Podcasts about pbms

On this episode of the podcast, Missouri Congressman Eric Burlison discussed his proposal for a new healthcare account, the MAHA account, which would function like a supercharged Health Savings Account (HSA), allowing individuals to save up to $25,000 tax-free annually for health insurance and wellness expenses.He emphasized the need for a new solution to address healthcare affordability issues, criticizing Obamacare's preserve incentives. The Missouri Republican also highlighted the role of pharmacy benefit managers (PBMs) in driving up pharmaceutical costs and advocated for giving patients direct choice. He believes MAHA accounts could be implemented by March 2026, potentially reducing healthcare costs and increasing consumer options.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode of Tech Trends by PrimeRx, we continue our deep dive into the evolving world of pharmacy technology. Building on the momentum from our previous discussion—where we explored the shifting landscape of pharmacy tech innovation—we now turn our focus to one of the most urgent challenges facing independent and community pharmacies: making sense of inventory and purchase data. Dr. Matthew Song joins us to break down why automation is no longer optional and how data intelligence is transforming pharmacy operations. With rising costs, shrinking margins, and increasing administrative demands, the ability to automate and optimize data workflows is becoming a competitive advantage. Dr. Song sets the stage by examining how automated systems offer unprecedented visibility into a pharmacy's financial and clinical activity. Today's modern PMS platforms, including PrimeRx, go far beyond dispensing—they automatically collect, analyze, and interpret operational data. Throughout the episode, we'll uncover how automation identifies top payers, high-impact drugs, key prescribers, patient adherence trends, and more. These insights help pharmacy leaders make informed decisions around purchasing, contracting, staffing, and patient care. Listeners will also gain actionable takeaways tied directly to real-time metrics, including dashboards that connect inventory fluctuations to financial performance. Dr. Song explains how automation eliminates manual entry errors, accelerates purchasing decisions, and helps pharmacies avoid costly stockouts or overstocking. From surfacing seasonal medication trends to pinpointing high-volume PBMs or top-referring providers, this episode demonstrates the power of transforming raw data into strategic intelligence. Stay tuned through the end as we tease what's next on the horizon—AI-driven predictive inventory management and the next evolution in pharmacy automation.

Dr. Robert Popovian is a pharmacist, and economist with a deep background in research and public policy. In this episode we have a nuanced discussion on policy impacting pharmacy including PBMs, President Trumps Most Favored Nation Executive Order, Rebates, and insurance premiums.    Links to resources referenced in discussion: • Pioneer Institute, 340B tool: https://pioneerinstitute.org/340babuse/ • Pioneer Institute, IRA tool: https://pioneerinstitute.org/the-inflation-reduction-act-ira-overview/ • Editorial regarding TrumpRX: https://www.linkedin.com/pulse/promise-trumprx-robert-popovian-vskne/?trackingId=dtiG1P%2B%2BSDq6adLfFeEbeg%3D%3D • Pioneer Institute, IRA report: https://pioneerinstitute.org/wp-content/uploads/Prescription-Drug-Price-Controls-06252025.pdf  • GHLF tool, Impact of Accumulators and Maximizers on Premiums: https://cutt.ly/Rr9Di7Vf • Conquest Advisors website: https://conquestadvisors.godaddysites.com/

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

Dr. Robert Popovian is a pharmacist, and economist with a deep background in research and public policy. In this episode we have a nuanced discussion on policy impacting pharmacy including PBMs, President Trumps Most Favored Nation Executive Order, Rebates, and insurance premiums.    Links to resources referenced in discussion: • Pioneer Institute, 340B tool: https://pioneerinstitute.org/340babuse/ • Pioneer Institute, IRA tool: https://pioneerinstitute.org/the-inflation-reduction-act-ira-overview/ • Editorial regarding TrumpRX: https://www.linkedin.com/pulse/promise-trumprx-robert-popovian-vskne/?trackingId=dtiG1P%2B%2BSDq6adLfFeEbeg%3D%3D • Pioneer Institute, IRA report: https://pioneerinstitute.org/wp-content/uploads/Prescription-Drug-Price-Controls-06252025.pdf  • GHLF tool, Impact of Accumulators and Maximizers on Premiums: https://cutt.ly/Rr9Di7Vf • Conquest Advisors website: https://conquestadvisors.godaddysites.com/

