Podcasts about pbms

Understanding Trump's Executive Order on Drug Pricing | ShiftShapersIn this episode of ShiftShapers, host David A. Saltzman welcomes Tiffany Ryder, emergency medicine PA, host of Healthcare Liberty Lab, and writer at Red Flag Hero on Substack. Tiffany breaks down President Trump's executive order on drug pricing and what it could mean for patients, providers, and pharmaceutical companies.She explores key issues like most favored nation pricing, transparency in drug costs, and the role of PBMs and middlemen. Drawing from her frontline experience and policy knowledge, Tiffany explains how these changes may impact everything from consumer behavior to research and development in the pharmaceutical world.

Analyzing Trump's plan to roll back soaring drug prices for Americans; Sports bras eliminate bounce but may take a toll on women's backs; RFK Jr. targets the chemicals in our food; Do Americans really eat more animal protein than any other of the world's nations? Causes and treatments for pulmonary hypertension.

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

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

In this episode, host Stacey Richter speaks with Ann Lewandowski about whistleblowing in the healthcare industry, focusing on a significant case involving a whistleblower at an employee benefit consultant (EBC) firm. This EBC allegedly pocketed their clients' pharma rebates, violating the Consolidated Appropriations Act of 2021.  The discussion highlights the nuances of being a whistleblower, the ethical dilemmas faced, compliance challenges, and the significant financial implications for companies and individuals involved in illegal activities.  Ann Lewandowski provides insights into documenting and protecting oneself legally and discusses the broader context of trust and transparency in the healthcare sector. Click through to the show notes below to access all of the mentioned links and prior episodes mentioned. === LINKS ===

Are billion-dollar secrets hiding in plain sight every time you pick up a prescription? While most of us trust the price tags and availability of life-saving medications, who's really pulling the strings—and why aren't these stories front-page news? In an era when legal battles against corporate giants can change lives and headlines, we need transparency and we need it now. This week on Cut to the Chase: Podcast, we're diving deep into the explosive world of pharmaceutical litigation with Mike Papantonio, legendary trial attorney, legal commentator, and acclaimed author. Mike's latest novel “The Middleman” pulls back the curtain on the mysterious—and disturbingly powerful—pharmacy benefit managers (PBMs) who are quietly shaping the cost and availability of vital medicines. The PBM industry is a $300 billion behemoth—raising medication costs across the board by up to 50%. Most Americans, including seasoned professionals, have no idea these gatekeepers exist. Tune in to hear how real courtroom drama translates into gripping fiction, what's really driving up drug prices, and what lawyers must know to make a transformative impact—financially and socially—through mass tort litigation. What you'll learn in this episode: The shocking influence and unchecked power of pharmacy benefit managers (PBMs)—and how they're raising drug prices, taking kickbacks, and operating as a modern-day mob Insider details from landmark cases (tobacco, opioids, human trafficking, Wall Street scams) and how those stories shape Mike's writing The criminal-like conduct behind life-saving drug pricing, vertical integration, and extortion in the pharma industry How whistleblowers drive 40% of mass tort cases—why they matter and how law firms can support them Tips for trial lawyers and young attorneys on building a meaningful, profitable practice—the legacy case approach A sneak peek at Mike's upcoming book, “Death in Arcadia,” exposing corruption and abuse in America's reform schools Key Takeaways: Look Beyond the Headlines: Mainstream media often misses (or avoids) big stories; legal professionals must dig deeper and use insider knowledge to expose injustice. Leverage Whistleblower Potential: Proactively support and educate potential whistleblowers—40% of mass torts begin with insider revelations. Consider Legacy Cases: Don't just chase profits—choose cases that have lasting impact and can become the cornerstone of your reputation. Educate Through Storytelling: Use creative outlets—novels, blogs, podcasts—to inform and inspire both the public and fellow attorneys. Adapt to Changing Legal Landscapes: Stay alert to new threats—PBMs, antitrust schemes, white-collar criminality—that need legal champions willing to take action.   Stay tuned for more updates, and don't miss our next deep dive on Cut to The Chase: Podcast with Gregg Goldfarb!   Subscribe, rate, review, and share this episode of the Cut to the Chase: Podcast!   Resources: Buy “The Middleman: A Legal Thriller” by Mike Papantonio: https://www.amazon.com/dp/1648211054 Connect with Mike Papantonio on LinkedIn: https://www.linkedin.com/in/mikepapantonio  Visit his website - Ring of Fire: https://trofire.com Subscribe to his YouTube channel - America's Lawyer: https://www.youtube.com/@TheRingofFire  Follow Mike on Instagram: https://www.instagram.com/rofpap Learn more about Mike's legal career: https://levinlaw.com/our_team/mike-papantonio    This episode was produced and brought to you by Reignite Media.

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma e Biotech world.Bayer has announced a restructuring that will result in 2,000 job cuts and a reduction in management layers. CEO Bill Anderson believes Trump's most favored nations policy could provide an opportunity for European countries to contribute more to biopharma innovation. Galapagos has abandoned plans for a spinout and cell therapy, causing a stir in the industry. Trump's most favored nation policy has led to a sell-off of PBMs, but analysts believe it may not have a significant impact without further congressional action. Sino Biological offers solutions for autoimmune diseases, with reagents for nearly 50 different conditions. In other news, CMS is preparing for a new cycle of drug negotiations, Azafaros has raised $150 million for rare neuro-metabolic diseases, and Roche's Genentech is investing $700 million in a North Carolina plant. 10x Genomics has cut 8% of its workforce, and there are upcoming webinars on biotech downturns and AI in life science R&D. Job opportunities include positions at 4D Molecular Therapeutics, Takeda, and Regeneron Pharmaceuticals.

ChatGPT & Jae Explain: POTUS Rx FixBrief DescriptionJae and Cass break down the explosive Most Favored Nation (MFN) executive order and its seismic threat to Big Pharma, PBMs, and the insurance industry. Learn why this isn't just price reform—it's a full-blown system shock, and why Jae saw it coming before the ink was dry.In This Video00:00:00 Cold Open – MFN Drops Like a Bomb00:00:35 Jae Predicted It – MFN Was Always the Domino00:02:15 What Most Favored Nation Pricing Actually Means00:04:00 Why the Benchmark Matters – Leveling the Global Field00:05:30 Graceful Exemption – Carveouts for the Poorest Nations00:07:00 Transfer Pricing – Cracking the Code of U.S. Drug Opacity00:09:00 MFN's Domino Effect on Employer Plans & Medicare Advantage00:11:00 PBMs in the Crosshairs – Toll Takers Face Transparency00:13:00 Insurers' Identity Crisis in a Post-MFN World00:16:00 Wall Street Panic & the Coming Industry Shakeout

And welcome back to the program. Well, president Trump signed an executive order today to lower pharmaceutical prices here in The United States. And, boy, that is welcome news because there's a lot about this that we don't know. Now we pay dramatically more here in this country than they do in other countries for the same pharmaceuticals. In fact, president Trump had an little bit of an anecdote about that today. I mean, I'll tell you a story. A friend of mine who's a a businessman, very, very, very top guy. Most of you would have heard of him. A highly neurotic, brilliant businessman, seriously overweight, and he takes the fat the fat shot drug. And he called me up, and he said, president. He calls me he used to call me Donald. Now he calls me president, so that's nice respect. But he's a rough guy, smart guy. Very successful, very rich. I wouldn't even know how we would know this, but because he's got comments. Said, president, could I ask you a question? What? I'm in London, and I just paid for this damn fat drug I take. I said, it's not working, they said. He said, I just paid $88, and in New York, I paid $1,300. What the hell is going on? Exactly. I love that. It's not working. That that's great. But we do we pay a lot more here than other countries do. Because you see and the big thing that they always talk about, oh, y'all, you know, we got research research and development, and we've got yada yada, and we've gotta pay for this and that, and we've gotta do well, why doesn't anybody else have to pay for it? Why isn't a a drug the same price in London as it is in The United States? Why isn't a a pharmaceutical the same price in Canada as it is here in The United States? Listen to what RFK Junior said. This is this is pretty darned amazing. It really is. Mister secretary, Trump says some prices will come down almost immediately. What is the timetable for these price cuts? Well, there's a series of escalating steps, but you know what? That that will bring them down to European levels. Right now, we spend we provide America provides 75% of the pharmaceutical revenues in the world, and we only have 4.2% of the world's population. Sure. We're paying in, in our country, the list price for Ozempic is $1,300 per dose. In London, it's $88. And Democratic and Republican politicians have been talking about for years, we gotta end these discrepancies. Nobody has had the courage to do it because of the power of the pharmaceutical lobby on Capitol Hill. K. The the and and answer your question, how soon will this happen, it it depends on how enthusiastically the drug companies cooperate. There are a series of escalating steps that we will take if they don't cooperate. But we're very you know, we've been meeting with the pharmaceutical companies. They admit that this is something that is should have ended a long time ago. And I think they're ready to figure out a way to get there. And they have advantages to this executive order, Stewart. Okay. Because we got rid of the PBMs. We got rid of the middlemen, and that's something that they've wanted themselves. Now here's the big question. Why aren't the Democrats celebrating this? I mean, after all, hey, then we just go back to Bernie Sanders. Back in 2016, Bernie Sanders ran on big pharma. Let's take a listen to what he said. Here we go. We pay in this country the highest prices in the world for prescription drugs. Maybe, just maybe, it might be time for the United States Senate to stand up to the pharmaceutical industry and all of their lobbyists here and all of their campaign contributions and say we're gonna stand with the American people who are sick and tired of being ripped off by the drug companies. There there are many reasons why we pay such outrageous prices, but one reason is we continue passing laws written by the pharmaceutical industry and their lobbyists year after year after year. I believe that the American people should know that the pharmaceutical industr ...

