just inherently the way I do it because of my background and education, if it's not repeatable for everybody and everybody doesn't understand the purpose for those steps, 38:36 the outcomes from those steps, like the end result, it's definitely not gonna be scalable. Thank you. Final question. Did you have fun on the sandbox today? I did. Thank you so much for having  me. Thank you, Donovan.  So to my listeners, if you liked this episode with Donovan Rikas from Ethos Benefits,  sign up for the monthly release of founders, business owners, corporate directors, and professional service providers that share their experiences. 39:06 and how to build with strong governance a resilient, scalable, and purpose-driven company to make profits for good. Signing off for this month, thank you very much. Have a great day.  

You know those mystery charges at the pharmacy that make zero sense? Yeah, turns out, there's a whole shadowy system behind it and no, it's not your pharmacist's fault. This week on Knock Knock Hi, Kristin and I talk with Deborah Keaveny , president of Pharmacists United for Truth and Transparency (PUTT), about the tangled web of pharmacy benefit managers (PBMs), why your copays never go down, and how independent pharmacies are basically being squeezed to death. We get into the secret contracts, gag clauses, clawbacks, and even why some pharmacists now run liquor stores and coffee shops just to keep the lights on. It's equal parts depressing, eye-opening, and—believe it or not—hopeful. There's real legislation happening, and maybe, just maybe, the tide is turning. Takeaways: Discover how PBMs started as simple payment processors… and morphed into billion-dollar healthcare gatekeepers. Learn why pharmacists sometimes lose money by filling your prescription—and how “clawback fees” make it worse. The shocking truth about mail-order pharmacies (hint: PBMs own them and pay themselves hundreds more per script). Why GoodRx isn't always good—and what lawsuits are revealing about patient data and price collusion. How new state and federal legislation might finally crack down on PBMs, save independent pharmacies, and protect patients. — Want more Deborah Keaveny Twitter/X: @TruthRx    Facebook: https://facebook.com/TruthRx Instagram: @putt_national Twitter/X: @keavenyrx    To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.  Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Suzanne Spradley and Carol Wood discuss the role of pharmacy benefit managers (PBMs) and the recent proliferation of state laws that regulate PBMs. Next, Suzanne explains how these state PBM laws interact with federal laws, which are supreme. Suzanne reviews ERISA preemption and the U.S. Supreme Court Rutledge case, and how state lawmakers continue to test the boundaries of their authority with PBM legislation. The conversation then turns to a controversial Arkansas PBM law and the related litigation that has gained national attention. Suzanne and Carol end by providing employer takeaways and explaining why it's important for employers to continue to monitor developments in this complex benefits area.

On this episode of HR Benecast, host Mike Stull is joined by CVS Health's senior vice president of government and public affairs, Melissa Schulman. She discusses the complexities of the legislative process, key proposals that may resurface and the impact of state legislation on federal actions. She also addresses common misconceptions about PBMs and emphasizes the importance of employer advocacy in shaping drug pricing policies. This episode was recorded on July 30, 2025. Some legislative developments may have changed since the time of recording. 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.

Pharmacy Benefit Managers, or PBMs, play a powerful but often invisible role in U.S. healthcare. While they're often blamed for rising drug costs, recent research suggests the real culprit may be drug manufacturers and patent protections. Our experts explain how PBMs have evolved from simple claims processors into complex organizations that work behind the scenes for insurance companies, pharmacies, and employers. Learn More: https://radiohealthjournal.org/pbms-the-invisible-influence-behind-modern-healthcare Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Dr. Lift podcast, hosts Dr. Spencer Nadolsky and Dr. Karl discuss the recent changes in obesity medication coverage, particularly focusing on the CVS Caremark decision to drop ZEPBound from their formulary in favor of Wegovi. They explore the implications of this decision for patients and providers, the role of pharmacy benefit managers (PBMs) in healthcare, and the ongoing advocacy efforts to ensure access to effective obesity treatments. The conversation highlights the complexities of insurance coverage, the need for patient-centered care, and the importance of making medications more affordable.- The recent changes in obesity medication coverage have raised concerns among providers and patients.- CVS Caremark's decision to drop ZEPBound has sparked a petition advocating for better access to medications.- Pharmacy Benefit Managers (PBMs) play a significant role in determining medication coverage and costs.- There is a need for more nuanced insurance policies that consider patient needs and clinical severity.- Advocacy efforts are crucial in reversing negative trends in medication coverage.- Patients often face challenges with prior authorization processes when switching medications.- The cost of obesity medications is a significant barrier to access for many patients.- Insurance companies are increasingly dropping coverage for anti-obesity medications, impacting patient care.- The conversation emphasizes the importance of patient-centered care in obesity treatment.- There is a call for making obesity medications more affordable and accessible to patients.https://www.change.org/p/stop-cvs-caremark-s-zepbound-ban-restore-coverage-of-the-superior-obesity-medicationClick to join Dr. Spencer's online clinic if you need help with this 

Welcome Back to PBM on the Rocks!Join Lord Dr. Jeremy and the PUTT Cocktail crew with special guests John Farina (AHF) & Kris Rhea (Pharmacy Marketplace) as they unpack the summer's most significant state and federal legislative updates, explore the CVS Omnicare lawsuit verdict, and discuss its ripple effects on independent pharmacies including retaliatory actions by PBMs. From shedding light on the critical role of independent pharmacies in our healthcare system - including the challenges they face with pharmacy MAC appeals, and the innovative solutions being developed to help them recover lost funds - to discussing how middlemen are draining resources from the American economy without delivering value - this episode is a must-listen for anyone passionate about reform, independent pharmacy advocacy, and the fight against PBM overreach in our healthcare system.Music by JuliusH | Production & Editing by Shannon Wightman-Girard

"I doubled my profit when I lost 70% of my customers, which is insane." - Brad HartMy guest this week, Brad Hart, owner of Forest Park Pharmacy, came on the show to discuss how he moved his pharmacy from struggling to survive in a broken, insurance-based reimbursement model to thriving as an all-cash, "cost-plus" business.Brad popped on my radar because of his very popular and informative Instagram profile, where he shows how everyday Americans are getting fleeced by PBMs. We break down the mechanics of his model and discuss the "low copay trap," why the term "specialty generic" is nonsense, and how his pharmacy's Price Checker tool brings radical transparency to a purposefully confusing industry.We also dive into the exponential overpayments Brad has uncovered in the Medicare system, where a drug that costs his pharmacy $96 is reimbursed for over $3,400.This is one you won't want to miss!Chapters:(00:00:00) This Pharmacy Went Cash-Only, Lost 70% Of Customers, & Doubled Profits(00:07:28) The "Cost-Plus" Pharmacy Model, Explained (00:08:49) How Brad Lost 70% of Customers & Doubled Profits (00:10:45) The Deceptive "Low Copay Trap" (00:13:29) The Pricing Breakdown: Cost + 15% + $10 (00:34:52) Why the Term "Specialty Generic" is Nonsense (00:47:53) What is the Average Wholesale Price (AWP)? (00:52:41) PBM Reform vs. Direct-to-ConsumerKey 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 eye-opening episode of Living Undeterred, Jeff Johnston sits down with Dr. Nate Harold, Chief Pharmacy Officer at MedOne, for a vulnerable and visionary conversation about family, faith, and the broken state of pharmaceutical care. What starts as a discussion about PBMs and prescription access quickly unfolds into a story of personal trauma, moral courage, and system-wide reform.Together, Jeff and Dr. Harold explore how their shared experiences with addiction and loss have fueled a mission to rethink mental wellness from the inside out.