In this episode of Future Fuzz, host Vince Quinn sits down with Vidya Drego (VP of Marketing at SmithRx) to explore how you create a new category in a highly regulated, complex industry. Vidya shares how SmithRx is positioning itself as the alternative to legacy pharmacy benefits managers (PBMs), how she transitioned from big‑company marketing roles to a smaller challenger brand, and how the marketing team is educating the market from scratch—starting with explaining problems people didn't even know they had. Along the way you'll learn how content, video, analogies and internal collaboration all drive the category‑creation process.Guest BioVidya Drego is the Vice President of Marketing at SmithRx, a modern pharmacy benefits manager focused on radical transparency and real cost savings in the PBM market. Prior to SmithRx, Vidya held leadership marketing roles at major tech and SaaS companies including HubSpot, LinkedIn, and Salesforce. Her diverse experience equips her with a deep marketing toolkit, which she now applies in a more entrepreneurial, category‑defining setting. (Vidya holds advanced academic credentials and has a track record of building marketing organizations from scratch.) At SmithRx, she leads strategy, content, brand development and demand generation to position the company not just as “another PBM” but as the modern alternative. TakeawaysYou're not just competin — you're recasting the conversation. Vidya emphasises that to create a category you must show your audience that the problem they thought they were solving is actually the wrong problem.Big‑company experience gives you tools, but smaller challenger brands give you freedom. Vidya shares how she moved from large organisations to SmithRx to “actually apply the toolkit” and run with bigger responsibility.Teaching the market matters when the category is novel. SmithRx's team invests heavily in educational content, blog posts, videos and analogies (e.g., the “$12 milk vs $5 milk” discount analogy) to help people grasp the mis‑framed problem.Video and storytelling help simplify complexity. In a nuanced, technical industry like PBMs, visual and narrative tools help clarify the value proposition and cut through jargon.Metrics beyond clicks count. In their context, success isn't just about big audience numbers—but about trust, thought‑leadership, and influencing decision‑makers in the market.Internal voices amplify external credibility. SmithRx intentionally involves team members from operations, contracting, pharmacy network etc to contribute their voices and drive authenticity in content.Chapters 00:00 – Intro and setting the scene 00:57 – What is SmithRx and the PBM business explained 02:32 – Vidya's background: from HubSpot/LinkedIn to SmithRx 04:49 – Why she chose a smaller company and the gap she saw to fill 07:12 – The market problem: how legacy PBMs aren't delivering as advertised 09:58 – How to start educating the market when they don't know the problem 12:35 – Content strategy: blogs, newsletters, videos, internal voices 14:52 – The “milk price” analogy: reframing discount vs actual cost 17:19 – Video as a tool: PBM 101 series and brand style 19:44 – The role of short video, webinars and multi‑format storytelling 20:47 – Experimentation and aligning tactics to business model 22:10 – Where to follow SmithRx and Vidya on LinkedIn 22:35 – Closing remarksLinkedIn Follow Vidya Drego on LinkedIn (you'll find her at SmithRx and content on modern PBMs).Company page: SmithRx on LinkedIn.Follow Vince Quinn

In this eye-opening episode of The ASHHRA Podcast, hosts Bo Brabo and Luke Carignan welcome Kinjal Patel and Brady Heiner from RxBenefits to demystify the complex world of pharmacy benefit management (PBMs). As costs skyrocket, driven by specialty drugs accounting for 50% of spend from just 2% of prescriptions, HR leaders face fiduciary risks, hidden contract clauses, and potential class-action lawsuits. Kinjal and Brady reveal how transparent PBMs differ from traditional models, why "transparency" claims often fall short, and how RxBenefits operates as a client-aligned Pharmacy Benefits Optimizer with 3 million members' negotiating power.Discover actionable strategies for hospitals and health systems to leverage in-house pharmacies, avoid rebate pitfalls, and conduct essential market checks and audits. The duo emphasizes the critical fine print in PBM contracts (e.g., CVS, Express Scripts, OptumRx) that can erode savings if overlooked. RxBenefits offers free, comprehensive contract analyses to uncover hidden opportunities and protect your organization.Key takeaways for healthcare HR professionals:Understand true PBM transparency vs. marketing hype… demand bias-free alignment.Specialty drugs dominate costs; optimize high-dollar prescriptions for massive savings.Hospital pharmacies are goldmines; structure contracts to maximize rebates and utilization.Fiduciary duty demands expertise; avoid legal risks with proactive audits.Don't DIY pharmacy benefits; partner with consultants for smarter plan design and pricing.A must-listen for HR managing escalating drug spend and compliance. Take control… request your free RxBenefits analysis today!From Our Sponsors...Optimize Pharmacy Benefits with RxBenefitsElevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital's own pharmacies. Discover smarter strategies with RxBenefits.Learn More here - https://rxbene.fit/3ZaurZNStreamline HR Compliance with oneBADGEhealthcareSimplify screening, credentialing, and compliance for healthcare HR. oneBADGEhealthcare from ISB Global offers a tailored solution to keep your workforce compliant and efficient. Built for healthcare leaders, it's your all-in-one compliance tool.Get Started here - https://isbglobalservices.com/onebadgeunitedstates/ashhra/ Support the show

TWIRx in the WORKS!!!  Welcome back to This Week in Pharmacy (TWIRx) — your weekly deep dive into the most important pharmacy news, innovations, and conversations shaping healthcare. In this episode, host Todd Eury brings you stories that move from data to impact, exploring how pharmacists are driving change through knowledge, leadership, and advocacy.

HOUR 1 What's fueling the surge of cancer across America's Midwest—and why won't the media name the most controversial suspect? In this gripping episode of Rush to Reason, John Rush, Dr. Kelly Victory, and Steve House expose alarming cancer trends and ask: are toxins to blame—or something far more recent and widespread? Dr. Kelly reveals evidence linking “turbo cancers” to spike proteins found inside tumors, while John and Steve question why the medical community stays silent. When proof threatens power, who decides what the public gets to know? Meanwhile, a buried $600 billion Big Pharma lawsuit reveals how PBMs have quietly controlled drug prices for decades. Could new technology finally break this monopoly—or has corruption gone too deep? Don't miss this explosive conversation that connects hidden lawsuits, rising cancers, and the fight to uncover the truth. HOUR 2 What happens when unlicensed, illegal truck drivers hit the road—and who's really responsible when things go wrong? Why did Denver come so close, yet fall short, in its bid to host the 2030 Gay Games—and what does that say about the city's political and cultural identity? Then, former President Trump makes a shocking move: ordering the Pentagon to prepare for nuclear weapons testing for the first time since 1992. What's behind that decision, and what message is it sending to the world? And finally—what would you do if you won $2 billion? One California man is using his winnings to buy up properties lost in the L.A. fires. Is it rebuilding or opportunism? HOUR 3 What drives a New Yorker who despises billionaires to throw his support behind socialist candidate Zorhan Mamdani for mayor? Is this a glimpse into the future of urban politics—or a warning sign for the rest of the country? Meanwhile, the CEO of Walmart takes on George Stephanopoulos over the real cost of Thanksgiving dinner this year—so who's telling the truth about inflation? And in a bizarre twist, how did an AI system mistake a bag of Doritos for a gun? What does that say about the technology shaping our everyday lives? Then—California's SEIU union is pushing a new ballot measure: a 5% wealth tax on billionaires, retroactive to 2025. Could this start an exodus—or a revolution? Plus, emergency funds for SNAP and a local race that hits close to home—Steve Altschuler is back in the running for Longmont City Council.