And welcome back to the program. Well, president Trump signed an executive order today to lower pharmaceutical prices here in The United States. And, boy, that is welcome news because there's a lot about this that we don't know. Now we pay dramatically more here in this country than they do in other countries for the same pharmaceuticals. In fact, president Trump had an little bit of an anecdote about that today. I mean, I'll tell you a story. A friend of mine who's a a businessman, very, very, very top guy. Most of you would have heard of him. A highly neurotic, brilliant businessman, seriously overweight, and he takes the fat the fat shot drug. And he called me up, and he said, president. He calls me he used to call me Donald, now he calls me president. So that's nice respect, but he's a rough guy, smart guy, Very successful, very rich. I wouldn't even know how we would know this, but because he's got comments. So president, could I ask you a question? What? I'm in London, and I just paid for this damn fat drug I take. I said, it's not working, they said. He said, I just paid $88. And in New York, I paid $1,300. What the hell is going on? Exactly. I love that. It's not working. That that's great. But we do we pay a lot more here than other countries do. Because you see and the big thing that they always talk about, oh, you know, we got research and development, and we've got yada yada, and we've gotta pay for this and that, and we've gotta do well, why doesn't anybody else have to pay for it? Why isn't a a drug the same price in London as it is in The United States? Why isn't a a pharmaceutical the same price in Canada as it is here in The United States? Listen to what RFK Junior said. This is this is pretty darned amazing. It really is. Mister secretary, Trump says some prices will come down almost immediately. What is the timetable for these price cuts? Well, there's a series of escalating steps, but you know what? The that that will bring them down to European levels. Right now, we spend we provide America provides 75% of the pharmaceutical revenues in the world, and we only have 4.2% of the world's population. Sure. We're paying in, in our country, the list price for Ozempic is $1,300 per dose. In London, it's $88. And Democratic and Republican politicians have been talking about for years, we gotta end these discrepancies. Nobody has had the courage to do it because of the power of the pharmaceutical lobby on Capitol Hill. K. And and answer your question, how soon will this happen, it it depends on how enthusiastically the drug companies cooperate. There are a series of escalating steps that we will take if they don't cooperate. But we're very you know, we've been meeting with the pharmaceutical companies. They admit that this is something that is should have ended a long time ago, and I think they're ready to figure out a way to get there. And they have advantages in this executive order, Stuart. K. Because we got rid of the PBMs. We got rid of the middlemen, and that's something that they've wanted themselves. Now here's the big question. Why aren't the Democrats celebrating this? I mean, after all, hey, then we just go back to Bernie Sanders. Back in 2016, Bernie Sanders ran on big pharma. Let's take a listen to what he said. Here we go. We pay in this country the highest prices in the world for prescription drugs. Maybe, just maybe, it might be time for the United States Senate to stand up to the pharmaceutical industry and all of their lobbyists here and all of their campaign contributions and say we're gonna stand with the American people who are sick and tired of being ripped off by the drug companies. There there are many reasons why we pay such outrageous prices, but one reason is we continue passing laws written by the pharmaceutical industry and their lobbyists year after year after year. I believe that the American people should know that the pharmaceutical industry has spent more than $3,000 ...

In this episode, we unpack the Supreme Court's unanimous decision in Cunningham v. Cornell University — a landmark ERISA case with major implications for retirement and health plan fiduciaries. We explain the facts behind the case, what “prohibited transactions” really mean, and why the Court's ruling on affirmative defenses matters. If your health plan pays fees to TPAs, PBMs, IDR vendors, or brokers, this episode is for you.

Send us a textSchedule an Rx AssessmentIs Your Pharmacy Prepared for a Cyberattack?In this episode of The Bottom Line Pharmacy Podcast, Scotty Sykes, CPA, CFP and Austin Murray sit down with Trenton Thiede, President of PAAS National, to unpack the rising cybersecurity threats facing independent pharmacies and what owners must do to stay compliant and protected.We dive into everything from:HIPAA compliance updatesAI risks, multi-factor authentication, and risk assessmentsThe growing pressure of PBM audits and the need for strong advocacyClick here for the transcriptMore About Our Guest:Trenton Thiede is the President of PAAS National (Pharmacy Audit Assistance Service).Trenton started his journey working at Shopko, a community pharmacy, in 1999 for 15 years, holding positions as Pharmacy Manager and Regional Pharmacy Supervisor while completing his PharmD from UW-Madison and MBA from UW-Oshkosh.In 2013, Trenton took over Shopko's Long-Term Care division and helped divest it to KPH HealthCare (Kinney Drugs/HealthDirect).There, he helped grow their business throughout the Midwest, eventually servicing 20,000 beds in just under four years. In 2018, Trenton joined PAAS and oversees the daily operations as President.With his operations experience, Trent knows what's involved, and at stake, with pharmacy audits; taking pride in helping independent pharmacies win against ruthless PBMs.Learn more about Trenton and PAAS National:Trenton Thiede LinkedInPAAS National WebsitePAAS National FacebookPAAS National Twitter (X)PAAS National LinkedInStay up to date on new episodes by liking and subscribing!Check out all our social media:FacebookTwitterLinkedInScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP TwitterMore resources on this topic:Podcast – Fraud, Waste, and Abuse Audit UpdatesPodcast – Pharmacy Audit Master Class: Strategies for Audit Success

We take a deep dive into the lesser-known industry of “pharmacy benefits managers” (PBMs) which are parasitical companies that sit in the middle of the incredibly consolidated and vertically integrated market of pharmaceuticals hospitals insurers pharmacy benefits managers pharmacies. Through the simple administrative business of making lists of drugs and networks of pharmacies, PBMs have managed to carve out a multi-billion dollar rent-seeking industry premised on controlling (and jacking up) how much drugs cost and where you can get them—and extracting as much money as possible from people who need those drugs. ••• Timeline of FTC lawsuit against PBMs and relevant documents: https://www.ftc.gov/legal-library/browse/cases-proceedings/221-0114-caremark-rx-zinc-health-services-et-al-matter-insulin ••• Concurring Statement of Commissioner Andrew N. Ferguson https://www.ftc.gov/system/files/ftc_gov/pdf/Ferguson-Statement-Pharmacy-Benefit-Managers-Report.pdf ••• Market Power and Inequality: The Antitrust Counterrevolution and Its Discontents | Lina Khan and Sandeep Vaheesan https://scholarship.law.columbia.edu/faculty_scholarship/2790/ ••• Inside the Mafia of Pharma Pricing | Matt Stoller https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing ••• A brief look at current debates about pharmacy benefit managers https://www.brookings.edu/articles/a-brief-look-at-current-debates-about-pharmacy-benefit-managers/ Standing Plugs: ••• Order Jathan's new book: https://www.ucpress.edu/book/9780520398078/the-mechanic-and-the-luddite ••• Subscribe to Ed's substack: https://substack.com/@thetechbubble ••• Subscribe to TMK on patreon for premium episodes: https://www.patreon.com/thismachinekills Hosted by Jathan Sadowski (bsky.app/profile/jathansadowski.com) and Edward Ongweso Jr. (www.x.com/bigblackjacobin). Production / Music by Jereme Brown (bsky.app/profile/jebr.bsky.social)

Gina Alsdorf has more than 15 years of experience in employee benefits, working on complex issues involving ERISA, employee benefit plans, and related laws. Her past clients include trustees, plan committees, plan sponsors, consultants, registered investment advisors, broker-dealers, banks, insurance companies, third-party administrators, and recordkeepers for retirement plans and individual retirement accounts. Gina received her JD, cum laude from University of Georgia Law School and was awarded an LLM in Employee Benefits with honors, from the University of Illinois, Chicago Law School.In this episode, Eric and Gina Alsdorf discuss:Evaluating PBM contracts with expert oversightPrioritizing transparency in pricing modelsAlign PBM incentives with participant outcomes, if possibleInvest in education and oversight for long-term successKey Takeaways:Engage legal and consulting professionals to analyze contract terms, ensuring alignment with fiduciary responsibilities and plan objectives.Understand the financial structure of PBM arrangements, favoring models that clearly show how costs and profits are distributed.Select partners and structures that place plan participant benefit above corporate profit, especially in vertically integrated PBM organizations.Encourage continuous learning and mentorship among benefit managers to adapt to a complex and evolving pharmacy benefits landscape.“ERISA does not give you the duty to go for the cheapest price. You're supposed to get the best service for the money for your people.” - Gina AlsdorfConnect with Gina Alsdorf:Website: https://www.carltonfields.com/team/a/gina-alsdorf LinkedIn: https://www.linkedin.com/in/gina-alsdorf/ Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information and content of this podcast is general in nature and is 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.