"I doubled my profit when I lost 70% of my customers, which is insane." - Brad HartMy guest this week, Brad Hart, owner of Forest Park Pharmacy, came on the show to discuss how he moved his pharmacy from struggling to survive in a broken, insurance-based reimbursement model to thriving as an all-cash, "cost-plus" business.Brad popped on my radar because of his very popular and informative Instagram profile, where he shows how everyday Americans are getting fleeced by PBMs. We break down the mechanics of his model and discuss the "low copay trap," why the term "specialty generic" is nonsense, and how his pharmacy's Price Checker tool brings radical transparency to a purposefully confusing industry.We also dive into the exponential overpayments Brad has uncovered in the Medicare system, where a drug that costs his pharmacy $96 is reimbursed for over $3,400.This is one you won't want to miss!Chapters:(00:00:00) This Pharmacy Went Cash-Only, Lost 70% Of Customers, & Doubled Profits(00:07:28) The "Cost-Plus" Pharmacy Model, Explained (00:08:49) How Brad Lost 70% of Customers & Doubled Profits (00:10:45) The Deceptive "Low Copay Trap" (00:13:29) The Pricing Breakdown: Cost + 15% + $10 (00:34:52) Why the Term "Specialty Generic" is Nonsense (00:47:53) What is the Average Wholesale Price (AWP)? (00:52:41) PBM Reform vs. Direct-to-ConsumerKey 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 do drugs like Ozempic cost $1500 in the U.S., but only $147 in Canada? Most people don't know about the invisible middleman making more than 10 of the top drug companies combined.Healthcare may seem like a broken system, but it's actually not broken at all. It works great; it's just not working for you. Pharmacy benefit managers use their contracts to make massive profits off of everyone.PBMs may appear to be helpful. They negotiate lower prices for manufacturing companies, reduce out-of-pocket expenses, and handle logistics between employers and insurance companies. Pharmacy benefit managers charge the employer a very high price and pay the pharmacies a very low price, pocketing the difference. This is known as spread pricing. PBMs decide which drugs your plan covers, how much you'll pay out of pocket, which pharmacy you can use, and when or if you'll get your medication.Cheaper and better drugs are often denied if PBMs don't get a big enough rebate. They can even force you to fill your prescriptions at specific PBM pharmacies for more profit.Drug companies have to give PBMs a kickback or “rebate” to get their drugs covered by insurance companies. To afford this rebate, drug companies raise the list price, and PBMs promote the drug that gives them the most profit.Pharmacy benefit managers own insurance companies and pharmacies. Three of the largest PBMs control 80% of the medications in the U.S. Surprisingly, PBMs don't exist in other countries. Dr. Eric Berg DC Bio:Dr. Berg, age 60, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media.