HOUR 1 What's fueling the surge of cancer across America's Midwest—and why won't the media name the most controversial suspect? In this gripping episode of Rush to Reason, John Rush, Dr. Kelly Victory, and Steve House expose alarming cancer trends and ask: are toxins to blame—or something far more recent and widespread? Dr. Kelly reveals evidence linking “turbo cancers” to spike proteins found inside tumors, while John and Steve question why the medical community stays silent. When proof threatens power, who decides what the public gets to know? Meanwhile, a buried $600 billion Big Pharma lawsuit reveals how PBMs have quietly controlled drug prices for decades. Could new technology finally break this monopoly—or has corruption gone too deep? Don't miss this explosive conversation that connects hidden lawsuits, rising cancers, and the fight to uncover the truth. HOUR 2 What happens when unlicensed, illegal truck drivers hit the road—and who's really responsible when things go wrong? Why did Denver come so close, yet fall short, in its bid to host the 2030 Gay Games—and what does that say about the city's political and cultural identity? Then, former President Trump makes a shocking move: ordering the Pentagon to prepare for nuclear weapons testing for the first time since 1992. What's behind that decision, and what message is it sending to the world? And finally—what would you do if you won $2 billion? One California man is using his winnings to buy up properties lost in the L.A. fires. Is it rebuilding or opportunism? HOUR 3 What drives a New Yorker who despises billionaires to throw his support behind socialist candidate Zorhan Mamdani for mayor? Is this a glimpse into the future of urban politics—or a warning sign for the rest of the country? Meanwhile, the CEO of Walmart takes on George Stephanopoulos over the real cost of Thanksgiving dinner this year—so who's telling the truth about inflation? And in a bizarre twist, how did an AI system mistake a bag of Doritos for a gun? What does that say about the technology shaping our everyday lives? Then—California's SEIU union is pushing a new ballot measure: a 5% wealth tax on billionaires, retroactive to 2025. Could this start an exodus—or a revolution? Plus, emergency funds for SNAP and a local race that hits close to home—Steve Altschuler is back in the running for Longmont City Council.

HOUR 1 What's fueling the surge of cancer across America's Midwest—and why won't the media name the most controversial suspect? In this gripping episode of Rush to Reason, John Rush, Dr. Kelly Victory, and Steve House expose alarming cancer trends and ask: are toxins to blame—or something far more recent and widespread? Dr. Kelly reveals evidence linking “turbo cancers” to spike proteins found inside tumors, while John and Steve question why the medical community stays silent. When proof threatens power, who decides what the public gets to know? Meanwhile, a buried $600 billion Big Pharma lawsuit reveals how PBMs have quietly controlled drug prices for decades. Could new technology finally break this monopoly—or has corruption gone too deep? Don't miss this explosive conversation that connects hidden lawsuits, rising cancers, and the fight to uncover the truth. HOUR 2 What happens when unlicensed, illegal truck drivers hit the road—and who's really responsible when things go wrong? Why did Denver come so close, yet fall short, in its bid to host the 2030 Gay Games—and what does that say about the city's political and cultural identity? Then, former President Trump makes a shocking move: ordering the Pentagon to prepare for nuclear weapons testing for the first time since 1992. What's behind that decision, and what message is it sending to the world? And finally—what would you do if you won $2 billion? One California man is using his winnings to buy up properties lost in the L.A. fires. Is it rebuilding or opportunism? HOUR 3 What drives a New Yorker who despises billionaires to throw his support behind socialist candidate Zorhan Mamdani for mayor? Is this a glimpse into the future of urban politics—or a warning sign for the rest of the country? Meanwhile, the CEO of Walmart takes on George Stephanopoulos over the real cost of Thanksgiving dinner this year—so who's telling the truth about inflation? And in a bizarre twist, how did an AI system mistake a bag of Doritos for a gun? What does that say about the technology shaping our everyday lives? Then—California's SEIU union is pushing a new ballot measure: a 5% wealth tax on billionaires, retroactive to 2025. Could this start an exodus—or a revolution? Plus, emergency funds for SNAP and a local race that hits close to home—Steve Altschuler is back in the running for Longmont City Council.

This is Derek Miller, Speaking on Business. RealRx was founded in 2020 as a joint venture between University of Utah Health Plans and Cooperative Benefits Group. They provide efficient, high-quality pharmacy solutions focused on delivering value to members. President, Jeffrey Dunn, joins us with more. Jeffrey Dunn: We all know that high drug costs can be a burden for Utah businesses and families. What you may not realize is that traditional pharmacy benefit managers, or PBMs, often profit when prices stay high. They make money through rebates, spread pricing, and fees that are all tied to the cost of the drug and the number of prescriptions. At RealRx, we knew there had to be a better way. Founded in Salt Lake City by local pharmacists and healthcare leaders each with more than 20 years of experience, the RealRx solution is transparent, 100 percent pass-through drug pricing. As an employer, you pay the exact amount paid to the pharmacy, less any applicable member cost - with no markup and no games - ever. Our model cuts prescription costs by 20 to 30 percent, while giving members a better experience. RealRx is proud to be part of this community, and we're committed to making prescription drugs more affordable. Derek Miller: By enhancing access to affordable, high-quality pharmacy care, REALRx continues to strengthen Utah communities. Their member-focused approach lowers costs, supports local health initiatives, and promotes better outcomes. Learn more at realRXsites.com. I'm Derek Miller, with the Salt Lake Chamber, Speaking on Business. Originally aired: 10/23/25

Brandon Weber, Co-founder & CEO of Nava Benefits, joined us on The Modern People Leader.We talked about why benefits have become the second-largest company expense — and how HR can “moneyball” their healthcare spend, cut down on benefits-related admin work, and deliver better employee outcomes through the emerging “alt marketplace.”---- Nava Links:

Back in June, pharmaphorum spoke with Entity Risk's CEO and co-founder, Neal Masia, a leading health economist, about the unknowns unfolding in the US following the commencement of the second Trump administration this year. Tune into today's podcast for an exploration of the potential scenarios Masia mused might arise, as well as his insights on the 340B Program, PBMs, and risk-based contracts. You can listen to episode 210 of the pharmaphorum podcast in the player below, download the episode to your computer, or find it - and subscribe to the rest of the series – on Apple Podcasts, Spotify, Overcast, Pocket Casts, Podbean, and pretty much wherever else you download your other podcasts from.