In this month's Digital Health Download, Steve and Halle unpack the headlines shaping healthcare, policy, and technology—with an eye toward where things may be heading next. From shifting political support for Medicaid and the ACA to state-level action on PBMs, they explore the unexpected ways the system is evolving.We cover:

North Carolina's House Bill 163 would require pharmacies to be reimbursed at NADAC (National Average Drug Acquisition Cost) plus a fair dispensing fee, which would protect NC pharmacies - ensuring they can stay in business and continue providing critical care to patients. As usual, PBMs are spreading misinformation designed to scare patients and lawmakers by mislabeling these reforms as “taxes” and falsely claiming reforms will increase premiums.Join the PUTT cocktail crew with NC pharmacy owners Wes Hickman, PharmD, & Stephen Joyce, RPh (PUTT board member) as they break down the benefits of HB 163, dispel the myths that PBM deceptions create, and discuss the importance of building strong relationships - because when it comes to pharmacy issues and helpful reform legislation, pharmacists really are the smartest people in the room.Music by JuliusH | Production & Editing by Shannon Wightman-Girard

Ever had to wait 45 minutes in the lobby just to wait another 30 in the exam room while imagining your doctor is in the back watching YouTube? In this episode, I break down what's really going on behind the scenes of a chaotic clinic day—and no, it's not lunch. Plus, a very satisfying rant about healthcare corporatization, a strangely relaxing moment involving blood in the eye (someone else's, not mine), and an update on Arkansas doing something good (I know, I'm surprised too). I also ask an important question: is it fair to say sneezing too hard might ruin your vision? Yes. Yes, it is. Takeaways: If I Could Wire My Brain to Every Patient's Brain, I Would. But since that tech doesn't exist, here's a 45-minute explainer on why your wait time is not me scrolling TikTok in a break room. Private Equity, Insurance Companies, and the Slow Death of My Schedule. Who's really making your doctor run behind? Spoiler: it's not your doctor. Arkansas Just Did Something Cool? I'm Shook. Finally, some legislation that takes aim at PBMs. Can we get 49 more of these, please? Sneezing Shouldn't Break Your Eye… But It Might. A 24-year-old. A sudden cloud in his vision. And the diagnosis I didn't expect to make until he mentioned allergy season. Yes, There Was Blood. But Only a Thimbleful. Ophthalmology is rarely a bloody field. But when it is, it gets… weirdly poetic. — 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.  Today's episode is brought to you by DAX Copilot from Microsoft. DAX Copilot is your AI assistant for automating clinical documentation and workflows helping you be more efficient and reduce the administrative burdens that cause us to feel overwhelmed and burnt out. To learn more about how DAX Copilot can help improve healthcare experiences for both you and your patients visit ⁠aka.ms/knockknockhi⁠. To learn more about Pearson Ravitz go to http://www.pearsonravitz.com/knockknock. Produced by⁠ Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the NASP Podcast, Sheila Arquette, President & CEO of NASP, speaks with Jeffrey S. Baird, Esq., Chairman of the Health Care Group at Brown & Fortunato, P.C. and Bradley W. Howard, shareholder and director at Brown & Fortunato, P.C. In today's environment, it is challenging enough to profitably run a specialty pharmacy. The pharmacy needs to avoid the additional challenge of inquiries, audits and investigations by governmental agencies and PBMs. This podcast will discuss the proactive steps the specialty pharmacy can take to lower the risk of inquiries, audits and investigations. This podcast will also set out steps the pharmacy can take to resolve inquiries, audits and investigations before they spin out of control. The podcast will focus on the following: • Corporate Compliance Program – The specialty pharmacy needs to implement a robust compliance program that is specific to the pharmacy's business model. Such a program will head off many problems before they arise…and a compliance program will resolve problems, once arisen, before they spin out of control. • PBMs – A PBM is in a stronger negotiating position than that of the specialty pharmacy. At the end of the day, the PBM “possesses the pharmacy's money.” This podcast will discuss the steps the pharmacy should take to establish a “win-win” relationship with a PBM. Doing so will eliminate uncertainty and prevent many problems from arising. However, if the PBM ends up bringing an inquiry, audit or investigation against the pharmacy, the podcast will set out the steps the pharmacy should take to resolve the inquiry, audit or investigation without it devolving into an adversarial action. • Governmental Agencies – There are a number of federal and state governmental agencies that a specialty pharmacy may have to deal with. These include (i) the Department of Justice, (ii) the Office of Inspector General, (iii) the DEA, (iv) the FDA, (v) state Attorneys General, and (vi) State Boards of Pharmacy. This podcast will discuss the steps the pharmacy should take when it is investigated by a governmental agency. As with working with PBMs, the pharmacy should strive to resolve a government investigation before it spins out of control. 

Jacob and Nikhil sit down with Otto Sipe. Otto is the CEO and Co-Founder of Photon Health, which enables patients to select their own pharmacies with price and inventory transparency. The company has raised over $16 million from investors including Flare Capital Partners and Notation Capital. They discuss where pharmacies and PBMs are headed, the evolution of E-Prescribing, the impact of GLP-1s & AI, and more. (0:00) Intro(0:51) History and Evolution of E-Prescribing(3:02) Challenges in Current E-Prescribing Systems(6:28) Photon Health's Innovative Approach(8:17) Patient and Provider Behavior Changes(11:21) Pharmacy Industry Landscape and Future(13:43) Interactions with PBMs and Market Dynamics(16:48) Future of PBMs and Drug Pricing(20:38) Quality and Marketplace Experience in Pharmacies(23:30) Advising Independent Pharmacies for Future Success(24:24) Challenges and Strategies in Retail Pharmacy(25:45) Pharmacy Economics and Supply Chain Issues(30:21) The Role and Potential of Pharmacists(36:01) AI in Pharmacy: Photon's Approach(38:28) Quickfire Out-Of-Pocket: https://www.outofpocket.health/

When it comes to pharmacy benefits, no topics make headlines like GLP-1s and weight loss programs. On this episode of HR Benecast,  Dr. Lia Rodriguez and Erin Bacon from CVS Health share what makes a clinical weight loss program really work. Listen to hear the latest obesity stats, obesity's link to other chronic conditions, the importance of lifestyle changes and more. 

qAM is NCPA's weekday email newsletter. Subscribe at ncpa.org/qam. Hosted by Sam Manas (smanas@ncpa.org).   Today's stories: NCPA urges DOGE to focus on PBMs for waste, fraud, and abuse   - https://bit.ly/4cNTTJb PhRMA report: 25 percent tariff could hike prices by up to 12.9 percent - https://bit.ly/3RzWmNx Ohio shows PBM and Medicaid reforms save money  - https://bit.ly/3YjsU25   For more information on our Congressional Pharmacy Fly-In, please visit our website here: https://ncpa.org/congressional-pharmacy-fly   Want to catch up on what else we've shared in qAM? You can find a running list of our stories, and Executive Update columns from NCPA CEO Douglas Hoey, on our website's Member Publications section (https://ncpa.org/news#memberpub).

How One Leader Came Out of Retirement to Transform Home Healthcare Jasper Freeman, Director of National Accounts at SC Pharmaceuticals, didn't just return to medical sales—he came back with a mission to change it. In this episode, Jasper shares how he helped launch Ferosix, a revolutionary heart failure treatment designed to keep patients out of the hospital and improve care at home. But that's just the beginning. We dive into: The untold story of Pharmacy Benefit Managers (PBMs) and their massive influence over drug pricing and access Why the insurance-sales-patient triangle is the key battleground in healthcare innovation What the U.S. can learn from other countries about lowering costs and improving care Bold reform ideas—from slashing med school tuition to rethinking drug distribution This is a rare, behind-the-scenes look at the business of healthcare, guided by someone who's lived it at the highest levels. If you're in medical sales—or trying to break in—this episode is a masterclass on what's next and how to lead the change. Connect with Jasper: LinkedIn Connect with Me: LinkedIn Love the show? Subscribe, rate, review, and share! Here's How » Want to connect with past guests and access exclusive Q&As? Join our EYS Skool Community today!

The Hidden Math Behind Drug Pricing: Why Patients Pay More Than They ShouldIn this episode, Michael Grosberg, VP of Product Management at Model N, breaks down the complex drug pricing ecosystem—revealing how rebates, PBMs, and outdated pricing models shape what patients actually pay.You'll learn how Pharmacy Benefit Managers (PBMs) really operate, why list prices are misleading, and how pricing negotiations impact patient access. Michael also unpacks the mechanics behind patient assistance programs, the role of compounding and independent pharmacies, and how emerging technology can bring transparency and efficiency to a broken system.Whether you're in life sciences, healthcare tech, or just want to understand why your prescription costs what it does—this is a must-listen conversation.

In this episode of Product in Healthtech, we reconnect with Scott Martin, founder and CEO of Rescription, to discover how his company has evolved since our previous conversation.Topics covered:Rescription's "radical clarity" approach to transforming prescription drug costsHow Rescription leverages the 340B federal program as intended to benefit both health systems and patientsResults from partnerships with Bergen New Bridge and Baton Rouge General, showing 27-35% savingsWhy patients under Rescription's model receive zero-dollar copays for prescriptionsThe patent-pending adjudication technology developed with Vynyl that enables upfront processing at scaleRescription's ambitious expansion plans across 14 states and 15 additional health systemsKey moments:[01:16] Scott explains how Rescription's model differs from traditional PBMs[03:09] Clarifying misconceptions about the 340B program[05:14] Updates on partnerships with Bergen New Bridge and Baton Rouge General[07:25] How Rescription addresses pharmaceutical manufacturer pushback[09:24] Details on Rescription's patent-pending adjudication technology[11:15] Future expansion plans and new service offeringsResources mentioned:Wall Street Journal article featuring Rescription (link to be added)Follow Product in Healthtech:Website: productinhealthtech.comLinkedIn: Product in HealthtechEmail: info@productinhealthtech.com Product in Healthtech is community for healthtech product leaders, by product leaders. For more information, and to sign up for our free webinars, visit www.productinhealthtech.com.

In this powerful episode of This Week in Pharmacy, Todd Eury explores the growing national backlash against pharmacy benefit managers (PBMs)—starting with bold action in Arkansas. Following Gov. Sarah Huckabee Sanders' recent signing of legislation to limit PBM influence, Arkansas has become a flashpoint in the nationwide struggle to protect independent pharmacies and ensure fair drug pricing. Special guest from Arkansas, Doctor's Orders Pharmacy Owner, Lelan Stice, as we dig into what this legislation means, how states like Alabama are following suit, and why pharmacists across the U.S. are calling for transparency, accountability, and reform. PBMs are under increased legal and political scrutiny across multiple states Independent pharmacies are gaining new allies in their fight for survival Legislative momentum is growing—this could be a tipping point Patients, too, are paying the price for PBM overreach Pharmacists must stay informed and involved in local/state policy Full AP article: APNews.com – Arkansas Takes on PBMs TWIRx Feature: Lumicera Health Services Guest: Dr. Ben Heiser, PharmD – General Manager, Specialty Pharmacy, Lumicera Health Services In this special TWIRx segment, This Week in Pharmacy dives into the world of specialty pharmacy with Dr. Ben Heiser of Lumicera Health Services, a nationally recognized leader in delivering specialty drug solutions with a patient-first approach. Dr. Heiser discusses how Lumicera leverages data-driven care models, collaborative payer partnerships, and a commitment to access and affordability to redefine what it means to support patients with complex, chronic conditions. From pharmacy innovation to value-based outcomes, this interview offers a behind-the-scenes look at one of the most forward-thinking organizations in specialty care. Lumicera Health is the Pharmacy Podcast Network sponsor for the AXS25 Press Coverage, learn more about  Lumicera here:  https://www.lumicera.com/  Subscribe to all 40+ Pharmacy Podcast Network podcasts from one link:  https://linktr.ee/pharmacypodcast 

An insider's look at the games PBMs play to hid fees and tack profits for community pharmacies. What a true transparent PBM should look like and why it matters.   