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: FDA approves the first fast-acting biosimilar insulin in the US, Tandem issues warning, DOJ stands up for remote monitoring in schools, GLP1 use protects against dementia, and more! Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom   Check out VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links:   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX We've got the first and only biosimilar FDA approved and moving to market. Kirsty – insulin aspart, which is a biosimilar to Novolog will be available as a single-patient-use prefilled pen for subcutaneous use and a multiple-dose vial for subcutaneous and intravenous use. KIRSTY has been available in Europe and Canada since 2022. This same company makes Semglee, the first biosimilar for long acting? Sales of Insulin Aspart in the United States were approximately $1.9 billion in 2024, according to IQVIA. https://www.globenewswire.com/news-release/2025/07/15/3115973/0/en/Biocon-Biologics-Expands-Diabetes-Portfolio-with-FDA-Approval-of-Kirsty-the-First-and-Only-Interchangeable-Rapid-Acting-Insulin-Aspart-in-the-United-States.html XX Tandem Diabetes Care (Nasdaq:TNDM) has issued an urgent medical device correction for some t:slim X2 automated insulin pumps. In a July 22 notice, the San Diego-based company warned of pumps that may exhibit a higher rate of speaker failure. During normal use, the insulin pump software monitors current flowing through the speaker during use. Measurements that fall within a pre-determined range indicate a functioning speaker. Meanwhile, measurements falling outside the range indicate a speaker failure.   When the measurements land outside the expected range, the system declares a malfunction, referred to as “Malfunction 16.” If the pump declares this malfunction, insulin delivery will stop and the pump will no longer be operational. Malfunction 16 terminates communication between the pump and continuous glucose monitor (CGM), as well as the t:slim mobile app.   If not addressed, the issue can lead to hyperglycemia, which can result in hospitalization or medical intervention. The company reports 700 adverse events and 59 reported injuries to date, with no reports of death.   Tandem identified that certain speaker versions have a higher rate of Malfunction 16 events due to a wiring issue within the speaker. Users can continue using their pump but with added precautions because Malfunction 16 can occur at any time. They should use the t:slim mobile app with push notifications turned on so the app alerts them if the malfunction occurs, the company said.   Additionally, Tandem intends to release a software update aimed at enhancing the early detection of speaker failure. The update also introduces persistent vibration alarms to help reduce potential safety risk. Tandem plans to notify affected pump users when it makes the update available. https://www.drugdeliverybusiness.com/tandem-warns-insulin-pump-speaker-malfunction/ XX BIG WIN! The DOJ protects T1D rights again! The US Attorney's office for the Western District of Washington State reached a settlement with a public school district that once again confirms remotely monitoring students' CGMs is a reasonable accommodation that schools must provide to comply with the Americans with Disabilities Act. If its true for one state its true for all states under federal law! If your local schools still refuse to remotely monitor CGMs of their students, provide them with this letter to compel them to FOLLOWT1Ds and FOLLOW Federal Laws. If they still refuse contact us! https://followt1ds.org/ XX new study finds people taking GLP-1 agonists had a significantly lower cumulative risk of developing dementia, when compared to metformin users. Past studies show that people who have type 2 diabetes — a chronic condition where the body does not use its insulin properly — are at a higher risk of developing dementia. The study found that when comparing the neuroprotective abilities of two diabetes medications — metformin and glucagon-like peptide-1 receptor agonists (GLP-1 agonists) — participants taking GLP-1 agonists had a significantly lower cumulative risk of developing dementia, when compared to metformin.   https://www.medicalnewstoday.com/articles/glp-1s-may-offer-better-dementia-protection-than-metformin XX Front office changes coming to Dexcom.  CEO Kevin Sayer will step down  & give the reins to current Chief Operating Officer Jake Leach. Scheduled for January 1, 2026, Leach will also join Dexcom's board of directors where Sayer will remain  executive chairman. One of our frequent guests here.. Leach has worked at Dexcom for 21 years. He served as chief technology officer from 2018 to 2022 before he was named COO in late 2022. He was given the title of president in May. https://www.medtechdive.com/news/dexcom-ceo-change-kevin-sayer-jake-leach/756382/ XX A major international study has revealed that many children and young adults in Sub-Saharan Africa who are diagnosed with type 1 diabetes (T1D) may actually have a different, non-immune-based form of the condition. Unlike the traditional autoimmune version of T1D, this form appears to develop without the immune system attacking the insulin-producing cells. This finding could significantly reshape how diabetes is diagnosed and treated across the region, potentially leading to more precise care and better health outcomes. The researchers found that many young people in Sub-Saharan Africa diagnosed with T1D often don't have the usual markers in their blood (called islet autoantibodies) typically seen in people with T1D in other parts of the world. Specifically, 65% of participants with T1D in this region did not have islet autoantibodies. When the researchers compared this data to studies in the U.S., they found a smaller but significant proportion (15%) of Black participants diagnosed with T1D had a similar form of diabetes found in Sub-Saharan Africa – characterized by negative autoantibodies and a low T1D genetic risk score.   However, white Americans with T1D showed the typical autoimmune pattern, even if they didn't have detectable autoantibodies, their genetics still pointed to autoimmune diabetes.   “The identification of this T1D diabetes subtype in Sub-Saharan African populations and among individuals of African ancestry in the U.S. suggests a potential ancestral or genetic link,” Dabelea notes. “These findings highlight the need to consider alternative etiologies in this group and a deeper understanding of the underlying mechanisms may provide important insights for future prevention and treatment strategies.”     https://scitechdaily.com/new-diabetes-subtype-discovered-in-africa-challenges-global-assumptions/   XX Formal recognition for the specialty of Diabetology.   Diabetology is the specialty focused on the full continuum of diabetes care — encompassing diagnosis, treatment, prevention, technology integration, education, and cardiometabolic management. While it intersects with endocrinology, primary care, and public health, diabetology is uniquely defined by its depth and focus on diabetes alone.       The American College of Diabetology (ACD) is the national professional organization representing clinicians who specialize in diabetes care. ACD advances clinical excellence and education to improve the lives of those affected by diabetes. https://www.businesswire.com/news/home/20250725766248/en/American-College-of-Diabetology-Announces-Formal-Taxonomy-Classification-for-Diabetology   XX Tidepool announces cloud-to-cloud integration with Abbott's FreeStyle Libre portfolio. From the release: This integration allows people living with diabetes using the FreeStyle Libre portfolio to connect their data to their Tidepool account seamlessly. For healthcare providers, this means more comprehensive insights and streamlined workflows, with FreeStyle Libre systems data flowing continuously into the Tidepool Data Platform. https://www.tidepool.org/blog/abbott-freestyle-libre-integration-launched XX Stelo dexom ai food XX With high drug prices remaining an ongoing concern for U.S. politicians, Roche is considering following in the footsteps of some of its peers with a direct-to-consumer (DTC) model to cut out the middlemen.     About 50% of the money spent on drugs in the U.S. healthcare system goes straight to PBMs instead of the companies that create the medicines, Roche CEO Thomas Schinecker called out in a press conference on Thursday.   Bringing the drugs directly to the consumer could be a solution to positively impact pricing for patients “without destroying innovation,” Schinecker added on a separate Thursday call with investors, noting that the company has discussed the matter with the U.S. government and its Department of Health and Human Services. The pricing talks come after President Donald Trump inked a “Most Favored Nation” executive order in May, aiming to tie U.S. drug prices to lower prices in other developed nations. The plan was quickly called out by industry voices such as the PhRMA trade group, which labeled it a “bad deal” for U.S. patients. https://www.fiercepharma.com/pharma/roche-weighing-direct-consumer-drug-sales-ease-us-drug-pricing-woes-cut-out-pbms-ceo-says XX SAB BIO secures substantial $175M financing to advance T1D therapy with impressive investor lineup and extended cash runway until 2028. Most critically, this financing fully funds the pivotal Phase 2b SAFEGUARD study evaluating SAB-142 for delaying progression of autoimmune Type 1 diabetes in newly diagnosed patients. By extending the cash runway into mid-2028, SAB has effectively eliminated near-term financing risk and provided clear visibility through this crucial clinical trial and potential commercialization preparation. Participation from strategic investor Sanofi, along with new investors RA Capital Management, Commodore Capital, Vivo Capital, Blackstone Multi-Asset Investing, Spruce Street Capital, Forge Life Science Partners and Woodline Partners LP, and existing investors Sessa Capital, the T1D Fund, and ATW Partners         https://www.stocktitan.net/news/SABS/sab-bio-announces-oversubscribed-175-million-private-fwsf2t91ek4z.html   XX In a landmark 14-year study, researchers have found that artificially sweetened drinks raise the risk of developing type 2 diabetes by more than a third, significantly higher than those loaded with sugar. It challenges the long-standing perception of diet drinks being a healthier alternative and suggests they may carry metabolic risks of their own. In the first longitudinal study of its kind, led by Monash University, researchers tracked 36,608 participants over an average period of 13.9 years to assess how both sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) impacted health outcomes. The self-reported health data, from the Melbourne Collaborative Cohort Study, was drawn from participants aged 40 to 69 years at the time of recruitment.   What they found was that drinking just one can of artificially sweetened soda increased the risk of developing type 2 diabetes by 38%, compared to people who didn't consume these drinks at all. For those consuming the same amount of sugary drinks, the risk was 23% higher. This suggests there's more than obesity at play. The researchers believe this result is due to an independent metabolic effect, possibly gut microbiome disruption or a change in glucose metabolism.   While the study didn't identify which artificial sweeteners were at play,   Evidence suggests that artificial sweeteners can alter the composition and function of gut bacteria, leading to glucose intolerance – a precursor to type 2 diabetes. And that some sweeteners may trigger insulin release, desensitize metabolic responses over time, or confuse the body's glucose regulation system – even without actual sugar in the picture.   Another hypothesis is that regular exposure to the kind of intense sweetness that artificial products deliver may condition the body to anticipate sugar calories that never come, affecting appetite regulation, insulin sensitivity and broader metabolic pathways. However, the authors suggest that how sweeteners affect the gut microbiota and glucose regulation are the most likely drivers of increased diabetes risk.   https://newatlas.com/diet-nutrition/one-drink-diabetes-risk/ XX After months of deliberation, information gathering and public testimony, a state board unanimously agreed Monday that two common medications for type-2 diabetes and other conditions appear to pose an affordability challenge to the state and Marylanders.   The state Prescription Drug Affordability Board approved two resolutions saying that prescription drugs Jardiance and Farxiga likely pose an “an affordability challenge for the state health care system” and the state should look for ways to bring down those costs.   Health care advocates call the long-awaited resolution an “important first step” in the process in bringing down prescription costs for those on the state's health plan.       That milestone has been years in the making. Created in 2019 by the General Assembly, the Prescription Drug Affordability Board was slow to launch due in part to a veto from former Gov. Larry Hogan (R) amid pandemic-induced economic uncertainty in 2020 that delayed the board's formation. The board also cited out-of-pocket costs for consumers and state and local spending on those drugs as indicators that there may be an affordability challenge.   The board will now look at options to address the potential affordability challenge, which could include setting an upper payment limit on those drugs. But it's not clear when the state will see cost savings.   That said, some members of the health care system and the pharmaceutical industry say that policies such as upper payment limits could weaken access to life-saving drugs. Others say that the board has not engaged enough viewpoints from the health care industry. https://marylandmatters.org/2025/07/29/state-board-determines-two-type-2-diabetes-drugs-may-be-unaffordable/   XX One year after it was revealed that Chrissy Teigen and John Legend's son, Miles, was diagnosed with type 1 diabetes, Teigen is revealing how she's making her son feel more included. Teigen first opened up about her 7-year-old son's diagnosis after she and her two oldest kids, Miles and 9-year-old daughter Luna were at the 2024 summer Olympics cheering on Simone Biles. Teigen posted a photo of Miles and Luna holding up a sign. Also visible in the picture was the insulin pump on Miles' arm. Now, Teigen is sharing some insight into how she's making Miles more comfortable with having type 1 diabetes, including giving LeBron James' Barbie doll type 1 diabetes as well. In a video shared on Instagram, Teigen is seen taking the T1D Barbie, removing her insulin pump and gluing the pump onto LeBron James' Barbie. “Turning T1D Barbie into T1D Lebron James for my son,” Teigen captioned the video, revealing James is Miles' hero. 41 million followers https://www.yahoo.com/lifestyle/articles/chrissy-teigen-gives-lebron-james-154608782.html  