Health care data strategist Lee Ann McWhorter discusses her article "Why health care reform must start with ending monopolies." Lee Ann explains how monopolistic control by entities like GPOs, PBMs, EHR vendors, and MMIS platforms drives up costs, suppresses innovation, and undermines patient safety. She highlights how opaque contracts and data silos leave hospitals flying blind, why favoritism often trumps performance, and how COVID-19 revealed the dangers of centralized sourcing models. Lee Ann emphasizes that hospitals have the power to break this cycle by rejecting monopolistic contracts and investing in transparent, independent, and sustainable solutions. Listeners will learn why cost is not the true crisis—control is—and how restoring competition can protect patients and rebuild trust in the system. Our presenting sponsor is Microsoft Dragon Copilot. Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click. Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it's backed by a proven track record and decades of clinical expertise, and it's built on a foundation of trust. It's time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Donovan Ryckis is the award-winning founder and CEO of Ethos Benefits, leading the charge in fiduciary-driven healthcare strategies for employers. A former Securities Advisor, he shifted from investment advising after uncovering inefficiencies in employer healthcare plans—achieving 40% savings for a client without reducing benefits. Alongside his wife and business partner, Chelsea, Donovan applies a fiduciary financial process to help organizations cut costs and improve outcomes.Brenda Kruse, CFO of Axiom Healthcare Services, brings over 26 years of financial leadership in healthcare and senior living. A licensed CPA, she excels in strategic planning, compliance, and cost management, driving both financial strength and quality care across her organization.In this episode, Eric, Donovan, and Brenda discuss:How employers can apply a fiduciary mindset to healthcare plans under ERISA.The importance of data transparency in managing plan costs and pharmacy benefit managers (PBMs).Aligning advisor compensation with employer and employee interests.Real-world examples of reducing costs while improving employee benefits.Key Takeaways:Many employers don't realize their healthcare plans carry ERISA fiduciary liability just like retirement plans. Creating a formal benefits committee ensures decisions are documented, consistent, and defensible.Data ownership and transparency are critical. Without detailed claims and pharmacy data, employers can't pinpoint where costs are being driven or negotiate effectively.Pharmacy Benefit Managers (PBMs) are often overlooked sources of cost savings. Changing PBMs can reduce plan expenses by up to 50–70% with minimal disruption to employees.Aligning broker and consultant incentives with the employer's goals prevents conflicts of interest and ensures decisions are made in the plan participants' best interests.“If we don't have data, we don't know where our costs are being spent… 60% of our costs were in pharmacy, and yet our previous broker really wasn't even trying to change our pharmacy plan at all.”— Brenda Kruse“Even disclosing fees is only since the CAA of 2021, even still today, companies are doing it very poorly… They say it's part of their entire book of business, so they can't calculate it per client—that's certainly a bad starting point.” — Donovan RyckisConnect with Donovan Ryckis & Brenda Kruse:Website: https://ethosbenefits.com/ & https://www.axmservices.com/LinkedIn: https://www.linkedin.com/in/donovanryckis/ / https://www.linkedin.com/in/brenda-kruse-1a90592b/Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ Important clarification from the podcast show dialogue: "If an ERISA plan exceeds 100 participants with an account balance but remains under 120 in perpetuity, then the plan would not require an audit for each subsequent year that it remains under 120 participants with a balance. Please verify current rules and check with your plan record-keeper, advisor, or CPA to ensure compliance with this requirement." The information and content of this podcast are general in nature and are provided solely for educational and informational purposes. It is believed to be accurate and reliable as of the posting date, but may be subject to change.It is not intended to provide a specific recommendation for any type of product or service discussed in this presentation or to provide any warranties, investment advice, financial advice, tax, plan design, or legal advice (unless otherwise specifically indicated). Please consult your own independent advisor as to any investment, tax, or legal statements made.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan-specific circumstances.