Ralph speaks to Washington Post columnist Dana Milbank about the Trump Administration's path of destruction in our federal government. Then, Ralph welcomes legendary public interest lawyer Alan Morrison to discuss the President's authority to impose tariffs and other constitutional questions.Dana Milbank is a nationally syndicated op-ed columnist for the Washington Post. He also provides political commentary for various TV outlets, and he is the author of five books on politics, including the New York Times bestseller The Destructionists and the national bestseller Homo Politicus. His latest book is Fools on the Hill: The Hooligans, Saboteurs, Conspiracy Theories and Dunces who Burned Down the House.I shouldn't be amazed, but Mike Johnson never ceases to amaze me with the rapidity with which he'll just drop to his knees whenever Trump says something.Dana MilbankWe're going to know this shortly, but it does appear that Trump's honeymoon may be over in the House as the conservatives finally seem to be finding their backbones. But I've thought that might happen before and then only to find out that they, in fact, they could not locate their backbones. So I don't want to be premature.Dana MilbankTrump seems to be gambling (and the administration seems to be gambling) that ultimately the Supreme Court is going to a wholesale reinterpretation of the Constitution to grant these never-before-seen executive powers, and it's possible that he's right about that. We're not going to know that. There have been a couple of preliminary rulings that seem friendly to Trump, but none of those is final, so we can't really be sure of it.Dana MilbankMy guess is that Chief Justice Roberts is seeing his legacy heading toward the ditch after his decision of Trump v. United States, where he said that Presidents cannot be criminally prosecuted….My guess is he's going to unpleasantly surprise Trump in the coming months.Ralph NaderAlan Morrison is the Lerner Family Associate Dean for Public Interest & Public Service at George Washington Law School. He currently teaches civil procedure and constitutional law, and previously taught at Harvard, NYU, Stanford, Hawaii, and American University law schools. He has argued 20 cases in the Supreme Court and co-founded the Public Citizen Litigation Group in 1972, which he directed for more than 25 years.It's inevitable that even for a non-economist like myself to understand that [the costs of tariffs] are going to be passed on. Other than Donald Trump, I don't think there's anybody who believes that these taxes are not going to be passed on and that they're going to be borne by the country from which the company did the exporting.Alan MorrisonIt's an uphill battle on both the statutory interpretation and the undue delegation grounds, but our position is rather simple: If the Congress doesn't write a statute so that there's something that the government can't order or do, then it's gone too far. In effect, it has surrendered to the President its power to set policy and do the legislative function. Interestingly, Trump has trumpeted the breadth of what he's doing here. He calls it a revolution. Well, if we have revolutions in this country, my copy of the Constitution says that the Congress has to enact revolution and the President can't do it on its own. So we think we've got a pretty strong case if we can get it to court.Alan MorrisonOne of the things that I've been struck by is that laws alone cannot make this country governable. That we can't write laws to cover every situation and every quirk that any person has, especially the President. We depend on the norms of government—that people will do things not exactly the way everybody did them before, but along the same general lines, and that when we make change, we make them in moderation, because that's what the people expect. Trump has shed all norms.Alan MorrisonNews 4/9/251. Our top story this week is the killing of Omar Mohammed Rabea, an American citizen in Gaza. Known as Amer, the BBC reports the 14-year-old was shot by the Israeli military along with two other 14-year-old boys “on the outskirts of Turmus Ayya” on Sunday evening. Predictably, the IDF called these children “terrorists.” According to NJ.com – Rabea formerly resided in Saddle Brook, New Jersey – Rabea's uncle sits on the board of a local Palestinian American Community Center which told the press “The ambulance was not allowed to pass the checkpoint for 30 minutes, a denial in medical treatment that ultimately resulted in Amer's death…[his] death was entirely preventable and horrifically unjust. He was a child, a 14-year-old boy, with an entire life ahead of him.” The Rachel Corrie Foundation, founded in honor of the American peace activist killed by an Israeli bulldozer while protesting the demolition of a Palestinian home, issued a statement reading “Rabea's death…was perpetuated by Israeli settlers who act with impunity…We believe that if our own government demanded accountability…Rabea would still be alive.” The Council on American-Islamic Relations (CAIR) has sent a letter to Attorney General Bondi demanding an investigation, but chances of the Trump administration pursuing justice in this case are slim.2. Meanwhile, President Trump seems to be driving the U.S. economy into a deep recession. Following his much-publicized tariff announcement last week – which included 10% tariffs on uninhabited Heard and McDonald Islands – the S&P dipped by 10.5%, among the largest drops in history, per the New York Times. Far from making Trump back off however, he appears dead set on pushing this as far as it will go. After the People's Republic of China responded to the threat of a 54% tariff with a reciprocal 34% tariff, Trump announced the U.S. will retaliate by upping the tariff to a whopping 104% on Chinese imports, according to the BBC. Reuters reports that JP Morgan forecasts a 60% chance of a recession as a result of these tariffs.3. In more foreign affairs news, on Friday April 4th, South Korea's President Yoon Suk Yeol was officially removed from office by that country's Constitutional Court, “ending months of uncertainty and legal wrangling after he briefly declared martial law in December,” per CNN. The South Korean parliament had already voted to impeach Yoon in December of 2024. The court's decision was unanimous and characterized the leader's actions as a “grave betrayal of the people's trust.” Upon this ruling being handed down, Yoon was forced to immediately vacate the presidential residence. A new election is scheduled for June 3rd. Incredible what a political and judicial class unafraid to stand up to lawlessness can accomplish.4. Speaking of ineffectual opposition parties, one need look no further than Texas' 18th congressional district. This safe Democratic district – including most of central Houston – was held by Congresswoman Sheila Jackson Lee from 1995 until her death in 2024. According to the Texas Tribune, Lee planned to run yet again in 2024, triumphing over her 43-year-old former aide Amanda Edwards in the primary. However, Lee passed in July of 2024. Edwards again sought the nomination, but the Harris County Democratic Party instead opted for 69-year-old former Houston Mayor Sylvester Turner, per the Texas Tribune. Turner made it to March of 2025 before he too passed away. This seat now sits vacant – depriving the residents of central Houston of congressional representation and the Democrats of a vote in the House. Governor Gregg Abbot has announced that he will not allow a special election before November 2025, the Texas Tribune reports. This is a stunning Democratic own-goal and indicative of the literal death grip the gerontocratic old guard continue to have on the party.5. One ray of hope is that Democratic voters appear to be waking up the ineffectual nature of the party leadership. A new Data for Progress poll of the 2028 New York Senate primary posed a hypothetical matchup between incumbent Senator Chuck Schumer and Democratic Socialist firebrand Congresswoman Alexandria Ocasio-Cortez – and found AOC with a staggering lead of 19 points. This poll showed AOC winning voters under 45 by 50 points, over 45s by eight points, non-college educated by 16 points, college educated by 23 points, Black and white voters by 16 points, and Latinos by 28. Schumer led among self-described “Moderates” by 15 and no other group. It remains to be seen whether the congresswoman from Queens will challenge the Senate Minority Leader, but this poll clearly shows her popularity in the state of New York, and Schumer's abysmal reputation catching up with him.6. Another bright spot from New York, is Zohran Mamdani's mayoral candidacy and specifically his unprecedented field operation. According to the campaign, between April 1st and April 6th, volunteers knocked on 41,591 doors. No mayoral campaign in the history of the city has generated a grassroots movement of this intensity, with politicians traditionally relying on political machines or enormous war chests to carry them to victory. Mamdani has already reached the public financing campaign donation cap, so he can focus all of his time and energy on grassroots outreach. He remains the underdog against former Governor Andrew Cuomo, but his campaign appears stronger every day.7. Turning to the turmoil in the federal regulatory apparatus, POLITICO reports Secretary of Health and Human Services Robert F. Kennedy Jr. has eliminated the Freedom of Information Act offices at the Centers for Disease Control, and other HHS agencies. An anonymous source told the publication that HHS will consolidate its FOIA requests into one HHS-wide office, but “Next steps are still in flux.” In the meantime, there will be no one to fulfill FOIA requests at these agencies. This piece quotes Scott Amey, general counsel at the Project on Government Oversight, who said this “sends a wrong message to the public on the administration's commitment to transparency.” Amey added, “I often say that FOIA officers are like librarians in knowing the interactions of the agency…If you don't have FOIA officers with that specific knowledge, it will slow down the process tremendously.”8. At the Federal Trade Commission, Axios reports the Trump administration has “paused” the FTC's lawsuit against major pharmacy benefit managers, or PBMs, related to “the drug middlemen…inflating the price of insulin and driving up costs to diabetes patients.” The case, filed against CVS Caremark, OptumRx and Express Scripts was halted by the FTC in light of “the fact that there are currently no sitting Commissioners able to participate in this matter.” That is because Trump unlawfully fired the two remaining Democratic commissioners Alvaro Bedoya and Rebecca Slaughter. In a statement, former FTC Chair Lina Khan called this move “A gift to the PBMs.”9. One federal regulatory agency that seems to be at least trying to do their job is the Federal Aviation Administration. According to the American Prospect, the FAA has “[has] proposed [a] rule that would mandate Boeing update a critical communications malfunction in their 787 Dreamliner plane that could lead to disastrous accidents.” As this piece explains, “very high frequency (VHF) radio channels are transferring between the active and standby settings without flight crew input.” The FAA's recommendation in is that Boeing address the issue with an update to the radio software. Yet disturbingly, in one of the comments on this proposed rule Qatar Airways claims that, “[they have] already modified all affected…airplanes with … [the recommended software updates] …However … flight crew are still reporting similar issues.” This comment ends with Qatar Airways stating that they believe, “the unsafe condition still exists.” Boeing planes have been plagued by critical safety malfunctions in recent years, most notably the 2018 and 2019 crashes that killed nearly 350 people.10. Finally, on a somewhat lighter note, you may have heard about Bryan Johnson, the tech entrepreneur dubbed “The Man Who Wants to Live Forever.” Johnson has attracted substantial media attention for his unorthodox anti-aging methods, including regular transfusions of plasma from his own son. But this story is not about Johnson's bizarre immortality obsession, but rather his unsavory corporate practices. A new piece in New York Magazine focuses on the lawsuits filed against Johnson by his all-too-mortal workers, represented by eminent labor lawyer Matt Bruenig. This piece relays how Johnson “required his staffers to sign 20-page NDAs,” and an “opt-in” document which informed his employees they had to be comfortable “being around Johnson while he has very little clothing on” and “discussions for media production including erotica (for example, fan fiction including but not limited to story lines/ideas informed by the Twilight series and-or 50 Shades of Grey.)” Bruenig says, “That stuff is weird,” but his main interest is in the nondisparagement agreements, including the one Johnson's former employee and former fiancée Taylor Southern entered into which has further complicated an already thorny legal dispute between Johnson and herself. Now Bruenig is fighting for Southern and against these blanket nondisparagement agreements in a case that could help define the limits of employer's power to control their workers' speech. Hopefully, Bruenig will prevail in showing that Johnson, whatever his pretensions, truly is a mere mortal.This has been Francesco DeSantis, with In Case You Haven't Heard. Get full access to Ralph Nader Radio Hour at www.ralphnaderradiohour.com/subscribe