In this episode of the Astonishing Healthcare podcast, we discuss recent health policy news and how to bring greater transparency to health benefits programs with returning guest, Jeff Hogan, President of Upside Health Advisors. Building on our previous discussion with Jeff - How First-Movers are Taking Control of their Health Plans in 2025 - we shed more light on the “PBM boogeyman” narrative, explaining how opaque pricing structures and unhelpful provisions buried in contracts must be discovered. Jeff reviews attempts by states around the country to intervene and halt steering and other practices that negatively impact health plans and their members - from early medical reform efforts to recent PBM-focused legislation. He also notes Medicaid cuts are likely to have some "second-order effects" that impact commercial plans, and the mood in Washington, DC, overall is "dazed and confused," so we can't count on help at the federal level.Highlighting the evolving role of PBMs and Capital Rx's expansion into medical benefit administration, it's apparent that the opportunity to reduce waste and take back control of benefits programs exists; however, "medical is worse," Hogan says. So, what is a plan sponsor or benefits consultant to do? Dig into those contracts - all of them (administrative services, broker, and stop-loss, to name a few) - and look at the provisions you're paying for! "This is where you discover the schemes that are occurring," he adds.Lastly, Jeff notes an interesting trend with health systems and direct contracting that's worth a listen, especially if you liked AH075 - What Health Systems Need [From a PBM]: A Blend of Tech, Transparency, and Understanding, with Lindsey Butler, PharmD, and Chris England.Related ContentCapital Rx Unveils Healthcare's First Unified Pharmacy and Medical Claims Processing PlatformSigns it is time to change your PBM vendor, and how to overcome common hesitations (BenefitsPRO)Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive ImpactTo learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn.For more information about Capital Rx and this episode, please visit Capital Rx Insights.

Elliot Cohen—PillPack co-founder and now co-founder of General Medicine—joins Jacob Effron and Nikhil (Out-of-Pocket) to unpack what “best care” really means in 2025. He explains why General Medicine is building a broad front door to care. Elliot also revisits the PillPack vs. PBMs saga, what Amazon Pharmacy got right (and what was unexpectedly hard), and how AI is already raising the bar in intake, clinical prep, and follow-up. (0:00) Intro(0:58) Simplifying Healthcare with General Medicine(1:53) The Importance of Triage in Healthcare(3:22) Consumer Empowerment in Healthcare(5:10) Patient Experience and Structured Forms(6:27) Challenges in Healthcare Pricing Transparency(8:28) Diverse Patient Needs and Quality of Care(10:00) The Philosophy Behind General Medicine(16:43) Consumer Directed Care: Pros and Cons(18:57) PillPack(35:53) Debating Insulin Search Results(38:16) AI in Healthcare: A New Era(39:15) Integrating AI with Clinical Teams(41:39) Challenges and Opportunities in Digital Therapeutics(58:21) Building a Healthcare Company: Lessons from Amazon(1:01:25) Quickfire Out-Of-Pocket: https://www.outofpocket.health/

Are PBMs stealing your profits? In this

On episode 244, Lynnsey and Matthew are joined by Ray Waldrup, Co-Founder and CEO of The Leaders Rheum, a national network of leading rheumatology practices. Drawing on 3 decades of experience in healthcare leadership, Ray shares his insights on the challenges and opportunities facing independent physician practices today. From the impact of hospital and private equity ownership to the growing influence of insurance companies and PBMs, Ray offers an inside look at the forces reshaping the healthcare landscape. We also dive into how The Leaders Rheum supports independent practices through aggregation, management services, and industry expertise. Tune in for a conversation on the future of independent care!

Hundreds of pharmacies have closed across Pennsylvania in recent years, and pharmacists are pointing the finger at pharmacy benefit managers (PBMs). The spotted lanternfly's next potential target: wine country. Hershey is raising its prices. Also, a community came together to find a lost dog.

The show discussions are Modern Medical Mafia and Patient Protector - two projects to help expose PBMs. We discussed ways independent pharmacy owners can get involved in local legislation and patient education about PBMs and how they impact pharmacies. 

What happens when patients can't afford the medicine you've worked so hard to create? In this episode, host Elaine Hamm, PhD, sits down with Vinay Patel, PharmD—Chief Pharmacy Officer at Proactive MD and Founder of MakoRx—to unpack the hidden complexities behind drug pricing, access, and affordability. Together, they explore how traditional insurance models impact patient care, and what drug developers and startups need to know to ensure their therapeutics actually reach the people who need them. In this episode, you'll discover: Why pharmacy benefit managers (PBMs) influence drug access—and what that means for your commercialization strategy. How cost-plus pricing models are changing the healthcare landscape. Key considerations for biotech innovators to ensure affordability, patient access, and long-term success. Whether you're developing a new therapeutic or trying to understand the real-world implications of drug pricing, this conversation offers a powerful look behind the pharmacy counter. Links: Connect with Vinay Patel, PharmD, and check out Proactive MD and MakoRx. Connect with Elaine Hamm, PhD, and learn about Tulane Medicine Business Development and the School of Medicine. Learn more about The Study, Elaine's wine bar. Connect with Ian McLachlan, BIO from the BAYOU producer. Check out BIO on the BAYOU and make plans to attend October 28 & 29, 2025. Learn more about BIO from the BAYOU - the podcast. Bio from the Bayou is a podcast that explores biotech innovation, business development, and healthcare outcomes in New Orleans & The Gulf South, connecting biotech companies, investors, and key opinion leaders to advance medicine, technology, and startup opportunities in the region.

In this episode of MedNation, Dr. David Farnin interviews Dr. Vinay Patel, a pharmacist and the founder of Makorx, who is on a mission to transform the pharmacy industry. Dr. Patel highlights the significant issues with pharmacy benefit managers (PBMs), which control drug prices and access. He explains Makorx's innovative cost-plus pricing model, which promotes transparency and affordability. With over 20,000 participating pharmacies, Makorx challenges the conventional pharmacy landscape, focusing on empowering patients and reducing costs. Dr. Patel shares his journey from a conventional pharmacist to a health industry innovator aiming to improve drug accessibility nationwide.Cutting Edge Foot and Ankle: Website: https://cefootandankle.com/ Instagram: @cefootandankle

At ACCESS US 2025, our live podcast The Future of Access features four experts exploring how to improve drug affordability and access while maintaining innovation. With rising drug costs, we ask: What bold models are emerging? We cover benefit design, PBMs, AI, evolving pharmacy models, and whether markets can act before regulation. Conference Overview Sarah Emond – ICER John O'Brien – National Pharmaceutical Council Annette Powers – Bristol Myers Squibb Ray Pressburger – Accenture Stuart Altman – Power, Politics and Universal Health Care PBMs 340B Program Copay Maximizers Net Price Lilly Direct Indolent Disease, PFS Concomitant Drug HIV & AZT Orphan Drugs Calquence vs Imbruvica Value-Based Contracts Outcome-Based Contracts Disruptive PBMs CostPlus Drugs Fair Access 2024 Drug Rebates Drug Carve-Outs Dynamic Pricing Accelerated Approvals ICER Assessment Questions? Email comments@prescriptionforbetteraccess.com. Follow us on X, LinkedIn, YouTube, and Threads.

What happens when a board-certified OB-GYN starts questioning everything she was taught? In this episode of Medical Disruptors, I sit down with Dr. Suzanne, a conventionally trained physician who nearly walked away from medicine altogether—until she realized the problem wasn't her. It was the system. And the ones impacted the most? Mid-life women searching for answers. In this episode, we talk about why so many midlife women are being ignored, misdiagnosed, or flat-out dismissed. As Dr. Suzanne puts it, “Tell me you don't like older women without telling me you don't like older women.” We talk about what it means to blend surgical precision with Ayurvedic wisdom, how integrative medicine started as a whisper behind closed doors. Dr. Suzanne opens up about the fear of being labeled “quacky,” the burnout of practicing within insurance constraints, and the radical act of slowing down enough to listen.  We also dig into the structural mess—PBMs, prior authorizations, and why clinicians and patients are both suffering.  But this conversation isn't just about what's broken. It's about what's possible. It's about women reclaiming agency in midlife and clinicians rebuilding medicine on their own terms. This one's for anyone who's tired of being dismissed, miscategorized, or left behind.  Come for the hormone talk.  Stay for the revolution. Learn more about your ad choices. Visit megaphone.fm/adchoices

GDP Script/ Top Stories for July 12th Publish Date: July 12th PRE-ROLL: From the BG AD Group Studio Welcome to the Gwinnett Daily Post Podcast. Today is Saturday, July 12th and Happy Birthday to Christine McVie I’m Peyton Spurlock and here are your top stories presented by Gwinnett KIA Mall of Georgia. Gwinnett charges dropped against detained journalist Mario Guevara Georgia Power to update energy forecasts amid uncertain demand Lawmakers conclude listening tour on access to cancer care All of this and more is coming up on the Gwinnett Daily Post podcast, and if you are looking for community news, we encourage you to listen daily and subscribe! Break 1: 07.14.22 KIA MOG STORY 1: Gwinnett charges dropped against detained journalist Mario Guevara Local journalist Mario Guevara, known for covering Atlanta's Hispanic community and ICE operations, is no longer facing traffic charges in Gwinnett County. Solicitor General Lisamarie Bristol announced insufficient evidence to prosecute charges of reckless driving, unlawful use of a telecommunication device, and failure to obey signs, as the incidents occurred on private property. However, Guevara still faces federal immigration charges, with ICE questioning his legal status despite his work permit and ongoing efforts toward permanent residency. Guevara claims he is being targeted for his journalism, which has drawn local and national attention. STORY 2: Georgia Power to update energy forecasts amid uncertain demand Georgia Power's 2025 Integrated Resource Plan (IRP) faces scrutiny for overestimating energy demand, driven by the rapid growth of data centers. Critics, including environmental groups, argue the projections could leave ratepayers covering billions in stranded assets if demand falls short. While Georgia Power committed to updating forecasts and reporting on large-load projects, many called for stronger demand-side management (DSM) efforts to reduce energy needs. The utility plans to increase DSM spending from $90M to $160M annually, but some remain dissatisfied. The PSC will vote next week, with debates ongoing over coal plant operations and natural gas upgrades. STORY 3: Lawmakers conclude listening tour on access to cancer care Around 66,000 Georgians will be diagnosed with cancer this year, with 19,000 deaths expected, prompting state lawmakers to study ways to reduce these rates. Georgia exceeds national averages for lung, prostate, breast, and colorectal cancer, with rural areas facing significant barriers to care due to rising costs, limited access, and medical industry consolidation. Experts highlighted issues like pharmacy benefit managers (PBMs) controlling drug markets and low reimbursement rates for clinics. Lawmakers aim to address drug pricing, access to screenings, and systemic healthcare challenges, with plans to continue studying cancer care access and solutions. We have opportunities for sponsors to get great engagement on these shows. Call 770.874.3200 for more info. We’ll be right back Break 2: STORY 4: Deputies: Buford man threw deep freezer at 59-year-old at Lake Lanier after fight over nudity A Buford man, Logan Nicholas Young, 42, was arrested on July 3 after a bizarre incident on Lake Lanier involving public indecency, a fight, and a flying deep freezer. Young allegedly got naked on a boat, argued with a 59-year-old man, punched him, and later threw a deep freezer at him, causing a head injury and knocking him into the lake. Deputies found Young hiding under a bed on his houseboat after he ignored their attempts to contact him. He was charged with six offenses, including aggravated assault, and released on bond on July 6. STORY 5: Robert Michener named Gateway85 CID's interim executive director The Gateway85 Community Improvement District (CID) appointed longtime employee Robert Michener as interim executive director following Emory Morsberger's resignation after nearly 20 years of involvement. Michener, with 17 years at Gateway85, previously served as director of operations, overseeing infrastructure, security, and landscaping projects. Board Chairman Shiv Aggarwal praised Morsberger's contributions and welcomed Michener's leadership during the transition. The CID will continue focusing on economic development, mobility, and quality of life improvements as it searches for a permanent leader. Michener expressed excitement about guiding the district's next phase of growth. Break 3: STORY 6: 'Superman' stars excited to bring DC reboot to theaters Edi Gathegi, Isabela Merced, and Anthony Carrigan star in the new "Superman" reboot, with Gathegi playing Mr. Terrific, Merced as Hawkgirl, and Carrigan debuting as Metamorpho. At a red carpet event in Atlanta, Gathegi contrasted his survival as Mr. Terrific with his infamous death as Darwin in "X-Men: First Class." Merced highlighted the mix of CGI and practical sets, comparing her Hawkgirl role to her experience in "Dora the Explorer." Carrigan, excited to bring fan-favorite Metamorpho to life, praised the detailed makeup used instead of CGI. STORY 7: Gwinnett fire investigators say arsonist tried to burn down Lawrenceville home Gwinnett County fire officials are investigating a suspected arson at a Lawrenceville home on Clairidge Lane on June 27. Firefighters responded to a fire alarm and smoke report, discovering an incendiary device behind the home. The fire was out by the time they arrived, and no injuries were reported. Officials are seeking public help to identify the suspect, with a potential reward of up to $10,000 for information leading to an arrest and conviction. Tips can be directed to the Gwinnett Fire Investigations Section or the Georgia Arson Control Hotline. We’ll have closing comments after this Break 4: Ingles Markets 2 Signoff – Thanks again for hanging out with us on today’s Gwinnett Daily Post Podcast. If you enjoy these shows, we encourage you to check out our other offerings, like the Cherokee Tribune Ledger podcast, the Marietta Daily Journal, or the Community Podcast for Rockdale Newton and Morgan Counties. Read more about all our stories and get other great content at www.gwinnettdailypost.com Did you know over 50% of Americans listen to podcasts weekly? Giving you important news about our community and telling great stories are what we do. Make sure you join us for our next episode and be sure to share this podcast on social media with your friends and family. Add us to your Alexa Flash Briefing or your Google Home Briefing and be sure to like, follow, and subscribe wherever you get your podcasts. Produced by the BG Podcast Network Show Sponsors: ingles-markets.com kiamallofga.com See omnystudio.com/listener for privacy information.

In this eye-opening episode of The Brian Nichols Show, we rip the mask off the growing crusade against pharmacy benefit managers (PBMs). Critics claim PBMs are behind rising drug costs, but is that the full story - or just the version Big Pharma wants you to believe? If you've ever looked at your pharmacy receipt and wondered why your medication costs more than your electric bill, you won't want to miss this deep dive. Studio Sponsor: Cardio Miracle - "Unlock the secret to a healthier heart, increased energy levels, and transform your cardiovascular fitness like never before.": CardioMiracle.com/TBNS Brian welcomes economist and researcher Satya Marar from the Mercatus Center to break down how PBMs actually work, why they're being blamed for high drug prices, and what the real drivers of healthcare inflation are. Together, they dismantle the most common talking points against PBMs, including rebate manipulation, lack of transparency, spread pricing, and claims of collusion with insurers. It's a masterclass in separating economic fact from political fiction. We also unpack the emotional tug-of-war between small-town pharmacies and corporate chains. What happens when “Fred's Pharmacy” can't compete with CVS and Walgreens? Is it worth paying more for drugs to keep the local guy afloat - or are there smarter ways to balance access, cost, and community values without wrecking the system? But here's the kicker: what if the real culprit isn't the PBMs at all, but a broken government pricing system and global freeloading by other countries? Yeah, we go there. From Medicare's price models to how the U.S. subsidizes R&D for the world, we expose what's actually driving your pill prices through the roof. If you're sick of the soundbites and want real answers about the mess that is American drug pricing - this episode delivers. Tune in, take notes, and walk away with a smarter, sharper view of healthcare economics than most politicians will ever have. ❤️ Order Cardio Miracle (CardioMiracle.com/TBNS) for 15% off and take a step towards better heart health and overall well-being!

Is the war on PBMs really about helping patients - or just another power grab dressed up as reform? In this eye-opening episode of The Brian Nichols Show, we rip the mask off the growing crusade against pharmacy benefit managers (PBMs). Critics claim PBMs are behind rising drug costs, but is that the full story - or just the version Big Pharma wants you to believe? If you've ever looked at your pharmacy receipt and wondered why your medication costs more than your electric bill, you won't want to miss this deep dive. We have a new show on Lions of Liberty! The Politicks Podcast! Be sure to subscribe to the standalone Politicks Podcast feed. This is the absolute best way to support the show! Listen and subscribe on Apple Podcasts and Spotify. And remember, they're all Blood Suckers! Studio Sponsor: ⁠Cardio Miracle⁠ - "Unlock the secret to a healthier heart, increased energy levels, and transform your cardiovascular fitness like never before.": ⁠CardioMiracle.com/TBNS⁠ Brian welcomes economist and researcher Satya Marar from the Mercatus Center to break down how PBMs actually work, why they're being blamed for high drug prices, and what the real drivers of healthcare inflation are. Together, they dismantle the most common talking points against PBMs, including rebate manipulation, lack of transparency, spread pricing, and claims of collusion with insurers. It's a masterclass in separating economic fact from political fiction. We also unpack the emotional tug-of-war between small-town pharmacies and corporate chains. What happens when “Fred's Pharmacy” can't compete with CVS and Walgreens? Is it worth paying more for drugs to keep the local guy afloat - or are there smarter ways to balance access, cost, and community values without wrecking the system? But here's the kicker: what if the real culprit isn't the PBMs at all, but a broken government pricing system and global freeloading by other countries? Yeah, we go there. From Medicare's price models to how the U.S. subsidizes R&D for the world, we expose what's actually driving your pill prices through the roof. If you're sick of the soundbites and want real answers about the mess that is American drug pricing - this episode delivers. Tune in, take notes, and walk away with a smarter, sharper view of healthcare economics than most politicians will ever have. Order ⁠Cardio Miracle⁠ (⁠CardioMiracle.com/TBNS⁠) for 15% off and take a step towards better heart health and overall well-being!Submit Listener Questions to ⁠brian@briannicholsshow.com⁠ to hear your questions and perspectives answered and shared each and every week! WATCH The Brian Nichols Show, available on ⁠YouTube⁠ & ⁠Rumble⁠. With over 990 episodes featuring local candidates, elected officials, economists, CEOs, and more, each show educates, enlightens, and informs. Follow Brian on social media: X.com/Twitter ⁠(https://www.briannicholsshow.com/twitter⁠) & Facebook (⁠https://www.briannicholsshow.com/facebook⁠) Don't forget to like, share, and subscribe to ⁠The Brian Nichols Show ⁠for more captivating interviews and insights into common sense solutions for local problems! Learn more about your ad choices. Visit megaphone.fm/adchoices

This Week in Pharmacy – June 27, 2025 Episode Title: “Going on the Offensive to Protect Public Health”

What does one do after selling their company to Amazon for $1 billion? Start a new one, of course.In this episode, Halle sits down with TJ Parker, pharmacist, entrepreneur, and advocate for consumer-centric digital health. After co-founding PillPack and selling it to Amazon, TJ stayed on for four years helping build Amazon Pharmacy. Now, he's back at it with General Medicine, a new company focused on making care as seamless as any other online transaction.We cover:

In this relaunch of the PBM Reform Podcast, Greg Reybold returns with a powerful and timely conversation exploring how concentrated economic power—particularly in the form of Pharmacy Benefit Managers (PBMs)—is undermining fair access to prescription medications, driving up drug costs, and crushing independent pharmacies. Greg is joined by Emma Freer, Senior Policy Analyst with the American Economic Liberties Project, a national non-profit and non-partisan organization dedicated to dismantling monopolistic control across critical sectors—including healthcare. Together, they dig deep into how PBMs serve as gatekeepers in the drug supply chain, extracting value at the expense of patients and providers, and how policy reform is urgently needed. Emma outlines how Economic Liberties is driving a new wave of anti-monopoly policy momentum in healthcare by advocating for stronger antitrust enforcement, corporate accountability, and legislative transparency. She highlights how concentrated PBM power not only threatens economic fairness but undermines public health outcomes.

In this episode, Chad Robichaux is joined by healthcare reformer & founder of Ways2Well, Brigham Buhler.Brigham uncovers the truth about the pharmaceutical industry, insurance company kickbacks, & why effective treatments like Ibogaine, stem cells, and peptides are being suppressed. He shares his personal journey from launching Cialis as a young pharma rep to walking away from the industry after seeing how off-label promotion, lobbying, and corporate greed were harming patients, especially veterans.He also breaks down the FDA's role in blocking alternative therapies, the corrupt relationship between PBMs and Big Pharma, and how he's fighting back through legislation and his own medical companies. If you've ever felt like the system is stacked against your health, this conversation will open your eyes.Brigham Buhler is the founder and CEO of Ways2Well and Revive Pharmacy. A former pharmaceutical rep, he's now a leading voice in the fight for patient-first, preventative care and healthcare transparency. His testimony before the Senate, viral appearance on Joe Rogan, and ongoing collaboration with leaders like RFK Jr. have made him one of the most trusted names in healthcare reform today.Learn more about Brigham & Ways2Well: https://ways2well.comFollow Brigham: https://www.instagram.com/brigham.buhlerRESILIENT:Live Resilient Store: https://theresilientshow.com/live-resilient-storeJoin Our Patreon: https://patreon.com/theresilientshowFollow Us On Instagram: https://www.instagram.com/resilientshowFollow Us On Twitter:⁠ https://twitter.com/resilientshowFollow Us On TikTok: ⁠https://www.tiktok.com/@resilientshowFollow Chad:⁠https://www.instagram.com/chadrobo_official⁠https://www.x.com/chadroboSPONSORS:Smith & Wesson: ⁠https://www.smith-wesson.com/⁠Vortex Optics:https://vortexoptics.comGatorz Eyewear: ⁠https://www.gatorz.com/⁠Allied Wealth:https://alliedwealth.comBioPro+: ⁠https://www.bioproteintech.com/⁠BioXCellerator:https://www.bioxcellerator.comThe Holy Waters:https://theholywaters.comGet The Resilient Show x Uncharted Supply Co Bag: https://liveresilient.com/shopTRS is a proud supporter of military & first responder communities in partnership with Mighty Oaks Foundation.

If there's one name to know in the fight for PBM reform, it's Benjamin Jolley. As Co-Founder of Apex Consulting and Senior Fellow at the American Economic Liberties Project, Ben has spent years exposing what's been broken in the pharmacy system—and what can still be fixed. Most recently, he addressed 20,000 attendees at a rally in Salt Lake City to advocate for Breaking Up Big Medicine (breakupbigmedicine.com). This week, Ben joins us on the Catalyst Pharmacy Podcast to talk about all things advocacy, legislation, and fighting for what's right from the front lines of the pharmacy all the way to Capitol Hill.  2:45 – Opening discussion on PBM reform momentum 8:16 – Legislative wins for pharmacy 11:44 – Banning vertical integration between PBMs and pharmacies 14:03 – “Break Up Big Medicine” campaign details 21:37 – Mandatory NADAC reporting: what's required and what it solves 29:36 – Chain vs. independent pricing: real-world examples of inequality 36:14 – Helping pharmacies with Medicare plan optimization 47:51 – Final thoughts and call to action for community involvement  Benjamin's Substack: https://benjaminjolley.substack.com/ Apex Consulting: https://www.apexpharmacyconsulting.com/  Hosted By: Mark Bivins | Chief Growth Officer, RedSail Technologies Guest: Benjamin Jolley | Pharmacist at Jolley's Compounding Pharmacy  Looking for more information about independent pharmacy? Visit https://www.redsailtechnologies.com 

The cost of healthcare is a concern nationwide, but Arkansas is trying to lead the way in bringing price relief to patients, particularly when it comes to prescription drugs. Governor Sarah Huckabee Sanders recently signed a new law banning pharmacy benefits managers from owning and operating pharmacies in her state. PBMs are third-party companies that act as intermediaries or middlemen between insurance companies, big pharma, and pharmacies and are supposed to negotiate for lower costs through rebates and discounts. However, President Trump and his administration have recently called them out for helping to drive up the price of drugs in the country. Governor Sarah Huckabee Sanders joins the Rundown to explain her state's efforts to get prices down and how she hopes other states and the federal government will follow Arkansas's lead. While the President's tariff strategy and efforts to reshape what he sees as an unfair trade system have created some uncertainty on both Wall Street and Main Street, the latest jobs data suggest the labor market is holding steady. Many investors took Friday's May jobs report as a sign that a recession isn't imminent. However, the housing market, inflation, interest rates, and other factors are still a concern. FOX Business Network's Gerri Willis joins the Rundown to discuss the state of the economy, including why she believes the housing market is under pressure but remains optimistic about the American consumer. Plus, commentary from RNC Youth Advisory Council Chair, Brilyn Hollyhand. Learn more about your ad choices. Visit podcastchoices.com/adchoices

EP. 215: I sat down with Brad Hart, owner of Forest Park Pharmacy in Fort Worth, to expose the shocking truth behind pharmacy benefit managers (PBMs) and how they're driving up drug prices. What I learned about vertical integration in the healthcare system, where insurers own the PBMs and the pharmacies, honestly left me furious. Brad breaks it all down, from Medicare waste to the skyrocketing cost of specialty drugs, and we talk about real solutions like compounding pharmacies and direct-to-consumer options. This is a must-listen if you've ever wondered why your medications cost so much—and who's really profiting. Topics Discussed:  What are pharmacy benefit managers (PBMs) and how do they increase drug prices? How are health insurance companies profiting from vertical integration in the pharmacy system? Why are independent and rural pharmacies struggling to stay open? What impact do PBMs have on Medicare spending and prescription drug costs? How can consumers save money on medications without relying on insurance? Sponsored By: Qualia | Go to qualialife.com/DRTYNA for up to 50% off your purchase and use code DRTYNA for an additional 15% Maui Nui Venison | Head to mauinuivenison.com/DRTYNA to secure your access now.  LMNT | Get your free Sample Pack with any LMNT purchase at drinkLMNT.com/drtyna BIOptimizers | Go to bioptimizers.com/tyna and use promo code TYNA10 to order Masszymes now and get 10% off any order Sundays | Get 40% off your first order of Sundays. Go to sundaysfordogs.com/DRTYNA and use code DRTYNA at checkout. Relax Tonic | Go to https://store.drtyna.com/products/relaxtonic and use code and use DRTYNASHOW to save 10% On This Episode We Cover:  00:00:00 - Introduction  00:04:34 - History of PBMs 00:09:02 - Insurance & Pharmacy Ties 00:12:17 - UnitedHealthcare's Role 00:15:59 - Pharmacy Kickbacks 00:18:01 - Emergency Med Access 00:23:11 - Rural Pharmacy Crisis 00:26:20 - How Insurance Works 00:30:05 - Compounding Pharmacies Explained 00:35:19 - How Pharmacies Save Money 00:37:14 - Arkansas PBM Bill 00:39:12 - Trump's Drug Pricing Executive Order 00:42:37 - Direct-to-Consumer Drugs 00:43:40 - Wegovy, Eli Lilly, & Changing Costs 00:46:27 - Medicare Waste 00:48:25 - Medicare Price Negotiation 00:49:58 - Specialty Drug Cost 00:54:18 - Brad's Pharmacy Model Further Listening:  The Fight For Affordable GLP1s & The Truth About Big Pharma | Dave Knapp  Check Out Brad:  https://www.forestparkpharmacy.com/ Instagram TikTok YouTube Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.

253: In this special episode recorded live from the White House, I sit down with some of the most influential voices shaping the future of health in America to discuss the newly released Make America Healthy Again (MAHA) Report. Guests include Dr. Oz, Kyle Diamantas, Vani Hari, Anthony Geisler, Brigham Buhler, and Max Lugavere. We dive into key topics like food policy, GRAS regulations, Medicaid and SNAP reform, PBMs, Alzheimer's research, and the push for preventative care, movement, and accountability in federal health initiatives. This is a behind-the-scenes look at how the MAHA coalition is working to make real change—and what it means for your health. Topics Discussed:  What is the Make America Healthy Again (MAHA) Report, and how does it aim to transform public health policy? How is the FDA planning to update GRAS regulations and food safety standards under the MAHA initiative? What changes are being proposed for Medicaid, Medicare, and SNAP benefits to support preventative health care? Why are PBMs (pharmacy benefit managers) under scrutiny, and how is the MAHA movement addressing prescription drug pricing? What are the latest findings on Alzheimer's disease research, and how is fraudulent science being addressed in national policy? Sponsored By: Beekeepers Naturals | Go to beekeepersnaturals.com/REALFOODOLOGY or enter code REALFOODOLOGY to get 20% off your order.  MASA | Go to MASAChips.com/Realfoodology and use code Realfoodology for 25% off your first order. Ollie | Head to MyOllie.com/REALFOODOLOGY, tell them all about your dog, and use code REALFOODOLOGY to get 60% off your Welcome Kit when you subscribe today!  Timestamps:   00:00:00 - Introduction  00:04:01 - Dr. Oz on CMS & Health Policy 00:06:09 - What MAHA Means for Real Food 00:07:28 - SNAP, Medicaid & Prevention 00:09:33 - Food Access & Health Equity 00:12:21 - Medicaid Waste & ACA Reform 00:15:16 - Movement, Sleep & Food w/ Anthony Geisler 00:17:14 - MAHA's Core 4 Explained 00:18:58 - Building Daily Healthy Habits 00:23:31 - Fitness Access in Schools & Communities 00:26:35 - Avoiding Burnout & Staying Consistent 00:29:33 - Kyle Diamantas on the MAHA Report 00:32:42 - GRAS Status & FDA Priorities 00:36:15 - FDA Reform & Food Regulation 00:39:26 - Red Dye, Food Bans & Ingredient Risks 00:42:14 - Vani Hari on MAHA & Food Advocacy 00:47:54 - Government Response to Health Demands 00:50:52 - MAHA Criticism & What's Ahead 00:56:06 - Fixing How We Grow & Source Food 00:59:59 - Whole Foods, Prevention & EO Impact 01:01:22 - Alzheimer's Fraud & Science Gaps 01:05:29 - New Alzheimer's Therapies & Creatine 01:10:38 - Brigham Buhler on FDA & Reform Efforts 01:12:05 - FDA Accountability & Future Goals 01:14:13 - GRAS Loopholes & Public Safety 01:15:55 - Strengthening Health Safety Nets 01:18:43 - Medical Overuse & Systemic Issues 01:20:30 - What Are PBMs & Why They Matter 01:23:10 - U.S. vs. Global Drug Pricing 01:24:18 - Trump's EO & Cutting Out PBMs 01:26:33 - Insurance Denials & Patient Delays 01:29:10 - Insurance Fixes from the Ground Up 01:32:21 - Progress in Reforming Health Insurance Show Links: Former Pharma Rep Breaks Down How Your Insurance Is Overcharging You + Keeping You Sick | Brigham Buhler Check Out:  Dr. Oz Anthony Geisler, CEO of Sequel Brands Kyle Diamantas Vani Hari Max Lugavere Brigham Buhler Check Out Courtney:  LEAVE US A VOICE MESSAGE Check Out My new FREE Grocery Guide! @realfoodology www.realfoodology.com My Immune Supplement by 2x4 Air Dr Air Purifier AquaTru Water Filter EWG Tap Water Database Produced By: Drake Peterson

We in the U.S. pay the highest prescription drug prices in the world, and a recent executive order takes aim at that inequity, the result of which remains to be seen. Clark explains why employee health plan drug prices through PBMs remain so high, and what you can do about it.  Speaking of prices, what's behind the sticker shock from the price of beef these days? Clark explains. PBMs & Rx Pricing: Segment 1 Ask Clark: Segment 2 Beef Prices: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Trump to sign executive order to cut prices of medicine to match other countries Warning: One Way You Should Almost Never Fill Prescriptions 10 Ways To Save on Prescription Drugs 7 Things To Know About Costco Pharmacy Should You Buy an Extended Warranty on Your Car? What Is a Fiduciary Financial Advisor and Do I Need One? How To Find and Choose a Financial Advisor What Is Umbrella Insurance and Do You Need It? US beef prices extend surge as ranchers face thinnest herds in 70 years Robinhood Review: Pros, Cons & Who Should Use It The WSJ's Jonathan Clements Wants to Leave a Living Legacy Clark.com resources: Episode transcripts Community.Clark.com  /  Ask Clark Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

(0:00) The Besties welcome Ben Shapiro! (1:53) A Bestie apology to Phil Hellmuth, All-In Poker Tournament (7:58) Trump's majorly consequential Middle East trip: Saudi, Qatar, Iran, and his vision for a "New Middle East" (35:18) US-China deal: is the tide turning on tariffs? (46:33) GOP divided over "Big, Beautiful Bill" due to its impact on our debt spiral (1:18:48) Science Corner: Montana bans cell-based meat, joining Florida and others (1:24:31) Trump's EO on pharma prices: role of PBMs, is this too much government intervention? Follow Ben Shapiro: https://x.com/benshapiro Follow the besties: https://x.com/chamath https://x.com/Jason https://x.com/DavidSacks https://x.com/friedberg Follow on X: https://x.com/theallinpod Follow on Instagram: https://www.instagram.com/theallinpod Follow on TikTok: https://www.tiktok.com/@theallinpod Follow on LinkedIn: https://www.linkedin.com/company/allinpod Intro Music Credit: https://rb.gy/tppkzl https://x.com/yung_spielburg Intro Video Credit: https://x.com/TheZachEffect Referenced in the show: https://www.whitehouse.gov/fact-sheets/2025/05/fact-sheet-president-donald-j-trump-secures-historic-1-2-trillion-economic-commitment-in-qatar https://www.whitehouse.gov/fact-sheets/2025/05/fact-sheet-president-donald-j-trump-secures-historic-600-billion-investment-commitment-in-saudi-arabia https://www.whitehouse.gov/articles/2025/05/in-riyadh-president-trump-charts-the-course-for-a-prosperous-future-in-the-middle-east https://www.semafor.com/article/05/16/2025/qatar-commits-more-than-200-billion-in-us-investment https://www.cnbc.com/2025/05/13/trump-saudi-investment-speech.html https://www.cnbc.com/2025/05/13/trump-says-us-will-remove-all-sanctions-on-syria.html https://www.reuters.com/world/what-have-china-united-states-agreed-geneva-2025-05-12 https://www.cnn.com/2019/07/02/politics/donald-trump-dictators-kim-jong-un-vladimir-putin https://newrepublic.com/post/185836/trump-brags-dictators-orban-debate-harris https://www.cnbc.com/quotes/US30Y https://www.politico.com/live-updates/2025/05/14/congress/the-titanic-johnson-predicts-houses-big-beautiful-reconciliation-bill-will-sink-in-the-senate-00348310 https://fred.stlouisfed.org/series/GFDEBTN https://fred.stlouisfed.org/series/GFDEGDQ188S https://www.nytimes.com/2025/05/12/opinion/josh-hawley-dont-cut-medicaid.html https://www.whitehouse.gov/fact-sheets/2025/05/fact-sheet-president-donald-j-trump-announces-actions-to-put-american-patients-first-by-lowering-drug-prices-and-stopping-foreign-free-riding-on-american-pharmaceutical-innovation/

EP. 212: Today I'm joined by Dr. Spencer Nadolsky, obesity specialist, Lipidologist, and founder of Vineyard, a cutting-edge direct care platform. We're diving deep into the conversation you've been asking for: the real story behind GLP-1s, obesity as a chronic disease, and why treating it goes far beyond weight loss. We break down everything from proper dosing, common side effects, and the dangers of vanity prescribing to the systemic issues with telemedicine and PBMs. Dr. Nadolsky and I also discuss strength training, preserving muscle mass, and how GLP-1s may support metabolic and cardiovascular health beyond their FDA indications. This episode cuts through the noise and misinformation. If you care about metabolic health, this one's essential. Topics Discussed:  What are the real benefits of GLP-1 medications beyond weight loss? Is obesity truly a chronic disease, and how should it be treated? What are the risks of GLP-1 vanity dosing and fast titration? How do GLP-1s impact muscle mass and metabolic health? Why are telemedicine and PBMs problematic for obesity treatment? Sponsored By: Maui Nui Venison | Head to mauinuivenison.com/DRTYNA to secure your access now.  LMNT | Get your free Sample Pack with any LMNT purchase at drinkLMNT.com/drtyna Qualia | Go to qualialife.com/DRTYNA for up to 50% off your purchase and use code DRTYNA for an additional 15% Liver Love | Go to https://store.drtyna.com/products/liverlove Use code LIVER20 for 20% off On This Episode We Cover:  00:00:00 – Introduction  00:02:48 – GLP-1 Dosing  00:06:35 – Side Effects of Vanity Dosing 00:08:51 – Reducing GLP-1 Dosing 00:12:27 – Med Spas & Telemedicine Risks 00:14:20 – Slow Titration for Better Tolerance 00:18:44 – Pharma Profits & Overdosing 00:20:49 – Obesity Treatment Pre & Post GLP-1s 00:27:58 – Obesity Is a Chronic Disease 00:32:45 – Defining obesity  00:36:16 – The Role of Genetics in Obesity 00:38:59 – Lifestyle Factors Beyond Genetics 00:40:46 – Insurance Barriers & PBM Costs 00:44:37 – Anti-GLP-1 Bias in Healthcare 00:46:22 – Why Strength Training Matters 00:51:39 – New Doctors & Role of AI 00:53:38 – Protecting Muscle on GLP-1s 00:58:55 – No Shortcuts to Health 01:02:01 – The Vineyard Show Links: Glp-1s Can Help Employers Lower Medical Costs In 2 Years, New Study Finds Further Listening GLP1 Uncovered FREE 4 Part Video Series  Ozempic Done Right Playlist EP. 202 | The Fight for Affordable GLP1s & the Truth About Big Pharma | Dave Knap Check Out Dr. Spencer Vineyard Instagram Website Podcast Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.