Florida's Octagon Doctor joins Nephilim Death Squad to pull the curtain back on modern medicine: how direct primary care actually works, why urgent care is mostly a money trap, what PBMs do to drug prices, the reality of AI “doctors,” and how to find a physician who knows you—not just your chart. We also hit COVID after-effects (phantom smells, dulled taste), moving from Puerto Rico → Iowa → Florida, and what it's like working cage-side for UFC/BKFC while running a patient-first clinic. If you're tired, burned out, or stuck paying a second mortgage for “healthcare,” this one's for you. Follow Dr. YaredWebsite: OctagonDoctor.com. Octagon DoctorInstagram: [@octagondoctor] Instagram+1X (Twitter): [@dryared] X (formerly Twitter)+1YouTube: Octagon Doctor channel. YouTubeFacebook (Page): Octagon Doctor. FacebookFacebook (Profile): Yared Vazquez. FacebookLinkedIn: /in/doctoryaredNEPHILIM DEATH SQUADPatreon (early access + Telegram): https://www.patreon.com/NephilimDeathSquadWebsite & Merch: https://nephilimdeathsquad.comSupport Joe Gilberti: GiveSendGoListen/Watch:Spreaker: https://www.spreaker.com/podcast/nephilim-death-squad--6389018YouTube: https://www.youtube.com/@NephilimDeathSquadRumble: https://rumble.com/user/NephilimDeathSquadX: https://twitter.com/NephilimDSquadInstagram: https://instagram.com/nephilimdeathsquadContact: chroniclesnds@gmail.comX Community – Nephilim Watch: https://twitter.com/i/communities/1725510634966560797TopLobsta:X: https://twitter.com/TopLobstaInstagram: https://instagram.com/TopLobstaMerch: https://TopLobsta.comRaven:X: https://twitter.com/DavidLCorboInstagram: https://instagram.com/ravenofndsSponsors:Rife Tech – https://realsrifetechnology.com/ (Code: NEPHILIM for 10% off)Purge Store – https://purgestore.com/ (Code: NEPHILIM for 10% off)Credits:Intro Animation: @jslashr on XMusic: End of Days by Vinnie PazBecome a supporter of this podcast: https://www.spreaker.com/podcast/nephilim-death-squad--6389018/support.☠️ Nephilim Death Squad — New episodes 5x/week.Join our Patreon for early access, bonus shows & the private Telegram hive.Subscribe on YouTube & Rumble, follow @NephilimDSquad on X/Instagram, grab merch at toplobsta.com. Questions/bookings: chroniclesnds@gmail.com — Stay dangerous.

The host has been a community pharmacy advocate for 22 years. Always looking for ways to help community pharmacies be more profitable. The guest is an experienced Pharmacist with a demonstrated history of working in the pharmaceutical industry. Skilled in Diabetes, Pharmacy Practice, Community Pharmacy, and Clinical Pharmacology.

In this special RxBenefits-sponsored episode of The ASHHRA Podcast, hosts Bo Brabo and Luke Carignan explore the dynamic pharmacy benefits landscape with experts Sarah Hearn and Wes Hill (Director of Compliance & Legal Operations). Amid the busiest legislative season yet—over 1,500 bills—they discuss PBM reforms, ERISA challenges, compounding alternatives for GLP-1 drugs like Ozempic, 340B pricing, and emerging lawsuits. Gain insights on transparency, cost savings, and compliance for healthcare HR pros navigating employee benefits.Key takeaways for healthcare HR leaders:Legislative Surge: 1,500+ state bills target PBMs, carriers, and more; expect increased reporting burdens but better data for informed decisions.ERISA Erosion Risks: States challenge federal uniformity—multi-state plans face conflicting laws; monitor for compliance headaches.Positive Reforms: New mandates empower plan sponsors with PBM data; leverage 340B and coupons to cut costs (e.g., Wegovy from $1,000 to $100/month).Compounding & Innovation: Affordable GLP-1 alternatives via telehealth, but ensure safety and avoid controlled substance pitfalls.Lawsuits to Watch: Oklahoma ERISA win; Arkansas PBM permit ban challenges interstate commerce—outcomes could reshape operations.Action Steps: Demand vendor transparency; align with ERISA; educate teams on benefits to prevent misuse and optimize savings.Essential listening for HR managing rising pharmacy costs and regulations. Spark curiosity—reach out to RxBenefits for guidance!From Our Sponsors...Optimize Pharmacy Benefits with RxBenefitsElevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital's own pharmacies. Discover smarter strategies with RxBenefits.Learn More here - https://rxbene.fit/3ZaurZNStreamline HR Compliance with oneBADGEhealthcareSimplify screening, credentialing, and compliance for healthcare HR. oneBADGEhealthcare from ISB Global offers a tailored solution to keep your workforce compliant and efficient. Built for healthcare leaders, it's your all-in-one compliance tool.Get Started here - https://isbglobalservices.com/onebadgeunitedstates/ashhra/ Support the show

Send us a textWhat does leadership look like when control disappears? We sit down with Jeff Moss—Bronze Star Army aviator, bestselling author of My Leading Edge, Pfizer veteran, and Inc. 5000 franchise owner—to trace a life built on moral courage, mentorship, and service that lasts. From piloting AH-1 Cobras in Desert Storm to refusing to field unsafe aircraft under pressure, Jeff explains how clear standards and documented truth protect people and missions. Then we pivot from the flight line to the family room: his daughter Mallory's intractable epilepsy, two brain surgeries, and the night a hospital chaplain asked the question that reframed Jeff's faith. If you've ever wondered how to carry purpose through a season that feels like autorotation, this story will meet you where you are.We also get practical about the civilian runway—19 years inside big pharma, what most people miss about drug access, and why pharmacy benefit managers (PBMs) complicate care with needless switches. Jeff opens the books on small business realities: lawfare, soaring insurance premiums, and the discipline it takes to build a values‑driven moving and junk removal company that still invests in people. Along the way, we talk tech and trust (autopilot doesn't replace a pilot, it demands one), media skepticism, and what it means to judge less by first impressions and more by character.Threading through it all is a simple flight plan: pre‑flight your life with mentors and values, commit on takeoff, build systems for normal flight, stay calm in autorotation, and debrief for legacy. If you care about leadership, faith, veteran transition, small business, healthcare access, or just becoming the kind of person others can trust when the air gets thin, this conversation belongs in your queue. Subscribe, share with a friend who needs a lift, and leave a review to help others find the show. What part of Jeff's story challenged you most?