We're covering an active week in the Legislature, from PBMs & farm bureau health plans to the cell phone ban & shark attacks. Plus @alexangle_'s dispatch from DC. Todd's guests: ▶️ Senator Arthur Orr ▶️ Alabama Department of Commerce Secretary Ellen McNair

"If you know how a PBM gets paid, that's the best transparency you can ask for.” - Julie WassermanJulie Wasserman, VP of Sales for VerusRx, joined me this week to discuss the PBM industry in 2025. If you're a PBM, how do you gain trust with employers and build plans that work for them? We talk about what every PBM should be doing for their employers, what true transparency looks like, how to reach employees directly through software, and how GLP1s are changing the industry.If you're a PBM or work with them, or are just curious about one of the biggest industries in healthcare, make sure to tune in this week to Self-Funded with Spencer to hear from Julie on what the best practices need to look like.Chapters:00:00:00 What The PBM Industry Should Focus On In 2025 | with Julie Wasserman00:15:07 Increasing Employee Engagement00:20:16 Complexity in the PBM Industry00:25:03 Data-Driven Health Savings for Employers00:31:27 What Does True Transparency Look Like00:49:36 Global Drug Price Discrepancies00:56:38 Incentivizing Cost-Effective Healthcare Decisions in PBMs01:01:11 Financial Risks of Covering GLP1s for Weight LossKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/Key Words: VerusRx, PBM, PBMs, Rebate, Rebates, Pharmacy Rebates, Transparency, PBMIndustry, GLP1, GLP1s, Ozempic, Wegovy, pharma, Reference Based Pricing, RBP, Healthcare Costs, julie wasserman, spencer smith, podcast, healthcare, health insurance, self funded, self funding, self funded health insurance, self funded insurance#VerusRx #PBM #PBMs #Rebate #Rebates #PharmacyRebates #Transparency #PBMIndustry #GLP1 #GLP1s #Ozempic #Wegovy #pharma #ReferenceBasedPricing #RBP #HealthcareCosts #juliewasserman #spencersmith #podcast #healthcare #healthinsurance #selffunded #selffunding #selffundedhealthinsurance #selffundedinsurance

"If you know how a PBM gets paid, that's the best transparency you can ask for.” - Julie WassermanJulie Wasserman, VP of Sales for VerusRx, joined me this week to discuss the PBM industry in 2025. If you're a PBM, how do you gain trust with employers and build plans that work for them? We talk about what every PBM should be doing for their employers, what true transparency looks like, how to reach employees directly through software, and how GLP1s are changing the industry.If you're a PBM or work with them, or are just curious about one of the biggest industries in healthcare, make sure to tune in this week to Self-Funded with Spencer to hear from Julie on what the best practices need to look like.Chapters:00:00:00 What The PBM Industry Should Focus On In 2025 | with Julie Wasserman00:15:07 Increasing Employee Engagement00:20:16 Complexity in the PBM Industry00:25:03 Data-Driven Health Savings for Employers00:31:27 What Does True Transparency Look Like00:49:36 Global Drug Price Discrepancies00:56:38 Incentivizing Cost-Effective Healthcare Decisions in PBMs01:01:11 Financial Risks of Covering GLP1s for Weight LossKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/Key Words: VerusRx, PBM, PBMs, Rebate, Rebates, Pharmacy Rebates, Transparency, PBMIndustry, GLP1, GLP1s, Ozempic, Wegovy, pharma, Reference Based Pricing, RBP, Healthcare Costs, julie wasserman, spencer smith, podcast, healthcare, health insurance, self funded, self funding, self funded health insurance, self funded insurance#VerusRx #PBM #PBMs #Rebate #Rebates #PharmacyRebates #Transparency #PBMIndustry #GLP1 #GLP1s #Ozempic #Wegovy #pharma #ReferenceBasedPricing #RBP #HealthcareCosts #juliewasserman #spencersmith #podcast #healthcare #healthinsurance #selffunded #selffunding #selffundedhealthinsurance #selffundedinsurance

On this episode of IPA's What, Why & How podcast, Kate Gainer welcomes Scott Pace, PharmD, JD, a pharmacy owner and partner at Impact Management Group (IMG), a government relations, public affairs, and consulting firm based in Little Rock, Arkansas. Kate and Scott discuss PBM reform, the role of the courts, PSAOs and more! Scott Pace joined IMG after more than twelve years with the Arkansas Pharmacists Association (APA), where he served as CEO and COO. While at the APA, Pace successfully worked with the legislature to pass scope of practice legislation for pharmacists, legislation to amend the Arkansas Constitution to require a pharmacist consultant be a part of the Arkansas medical marijuana dispensaries, and he worked with Governor Asa Hutchinson and the legislature to pass legislation to license and regulate pharmacy benefits managers (PBMs) in Arkansas. Scott was also instrumental in crafting and passing Arkansas Act 900 of 2015, the pharmacy legislation that was the subject of the landmark Rutledge v. PCMA case that was decided by the U.S. Supreme Court in December of 2020. Connect with us on LinkedIn: Scott Pace Kate Gainer Iowa Pharmacy Association

In this episode I share one of the more difficult days in the OR—when a routine cataract surgery didn't go according to plan. I walk through the moment everything shifted, how I kept my cool, and what came after—both technically and emotionally. If you've ever wondered what it feels like to be a surgeon in that moment, this episode is a rare, honest window into it. Takeaways: Sometimes, Even “Routine” Surgeries Aren't: Dr. Flanary opens up about a recent case that didn't go as expected—and why even years into practice, there are still moments that test every skill you've got. Staying Calm When Things Go Sideways: When a complication unfolds in real time, there's no time to panic. Dr. Flanary shares how he handled a challenging situation, and what surgeons learn to do when instincts and training have to carry the moment. Confidence Doesn't Mean Perfection: Through a powerful metaphor, Dr. Flanary reflects on how surgical confidence evolves—not as certainty that nothing will go wrong, but as the ability to keep moving when it does. Conversations After Complications Matter: How do you talk to a patient—and their family—when the procedure didn't go exactly as planned? Dr. Flanary talks about how he approaches these moments with honesty and trust. The Policies Behind the Pressure: In a classic healthcare rant, Dr. Flanary traces how systems like Medicare Advantage add stress behind the scenes—and why real reform, especially around PBMs, can't come soon enough. — We have an active survey going. Hope you participate here: http://glaucomflecken.com/survey 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:  Anatomy Warehouse 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.  Today's episode is brought to you by DAX Copilot from Microsoft. DAX Copilot is your AI assistant for automating clinical documentation and workflows helping you be more efficient and reduce the administrative burdens that cause us to feel overwhelmed and burnt out. To learn more about how DAX Copilot can help improve healthcare experiences for both you and your patients visit aka.ms/knockknockhi. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of ShiftShapers, host David A. Saltzman sits down with Vinay Patel, PharmD, founder of MakoRX, to expose why prescription pricing remains so confusing—and what can be done to fix it.Patel breaks down how pharmacy benefit managers (PBMs), vertical integration, and opaque pricing structures are driving up costs for patients—while limiting access and undermining local pharmacies. From subscription pharmacy programs to cash-pay and compounding models, Patel shares bold, practical solutions for bringing real transparency back into the healthcare system.

On this episode I sit down with my friend Dave Knapp, an independent journalist and community leader in the world of GLP-1 receptor agonists. Living with obesity and type 2 diabetes himself, Dave has built a platform dedicated to connecting and educating people using these life-changing peptides. We break down the latest updates on the FDA's crackdown on compounding pharmacies and what it could mean for the future of GLP-1 access. We also dive into the shady role of Pharmacy Benefit Managers (PBMs) in driving up drug prices, the realities of living with obesity, and why traditional approaches to weight loss often fall short. Dave shares insights from his personal journey, including his experiences with keto and the struggles his community has faced.  Topics Discussed:  What is happening with the FDA's crackdown on compounding pharmacies and GLP-1 medications? How do Pharmacy Benefit Managers (PBMs) drive up drug prices and impact patient access? What are GLP-1 receptor agonists, and how are they changing the lives of people with obesity and type 2 diabetes? Why do traditional weight loss methods like “eat less, move more” often fail for people with metabolic disorders? What is the future of compounded GLP-1 medications, and how can patients stay informed? GLP1s Uncovered FREE 4 Part Video Series  On This Episode We Cover: 00:00:00 - Introduction  00:05:17 - Dave's background  00:11:07 - The Diabetes cycle 00:16:11 - Starting On The Pen 00:21:44 - Compound pharmacies and drug shortages  00:26:23 - Increase in compound drug use  00:29:34 – Better Accessibility 00:34:55 – PBMs & Insurance Kickbacks 00:41:31 – Copays vs. Cash Pay 00:45:29 – GLP-1 & FDA Lawsuits 00:53:14 – MAHA & Compounding Pharmacies 00:55:09 – Pharmacy Types & The Future of Compounding 00:59:47 – Confidence in Providers 01:02:13 – Bias in the MAHA Movement 01:09:19 – Lowering Medication Costs 01:11:39 – Deplatforming & Censorship 01:18:34 – “Eat Less & Move More” Show Links: GLP1s Uncovered FREE 4 Part Video Series  Find A Doc Sponsored By: Nutrisense Head over to nutrisense.io/drtyna to get $125 off your program.  Puori Go to Puori.com/drtyna and use code DRTYNA to get 20% off Momentous Go to livemomentous.com and try it today at 20% off with code DRTYNA, and start living on purpose. Purity Woods Go to puritywoods.com/DRTYNA or enter DRTYNA at checkout for 27% off LMNT Get your free Sample Pack with any LMNT purchase at drinkLMNT.com/drtyna Check Out Dave:  Instagram https://www.onthepen.com/ Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.

"I think innovation is supposed to be hard. That's why it's innovation.” - Seth Denson“Better consumption requires a lot more education.” - Trey Marinello"Don't compare GLP-1s to working out, because if they were working out, they wouldn't need the GLP1s." - Danish Nagda“I think what RFK has done with the MAHA movement is he's gotten people interested in health again.” - Jonathan LopezSeth Denson, Trey Marinello, Danish Nagda, and Jonathan Lopez joined me for the most ambitious podcast we've ever attempted. On location in the Red Phone Booth speakeasy in The Colony, Texas, 35 guests joined us from across the United States to share ideas to shape the future of healthcare. In my longest podcast ever, we covered the doctor shortage in America, GLP-1s, AI's role in healthcare, answered live audience questions, and so much more.This podcast was made possible by Havencrest Capital Management and True Rx Health Strategists. Special thank you to Sawyer Stratton.No matter what role you play in our healthcare ecosystem, I promise that you'll learn something from these four amazing guests I had on this week's episode of Self-Funded with Spencer.Chapters:00:00:00 The Future Of Healthcare Podcast00:11:31 Solving The Healthcare Provider Shortage00:16:49 AI's Role In Healthcare00:23:01 Enhancing The Healthcare Consumer Experience00:29:27 Empowering Individuals in Healthcare Decision-Making00:32:20 PBMs Role In Healthcare00:39:06 GLP-1 Concerns00:51:02 Improving Patient Outcomes01:13:05 Audience Q&AKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/Key Words: Healthcare Innovation, Future Of Healthcare, Doctor Shortage, Care Navigation, GLP1, Ozempic, PBMs, Healthcare Incentives, MAHA, make america healthy again, rfk, jonathan lopez, danish nagda, seth denson, trey marinello, spencer smith, podcast, healthcare, health insurance, self funded, self funding, self funded health insurance, self funded insurance#HealthcareInnovation #FutureOfHealthcare #DoctorShortage #CareNavigation #GLP1 #Ozempic #PBMs #HealthcareIncentives #MAHA #makeamericahealthyagain #rfk #jonathanlopez #danishnagda #sethdenson #treymarinello #spencersmith #podcast #healthcare #healthinsurance #selffunded #selffunding #selffundedhealthinsurance #selffundedinsurance

"I think innovation is supposed to be hard. That's why it's innovation.” - Seth Denson“Better consumption requires a lot more education.” - Trey Marinello"Don't compare GLP-1s to working out, because if they were working out, they wouldn't need the GLP1s." - Danish Nagda“I think what RFK has done with the MAHA movement is he's gotten people interested in health again.” - Jonathan LopezSeth Denson, Trey Marinello, Danish Nagda, and Jonathan Lopez joined me for the most ambitious podcast we've ever attempted. On location in the Red Phone Booth speakeasy in The Colony, Texas, 35 guests joined us from across the United States to share ideas to shape the future of healthcare. In my longest podcast ever, we covered the doctor shortage in America, GLP-1s, AI's role in healthcare, answered live audience questions, and so much more.This podcast was made possible by Havencrest Capital Management and True Rx Health Strategists. Special thank you to Sawyer Stratton.No matter what role you play in our healthcare ecosystem, I promise that you'll learn something from these four amazing guests I had on this week's episode of Self-Funded with Spencer.Chapters:00:00:00 The Future Of Healthcare Podcast00:11:31 Solving The Healthcare Provider Shortage00:16:49 AI's Role In Healthcare00:23:01 Enhancing The Healthcare Consumer Experience00:29:27 Empowering Individuals in Healthcare Decision-Making00:32:20 PBMs Role In Healthcare00:39:06 GLP-1 Concerns00:51:02 Improving Patient Outcomes01:13:05 Audience Q&AKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/Key Words: Healthcare Innovation, Future Of Healthcare, Doctor Shortage, Care Navigation, GLP1, Ozempic, PBMs, Healthcare Incentives, MAHA, make america healthy again, rfk, jonathan lopez, danish nagda, seth denson, trey marinello, spencer smith, podcast, healthcare, health insurance, self funded, self funding, self funded health insurance, self funded insurance#HealthcareInnovation #FutureOfHealthcare #DoctorShortage #CareNavigation #GLP1 #Ozempic #PBMs #HealthcareIncentives #MAHA #makeamericahealthyagain #rfk #jonathanlopez #danishnagda #sethdenson #treymarinello #spencersmith #podcast #healthcare #healthinsurance #selffunded #selffunding #selffundedhealthinsurance #selffundedinsurance

In this episode of the DeviceTalks Weekly podcast, Host Tom Salemi interviews Alan Lotvin, MD, the CEO and co-founder of Sequel Med Tech, a small company promoting another BIG idea from prolific inventor Dean Kamen. Lotvin, who was formerly a senior executive at CVS/Caremark and PBMs, explains how Twiist, the automated insulin delivery system, could be a game-changer for people with diabetes. Before the interview, we'll hear from Ivan Tornos, the CEO and president of Zimmer Biomet. Tornos, who is the opening keynote interview guest at DeviceTalks Boston on April 30 at the Boston Convention & Exhibition Center talks with Salemi and Joe Mullings about the the changes at Zimmer Biomet and in orthopedics. Register to see Tornos live at Boston.DeviceTalks.com. Use the code mentioned in the podcast to save 25%. Thanks for listening to the DeviceTalks Weekly Podcast. Subscribe to the DeviceTalks Podcast Network so you don't miss a future episode.

The Middleman is an epic drama of whistleblowers, murder, thrills, and legal combat—torn out of today's headlines.Nicholas “Deke” Deketomis and his law firm take on America's Big Pharma when Deke's college pal, Matt Redmond, presents him with a case of possible fraud involving EirePharma, the Redmond family business and a powerful Pharmacy Benefit Manager (PBM). PBMs serve as the “middlemen” between drug manufacturers and insurance companies, working in cryptic ways to determine not only the cost of drugs but also placing them on insurers' preferred formularies. EirePharma was recently taken over by the charismatic CEO, Connor Devlin, who has a Rasputin-like influence over Matt's cousin, Amy, the company's current president. Devlin may be utilizing racketeering practices—and perhaps murder—to raise the prices of insulin and other drugs for his own profit and to the detriment of consumers.Amy, who at first was in love with Devlin, decides—at great peril—to become her company's whistleblower and provide evidence to Deke and his team. When key witnesses and even Redmond family members meet mysterious and violent deaths, Amy finds herself a pawn caught in the center of a frightening and deadly game of wills between a formidable gangster, who in the eyes of the public is a respected businessman, and a law firm that is determined to investigate and uncover the Middleman's crimes.In the tradition of Suspicious Activity and Inhuman Trafficking, Mike Papantonio takes Deke and his cohorts on a new and different kind of legal gamble in The Middleman, which is chock full of the action and thrills for which he is known.Support this show http://supporter.acast.com/houseofmysteryradio. Become a member at https://plus.acast.com/s/houseofmysteryradio. Hosted on Acast. See acast.com/privacy for more information.