After I posted the final part of my 3-part series on GLP-1s and kidney function, I got a question from reader Liza:“I appreciate how you always talk about how the authors get money from the drug company, I think it's important to know. As I read this newsletter [GLP-1 and Kidney Function Part 3] I was wondering if it is possible to calculate how much the drug company themself would make?”This is an interesting question. I think it's tough to figure out because (at least here in the US) discount cards and insurance companies and PBMs and discount pharmacies et al. mean that people (even people in the same family!) can pay vastly different amounts for the same drugs.I do think it's possible to at least come up with an estimate of the highest possible amount of gross profit. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In the 2025 Payer Oncology Trend Report, we analyze how health plans and PBMs are navigating the shifting landscape of branded cancer drug management. To deepen our findings, we spoke with industry experts Michael Kolodziej, MD, and Ira Klein, Vice President, Medical Affairs & Payer Relations at Tempus, who shared their perspectives on the data, key trends, and what these insights mean for manufacturers moving forward.

Brigham Buhler is a healthcare entrepreneur transforming America's broken system. As founder of Ways2Well, owner of Revive Rx Pharmacy, and an investor in psychedelic research, he champions a model of care that prioritizes patients over profits through preventative medicine, transparency, and innovation. His work is guided by a few core convictions: -Former insider's perspective: With deep experience navigating the corrupt systems of pharmacy benefit managers (PBMs), insurance companies, and the FDA, Brigham knows firsthand how the system is stacked against patients. -Uncompromising advocate: He pushes to expose and dismantle the corporate capture of American healthcare. -Bold truth-teller: He believes in revealing the realities of the insurance Ponzi scheme and providing practical ways to bypass outdated systems. -Relentless reformer: He is dedicated to replacing a model that profits off sickness with one centered on health, longevity, and patient empowerment.   Today's Sponsors: Black Rifle Coffee: https://www.blackriflecoffee.com LMNT: https://www.drinklmnt.com/clearedhot        

On this episode of Alloutcoach, host Tim Mikhelashvili, CEO, Amedea Pharma convenes a panel you rarely hear in one room: a policy-minded biohacker and investor (John Hemming, CEO of Cirrostratus, Biohacking Team Leader), a strategy and operations leader who reshapes patient journeys (Bart Zoni, Senior Vice President, Marketing, Woven Health Collective), and an early-stage investor focused on medical technologies (Chris Piedmonte, Managing Director, Neoterra Capital) as well as a senior pharma thought leader in Medical Affairs and Health Economics, Janelle Hardisty. Their catalyst? Fresh takeaways from the 2025 Financial Times US Pharma summit — and an honest look at what's truly accelerating innovation, what's stalling it, and where capital and talent should go next.00:00:00 Cold Open - Episode Highlights: AI accuracy and access00:03:43 Host Intro and Why This Episode00:04:41 Guest Intros00:08:06 State of Innovation - Tailwinds and Headwinds00:12:41 What's Really Accelerating Innovation?00:19:27 Drug Discovery - Reducing the 90% Failure Rate00:22:01 Clinical Trials - Modernize or Stall00:25:11 Access, PBMs, and Direct-to-Patient00:27:03 Longevity and Prevention - Can We Measure It?00:36:52 Data Culture Maturity and Pilot Fatigue00:45:52 Training the Future Workforce00:51:09 Investing - Where Should Capital Flow?00:57:08 Regulatory Reality and Time-to-Access00:59:27 Closing and Invite to Medical Innovation Olympics

GLP-1 therapies are transforming pharmacy benefits, and Express Scripts is leading the way. Harold Carter, PharmD, SVP of Trade Relations, joins host Eric Glazer to discuss how one of the nation's largest PBMs is navigating this disruptive moment in healthcare. Harold shares how Express Scripts is: Capping costs of GLP-1 therapies to expand patient access while keeping plan spending predictable. Redesigning funding models to strike a balance between affordability, predictability, and outcomes. Leveraging digital tools and AI to reduce friction in the member experience and support long-term adherence. Rethinking formularies not just as cost-control tools but as part of a broader population health and behavioral change ecosystem. You'll also hear his forward-looking perspective on how PBMs will evolve over the next three to five years, and the key questions health plans and employers should be asking today to prepare for the future of pharmacy benefits. About Dr. Harold Carter:   Harold Carter, PharmD, is responsible for leading all interactions and contracting with pharmaceutical manufacturers and oversees strategy and management of Express Scripts' drug formularies, data & insights, client underwriting, and product strategy and development. In his nearly 14 years with the organization, Harold has held numerous leadership roles oriented around critical efforts to lower the cost of prescription drugs and ensuring medication access for Express Scripts clients and members. Harold's previous responsibilities include oversight of the organization's medical pharma contracting and drug procurement teams, as well as leading the strategy, development and execution of Express Scripts' wholesale market, value-based solutions and generic strategy, and development of Express Scripts' advanced utilization management solutions.  In addition to his work at Express Scripts, Harold serves on numerous boards including LifeWise Stl Board of Directors, St. Louis University High School Board of Trustees and IVI Board of Directors. Harold earned his doctorate in pharmacy from St. Louis College of Pharmacy.   Partner with Bright Spots Ventures: If you are interested in speaking with the Bright Spots Ventures team to brainstorm how we can help you grow your business via content and relationships, email hkrish@brightspotsventures.com  About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the “bright spots” in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

#IndependentNews #Healthcare #MilitarySEGMENT 1:Feeling anxious and broke? We've got the research-backed habit that lowers anxiety in 7 days (pick ONE and see results).SEGMENT 2: Current eventsWe cut through the BS: the shutdown ISN'T about "illegals getting free healthcare"—that's clickbait. The real fight? ACA subsidies vs. tax cuts while hospital cartels and PBMs bleed you dry. We break down what's actually happening with healthcare costs and why lobbying, not immigrants, is bankrupting families.PLUS: Hegseth's fat generals and the Comey indictment that probably goes nowhere.We're done with team politics. Time to focus on what actually makes America work—new frontiers, real solutions, and getting out of our own way. Drop a comment with which 7-day habit you're trying. Let's go.#OverFiftyStartingOver #O5O #Shutdown #ACASubsidies #Hegseth#Comey #healthcarereform #governmentshutdownSubscribe to O5O on Youtube: https://www.youtube.com/@OverFiftyStartingOver