In this episode our hosts sit down with Tennessee State Senator Shane Reeves, a pharmacist-turned-legislator, to discuss his journey from pharmacy to public office. Senator Reeves shares his firsthand insights into the obstacles pharmacists face in patient care and policy, the role of pharmacy benefit managers (PBMs), and why transparency in health care pricing is crucial for patients. He also breaks down his legislative efforts to support independent pharmacies, improve medication adherence, and advocate for patient-first policies. Tune in for an engaging conversation on the intersection of health care and policy, and why patients should build strong relationships with their pharmacists. Among the highlights in this episode: 01:14: Sen. Reeves shares how his father’s role as both a pharmacist and public servant inspired his own path into politics 02:07: Sen. Reeves discusses the unique presence of multiple pharmacists in the Tennessee State Senate and how it benefits health care legislation 03:10: Sen. Reeves explains the role of pharmacy benefit managers (PBMs) in the health care system and how their increasing control has negatively impacted pharmacists and patients 04:39: Steven and Sen. Reeves discuss how PBMs evolved from cost controllers to powerful entities influencing patient care decisions 05:34: Sen. Reeves describes his legislative efforts to prevent “patient steering,” ensuring prescriptions are filled at the provider or patient’s preferred pharmacy 07:18: Sen. Reeves emphasizes the lack of price transparency in health care and provides an example from Singapore, explaining how full health care price transparency allows patients to know the costs of medical services upfront in contrast with the U.S. where prices are often hidden until after services are rendered 08:06: Sen. Reeves discusses the impact of PBMs on independent pharmacies and the struggle to keep small, community-based pharmacies in business 09:12: Steven and Sen. Reeves discuss the real-life consequences of PBMs interfering in patient care, including delayed access to life-saving medications 09:51: Sen. Reeves shares his advocacy for better medication adherence and the role of pharmacists in helping patients stay on track 12:15: Zoe and Steven reflect on the discussion, emphasizing the importance of having legislators with health care expertise in office Contact Our Hosts Steven Newmark, Chief of Policy at GHLF: snewmark@ghlf.org Zoe Rothblatt, Director of Community Outreach at GHLF: zrothblatt@ghlf.org A podcast episode produced by Ben Blanc, Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments in the form of an email, video, or audio clip of yourself to podcasts@ghlf.org Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

For New Yorkers, C.O. Bigelow is an institution.  “There's something about the [Bigelow] apothecary that emotionally appeals to people,” Ian Ginsberg, president, pharmacist and third generation owner of C.O. Bigelow, told Glossy. “Everybody, no matter how young or old you are, has some memory about going to the apothecary and the pharmacist telling you what to do. That's where I started [when I joined the family business four decades ago]. I started focusing on what happens when you walk in the door.” Opened in 1838, C.O. Bigelow is a mainstay in the Greenwich Village neighborhood of New York City and touted as the city's oldest apothecary. To wit: The original Kiehl's apothecary opened 14 years later in 1851.  C.O. Bigelow is known as a go-to for well-heeled New Yorkers, NYU students, tourists and neighborhood locals. Its lore includes customers like Sarah Jessica Parker and the late Carolyn Bessette-Kennedy, who purchased her iconic headbands in the shop, according to C.O. Bigelow.  “It's not always about what you buy, it's about how you feel when you're there,” said Ginsberg. “I always say we have to be in the want business, not the need business. The minute we're in the need business, we're dead.”  His family has built more than a pharmacy and retail. The company also has an eponymous beauty brand made in partnership with Bath & Body Works, formerly Limited Brands. The products range from makeup to body care and currently sell in the Greenwich store as well as through Bath & Body Works, Bloomingdale's and Revolve, among other retailers.  The company also sells its wares direct to consumers. They include the namesake beauty line and the diverse curation found in store. Its stores offers luxury brands like Westman Atelier and Augustinus Bader, prestige offerings from RMS Beauty and Caudalie, and masstige products like Avene and Bioderma.  “You can't just put stuff on shelves anymore,” Ginsberg said. “Anybody can find unique things and put them on shelves, but it's about making people feel good -- that's more important now than ever before. People talk about experiential retail, but our experimental retail is just person-to-person communication, helping people, explaining things to them and answering questions and showing them how to use things in whatever category it is. That's the secret sauce.” The company also owns a distribution company called Bigelow Trading that imports and distributes small brands into the U.S., for its own retail and others. Marvis toothpaste is among those brands. In addition, Bigelow Trading has a thriving hotel amenities business that works across hospitality brands like Aman, Nobu Hotel and Soho Grand Hotel, among others.  But perhaps the most surprising thing about C.O. Bigelow is the role of the pharmacy in the overall business.  “People sometimes say to me, ‘You have this great beauty business because you have this strong pharmacy business,” Ginsberg said. “But they have it all wrong. [The pharmacy business is supported by the beauty business].”  As previously reported by Glossy, 2024 was a bad year for American drugstores, and 2025 could end up even worse. Just last year, CVS closed 586 locations, Rite Aid closed 408 stores, and Walgreens closed 259 locations, which has created “drugstore deserts” across the U.S. As a pharmacist and third-generation pharmacy owner, Ginsberg also shared his perspective on a buzzy topic in the industry: pharmacy benefit managers, which act as middlemen between drug companies and consumers. PBMs are currently under investigation by the U.S. Federal Trade Commission for alleged pricing abuse, according to reporting by Reuters in January,  Paired with razor-sharp drug margins, pharmacist staffing shortages and more issues native to pharmacies, the industry is struggling. Ginsberg joined the Glossy Beauty Podcast to discuss the company's secret sauce behind its thriving brick-and-mortar business and the role beauty retails plays in it. 

We're covering another busy week in the Legislature and in Congress: budgets, crime, immigration, veterans affairs, cell phones in schools, medical marijuana, PBMs  & more.   Todd's guests: Rep. Rex Reynolds Rep. Neil Rafferty John Driscoll of the Alabama Port Authority

The Hidden Costs of PBMs: How Aggregate Discount Guarantees Inflate Drug Prices. In episode 465 of Relentlessly Seeking Value, host Stacey Richter interviews Chris Crawford, CEO of RxSaveCard, about the inflated costs within the pharmacy benefits industry. The discussion centers around a lawsuit involving J&J, highlighting how large PBMs can significantly overcharge for drugs that are available much cheaper through cash-pay options like Mark Cuban's Cost Plus Drugs. Crawford explains how Aggregate Discount Guarantees, a common contracting mechanism, often fail to control spread pricing effectively and instead may lead to higher costs for plan sponsors and employees. The episode also covers how RxSaveCard can help employers and employees access these lower cash prices, circumventing the inflated costs from traditional PBMs. === LINKS ===

In this episode of Shift Shapers, Susan Thomas, Chief Commercial Officer at LucyRx, discusses how LucyRx is addressing the issues and conflicts within the traditional Pharmacy Benefit Manager (PBM) landscape. The conversation delves into the structural problems of traditional PBMs, the role of misaligned incentives, and how LucyRx aims to eliminate these conflicts to benefit plan sponsors and patients. Key topics include formulary management, specialty pharmacy networks, and the importance of transparency and true net cost evaluations.This Episode is Sponsored by BenepowerBenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.Key Takeaways**Misaligned Incentives in PBMs**: Traditional PBMs have misaligned incentives due to their vertical integration with large insurance companies and ownership of mail and specialty pharmacies. This drives up costs for plan sponsors.**Transparent Formulary Management**: LucyRx offers a formulary marketplace that eliminates exclusive arrangements with Group Purchasing Organizations (GPOs), allowing plan sponsors broader access to formularies and more flexible utilization management.**Independent Pharmacy Network**: LucyRx contracts with independent pharmacy networks, such as Amazon, to provide a more efficient and cost-effective mail delivery service, ensuring quicker access to medications.**Educational Initiatives**: LucyRx is actively educating advisors and plan sponsors on the benefits of their new pharmacy care model through a robust roadshow and sharing real-world case studies. **Future of Pharma**: With advancements in AI and machine learning, precision medicine can help in developing more effective targeted treatments. However, skepticism remains about whether large PBMs and pharma companies want a smaller, more precise target population.In This Episode00:00 Introduction to PBM Issues00:39 Meet Susan Thomas from LucyRx00:50 Susan's Journey into Healthcare02:06 Problems with Traditional PBMs02:28 LucyRx's Approach to PBM Conflicts06:23 Formulary Management Innovations13:55 Network and Specialty Pharmacy Solutions16:17 Educating Advisors and Plans20:23 Future of Pharmacy Benefits and AI22:07 The Story Behind LucyRx23:25 Conclusion and Farewell

 Show notes  To learn more about the FTC's most recent report on PBMs, click here.  To learn more about the FTC's first report on PBMs, click here.  To learn more about health care actions taken by the second Trump Administration during it's first month, click here.  To learn more about the views of Mehmet Oz, MD (more commonly known as Dr. Oz) on price transparency ahead of his congressional confirmation hearings as President Trump's nominee for HHS Secretary, click here. 

In this episode, Our guest is MARC RYAN, who has extensive leadership experience across the healthcare industry. Most recently, he was a founding executive and President of MedHOK (MHK, acquired by Hearst Health). He has launched and operated multiple health plans. Marc served in senior policy roles in state and federal government, including as state management secretary of Connecticut and helping build Medicare Part D's relationship with state drug assistance programs in 2006. He created Connecticut's Medicaid and children's health managed care programs and its long-term care continuum. Marc is the author of The Healthcare Labyrinth: A Guide To Navigating Health Plans and Fixing American Health Insurance and the host of the Healthcare Labyrinth Podcast.Topics covered:(1) What are the trends in drug spending and the impact on all types of insurance products -- Medicare, Medicaid, commercial/employer -- cost trends for medical and retail(2) What is driving the major increases in drug costs/spending?(3) How are GLP-1s treated across various products? And will coverage change?(4) American drug prices compared with others?  Can you discuss how we compare vs. other developed countries and why (more than twice -- in many cases 3, 4, and 5 times more -- impacts on employer, Medicare, etc. -- rising percentage of healthcare as well as employer) (5) Medicare drug price negotiations -- what it is and what has happened so far? where do you stand?(6) A lot is occurring in plans on PA, formularies, benefit design, PBM reform -- a very hot topic -can you tell us more about this and what you predict? (7) Can you explain the traditional PBMs vs. transparent ones? FTC lawsuit against PBMs and drug supply channel issues(8) There have been major changes to Part D and it is impacting Medicare Advantage and Part D -- what is happening for 2025 benefits as well as can you tell us a little on a study that questioned the value of Part D?(9a) Medication Adherence in the Star program for MA and Part D plans -- key.  Can you tell us more here? 9(b) How could pharmacists in the community support medication adherence etc -- Will discuss trends from health plans about recognizing the best way to ensure medication reconciliation and adherence is teaming up with pharmacists. Guest - Marc RyanHost - Hillary Blackburn, PharmD, MBAwww.hillaryblackburn.comhttps://www.linkedin.com/in/hillary-blackburn-67a92421/ @talktoyourpharmacist for Instagram and Facebook ★ Support this podcast on Patreon ★