Join co-hosts Jeremy Counts and Lauren Young as The PUTTcast teams up with the PBM OTR Cocktail Crew for Part 1 of our special live crossover episode! We're breaking down the biggest moments from the 2025 PUTT Virtual Summit, and diving deep into the ever-changing world of PBM reform. This powerhouse discussion features an incredible lineup of guests who share their unique perspectives on the latest legislative battles, grassroots advocacy, and what independent pharmacy owners are facing on the front lines.Special Guest: Greg Reybold, VP of Healthcare Policy & General Counsel, APCIMusic by cat_herding_diva & JuliusH | Mixing by Andre Barden | Production & Editing by Shannon Wightman-Girard

If you are listening to this prior to October 9, 2025, go to the 32BJ Changing the Playbook on Hospital Prices event, where Mark Cuban will be keynoting. Cora Opsahl will also be speaking, and I will be there listening. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, trust, simplicity, and a chicken. Yeah, this is where this whole conversation with Mark Cuban and Cora Opsahl winds up. And it is a barnstormer because you know what some really good advice is for anybody trying to do right by patients and taxpayers and plan sponsors? It will take trust. It will take making the complicated as simple as possible. And also if you could pay with a chicken, like in the good old days, that would be messy—I can say with confidence, having grown up in Pennsylvania Dutch country, where there are many, many chickens—but also being able to pay with a chicken could also indicate that healthcare prices are reasonably chicken proportionate and that the doctor-patient relationship is good enough to break bread (or have chicken). That last part is really important, and Cora Opsahl says this at one point in the episode that follows. It doesn't matter how wonderful the transparency or the financing. If the prices are insane and there's no more reasonably priced options in any given market, then yeah. Shane Cerone says in an upcoming show, he says, “We do not have a broken healthcare market. We do not have a healthcare market. There is no market.” Okay … so, you could call this conversation a continuation of the episode with Ann Kempski (EP444), entitled “Two State Healthcare Laws Often Don't Go as Planned.” But it's not just healthcare laws that often don't go as planned. It's some very foundational constructs that we have built the healthcare sector upon that may also not go as planned. The healthcare sector is like a game of pachinko. You chuck an input into the mix, and it will bounce all around into all the perverse incentives and human beings and the non-market that we have. And who the heck knows what is gonna pop out the other side? It's like game theory at its most unpredictable. So, in healthcare, there are many, many examples of when the solution to a problem arguably creates worse problems than the problems the solution was trying to solve for. But we—Mark Cuban, Cora Opsahl, and I—are gonna shake our fists at two such solutions today: high deductible health plans (or just high deductibles in general) and then self-insured employers trying to solve the complexity of the healthcare industry by hiring consultants and middlemen, middle people, and other vendors to navigate the pachinko parlor (that is, our $4.9 trillion healthcare sector) on their behalf. Now, I am not in any way saying the spirit of these two endeavors—high deductibles and hiring consultants and middlemen—weren't wholehearted. They seem just like many other well-intentioned solutions: very logical on their face. What I am saying is there are many ways in the real world for even the most, again, genuine endeavor to turn into a money grab for those so inclined. While at the same time I'm saying all this, I'm also very much saying that there are some amazing consultants and middle folks such as independent third-party administrators, otherwise known as TPAs, and PBMs (pharmacy benefit managers) who are transparent and hold themselves accountable to the fiduciary responsibilities that their clients are held to in real terms—not just in marketing speak with 40 pages of disclaimers following. There are great folks out there, many of whom listen to this podcast and are part of our tribe on the regular. And to you, I say thank you for being here, because it takes all the knowledge and more from every one of the guests featured in these past 487 Relentless Health Value episodes plus treating every day like a school day to make sure that we all are not getting shanked from behind by some innocent-looking contract term that turns out to be anything but. The conversation that follows starts out talking about high deductibles; naturally segues into how third-party intermediaries can actually exacerbate the issues here; then we get into transparency, financing, clinical organizations taking on risk, and the benefits and challenges of direct contracts; then Mark lays out a vision for the future. Okay … I wanna get to this conversation. If you are a new listener here—and you might be because … yeah, Mark Cuban—let me just inform you that this podcast is largely listened to by those who work in the healthcare industry. So, you are going to encounter acronyms. You will also encounter me referencing earlier episodes because surveys say listeners really appreciate these callbacks to go get additional information about any given topic. You can get what amounts to a personalized Master's of Healthcare Administration curriculum if you follow the episode threads long enough. And that was a direct quote from a listener. About the acronyms: They are holy terrors, and we in the healthcare industry are chock-full of them. See the list of acronyms that come up so that you can follow along at home if this is your first day at our rodeo. Also in the show notes is a transcript of this show, along with links to all of the mentioned episodes. Okay … here's my conversation with Mark Cuban, who is Mark Cuban and also CEO and founder of Mark Cuban Cost Plus Drugs. Also, we have Cora Opsahl, who is health fund director of the 32BJ Health Fund and an expert in many things healthcare. Also mentioned in this episode are Shane Cerone; Ann Kempski; Mark Cuban Cost Plus Drugs; 32BJ Health Fund; Preston Alexander; Stanley Schwartz, MD; Elizabeth Mitchell; Kimberly Carleson; Andreas Mang; Jonathan Baran; Claire Brockbank; Dave Chase; Cristin Dickerson, MD; Green Imaging; Kevin Lyons; and Vivian Ho, PhD.   You can learn more at markcubancompanies.com and costplusdrugs.com and follow Mark on LinkedIn, Bluesky, Threads, and X. You can follow Cora on LinkedIn.   Mark Cuban, a native of Pittsburgh, PA; a graduate of Indiana University; and now a Dallas, TX, resident, has always been an entrepreneur. From selling and trading baseball cards, selling garbage bags and magazines door-to-door, to starting a business buying and selling stamps at age 16, there have been few years in his life when he wasn't starting or running a business. He got a job at one of Dallas's first retail software stores, Your Business Software. He spent nine months doing everything from learning how to code, supporting and installing every type of business software, and of course, making sure the store opened on time. That went well until he made the executive decision to turn over the store opening duties to a peer so he could pick up a check for a sale. He was fired. Mark decided it was time to start on his own. The next day, MicroSolutions was founded. Over the next seven years, MicroSolutions became a national leader in Systems Integration and custom applications for local and wide area networks. Growing to 80 employees, never having a losing month of operations and nearly $36M in annualized sales, in 1990, MicroSolutions was sold to CompuServe. At that point Mark “retired” to investing in public and private companies. His knowledge of the networking industry led to success and brought returns of 80% and more each year. Mark purchased the Dallas Mavericks for $285M. The Mavs would have the second-best record in the NBA during his ownership tenure. Mark sold majority control of the Mavs in 2023 but continues to be actively involved with the team. He first appeared as a “Shark” on ABC's Emmy Award–winning hit business show Shark Tank in 2011 and quickly established himself as one of the most popular and tough Sharks, investing millions of dollars in hundreds of small businesses. He's been nominated nine times for an Emmy for Shark Tank. His last appearance on the program was during season 16 in May 2025. In 2019, Mark co-founded costplusdrugs.com. Its launch on January 19, 2022, with transparent pricing and a limited markup, has fundamentally changed the pricing of medications in the United States. Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of SEIU 32BJ have easy and sustained access to affordable, high-quality healthcare. Cora has prioritized a data-driven approach, focusing on reducing trend, solving the affordability challenge on behalf of union members, and, most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. In 2024, Cora conducted an innovative medical request for proposal, stipulating that all finalists have a signature-ready contract drafted by the 32BJ Health Fund prior to award. As a result, the Fund negotiated an agreement that brought unprecedented visibility and increased accountability to its benefit. In 2025, the Health Fund is focused on direct-contracting opportunities that allow it to carve out key benefits and ensure quality while managing spend. Cora is regarded as an expert in pharmacy benefit management and was recently appointed to the Board of Governors for the National Alliance for Healthcare Purchaser Coalitions and the Purchaser Advisory Council for the National Quality Forum and Joint Commission. She previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations, strategy, and acquisitions. Cora earned an MBA from Saint Louis University.   06:25 What was the original rationale behind high deductibles? 07:38 How high deductibles are creating a class of functionally uninsured people. 09:29 EP482 with Preston Alexander. 10:20 “We're using health insurance as a proxy for healthcare.” —Mark 12:30 How providers are now in the debt collecting business rather than the healthcare business. 12:55 EP486 with Stan Schwartz, MD. 15:16 “We have a fundamental reasonability problem.” —Cora 16:07 EP425 with Marshall Allen. 18:25 Direct contracting versus self-funded employers. 19:27 EP436 with Elizabeth Mitchell. 19:30 EP480 with Kimberly Carleson. 19:33 EP372 with Cora Opsahl. 23:53 Why the current system doesn't allow the accountability that is needed. 24:39 EP452 with Cora Opsahl. 26:34 How direct contracting gives strength back to independent practices that high deductible plans take away. 27:46 Who pays, what's the price, and where does the power lie? 31:24 EP419 with Andreas Mang. 34:45 How it comes down to power and leverage when controlling healthcare costs. 38:13 EP483 (Part 1 and Part 2) with Jonathan Baran. 38:35 Why putting together a network and just buying healthcare—not discounts—is not as difficult as it seems. 40:10 Why we need to stop talking about disruption and start talking about change. 40:56 EP453 with Claire Brockbank. 41:02 EP484 with Dave Chase. 43:07 EP485 with Cristin Dickerson, MD. 44:32 EP487 (Part 1) with Kevin Lyons. 46:34 EP466 with Vivian Ho, PhD. 47:40 Why it's the incentives that are different between American hospitals and hospitals in a single-payer program. 50:25 The main takeaways from the conversation. 51:08 Why you can't fix the problems in healthcare without transparency.   You can learn more at markcubancompanies.com and costplusdrugs.com and follow Mark on LinkedIn, Bluesky, Threads, and X. You can follow Cora on LinkedIn.   @mcuban of @costplusdrugs and Cora Opsahl discuss trust and simplicity in #healthcare on our #healthcarepodcast. #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Kevin Lyons (Part 2), Kevin Lyons (Part 1), Dr Stan Schwartz (EP486), Dr Cristin Dickerson, Elizabeth Mitchell (Take Two: EP436), Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander

One of the biggest drivers of high drug prices in America is the opaque rebate system between pharmaceutical companies and insurance providers, where savings rarely reach the patient. In this episode, Vinay Patel explains how drug prices are formed, from R&D and manufacturing to complex negotiations involving insurers and pharmacy benefit managers. He breaks down the mechanics of rebates, formulary restrictions, and the consolidation of power among PBMs, showing how these hidden forces raise prices and limit access. He also offers promising alternatives like cost-plus pricing models and calls on employers to take control of their health care contracts to cut costs. Tune in and learn how this broken system works, and what it might take to fix it! Learn more about your ad choices. Visit megaphone.fm/adchoices

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

On this episode of #TheShot of #DigitalHealth Therapy, Jim Joyce and I welcomed Mark S. Gaunya, GBA, LIA - benefits innovator, wrestling fanatic, rugby convert, and author - who's on a mission to transform healthcare from a cost center into an asset. From cutting weight in high school wrestling to cutting healthcare costs, Mark brings equal parts grit, vision, and humor to the conversation. Some highlights:

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.

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)  

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

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

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

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 

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  

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. 

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

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