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to outcomesrocket.com Sustainable weight loss through medication and lifestyle changes improves health outcomes and reduces healthcare costs. In this episode, Robert MacNaughton, CEO of Calibrate, discusses his company's approach to weight and obesity management, which integrates GLP-1 medications with physician-led lifestyle coaching. He emphasizes that while medications are powerful, sustainable results are achieved with lifestyle intervention. Calibrate provides a DTC solution but is increasingly focusing on enterprise partnerships with self-insured employers and PBMs, to provide better access to these solutions. Rob mentions his company's published results that show members losing 16% of their body weight after one year, 17% after two years, and 19% after three years. He also highlights the growing discussion around AI's role in healthcare and expresses optimism about weight management, believing this is a vanguard area that will improve healthcare outcomes and sustainability.  Tune in and learn more about Calibrate and its approach to weight management solutions! Resources:  Connect and follow Robert MacNaughton on LinkedIn. Follow Calibrate on LinkedIn and visit their website.  Fast Track Your Business Growth: Outcomes Rocket is a full service marketing agency focused on helping healthcare organizations like yours maximize your impact and accelerate growth. Learn more at outcomesrocket.com

Pharmacy CrossRoads is celebrating an incredible year of more than 60+ interviews with people in independent community pharmacy making a difference through technology, practice innovation, and networking to build stronger community pharmacies. Pharmacy CrossRoads is one of the most popular podcasts on the Pharmacy Podcast Network with an impressive 40,000+ downloads this podcast is one of the best shows about Independent Community Pharmacy.  With an increase of pharmacy deserts throughout the country threatening access to life saving medicaitons and primary care providers driven to the brink exhaustion with so many patients needing access to care, the community pharmacy is more importatnt than ever before. Pharmacy CrossRoads is expanding its team. Started by Bruce Kneeland through the Pharmacy Podcast Network, the popularity of the show and themes will bring our listeners 4 new Hosts, each taking a theme which has personally impacted their work in community pharmacy. Adam Robinson We have Dr. Adam Robinson, PharmD, known as the "Work flow Whisperer" as a pharmacy owner of Save Rite Drugs in Radcliff KY, Adam will be brining real-world experieces of pharmacy ownership. Kris Rhea With over 15 years of pharmacy and healthcare business experience, Director of Business Development of Pharmacy Marketplace, Kris Rhea is joining the Hosts of Pharmacy CrossRoads to drive content about the business of pharmacy's impact on independent owners. Shahida Choudhry Owner of The Palms Pharmacy in Tampa FL, member of the board of directors with Independent Pharmacy Cooperative, and voted 4 years in a row as one of the "50 Most Influential People in Pharmacy" Dr. Shahida Choudhry PharmD is joining Pharmacy CrossRoads to participate in discussions about moving community pharmacy forward and away from the clutches of the PBMs hampering the effectiveness of our Pharmacists in communites across the country. Stacy Hall Pharmacy Business Executive Stacy Hall, MBA is the CEO of the Florida Pharmacy Association which brings Pharmacy CrossRoads significant insights from state policies, government programs, and a diverse knowledge of multiple sectors of pharmacy care. As CEO of the FPA, Stacy is in conistent communitcations with national organizations like the National Alliance of State Pharmacy Associations (NASPA) and the American Pharmacists Association (APhA). This will bring Pharmacy CrossRoads listeners an indepth conversation about issues impacting independent community pharmacies. "It's been an honor to work with Bruce. With over 40 years of Pharmacy Business experience and as a prolific writer for Pharmacy Times, Drug Topics, Computer Talk, Dispense Times, and other publications, podcasting was a natural fit to draw out Bruce's insights and guidance of relevant conversations about community pharmacy in the U.S." --stated Todd Eury, CEO of RxPR, LLC dba Pharmacy Podcast Network, "There's no other host on the PPN that's connected better with businesses looking to use podcasting as education for pharmacy onwers in a meaninful way which doenst sound like a boring commerical. We're looking forward to adding our 4 new podcast hosts to one of our most popular shows." To listen to the latest Pharmacy CrossRoads podcast featuring the new hosts, click here: (LINK) Subscribe on Spotify, Apple, and all podcast directories. About Pharmacy Podcast Network (PPN) The only platform of its kind, PPN offers a comprehensive range of podcasts and content related to pharmacy, covering topics such as careers, compounding, education, hospital and health system issues, politics, professional development, retail and community pharmacy, senior and long-term care, specialty pharmacy, and student pharmacists.

A group of lawmakers have introduced legislation that would break up health care conglomerates, aiming to rein in the power of pharmacy benefit managers. We’ll explain what PBMs do and why all sides of the health care industry are pointing fingers at one another over high costs. And, we’ll get into how the future of the Trump-era tax cuts could impact the federal deficit and why General Motors is ditching its robotaxi business. Plus, now’s your chance to talk with an AI Santa Claus. Here’s everything we talked about today: “Yellen Talks Russia Sanctions, Tariffs and Deficit” from Bloomberg via YouTube “Yellen says Trump’s tariffs could derail US inflation progress, raise costs” from Reuters “Senators Warren and Hawley introduce a bipartisan bill to break up pharmacy-benefit managers” from CNBC via YouTube “Elizabeth Warren, Josh Hawley Co-Sponsor Bill to Break Up Giant Health Care Conglomerates” from The New York Times “What is a pharmacy benefit manager, anyway?” from Marketplace “GM to stop funding troubled Cruise autonomous vehicle unit, abandoning robotaxis” from CBS San Francisco “GM to Shut Down Its Cruise Robotaxi Project” from The New York Times “OpenAI introduces ‘Santa Mode’ to ChatGPT for ho-ho-ho voice chats” from Ars Technica Tomorrow is our last episode of the year! Join us for our annual holiday party on “Economics on Tap.” The YouTube livestream starts at 3:30 p.m. Pacific time, 6:30 p.m. Eastern.

A group of lawmakers have introduced legislation that would break up health care conglomerates, aiming to rein in the power of pharmacy benefit managers. We’ll explain what PBMs do and why all sides of the health care industry are pointing fingers at one another over high costs. And, we’ll get into how the future of the Trump-era tax cuts could impact the federal deficit and why General Motors is ditching its robotaxi business. Plus, now’s your chance to talk with an AI Santa Claus. Here’s everything we talked about today: “Yellen Talks Russia Sanctions, Tariffs and Deficit” from Bloomberg via YouTube “Yellen says Trump’s tariffs could derail US inflation progress, raise costs” from Reuters “Senators Warren and Hawley introduce a bipartisan bill to break up pharmacy-benefit managers” from CNBC via YouTube “Elizabeth Warren, Josh Hawley Co-Sponsor Bill to Break Up Giant Health Care Conglomerates” from The New York Times “What is a pharmacy benefit manager, anyway?” from Marketplace “GM to stop funding troubled Cruise autonomous vehicle unit, abandoning robotaxis” from CBS San Francisco “GM to Shut Down Its Cruise Robotaxi Project” from The New York Times “OpenAI introduces ‘Santa Mode’ to ChatGPT for ho-ho-ho voice chats” from Ars Technica Tomorrow is our last episode of the year! Join us for our annual holiday party on “Economics on Tap.” The YouTube livestream starts at 3:30 p.m. Pacific time, 6:30 p.m. Eastern.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company's Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum's insights help connect healthcare spending to broader economic issues while exploring potential reforms and the role of technology in improving efficiency. Saum highlights how choice and innovation distinguish the U.S. healthcare system, explores the reasons behind exorbitant drug prices, and examines the potential solutions, challenges, and trade-offs involved in lowering costs while striving to improve access, quality, and affordability. The opinions expressed by Saum in this episode are his own and do not represent the views of his employer. We discuss: The US healthcare system: financial scale, integration with economy, and unique challenges [5:00]; Overview of how the US healthcare system currently works and how we got here [9:45]; The huge growth and price impact due to the transition from out-of-pocket payments in the 1950s to the modern, third-party payer model [18:30]; The unique structure and challenges of the US healthcare system compared to other developed nations [22:00]; Overview of Medicare and Medicaid: who they cover, purpose, and impact on healthcare spending [27:45]; Why the US kept a employer-sponsored insurance system rather than pursue universal healthcare [32:00]; The evolution of healthcare insurance: from catastrophic coverage to chronic disease management [36:00]; The challenge of managing healthcare costs while expanding access and meeting increased demand for chronic illness care [44:15]; Balancing cost, choice, and access: how the US healthcare system compares to Canada [48:45]; The role of the US in pharmaceutical innovation, it's impact on drug pricing, and the potential effects of price controls on innovation and healthcare costs [56:15]; How misaligned incentives have driven up drug prices in the US [1:05:00]; The cost of innovation and choice, and the sustainability of the current healthcare cost expenditures in the US in the face of a shrinking workforce and aging population [1:11:30]; Health outcomes: why life expectancy is lower in the US despite excelling at extending lifespan beyond 70 [1:18:45]; Potential solutions and challenges to controlling drugs costs in the US while balancing choice and access and preserving innovation [1:26:15]; Balancing GLP-1 drug innovation with affordability and healthcare spending sustainability [1:40:00]; Reducing healthcare spending: complexities, trade offs, and implications of making needed cuts to healthcare expenditures [1:46:45]; The role of government regulation, opportunities for cost savings, and more [1:56:15]; Hospital billing: costs, charges, complexities, and paths to simplification [2:01:15]; How prioritizing access and choice increased expenditures: reviewing the impact of healthcare exchanges and the Affordable Care Act [2:08:00]; Feasibility of a universal Medicare program, and what a real path to sustainable healthcare looks like [2:15:45]; The challenge of long-term care and the potential of innovation, like device-based therapies and AI, to improve health [2:23:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube