Podcasts about pbms

What does it take to move from fixing one broken corner of healthcare to reimagining the whole thing? On this episode of Astonishing Healthcare, host Justin Venneri sits down with two of his favorite guests together for the first time: Judi Health's CEO, AJ Loiacono, and Chief Commercial Officer, Kristin Begley, PharmD.The catalyst for this special episode is the company's rebrand, the evolution from Capital Rx, the transparent PBM that built Judi®, into Judi Health, a unified health technology company. AJ and Kristin explain why the "Rx" designation remains a core piece of the company's identity but no longer fully reflects the organization's evolving mission. They also describe the difference between "little T" transparency and the real thing, why incentive alignment matters so much, and what it took to build the first platform to process medical, pharmacy, dental, and vision claims on one system. They also express gratitude to the team and share bold predictions for where health benefits go next.Key TakeawaysThe rebrand reflects an expanded mission, not a new one. Capital Rx launched as a transparent PBM, with "Rx" signaling its focus on pharmacy. Over eight years, the company broadened its administrative capabilities, including medical claims processing, and much more - all powered by Judi. Thus, the primary brand: Judi Health, with services harmonized as Judi Rx (pharmacy), Judi Care (medical administration, TPA, navigation), and Judi Cloud (platform licensing for health plans and TPAs).There's a real difference between "little T" transparency and true transparency. AJ argues that true transparency means an auditable workflow: full disclosure of all compensation, proof that every customer receives the same pricing and benefit, and no hidden earnings. He calls out the "little H" holding company trick and explains why alignment yields better outcomes for plans and their members.‍Nobody had built unified claims processing before. AJ recalls initial skepticism around unified claims. His response: "If Netflix had kept mailing DVDs, we wouldn't be talking about Netflix." To date, no other organization has built a unified claims processing platform. Judi is the exception.Unified claims processing will become the standard. Once employers realize they have options, markets shift quickly. AJ, who predicted the rise of transparent PBMs, makes a new call: unified claims will be the industry norm.Related ContentJudi Health™ Announces Capital Rx is Now Judi Rx™, Launches Judi Care™ and Judi Cloud™ to Power the Next Era of Health Benefits Administration and Patient CareAH100 - The End of the Age of Confusion, It's Time for Acceptance, with AJ LoiaconoAH067 - Aligned Health Benefits and the Freedom to Unbundle, with Kristin Begley, PharmDWhat is a Core Administrative Processing System (CAPS) in Healthcare Payer Operations?AH111 - Building a Single Source of Truth for Medical and Pharmacy Benefits, with Kevin Sundquist & Liya LomsadzeFor more information about this episode, please visit Judi Health Insights.

Cash-Pay Generic Drugs Are a Functioning Market in Healthcare, and Policymakers Could Break It. Episode 520. Cash-pay generic drugs are one of the few corners of US healthcare where a real, functioning market already exists — which is why Stacey Richter argues policymakers need to tread carefully when trying to "fix" drug affordability. In this solo episode, Stacey explains why cash generic prices can run as low as $1 a prescription, then plays clips from four past guests — Ge Bai, PhD, CPA; Bryce Platt, PharmD; Benjamin Jolley, PharmD; and Luke Slindee, PharmD — showing how inserting a PBM extracts $41 out of every $100 spent, leaving patients paying more for the "privilege" of using their insurance. WHAT YOU'LL LEARN ✅ Why cash-pay generic drugs are one of the few genuinely functioning markets left in US healthcare, with multisource manufacturer competition keeping prices as low as $1 to $18 per prescription ✅ Why using insurance/PBM coverage makes the 20 most prescribed generics more expensive 43% of the time overall, and up to 79% of the time in the deductible phase, per Ge Bai, PhD, CPA's research in Annals of Internal Medicine ✅ How PBMs extract $41 out of every $100 spent on generic drugs that cost roughly 47 cents to manufacture, largely through the administrative overhead of risk pooling ✅ How Most Favored Nation "lesser of" clauses in PBM-pharmacy contracts punish pharmacies for lowering their cash prices, and why Luke Slindee, PharmD, argues removing that single clause could unlock a more robust cash-pay market without pulling generics from insurance entirely ✅ Why generic drug adoption has slowed from about one month to six months to reach peak uptake, which Bryce Platt, PharmD, ties to PBM formulary control rather than reduced competition or prescriber resistance ✅ Four policy ideas Stacey floats for keeping generics affordable without wrecking the underlying market: eliminating MFN clauses, funded wallets or prepaid cards, pre-funded cash-pay pharmacy relationships, and removing generics from PBM adjudication entirely WHY THIS MATTERS Generic drugs are one of the only truly functioning markets left in US healthcare, and cash prices are already low because of it. But policymakers trying to make medications more affordable often reach for the same lever — routing everything through insurance/PBM adjudication — which the data shows frequently raises what patients pay while handing PBMs a 41-cent cut of every dollar spent. As Stacey puts it, "you have to be really careful what levers you push because you can't see what they're attached to," and the wrong fix could break the one part of healthcare that's actually working. MENTIONED IN THIS EPISODE EP444 with Ann Kempski: Apple Podcasts | Spotify | Other Apps LinkedIn Post by Bryce Platt, PharmD EP495 with Mick Connors, MD: Apple Podcasts | Spotify | Other Apps EP420 with Ge Bai, PhD, CPA: Apple Podcasts | Spotify | Other Apps EP422 with Benjamin Jolley, PharmD: Apple Podcasts | Spotify | Other Apps EP517 with Stacey: Apple Podcasts | Spotify | Other Apps LinkedIn Post by Bryce Platt, PharmD EP439 with Luke Slindee, PharmD: Apple Podcasts | Spotify | Other Apps LinkedIn Post by Patrick Moore EP465 with Chris Crawford: Apple Podcasts | Spotify | Other Apps === LINKS ===

Integrative Care Impact and the Expanding Role of the Pharmacist | TWIRx Today's episode of This Week in Pharmacy explores two major opportunities shaping the future of the profession: the growth of holistic and integrative pharmacy services inside community pharmacies, and the expanding demand for pharmacists across the business, insurance, and PBM sectors. In our first segment, Todd Eury welcomes special guests Robert Kress, RPh, and Dr. Bianca Bradshaw, PharmD, owner of Elmore Pharmacy in Red Bluff, California. Together, they discuss the tremendous opportunity for independent pharmacies to build holistic and integrative health departments that respond to growing consumer demand for natural products, supplements, wellness solutions, and personalized care. Dr. Bianca Bradshaw, PharmD https://www.linkedin.com/in/bianca-bradshaw-141092205/ Patients are increasingly seeking more natural approaches to health, but they still need trusted clinical guidance. Community pharmacists are uniquely positioned to help patients evaluate products, avoid harmful interactions, understand evidence, and develop safer, more effective wellness plans. This conversation explores how pharmacies can create new service lines, improve patient relationships, and establish sustainable revenue opportunities through integrative care. In our second segment, Dr. Bonnie Hui-Callahan, PharmD, returns to the show to discuss career opportunities for pharmacists within Judi Health and Capital Rx, as well as the broader business and insurance side of pharmacy. Dr. Bonnie Hui-Callahan, PharmD https://www.linkedin.com/in/bonnie-hui-callahan/ As PBMs continue to evolve, new-generation models are creating demand for pharmacists who understand clinical care, benefits, formulary strategy, patient access, data, and healthcare economics. Bonnie shares why pharmacists will remain essential as PBMs transform and why the profession should look beyond traditional dispensing and clinical practice roles when considering future career paths. Today's episode is sponsored by Independent Pharmacy Cooperative and SuiteRx. Listen to This Week in Pharmacy on the Pharmacy Podcast Network.

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

"The most unused cash in the country right now is the money you're wasting on healthcare... If you save a million dollars a year, that's $20 million in market cap."Is your company treating its healthcare spend like a business strategy, or are you just writing a blank check to the major insurance carriers every year?In this episode, I was (finally) joined by Mark Cuban, Ann Lewandowski, and Matt Miron. After answering how he would approach healthcare for a hypothetical company on Shark Tank, Mark broke down his exact playbook for mid-market employers: why you should fire traditional networks, the massive ROI of hiring an internal "Healthcare CFO" to negotiate single-case agreements, and why "carve-out" is the most important phrase for your benefit strategy this year. Together, we also discussed the dark side of healthcare economics, including the exorbitant spread pricing of PBMs and distributors, how to use AI (like Claude or ChatGPT) to find the hidden "gotchas" in your ASO contracts, and the terrifying legal liabilities CEOs face when their carriers deny life-saving treatments.This one has been in the works for years, and I hope it doesn't disappoint. Tune in!Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Introductions: Mark Cuban, Ann Lewandowski, and Matt Miron (00:01:08) Mark Cuban's Healthcare Playbook for Shark Tank Companies (00:05:54) Single Case Agreements and Hiring an Internal Healthcare CFO (00:10:08) Why the Keyword for 2026 is "Carve Out" (00:14:32) Fiduciary Duty and Waiving Employee Deductibles (00:20:52) Starting with Out-of-Network Negotiations (00:25:09) The No Surprises Act, IDR Arbitration, and Secret Payouts (00:29:12) Why Mark Started Cost Plus Drugs (and Cost Plus Wellness)(00:32:10) How Distributors and PBMs Inflate Drug Prices (00:36:49) Using AI (Claude/ChatGPT) to Audit Your Carrier Contracts (00:37:52) The 340B Scam and Fiduciary Lawsuits (00:44:27) Increasing Enterprise Value: Why Healthcare Savings = Market Cap (00:47:46) CEO Liability for Life-Threatening Claim Denials (00:50:37) The Perverse Economics of Prior Authorizations and Appeals (00:52:59) Final Takeaways: Watch Your Money and Carve OutKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"The most unused cash in the country right now is the money you're wasting on healthcare... If you save a million dollars a year, that's $20 million in market cap."Is your company treating its healthcare spend like a business strategy, or are you just writing a blank check to the major insurance carriers every year?In this episode, I was (finally) joined by Mark Cuban, Ann Lewandowski, and Matt Miron. After answering how he would approach healthcare for a hypothetical company on Shark Tank, Mark broke down his exact playbook for mid-market employers: why you should fire traditional networks, the massive ROI of hiring an internal "Healthcare CFO" to negotiate single-case agreements, and why "carve-out" is the most important phrase for your benefit strategy this year. Together, we also discussed the dark side of healthcare economics, including the exorbitant spread pricing of PBMs and distributors, how to use AI (like Claude or ChatGPT) to find the hidden "gotchas" in your ASO contracts, and the terrifying legal liabilities CEOs face when their carriers deny life-saving treatments.This one has been in the works for years, and I hope it doesn't disappoint. Tune in!Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Introductions: Mark Cuban, Ann Lewandowski, and Matt Miron (00:01:08) Mark Cuban's Healthcare Playbook for Shark Tank Companies (00:05:54) Single Case Agreements and Hiring an Internal Healthcare CFO (00:10:08) Why the Keyword for 2026 is "Carve Out" (00:14:32) Fiduciary Duty and Waiving Employee Deductibles (00:20:52) Starting with Out-of-Network Negotiations (00:25:09) The No Surprises Act, IDR Arbitration, and Secret Payouts (00:29:12) Why Mark Started Cost Plus Drugs (and Cost Plus Wellness)(00:32:10) How Distributors and PBMs Inflate Drug Prices (00:36:49) Using AI (Claude/ChatGPT) to Audit Your Carrier Contracts (00:37:52) The 340B Scam and Fiduciary Lawsuits (00:44:27) Increasing Enterprise Value: Why Healthcare Savings = Market Cap (00:47:46) CEO Liability for Life-Threatening Claim Denials (00:50:37) The Perverse Economics of Prior Authorizations and Appeals (00:52:59) Final Takeaways: Watch Your Money and Carve OutKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

The 401-Level Financial Motive Behind Prior Auths and Pharma Rebate Contracting Imagine a cheaper, generic, or even clinically better drug that somehow ends up not on formulary at all, or stuck behind step edits and prior authorizations with a higher copay than the pricier brand sitting right next to it. In this solo episode, host Stacey Richter breaks down exactly how that happens, walking through a case study she calls Brand Number 2 versus the formulary's reigning Brand Darling to show how PBM and GPO rebate economics, not clinical need, often decide which drugs patients can access easily and which ones get thrown up against a wall of red tape. This is Episode 517 (EP517) of Relentless Health Value. WHAT YOU'LL LEARN ✅ How a high-volume Brand Darling generating billions in sales and huge aggregate rebates can keep a cheaper, generic, or more effective Brand Number 2 stuck on a nonpreferred tier, behind step edits and prior authorizations, regardless of price or efficacy ✅ Why a structural rebate cliff makes it nearly impossible for a new entrant to unseat an established Brand Darling on formulary, even if that new entrant offers a 99 percent rebate ✅ How rebate dollars a PBM or GPO wants to keep can be relabeled as a data fee, a service fee, or an admin fee, a dynamic also flagged by benefits consultant Robyn Tikia, letting a PBM still claim it passes along 100 percent of rebates ✅ Why a prior authorization is often used as a financial negotiating lever against a manufacturer's rebate offer rather than a clinical determination of whether a patient needs the drug ✅ How regulation such as the Inflation Reduction Act is compressing list prices and collapsing the rebate spread that the traditional contracting math depends on ✅ How GoodRx runs a reverse auction among PBMs to surface its advertised cash price, making coupon sites effectively a sales channel for the same PBMs that lock manufacturers into exclusive formulary contracts WHY THIS MATTERS As Stacey Richter lays it out, a PBM with a fiduciary duty to its shareholders has every financial incentive to double down on a high-volume Brand Darling and freeze out a cheaper or better Brand Number 2 with step edits and prior auths, whether or not that serves the patient stuck in the middle. As regulation compresses list prices and rebate spreads get less stable, more pharma manufacturers are deciding it is worth giving up access to large blocks of insured lives in order to control their own price directly through cash pay, patient assistance programs, or their own copay cards. It is not a clean alternative, since cash pay still runs through PBM-linked coupon platforms like GoodRx, but for some brands it is starting to look like the more controllable bet. === LINKS ===

Stéphan Wener, chief customer officer at Compugen Recorded on-site at HPE Discover in Las Vegas, this episode of In The Channel features Stéphan Wener, chief customer officer at Compugen, one of Canada’s most established HPE partners. It was a big week for Compugen at Discover. The company achieved Triple Platinum Plus status under HPE’s Partner Ready Vantage program — the highest tier available, reflecting deep investment across compute, networking, storage, and security — and was named HPE Canada Solution Provider of the Year at the Partner Growth Summit on Monday. Wener credits the recognition to consistent, long-term investment in the full HPE portfolio and what he describes as genuine “exec-to-field” engagement with the HPE Canada team. But the conversation moves quickly from celebrating to analyzing — and that’s where it gets useful for Canadian partners. His take on HPE’s evolution is direct: “It’s not anymore a compute-led company. I think it’s an AI technology-led company, but with a big focus on networking.” He sees the Aruba acquisition as having already delivered strong returns for both sides, and the Juniper integration as filling the data centre gap to create what he calls a genuine “powerhouse” networking portfolio — a view that aligns with what Antonio Neri laid out in Tuesday’s keynote but carries different weight coming from the partner side. On the Canadian market, Wener flags two converging trends: data sovereignty concerns continuing to push customers — especially in the public sector and regulated industries — toward on-premises and edge deployments, and the economics of cloud-based AI creating a second wave of on-prem investment as the cost of tokens at scale starts to sting. The “Power of One” program consolidation? Compugen has been asking for it for a couple of years and welcomes it — with the candid observation that the compute and networking sales motions are still distinct, and that closing that gap in practice will take ongoing work. And on self-driving networks and the automation question: Wener is a believer — but as an Air Canada Super Elite, he has some pointed thoughts about where the human layer still matters. Read Full Transcript ROBERT DUTT: This episode of In The Channel is brought to you by HPE Discover 2026. Check out our full coverage of the event on ChannelBuzz.ca. You’ll find our HPE Discover 2026 news hub in the menu bar at the top of the page. Hello and welcome to In The Channel from ChannelBuzz.ca, bringing news and information to the Canadian IT channel community for the last 16 years. I’m Robert Dutt, editor of ChannelBuzz.ca, and your host for the show. We’re recording this one on-site at HPE Discover in Las Vegas, and if you’ve been following our coverage from the event, you know it’s been a full one. Big keynote from Antonio Neri on Tuesday, a lot of networking announcements from Rami Rahim and the HPE networking team, the Partner Growth Summit on Monday, where HPE laid out some significant program changes, most notably the coming unification of the Juniper Partner Program under Partner Ready Vantage by November 1. My guest for this episode is Stéphan Wener, chief customer officer at Compugen. Compugen is one of Canada’s largest and most prominent HPE partners. They just achieved Triple Platinum Plus status under the Partner Ready Vantage program, which is the highest tier available under HPE’s partner program, reflecting deep investment across compute, networking, storage and security. And at the Partner Growth Summit earlier this week, they were named HPE Canada Solution Provider of the Year. So yeah, it’s been a pretty good week to be Compugen in Las Vegas. I sat down with Stéphan to talk about the story behind that recognition, how Compugen sees the evolution of the HPE portfolio, especially now that it includes both Aruba and Juniper, and what’s actually resonating in the Canadian market right now around AI infrastructure, data sovereignty, and the economics of running AI workloads in the cloud versus at the edge. There’s also a moment in here about self-driving networks that any Air Canada Super Elite will relate to. Let’s get right into it. My chat with Stéphan Wener. ROBERT DUTT: Stéphan, thank you for taking the time. STÉPHAN WENER: [It’s my] pleasure. ROBERT DUTT: Big week for Compugen here at Discover. You were named HPE Canada Solution Provider of the Year. Separately, just announced Triple Platinum Plus status under Partner Ready Vantage. That’s the highest tier, as if the name didn’t give that away, right? Tell me the Compugen-HPE story that led here. When you think about why you’ve ended up at this point, what do you credit it to? STÉPHAN WENER: I would say it’s a long-term engagement. We’ve been really connected. It’s important, if you want to succeed with the OEM, it’s all about connection from the execs to the field. I think our sales resources are really well-engaged with HPE’s sales resources. It’s really a teamwork. The results are all around this collaboration. It’s all about also bringing common value to the customer. We’re working very closely, making sure that we are doing the right thing and growing the business. Being Partner of the Year was actually a surprise, but one element is we’re really engaged in the entire portfolio of HPE. HPE is a different company right now. We were dealing with Aruba in the past and HPE and all this, now being one portfolio. The fact that we are engaged with all lines of business really helps us out, taking it to another level. Having this recognition is great. It’s great for us. It’s great for our teams because there’s a lot of people trained on the technology. There’s a lot of investment we’re making internally, both on the technical side but also on the sales side. We have BDR motions. We have a lot of engagement commonly with HPE. I think it’s really the combination of all these actions that made us successful. We have to thank the HPE team in Canada as well because we don’t win this award by ourselves. It’s really by working very closely with them. The Triple Platinum is a commitment to HPE. We believe that Compugen with HPE can provide great solutions to the market and we want to bring this engagement to another level. We’re also very proud. It was a lot of work on the technical side to be able to ramp up to this level, both on the compute, same thing on the networking side, security. So it’s the entire portfolio. ROBERT DUTT: To that point, the entire portfolio — some listeners may still think of HPE primarily as a server company, a server and storage company with networking kind of on the side. Can you walk me through what the HPE relationship actually looks like at Compugen today in terms of how you work with each part of that business, and how’s that picture changed over the last couple of years? STÉPHAN WENER: I would say HPE is a different company because they kept for a very long time Aruba and the compute side and the networking side separately. You can really feel now that it’s more one company. I actually feel, and Antonio said it today, the networking piece with AI is a big, big part of the strategy right now. So the fact that now networking and compute and storage, all the technology is really evolving in one big channel. It’s really changing what HPE is. It’s not anymore a compute-led company. I think it’s an AI technology-led [company], but a big focus on networking, especially in an AI world. Networking is key for all organizations. And I think specifically, Aruba was already a great company. That was a great acquisition. For all of us — I’m a shareholder of HPE — I can say that for the shareholders, the acquisition of Aruba was amazing, very profitable. But adding Juniper to the mix, it fills the gap. Data centre, DC — it was more campus and branch with Aruba. Now it’s really, really a powerhouse. So networking is definitely… you don’t make these type of investments as a company if you don’t believe that networking is a big part of your future. And already the Aruba part was one of the most profitable pieces of the business. In the years where compute was struggling a little bit more on the profit side, now, okay, HPE is having a great year with all AI and the shortage and all this. It’s great. But I think now HPE [has] a complete portfolio of technology, and that’s what makes it very appealing to the market right now, in my opinion. ROBERT DUTT: On that profitability point, what is having that unified networking story doing for you guys in terms of margin opportunity and that sort of thing? STÉPHAN WENER: I would say HPE would love us to leverage both sides of the portfolio. It’s still two different sales motion[s], let’s call it out. The compute and storage is one element, the network is on the other [end]. I think profit comes with investment. Compugen is a service-led company. So a lot of our sales motion is based on leading with our services, our managed services, our professional services. So we can have great margin when we are leading with our services. So technology with services, it’s the best. We even deliver — we do partner-branded support on the behalf of HPE, so really engage as one company. This is where we maximize our profitability. Again, I know because I’ve been hearing it and hearing it from the leaders, that we would like to lead more with the entire portfolio now. I think it makes a lot of sense as a strategy. Let’s see how we can accomplish and deliver on this because I still see that it’s two different business needs. The networking and security is one element and the compute and storage and all the tools around it are another motion technology-wise. ROBERT DUTT: Well, a big step towards that I suppose was announced yesterday at the Partner Growth Summit. The big theme being “Power of One” — one portfolio, one partner program, one integrated partner experience, a whole bunch of stuff changing as of November 1. From where you sit, is that message landing with you as a partner? What does consolidating under one program actually mean for how you go to market and how you work with HPE? STÉPHAN WENER: I should add my colleague, Lorene, to the discussion. She deals with them. But to be honest with you, we’ve been waiting for this moment for a while. It was a question we asked them for a couple of years actually, saying, “Listen, we see these two programs. We took the best of both programs because we were having large volume with both sides of the business.” But I think having something unified, that makes a lot of sense, and it’s going to bring more opportunity. It’s also going to reward partners that are invested with HPE. That’s what we like about this program: with this Platinum, Triple Platinum Plus certification, we’re rewarded for the investment we’re making, which is I think something that really resonates for some of us partners. The other element, to be honest, the go-to-market is going to be evolving with time. AI is transforming everything that is happening. So having one program, I think it’s putting HPE in a position that we can leverage all the success we can have on the market. No, I think it’s great news. We’ve been seeing it coming. Now it’s there. It’s still two teams because we’re still interacting with people on compute. We still have two PBMs. We’re still on a service, partner-branded support discussion around the table a little earlier. Now they’re coming with a program that’s going to be one partner-branded support. Juniper had one, Aruba had one, and now all of a sudden HPE wants to have their own. So on the compute side, they’re going to come with one program, which makes it better because it’s going to allow us to have a better ROI on our investment moving forward. ROBERT DUTT: Today was Antonio Neri. STÉPHAN WENER: Yes. ROBERT DUTT: Keynote. “Architecting AI starts with the network.” Pretty deliberate framing. From where you’re sitting and when you’re talking to Canadian organizations day to day, does the premise ring true? Are customers coming to you and saying that the network is the constraint, or is the conversation starting somewhere else? And maybe you discover along the way, “By the way, if you want to get the most out of this, you’re probably going to have to do something with the state of your network.” STÉPHAN WENER: I would say, yes, customers are looking at the network. I think it’s something that I think HPE but other OEM[s] are wishing, that AI transform[s] the network because it’s a good way to kind of, let’s say, let’s refresh these networks. Let’s make sure to create opportunity. I would say, on top of network, I’m really attracted by the security side of it, which means with AI — I was with a customer at lunch today because also we have multiple hats, we meet customers while we’re here — and he was sharing with me that the challenge they live with security, with this AI motion that we see right now, with this new AI world where now it’s not about traditional security. You know, you can get attacked from all over the place. So I think this is going to change the way customers see their network and they’re going to make sure to secure it, but also integrate performance, security, evolution for AI. Because again, you’re building something now. You don’t know what AI is going to be in a year and a half. That’s like — I was actually talking to some customers and we were saying, you know, you have to revise your AI strategy every quarter, every month, because you’re starting somewhere and then, oh, you’re figuring out that there’s another business need that needs to go quicker. So there’s a lot of unknown where it’s going to take us. I think [Antonio] making the right decisions on the network, it’s brilliant for Antonio. And again, when you do a $15 billion investment, okay, you’re going to say this to the market, but I mean, it’s a strength. It’s the strength of HP. If you look at competition, HP has a broader portfolio and being able to lead on the network security side and AI network and all that is brilliant. Now let’s see how the market takes it. I think the AI discussion is not exactly the same depending on where the customer is in his journey. Some of them are more focused on “where do I put my compute?” What we really see now is that it’s not only cloud only anymore. The move back to on-prem is for real now. And we’ve been saying it, we’ve been dreaming it for a while, you know, because it allows us to have more opportunity to… like, to put AI not only on-prem, but also at the edge. We see that coming more and more. So I think the discussion is broader because again, if you go at the edge, it’s all different architecture for networking. You need to protect multiple sites, you know, so… there’s a lot of moving pieces, but I think HP has everything to cover that very well. ROBERT DUTT: When you’re talking to customers today in Canada, what are the big drivers of that move towards the edge and that kind of thing? Just curious how you’re hearing customers weighing data sovereignty versus tokenomics, the big topic of the day. STÉPHAN WENER: There’s two different discussion[s] there. The one part is that — because we do a lot of business in banking and retail and all of this — we have a lot of customers that are looking at the edge. And to be honest, what we were observing a couple of years ago was that they all thought that they didn’t need anything at the edge anymore. “Let’s centralize everything. Let’s go to the cloud. Let’s use VMware. Let’s not even [have] the server at the edge. Let’s just figure out other ways to manage it.” Now we see a total[ly] different direction. Now, customers are realizing that you need to perform a lot of stuff at the edge. So it’s forcing a lot of organization[s] to revisit their plan. So that’s… disruptive when you have… when you had a plan two years ago or five years ago and now you have to revisit it to do it a bit differently. But I mean, I think everyone realizes that you need to run a lot of stuff at the edge right now. AI is one thing, but there’s so many other application[s] that are not really [running] really well in the cloud, you know, security cameras and all of that. So we see a big shift towards having more compute at the edge. But also you need networking to back this up because if you start breaking up, so it creates a lot of opportunities. When you have customers looking [at this], also the explosion of cost of AI. Because if you run all your models in the cloud, it’s highly expensive. So some customers are realizing that for some specific business outcome or business needs, they better run it at the edge because it becomes more economical. I think that was ramping up pretty heavily and it’s really exploded since that [news of the] $500 million [monthly] tokens [bill] came public. And it’s funny, we hear because we have a lot of our people involved in AI, talking with different OEM[s], and I don’t know what’s going to be the end of the future model. You know, these tokens are one element, but there’s going to be competition there, too. You know, it’s never, at the end of the day, they’re all playing in one field where there’s going to have to [be] competition and not… it’s not going to be unlimited token[s] and paying that forever because of the cost. It’s the same thing with the cloud, you know, running AI in the cloud for some large organization[s]. It’s costly. So they have no choice [but] to look at alternatives because, yes, you have business value when you run an AI model that addresses a business need, but at which cost? It’s always the question. You know, where all these customers are running businesses. So they need to make decisions accordingly. ROBERT DUTT: In this moment, for whatever reasons, it may be regulation, general interest in data sovereignty. How do you find data sovereignty is weighing amongst [your customers]? STÉPHAN WENER: It’s big in Canada, especially. Let’s call it out. You know, we’re a Canadian business partner. It’s a big, big subject, sovereignty, both in provincial jurisdiction and also in the country. There’s multiple ways. We all have different options of sovereign [cloud], but also some customers are also rethinking what kind of data do we want to keep to ourselves? This is why there’s a bit [of] turning around to co-location or having on-premise, just because [of] you want to control some of your data. It’s always… there’s always a cautious side to which extent do I think that everything in the cloud is going to be in sovereign cloud in Canada one day? I don’t think so because I think… Azure, all the cloud providers are now having data center[s] in the country. So they found ways to kind of say[ing] that their cloud is also sovereign in a certain way because it’s located in Canada. So they found ways because they don’t want to lose all this market. So they had to have no choice but to go with the flow and figure out a way to address this element. But yeah, it’s definitely a big [topic]. No one wants to send data anywhere in the cloud without controlling where it resides. That’s a very important [consideration], even more in public sector and regulated [industries] in Canada. In Canada, public sector is a big, big part of the business and they are regulated and they have no choice but to follow this very closely. And I think it’s the same in the U.S. as well. We have a lot of discussion with U.S. peers and there’s also this tendency even from state to state, you know, and that there’s like… you never know, you know, there’s all these stories you hear about where’s your data going. You know, the value your data has. A lot of value. These organization[s] know that now. It’s all start[ing] there because you cannot have AI without having the right data. ROBERT DUTT: Today’s presentation from Rami Rahim was mostly about self-driving networks, AI-native, agentic, experience-driven operations, a whole new way of thinking about running the network. It’s a compelling vision. Where’s that at when you’re selling to, say, a 500-person mid-market company? STÉPHAN WENER: It’s great. I would say even enterprise. It’s just, in my opinion, it’s just the beginning. I think it’s great, and it’s really a great vision of HP with Juniper and all that to have that self-[driving capability]. We’ve been hearing about it for a couple of years, but now it’s really for real. I [think], in my opinion, it’s just the beginning because they are going to accelerate that, they’re going to figure out ways to be even more proactive about the network and having more powerful tools. I think it has a lot to do, especially with the SMB and the smaller customers who have a hard time having technical resources to support them. So that’s a big [win]. But on the other side, I always say automation is great, but you always need human[s]. So it’s also a great opportunity for us partners that are delivering a lot of managed services because we’re able to leverage these tools to deliver, to add this little layer where they don’t want to just have a self-[driving] solution that nobody’s going to look at. You know, it’s like you have a dashboard. Somebody needs to keep an eye on the dashboard. So I think it’s also going to change the way we deliver services. So as a service organization, we’re really transforming, leveraging AI as customer zero. So I think it forces us business partners that deliver managed services to our customers to… adjust the way we deliver services to leverage these tools and just add that human layer that is needed. I still believe in AI. We’re looking at it internally and we have a bunch of initiatives. It’s never going to replace totally human because at the end of the day, especially when you have a customer at the end, because the customer experience is very important. So you cannot just decide that you automate the way you answer the phone. See, I was telling [and] giving the example today: I’m [with] an airline that I’m a Super Elite with, Air Canada. I don’t want to call the 1-800 number and be asked 24 questions. I’m very happy because my nicest perk with Air Canada is, I think, a concierge line where I can call as a Super Elite member and somebody’s answering the phone and they’re changing my ticket in three minutes and I don’t have to press one and two and five and six. So in a way, I’m just giving you this example because I, as a user, there’s a frustration with AI. So I think it’s very important to leverage AI, but keep that human touch that you need to complete the CX at the end of the day. ROBERT DUTT: So is that the pitch that lands then — the idea that we can take some cost out of operating the network by automating a lot, but we’re still going to have that trust. But we can… STÉPHAN WENER: I think we can do more with less. I think it’s all about bringing even more value to our customer and leveraging these tools. It’s a must. You know, we see it all over the place in our service organization. We see it on the field services where we have to use this intelligence to be more effective. And I was… I can call it out, it’s like I was with an airline for lunch. That’s why it’s all in my head. And they’re using AI for maintenance because they said it’s so powerful because the data is amazing. All these manuals about the aircrafts and everything, so you can document this with also other tickets they had and they can give instruction to the maintenance team and they save them. They’re telling them it’s either A or B before they add ABCD and they were doing try and try out. So they’re way more effective. So I’m just saying AI is helping us doing more with less, being better at what we do. But I mean, you still need to leverage it the right way. You need to have human intelligence behind and bring the value around it. That’s my [view], my opinion about AI. And in the case of what Rami said and where Juniper is going, all these tools are amazing. But I think it’s important. Customers are going to leverage it. They’re going to be able to do more with less, too. But I think for the mid-market type of customers, it’s more important for us business partners to add these services to our portfolio and be able to complete the service offering of HP, HP, Juniper and Aruba, or whatever HP networking [is called] now. More services, always a win. That’s what to do. ROBERT DUTT: We’ve covered a lot of territory. I’m curious. What else have you taken away from this week? When you’re going back and meeting with your teammates, what’s going to be the thing that goes, “Hey guys, did you think about or did you hear about…?” STÉPHAN WENER: I would say it’s the broad portfolio that HP has to bring to the market right now. And the fact that, you know, it was amazing to see all these announcement[s] about HP [and] the new tools, the way they are, the evolution of Central, the evolution of Mist. I think HP now, after these big acquisition[s], [is] getting their act together. And I think they’re one of the best OEM[s] ready… to be ready for AI. They’re all saying it because all our team members are going to Cisco and all that, and they all have a message around AI. I think it’s a must in this industry right now. But I’m telling you, as an experienced [partner], as a technology ally that we are at Compugen, we see that HP has a real story and they’re really doing the right thing to be a key player in this AI transformation that we see right now. So I think the value HP brings, all the tools around… there’s multiple examples to give. But I think the portfolio, the engineering, you know, Antonio is an engineer at the end of the day. And Antonio’s vision is about integrating the solution and doing the right thing so we can bring the right set of solution to the market. And I think we can feel it now that this is all getting together nicely, adding the building blocks that are missing to the offering. But HP is really [positioned] to be a strong partner for all customers in this AI journey. That’s what I see. ROBERT DUTT: Last question. What should partners and customers of yours who aren’t here this week take away from what’s been announced, what’s been discussed here? If you’re updating a customer on what you’ve learned here, what’s the headline you’re going with? STÉPHAN WENER: I would say one thing I was impressed [by]. I feel, and again, I’m on the partner advisory board of HP Networking. So I’m going to see tomorrow what they say. But I have a feeling that the transition of bringing HPE, Aruba and Juniper is going quicker than expected. I think they’re doing a very good job at it. And that’s going to create a very good motion. So I would say that’s a powerhouse now when you put Juniper and HPE Aruba together. So I think for all customers, I see HP like a very strong dominant player in the future in that networking and security space. So the fact that this integration seems to go very smoothly and rapidly, I think is going to have a very positive impact on the market. That’s one element I see. Again, I love what I see, all these announcements about compute and storage and all these AI-ready solution[s]. That’s also, again, what I would take back. It’s all [about]: if you need help in AI, HP has a solution for you. That’s pretty much what I would say to customers: wherever you need to invest because they’re not all investing at the same area. Some of them, it’s only the network and they decided to do it in the cloud and they’re going to do it in the cloud. Some others are looking at different models. So that’s my biggest takeaway: where HP is as a portfolio right now and the role it can play on all customers’ AI journey. Considering the attention on AI, [it’s] pretty good, to be honest with you. But again, AI is also driving a lot of other transformation. It drives the way customers are looking at their IT services because again, I was talking to [another] customer yesterday. If you have to invest in AI, they’re not going to tell you, “Hire 20 more employees to do your AI.” They’re going to say, “Listen, figure out a way to do your AI with the staff you have.” So if I’m a CIO, the way I’m going to look at it, I’m going to say, “Listen, I’m going to need help elsewhere. If I’m able to allocate a certain number of my resources working on AI, I’m going to need business partners to perform some IT services on my behalf.” So it creates an amazing opportunity for us business partners, not only the AI journey itself, but the fact that they have no choice but to kind of reinvent the way they’re providing their services, because nothing changes: you still have users, you still have infrastructure, you still have to keep the lights on and run your business. So this is something I see a lot: AI is transforming the way they look at where they’re going next. Because they’re not going to have an explosion of cost, especially now with what we are experiencing in supplies and the price increase. They still have to do the same with the same money a lot of time. So they need to reinvent themselves to figure out a way to meet their budgets and meet their business outcomes. ROBERT DUTT: Good luck on helping many customers, man. STÉPHAN WENER: We will do it. And our goal is to do it as a team with HPE. We got the title for 2025 and we want to do what’s best to make sure we do it for 2026 as well. ROBERT DUTT: Good luck with that. And thank you again for taking the time. STÉPHAN WENER: My pleasure. ROBERT DUTT: There you have it. Stéphan Wener from Compugen. I’d like to thank Stéphan for his time on what was a very busy week at HPE Discover and a very successful one for Compugen. If you’ve been following the news from the event on the site, you now got a pretty complete picture of HPE Discover from a few different angles: the preview with Jeremiah Jenson, the partner program announcement deep dive on Tuesday, and now a partner’s-eye view from one of HPE’s top Canadian players. The thing I keep coming back to from this conversation is something Stéphan said fairly early: that HPE is “a different company right now” — not compute-led anymore, but AI technology-led with networking increasingly at the center of gravity. That message was all over Neri’s keynote and Rahim’s session, but hearing it reflected back from a partner who’s been in the trenches with HPE for years and who had to make real investment decisions to get to Triple Platinum Plus — that carries a different kind of weight. The data sovereignty and tokenomics point is one I’d flag for your own customer conversations if you’re an HPE partner, or really any partner in the infrastructure space. The cost of running AI at scale in the cloud is increasingly nudging customers, particularly in the Canadian public sector and regulated industries, back toward on-prem and edge deployments. That’s not a new idea, but it’s getting sharper, and it plays directly into the HPE portfolio story that was front and centre this week. In The Channel is available on Apple Podcasts, Spotify, YouTube, and most podcast directories. If you find value in what we’re doing here, a rating or review is always appreciated — it helps other people in the Canadian channel find us. Until next time, I’m Robert Dutt for ChannelBuzz.ca, and I’ll see you in the channel.

Most Americans think they live in a free market.But if that's true, why do we keep ending up with fewer airlines, fewer hospitals, fewer pharmacies, fewer banks, fewer food processors, and fewer choices?In this episode of Common Sense with Chad Law, we take a hard look at the forgotten conservative history of antitrust, trustbusting, and competition. From Theodore Roosevelt and Standard Oil to Reagan and AT&T, we explore why conservatives once saw concentrated corporate power as a threat—and why that conversation disappeared.We'll break down how government intervention, regulation, consolidation, lobbying, and market concentration created an economy where giant corporations increasingly dominate healthcare, technology, food, airlines, banking, and communications.This isn't an argument against capitalism.It's an argument for competition.Because capitalism isn't giant corporations.Capitalism is the freedom to take your business somewhere else.Topics include:• Standard Oil• AT&T and the Reagan breakup• Google's dominance• Healthcare consolidation• PBMs and prescription drug costs• Food industry concentration• Defense contractor consolidation• Government regulation and barriers to entry• Competition vs competitors• Why your paycheck doesn't go as far as it used toIf you enjoy thoughtful conversations about economics, politics, public policy, and common sense solutions, subscribe and share the show.00:00 The Illusion of Monopolies00:27 The Burden of Regulation06:20 The Myth of Free Markets11:48 The Conservative Legacy of Antitrust20:00 Lessons from History: Standard Oil and AT&T26:45 The Pressure of Competition in a Free Market28:27 The Role of Conservatives in Trustbusting28:52 Government Intervention and Market Consequences31:01 The Cycle of Government Fixes and Market Distortion32:53 The Impact of Regulations on Small Businesses36:17 The Creation of Monopolies through Government Meddling38:07 The Loop of Market Concentration and Political Influence41:12 The Healthcare Market and Its Concentration46:05 The Modern Monopoly: Google and Its Influence51:42 Concentration in the Food Industry57:38 The Squeeze on Farmers and Consumers59:34 The Velvet Rope of the Food Market01:00:11 The Role of Middlemen in Healthcare01:01:33 The Airline Industry's Struggles01:03:25 Concentration of Power Across Industries01:04:10 The Confusion of Antitrust Principles01:07:46 The Shift from Building to Bargaining01:11:12 The Path to Restoring Competition01:12:19 Lessons from History: The Breakup of Ma Bell01:14:09 The Call to Action for Competition

In this episode of Healthcare Happy Hour, host David Saltzman sits down with Jim Jusko, chief strategy officer at Excel Health Plans, to explore how hospital systems, provider networks, and pharmacy benefit managers (PBMs) shape healthcare costs, competition, and consumer choice behind the scenes. Jim discusses the impact of consolidation, limited transparency, and anti-competitive practices on employers and consumers, while highlighting policy and market-based solutions that could improve affordability, increase competition, and create a more transparent healthcare system. He also shares his vision for a healthcare marketplace that better aligns incentives for employers, providers, and patients.

In this episode, we are joined by Chris Hamilton, Partner and Employee Benefits Practice Leader at Hotchkiss Insurance, an independent insurance agency based in Texas. With nearly two decades of experience in corporate finance and employee benefits, Chris helps employers navigate the complexities of the healthcare system, reduce costs, and gain greater control over their health plans by moving beyond traditional insurance models. In addition to his work at Hotchkiss Insurance, Chris is the founder of Benefits Insider, an educational platform dedicated to helping employers understand how healthcare financing really works. Through practical case studies, industry analysis, and real-world examples, he empowers business leaders to make more informed decisions about employee benefits and healthcare spending. Recognized as the 2025 BenefitsPro Advisor of the Year, Chris has become a leading voice on healthcare transparency, employer-sponsored health plans, and cost-containment strategies. He regularly contributes to podcasts, conferences, and educational content designed to simplify one of the most misunderstood areas of business. This conversation explores: How Chris got started in the healthcare and employee benefits industry The unintended consequences of the Affordable Care Act on employers and healthcare  The incentives that drive insurance companies, pharmacy benefit managers (PBMs), and other healthcare stakeholders Alternative approaches to controlling healthcare costs  Why are healthcare costs continuing to rise, and what can employers do to take back control of their benefits strategy? Tune in to hear Chris's practical insights into the healthcare system and how businesses can create more efficient, cost-effective plans for their employees. Connect with Chris: Personal Website Hotchkiss Insurance LinkedIn Youtube Tiktok

Let's talk PBM's.  What even is a P-B-M? Pharmacy benefit managers have been around since the 1960's, although back then, they were basically claims processors. Things changed in the 80's and 90's following the first iteration of ERISA when employers saw PBMs as potential cost containment strategies. The industry continued to explode until 2007 when CVS acquired Caremark, and now the market is really consolidated into just three major players. Why does this matter? Well, PBMs control just about everything drug-related in the US these days, and that includes the cost. Given that we have not seen the promised drop in drug prices, Americans and employers are still bearing the burden of this bloated and broken system.  To unpack how this works and what folks are doing about it, we invited back Shawn Gremminger, the President and CEO of the National Alliance of Healthcare Purchaser Coalitions. His organization works with regional coalitions of employers to help them advance health policy, leverage their collective power, and drive market change.

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY CVS HEALTH.In this sponsored episode, James Margiotta, Chief Growth Officer at CVS Caremark, joins Health Affairs Publishing's Jessica Bylander to unpack the role of pharmacy benefit managers (PBMs), their impact on prescription drug costs, and the value PBMs bring to the health care system.James has nearly 35 years of experience driving innovation, operational excellence, and enterprise value across the healthcare system. In his current role, James leads the team responsible for partnering with clients to identify their unique needs and bringing forward strategic solutions to meet their objectives.Throughout his career at CVS Health, James has scaled businesses across CVS Caremark, CVS Accountable Care, Minute Clinic, Aetna, and CVS Pharmacy — each with its own challenges, cultures, and market dynamics.James and Jessica's conversation explores how PBMs help employers, health plans, governments, and unions manage rising prescription drug costs while balancing affordability, transparency, and member experience. James explains CVS Caremark's approach to controlling costs, dives into the growing demands for price transparency, and how artificial intelligence may transform pharmacy benefits and member navigation services.

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY CVS HEALTH.In this sponsored episode, James Margiotta, Chief Growth Officer at CVS Caremark, joins Health Affairs Publishing's Jessica Bylander to unpack the role of pharmacy benefit managers (PBMs), their impact on prescription drug costs, and the value PBMs bring to the health care system.James has nearly 35 years of experience driving innovation, operational excellence, and enterprise value across the healthcare system. In his current role, James leads the team responsible for partnering with clients to identify their unique needs and bringing forward strategic solutions to meet their objectives.Throughout his career at CVS Health, James has scaled businesses across CVS Caremark, CVS Accountable Care, Minute Clinic, Aetna, and CVS Pharmacy — each with its own challenges, cultures, and market dynamics.James and Jessica's conversation explores how PBMs help employers, health plans, governments, and unions manage rising prescription drug costs while balancing affordability, transparency, and member experience. James explains CVS Caremark's approach to controlling costs, dives into the growing demands for price transparency, and how artificial intelligence may transform pharmacy benefits and member navigation services.

In this episode of the PBM Reform Podcast, host Greg Reybold, Vice President and General Counsel at APCI, welcomes Josh Golden, Senior Vice President of Strategy at Judi Health and a nationally recognized voice in Pharmacy Benefit Manager reform. With more than 20 years of healthcare consulting experience, Golden brings deep expertise in vendor procurement, contract negotiation, plan design, and benefit strategy for large employers, government entities, and unions. Together, Reybold and Golden examine the financial models behind today's PBM industry and why true transparency remains so difficult for employers, plan sponsors, patients, and pharmacies. The conversation explores how current PBM arrangements often benefit the PBMs more than the employers paying for coverage or the patients relying on their prescription benefits. Golden explains why auditing PBM contracts, rebate structures, spread pricing, administrative fees, pharmacy networks, and formulary decisions is essential to understanding the real economics of prescription drug benefits. This episode also addresses a growing concern in healthcare: PBM steering behavior. Are patients being quietly pushed toward specific formularies, specific pharmacies, and restricted networks that operate like closed networks without being clearly disclosed? Reybold and Golden discuss how this behavior can limit patient choice, disadvantage independent pharmacies, and distort the stated goal of lowering drug costs. The discussion also tackles the role of federal reform efforts, including whether the Appropriations Act represents meaningful PBM accountability or whether it risks becoming another layer in the broader shell game surrounding PBM reform. Finally, the episode asks one of the most important questions in pharmacy policy today: should PBMs own pharmacies? If vertical integration is promoted as a way to lower drug costs, where is the proof — and who actually benefits? Transparency, Auditing, and the PBM Shell Game | PBM Reform

This time on Healthcare Now we've got a friendly face returning (by phone)! Dr Betsy Dovec is the brain behind The Surgical Institute Of Central Florida, she joins Larry and Doctor Mark from out on the scene in Winter Garden to talk with them about the world behind health care now! What's the latest about those weight-loss drugs? What do you need to know to keep yourself safe if you use them? More big lawsuits about billing, learn the math in play at some of the PBMs and insurance companies! Rural care challenges and the ACA are just a couple of the subjects at hand! And what about burgers? See omnystudio.com/listener for privacy information.

This time on Healthcare Now we've got a friendly face returning (by phone)! Dr Betsy Dovec is the brain behind The Surgical Institute Of Central Florida, she joins Larry and Doctor Mark from out on the scene in Winter Garden to talk with them about the world behind health care now! What's the latest about those weight-loss drugs? What do you need to know to keep yourself safe if you use them? More big lawsuits about billing, learn the math in play at some of the PBMs and insurance companies! Rural care challenges and the ACA are just a couple of the subjects at hand! And what about burgers? See omnystudio.com/listener for privacy information.

Mike and Madison discuss TrumpRx's expansion to include more than 600 generic drugs, Optum Rx's latest pharmacy transparency announcement and what potential Federal Trade Commission action against PBMs could mean for plan sponsors. Register for upcoming Employers Health webinars or watch on demand at https://www.employershealthco.com/resource-center/events/ Sign up for our monthly newsletter at https://www.employershealthco.com/#subscribe_cta Find additional helpful benefits strategies and resources at https://www.employershealthco.com/resource-center/articles/

So much for common ground… Buckle up because this week Jillian Michaels sits across from Sam Seder, host of The Majority Report, for a bare-knuckle debate on government waste, Iran, Israel, Russia, Ukraine, DOGE, USAID and more. Nothing was off-limits. If you wanted a polite, coordinated conversation, go somewhere else. This is a full-throated ideological fight. In this episode, they tear into: The Global Health & Foreign Aid Crisis: The dismantling of USAID is front and center — is America's withdrawal from international NGO funding a necessary correction or a catastrophic failure? The debate gets heated fast, with the "last-mile" operational collapse in Uganda and the human cost of overnight co-investment mandates laid bare. The Mamdani-Khomeini Comparison: The Iranian diaspora isn't staying quiet — and this is where things get truly combustible. Jillian comes in swinging, amplifying the voices of exiles who lived through the revolution and are drawing chilling parallels between Mamdani's ideological framework and the Ayatollah's early intellectual positioning and Sam gets outraged. The Iran Conflict & The Fog of War: A fierce legal and ethical battle erupts over the recent strikes in Iran. The tragic Minab school bombing, the possibility of flawed targeting intelligence, and the complex question of civilian protections when military assets are embedded in non-military infrastructure all get put under the microscope. Russia, Ukraine & the NATO Fault Line: With the war grinding into a new phase, they go head to head on whether Western alliance commitments are a stabilizing force or a provocation that made this conflict inevitable DOGE, PBMs, and Domestic Warfare: The heat turns inward to tackle domestic deregulation, the rising influence of the Department of Government Efficiency, and whether the new delinking and transparency rules under the TrumpRx framework are liberating healthcare or creating new corporate loopholes for PBMs to exploit. Two distinct worldviews. Absolute zero consensus. Who held their ground, and who got exposed? Stream the full, unfiltered debate now and drop your thoughts in the comments below. OneSkin: Get 15% off OneSkin with the code KEEPINGITREAL at https://www.oneskin.co/KEEPINGITREAL #oneskinpod Skims: Shop Everyday Cotton, and all of my favorite bras and underwear at http://www.skims.com/jillian #skimspartner Beam: Visit https://shopbeam.com/REAL and use code REAL to get our exclusive discount of up to 40% off. Learn more about your ad choices. Visit megaphone.fm/adchoices

The city of Des Moines is expecting a budget shortfall after Governor Kim Reynolds signed a property tax bill into law. Democratic candidate for governor Rob Sand says he would address PBMs. And who are the Republicans running to represent Iowa's Second Congressional District?

On today's episode of The Gist Healthcare Podcast: health systems join a new federal initiative aimed at streamlining prior authorizations, lawmakers revive legislation that would ban PBMs from owning retail pharmacies, and a judge clears the way for CVS Health to sell its long-term care pharmacy business. Hosted on Acast. See acast.com/privacy for more information.

Independent pharmacies in Rhode Island are making a call for pharmacy benefit manager reform, pointing to "predatory practices" such as price gouging and limiting access to medications. Local pharmacy owner have now launched a campaign seeking immediate relief from the Rhode Island General Assembly to protect independent pharmacies and customers from what they describe as harmful conduct by PBMs. Nicholas Shanos of Suburban Pharmacy joins Gene to discuss these issues.See omnystudio.com/listener for privacy information.

In 2008, Katy Talento walked away from Capitol Hill and into a Catholic convent. Within a year, she walked out. Within another decade, she sat inside the White House shaping health policy. Somewhere in between, she got labeled “infertile” after a single cycle of testing and spent years believing it.That label stuck. The pain that came before it never got investigated. Doctors offered birth control and moved on. No one asked why her body was struggling. No one followed the thread.Talento built her career inside the very systems she now critiques. She worked on federal health policy, global disease programs, and later advised the Trump administration on healthcare reform. She helped advance price transparency rules in a system where hospitals can still list 457 different prices for the same service.Then she left.Now she builds employer health plans that bypass insurers, PBMs, and traditional networks. Her approach replaces insurance contracts with direct payment, nurse navigators, and cost sharing models that promise simplicity but raise hard questions about risk and protection.This conversation sits in that tension.Talento describes a healthcare system shaped by layered incentives, where insurers, hospitals, and intermediaries profit from complexity. She argues that employers hold the leverage to disrupt it. The host pushes on what happens when patients fall outside those structures, when contracts disappear, and when community based models fail.The episode moves through infertility, misdiagnosis, insurance design, and the mechanics of employer sponsored care. It tracks how policy decisions made in Washington ripple into exam rooms, billing departments, and family lives.It also confronts a harder truth.Even insiders who understand the system can still get caught in it.RELATED LINKSAllBetter HealthKaty TalentoThem Before UsAn Arm and a LegRelentless Health ValueFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

**In this episode, I explain why rapid growth in a PBM-heavy pharmacy actually triggers serious cash flow problems, how the timing gap between paying your wholesaler and getting reimbursed by PBMs creates a financial squeeze, and what you can do to offset it.** **Show Notes:** 1. **Introduction** [0:00] 2. **Cash Flow Challenges in Pharmacies** [0:10] 3. **Impact of Rapid Growth on Cash Flow** [2:45] 4. **Strategies to Mitigate Cash Flow Issues** [3:54] 5. **Financial Consequences of Pharmacy Growth** [6:19] 6. **Controlling Your Pharmacy Cash Flow** [7:17] **Links mentioned in this episode:** Join our DiversifyRx Facebook Group for FREE: https://www.facebook.com/groups/diversifyrx/   ----- #### **Becoming a Badass Pharmacy Owner Podcast is a Proud to be Apart of the Pharmacy Podcast Network**

Welcome back to Last Month in Healthcare! This month, Spencer and Nathaniel sit down without a guest to unpack the biggest healthcare headlines and regulatory shifts from April 2026.From state-level crackdowns on PBMs to a surprising loophole that allows urban hospitals to siphon rural hospital aid, the guys dissect the policy changes and market moves that are actively reshaping the industry. They also discuss the affordability crisis driving a 26% surge in ACA Bronze plan enrollment, Amazon's aggressive new play into the GLP-1 and primary care market, and why CMS is finally (and officially) killing the fax machine by 2028.Plus, Spencer plays a game of "Blind Ranking," attempting to properly order the top 10 best practices and features of a modern self-funded health plan (including pass-through PBMs, cash-pay surgery networks, and pharmacogenomics) without knowing what's coming next.Thank you to this year's sponsor, Walk On Clinic!If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Chapters: (00:00:00) Intro & Sponsor Shoutout: Walk On Clinic (00:01:42) Bipartisan State Healthcare Regulations & PBM Oversight (00:04:40) ACA Shifts: The Rise of Bronze Plans & HSA Eligibility (00:08:38) The FTC's Vague New Healthcare Task Force (00:10:10) The Rural Hospital Aid Loophole Exploited by Urban Hospitals (00:11:27) Amazon Launches a $149/mo GLP-1 & Primary Care Program (00:15:18) CMS is Finally Ending the Fax Machine (Saving $781M) (00:16:48) Game: Blind Ranking the Best Self-Funded Plan Features (00:24:45) PSA: Watch Out for These Hidden Carrier Contract Clauses

Welcome back to Last Month in Healthcare! This month, Spencer and Nathaniel sit down without a guest to unpack the biggest healthcare headlines and regulatory shifts from April 2026.From state-level crackdowns on PBMs to a surprising loophole that allows urban hospitals to siphon rural hospital aid, the guys dissect the policy changes and market moves that are actively reshaping the industry. They also discuss the affordability crisis driving a 26% surge in ACA Bronze plan enrollment, Amazon's aggressive new play into the GLP-1 and primary care market, and why CMS is finally (and officially) killing the fax machine by 2028.Plus, Spencer plays a game of "Blind Ranking," attempting to properly order the top 10 best practices and features of a modern self-funded health plan (including pass-through PBMs, cash-pay surgery networks, and pharmacogenomics) without knowing what's coming next.Thank you to this year's sponsor, Walk On Clinic!If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Chapters: (00:00:00) Intro & Sponsor Shoutout: Walk On Clinic (00:01:42) Bipartisan State Healthcare Regulations & PBM Oversight (00:04:40) ACA Shifts: The Rise of Bronze Plans & HSA Eligibility (00:08:38) The FTC's Vague New Healthcare Task Force (00:10:10) The Rural Hospital Aid Loophole Exploited by Urban Hospitals (00:11:27) Amazon Launches a $149/mo GLP-1 & Primary Care Program (00:15:18) CMS is Finally Ending the Fax Machine (Saving $781M) (00:16:48) Game: Blind Ranking the Best Self-Funded Plan Features (00:24:45) PSA: Watch Out for These Hidden Carrier Contract Clauses

In this episode, guest Antonio Ciaccia, president of consulting firm 3 Axis Advisors and founder/CEO of non-profit 46brooklyn Research, joins host Dan Karnuta for a discussion about U.S. drug pricing. The model is opaque because it runs on inflated list prices and hidden discounts created by government policy and industry incentives. Instead of competing on price, drug companies raise prices and offer rebates through intermediaries like pharmacy benefit managers (PBMs), who control which drugs are covered. This system weakens normal market forces and concentrates power in the middle of the supply chain. Karnuta is an associate professor in the Naveen Jindal School of Management's Organizations, Strategy and International Management Area as well as director of its Professional Program in Healthcare Management.

In this episode of the AI at Health series on The Beat Podcast, host Sandy Vance sits down with Venky Ananth, Executive Vice President and Head of Healthcare at Infosys, for a wide-ranging and energizing conversation about what it actually means for AI to transform healthcare at scale. Venky brings a refreshingly honest and structured perspective to a conversation that is often dominated by hype, breaking down why AI is fundamentally different from every other technology wave healthcare has been through, laying out the five areas where Infosys is seeing real traction with payers, providers, and PBMs right now, and sharing the story behind two exciting developments: the acquisition of Optimum Health IT and the Pacesetters podcast and executive leadership community. If you are a healthcare leader trying to figure out where to start or how to think about AI as a whole-enterprise challenge rather than a point solution, this episode is essential listening.  In this episode, they talk about: AI is not a point solution; it is a new operating system that will touch every function in every organization Healthcare is broken, fragmented, and frustrating, and AI is the first technology with the potential to fix all three at once Legacy modernization must come before AI adoption because you cannot layer intelligence on top of broken processes AI can now reverse engineer legacy systems that used to depend entirely on tribal knowledge The five pillars of AI transformation are strategy and engineering, legacy modernization, data, process reengineering, and physical AI Training AI on your own private data is the competitive wedge that separates leaders from followers Agents are the new team members, and organizations need to rethink how humans and agents orchestrate workflows together Infosys acquired Optimum Health IT, the number one-ranked Epic implementation partner according to KLAS, to deepen its provider capabilities Epic now covers an estimated 220 to 230 million distinct patients in the US and is growing internationally The Pacesetters podcast and annual executive gathering bring together CIOs, CTOs, academics, and analysts for candid, off-the-record dialogue about the future of healthcare A Little About Venky Ananth: Venky is a technology and transformation executive with deep experience leading a global business unit, scaling high-performance organizations, and delivering large-scale change through AI, cloud, and modern growth operating models. His career has focused on helping enterprises modernize core systems, improve operational efficiency, and unlock new growth through platform innovation and disciplined execution. He founded and scaled Infosys Helix, a cloud-native platform business that continues to shape payer and health platform modernization. In addition, he has led global teams across engineering, delivery, consulting, and product, giving him a broad view of strategy, technology, operations, and organizational scale. He operates at the intersection of technology, business model transformation, and leadership development, with a track record of strengthening enterprise performance and building organizations capable of sustained growth. Beyond his operating role, I host PaceSetters, a CXO leadership platform featuring conversations with leaders from healthcare, academia, private equity, and technology. 

On this special LIVE from HIMSS 2026 Gil is joined by two-time TEDx speaker Christina Madison, PharmD, FCCP, AAHIVP, the founder and CEO of The Public Health Pharmacist, for a candid, wide-ranging conversation about the profession's inflection point. From the chronic misdiagnosis of cardiovascular disease in women, to the existential threat posed by PBMs and automation, to the urgent fight for pharmacist provider status, Dr. Madison articulates a bold vision: community pharmacists aren't just pill dispensers, they are public health's most accessible, underutilized, and undercompensated front line. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

The Nurses Report on America Out Loud with Ashley Caputo, RN, FMP – This episode of The Nurses Report explores how Pharmacy Benefit Managers shape access to medications, often leading to delays and denials. It examines carve-outs, ERISA limits, and real patient impacts while highlighting the growing need for transparency, advocacy, and patient-centered decision-making in today's healthcare system...

Congratulations to Logan Eury and his new wife Emily, got married today, May 1, 2026!  This C.O. Bigelow Collab Introduces the 188-Year-Old Pharmacy to a New Generation Abbode is taking over the Carolyn Bessette-Kennedy-approved shop for a month-long pop-up. https://fashionista.com/2026/05/co-bigelow-abbode-pop-up-carolyn-bessette-impact  The article highlights how a pop-up and renewed interest in C.O. Bigelow has been fueled by the cultural resurgence of Carolyn Bessette-Kennedy's minimalist style, amplified by media and social buzz. This renewed attention has driven significant foot traffic and sales, showing how storytelling, nostalgia, and “quiet luxury” aesthetics can translate into real retail impact.   Q&A: Mayo Clinic leaders share strategies for managing high-cost drugs without breaking the bank | Asembia AXS26 Summit https://www.managedhealthcareexecutive.com/view/q-a-mayo-clinic-leaders-share-strategies-for-managing-high-cost-drugs-without-breaking-the-bank-asembia-axs26-summit Mayo Clinic leaders emphasize that managing high-cost drugs requires clear definitions, structured formulary review processes, and multidisciplinary collaboration to balance cost, access, and clinical value. They highlight the importance of evaluating safety, efficacy, financial impact, and site-of-care decisions together, while noting that non-340B systems face increasing pressure from rising costs and reimbursement constraints. Ultimately, success depends on stronger alignment between health systems, manufacturers, and payers to sustain access without compromising quality of care.  Where Gross-to-net Pressure Actually Lives After Launch Today's guest post comes from Cindy Baksh, Chief Product Officer at ConnectiveRx. https://www.drugchannels.net/2026/05/where-gross-to-net-pressure-actually.html The article explains that “gross-to-net pressure” isn't driven by a single factor, but by a combination of rebates, discounts, fees, and policy changes that continue to reshape how drug pricing actually works behind the scenes. As the industry shifts toward a “net pricing” model, traditional rebate-driven strategies are weakening, forcing manufacturers, PBMs, and pharmacies to rethink how value and profits are generated. Today's featured guest is Dr. Ndidiamaka Okpareke PharmD for Congress Dr. Ndidiamaka “Didi” Okpareke, PharmD, is a pharmacist, entrepreneur, and political candidate running for Congress in New Mexico's 1st Congressional District. A first-generation Nigerian-American, she built her career in healthcare after graduating from the University of New Mexico College of Pharmacy and went on to found and lead a successful compounding pharmacy serving her community.  Motivated by nearly two decades of patient care experience, Okpareke entered the political arena to address challenges such as healthcare access, rising costs, and the shortage of providers in New Mexico. Running as a Republican, she emphasizes strengthening healthcare systems, supporting economic growth, and preserving opportunity for future generations, positioning herself as a community-focused leader bringing frontline healthcare insight into public policy.  This special episode highlights how TJM Labs is redefining pharmacy operations through AI-driven automation, bringing together insights from industry leaders Bhavesh Patel, PharmD—CEO of Carepoint Pharmacy—and Jonathan Adly, PharmD, MBA—CEO of TJM Labs. At the center of the conversation is how modern pharmacies are facing rising prescription volumes, staffing constraints, and increasing operational complexity, and why traditional manual workflows can no longer keep pace. TJM Labs addresses this challenge by deploying AI-powered “digital workers” that automate tasks like prescription intake, data entry, and patient communication—allowing pharmacy teams to shift their focus back to patient care and clinical decision-making.  Through the lens of both operator and innovator, the discussion explores how AI is not replacing pharmacy professionals, but augmenting them—reducing burnout, improving accuracy, and enabling scalable growth. With automation handling up to the majority of repetitive workload and delivering measurable ROI, TJM Labs represents a new model where technology and pharmacy expertise work together to create more efficient, patient-centered operations. 

The Nurses Report on America Out Loud with Ashley Caputo, RN, FMP – This episode of The Nurses Report explores how Pharmacy Benefit Managers shape access to medications, often leading to delays and denials. It examines carve-outs, ERISA limits, and real patient impacts while highlighting the growing need for transparency, advocacy, and patient-centered decision-making in today's healthcare system...

The Speaker of the Tennessee House of Representatives Cameron Sexton (R) gives us insight to the last bills passed during this legislative session. Here are some of the main points. AIRPORTS- From the 9 member board of the Nashville Airport Authority, 6 state appointments and 3 local appointments. Sexton says, "We put in a lot of money, we have done a lot of things to help the airport, and so we are saying we want some picks on the board. The mayor still has picks, the governor and 2 Speakers have picks. When asked why change the Airport Authority when it is already successful? Sexton added, "It's not a power grab, I would say if you're investing $50, $100, $150 million dollars into something, wouldn't you want to have people on the board to make sure that your investment is doing well?" AFFORDABILITY- Sexton says that the state has temporarily reduced taxes several times, Cracked down on PBMs, struck down laws preventing hospitals from expanding and created workforce housing. Sexton says, "We are already an affordable state and will continue to be that way." SCHOOL VOUCHERS AND ESA- Although the state of Tennessee ranks 47th out of 50 states for student funding per capita, Sexton believes private schools with students who already attend private school are justified in receiving the $7530 Education Freedom Scholarship (an increase from last year from $7295) to go directly to pay a portion of private school tuition. The 3.2% increase would remain consistent with per-pupil base increase in the TISA formula, but less per student than what is given to private schools. When it comes to testing, public schools use TCAP, and was required for students using Education Savings Account money for private school, but without TCAP used, how will private schools show student competency? "The private schools are going to tell us what standardized test they are using. Because we want to know what that is. What I think we need to do is look at those tests, look at the TCAP and allow the public schools to use whichever national standardized test that they want to and that's fair... It would be a fascinating argument which they would choose." NewsChannel 5+ can be seen on Spectrum/Charter Ch. 182 and over the air on Ch. 5.2. Inside Politics also streams live Fridays at 7pm and Saturdays at 3pm on our website: https://www.newschannel5.com/live3 as well as the NewsChannel 5 Now app on Connected TVs through Roku, AppleTV, AndroidTV, etc. The episode will air throughout the weekend on NewsChannel 5+ Sat. at 5:30am, 3pm, Sun. at 1am, 9am, 7pm, Mon. at 2:30pm and Tues., 3pm unless pre-empted.See omnystudio.com/listener for privacy information.

Tennessee lawmakers have passed a major pharmacy reform bill aimed at pharmacy benefit managers, or PBMs, by barring companies from owning both a PBM and a pharmacy. The legislation is widely seen as targeting CVS Health, which owns Caremark and operates pharmacies across the state. Supporters say the bill is designed to curb vertical integration, restore fair competition, and protect independent pharmacies from reimbursement practices they view as harmful to patient access and community pharmacy survival. CVS has pushed back hard, warning that the new law could force it to shut down its 134 Tennessee pharmacy locations and trigger a legal challenge. The company argues the measure would reduce access for patients and does not directly address broader PBM issues like pricing or formularies. This Tennessee fight reflects a larger national battle over PBM reform, pharmacy ownership, market power, and the future of prescription drug access.  

Joseph Kleiman, President of Buzz Health, is working to improve price transparency and affordability of prescription drugs. He states that providing price transparency as early as possible in the prescription process is critical for prescribers, patients, and health plans to make better, more cost-effective decisions. To achieve true transparency, all parties in the ecosystem must cooperate and share data, moving beyond pricing visibility to fully integrate systems and use real-time information to improve patient adherence and lower costs. Joseph explains, "Buzz Health really focuses on improving the process behind the scenes, developing technologies that sit within the prescription ecosystem, creating opportunities to improve price transparency, early adoption, and integrated benefits for members."  "We work with everybody from pharmacies to PBMs to payers to employer groups. Anybody we believe has an opportunity that, with technology and early adoption of price transparency and adherence, could benefit them and the members they serve." "What's interesting is that, like most things, the earlier you have information, the easier it is to make actionable change, things with long-term impact. So if you have price transparency and you have it early on, a prescriber can make more informed decisions. A patient, rather than showing up at a pharmacy counter, can make decisions earlier on. So again, it's kind of like the earlier you have anything in making a decision, the easier it is for you to make a really actionable change all the way up through a PBM or health plan. If they see gaps in coverage and they have that information, they can make changes early on as well." #BuzzHealth #PrescriptionDrugs #Pharmacies #HealthcareIT #PriceTransparency #PrescriptionAffordability #PharmacyTech #MedicationAccess #HealthcareTransparency #PrescriptionPricing #PatientCare #HealthTech #PharmacyBenefits #HealthcareInnovation #PatientOutcomes #MedicalTechnology buzzhealth.com Download the transcript here  

Joseph Kleiman, President of Buzz Health, is working to improve price transparency and affordability of prescription drugs. He states that providing price transparency as early as possible in the prescription process is critical for prescribers, patients, and health plans to make better, more cost-effective decisions. To achieve true transparency, all parties in the ecosystem must cooperate and share data, moving beyond pricing visibility to fully integrate systems and use real-time information to improve patient adherence and lower costs. Joseph explains, "Buzz Health really focuses on improving the process behind the scenes, developing technologies that sit within the prescription ecosystem, creating opportunities to improve price transparency, early adoption, and integrated benefits for members."  "We work with everybody from pharmacies to PBMs to payers to employer groups. Anybody we believe has an opportunity that, with technology and early adoption of price transparency and adherence, could benefit them and the members they serve." "What's interesting is that, like most things, the earlier you have information, the easier it is to make actionable change, things with long-term impact. So if you have price transparency and you have it early on, a prescriber can make more informed decisions. A patient, rather than showing up at a pharmacy counter, can make decisions earlier on. So again, it's kind of like the earlier you have anything in making a decision, the easier it is for you to make a really actionable change all the way up through a PBM or health plan. If they see gaps in coverage and they have that information, they can make changes early on as well." #BuzzHealth #PrescriptionDrugs #Pharmacies #HealthcareIT #PriceTransparency #PrescriptionAffordability #PharmacyTech #MedicationAccess #HealthcareTransparency #PrescriptionPricing #PatientCare #HealthTech #PharmacyBenefits #HealthcareInnovation #PatientOutcomes #MedicalTechnology buzzhealth.com Listen to the podcast here  

In this episode of The Dish on Health IT, Tony Schueth is joined by Dr. Thomas Keane, National Coordinator for Health IT at ONC, along with Alix Goss and Janice Reese. The conversation moves between policy, standards, and real-world implementation, with Tony often grounding the discussion in the practical friction points the industry continues to face. Tony opens by noting that “ONC is ONC again,” setting a lighter tone while also framing the broader conversation around where federal health IT policy is headed. He highlights Dr. Keane's unusual background spanning engineering, clinical practice, and federal leadership, asking how that path shaped his perspective on impact. Dr. Keane explains that his transition into policy was driven by exposure and opportunity, but importantly, he continues to practice medicine. Tony picks up on that point, noting how rare it is for a National Coordinator to still be actively practicing, reinforcing the value of having a policy leader grounded in real-world care delivery. Interoperability at the “Speed of Trust” Tony then shifts the conversation to one of his core themes: interoperability as infrastructure. He references Dr. Keane's framing of interoperability needing to operate at the “speed of trust,” and pushes on the tension between that vision and the reality of legacy systems still dominating the market. Dr. Keane responds by walking through ONC's dual-track approach. On one hand, rulemaking like HTI-5 is pushing toward a FHIR-based, API-driven future. On the other, ONC recognizes that legacy standards are deeply embedded and must continue to be supported. He also points to the CMS Health Tech Ecosystem initiative as a powerful example of how government can accelerate progress by convening stakeholders rather than relying solely on regulation. Tony brings Janice Reese into the discussion to ground this vision in implementation reality. Janice emphasizes that the biggest barriers are not the APIs themselves, but the underlying trust infrastructure. She outlines identity, security, consent, and directory services as the key gaps preventing interoperability from scaling nationally. Imaging as a Case Study in Misaligned Incentives Tony pivots to diagnostic imaging, framing it as a clear example where standards exist but adoption lags. He references the continued reliance on physical media like CDs and asks whether the issue is less about technology and more about incentives and certification. Dr. Keane agrees and shares a detailed example from his time as a radiologist, describing how consolidating imaging workflows improved efficiency and reduced turnaround times. He uses this to illustrate the broader point: the technology exists, but economic and operational incentives often work against seamless data exchange. He also notes that ONC's recent RFI is intended to better understand these barriers and inform future rulemaking. Tony keeps the tone light with a quick aside about McDonald's and queue efficiency, but uses it to reinforce a serious point. Even when better systems exist, organizations sometimes stick with less efficient models because they are familiar or expected. Prior Authorization: Progress, but Still Fragmented Tony then moves into prior authorization, referencing CMS-0057 and Da Vinci use cases as signs of progress, particularly on the medical side. He contrasts that with the ongoing fragmentation in pharmacy prior authorization and asks how ONC is thinking about bridging that gap. Dr. Keane emphasizes that standards alone are not enough. Real progress depends on making those standards usable in practice. He points to ongoing work with EHR vendors, PBMs, and intermediaries to ensure that real-time prescription benefit tools deliver complete and accurate information that clinicians can trust. Tony and Alix build on this by connecting real-time benefit checks to broader price transparency efforts, suggesting that combining these capabilities could fundamentally change how patients and providers make decisions together at the point of care.  Price Transparency: Still Not Patient-Friendly Tony directly challenges the current state of price transparency, asking how the industry moves beyond “check-the-box” compliance to delivering something that is actually usable for patients. Dr. Keane acknowledges that while progress has been made, much of the data remains too complex and not sufficiently tailored to individual patients. He notes that CMS continues to iterate on requirements, but that making cost information actionable at the point of care remains an ongoing challenge. AI: From Hype to Real Utility Tony transitions to AI with a callback to a joke Dr. Keane made about AI either transforming healthcare or reducing it to three bullet points. He uses that setup to ask whether AI can realistically make complex healthcare data usable for patients and clinicians. Dr. Keane answers with a firm yes, pointing to existing use cases in radiology and clinical workflows where AI is already improving accuracy and efficiency. He shares examples of AI identifying stroke patterns, highlighting abnormalities in imaging, and even summarizing clinical reports. Tony then brings the conversation back to risk, asking about overreliance on AI and how policy should address bias and accountability. Dr. Keane is clear that responsibility still sits with the clinician, noting that physicians are trained to recognize bias and must independently validate AI-driven insights. Janice and Alix add that AI's success ultimately depends on the quality and standardization of the underlying data. Without consistent, trusted data, AI will simply amplify existing gaps. Information Blocking and Enforcement Tony closes the main discussion by turning to information blocking, asking what message ONC has for organizations that continue to restrict data access under the guise of technical or legal constraints. Dr. Keane outlines a range of enforcement mechanisms, from corrective action plans to potential financial penalties. He emphasizes that while ONC prefers to work with organizations to resolve issues, the expectation is clear: data must flow. Final Call to Action: Data Liquidity As always, Tony ends with a call-to-action question. If there were one thing the industry could do starting tomorrow, what would it be? Dr. Keane's answer is direct: make data liquid. He ties this back to reducing administrative burden, improving price transparency, and enabling better patient decision-making. The goal is a system where data flows seamlessly, at the direction of the patient, to support care and operations. Janice and Alix close by reinforcing that the industry does not lack standards or policy direction. The real challenge is aligning stakeholders and scaling adoption.  

In this episode, Suzanne Spradley and Chase Cannon discuss two recent circuit court decisions and their impact on employer-sponsored group health plans. Suzanne first discusses a Sixth Circuit decision involving a state law that attempts to regulate PBMs. Suzanne and Chase walk through Supreme Court precedent that appears to be driving states to enact PBM laws, and they explain how ERISA preemption is at the heart of it all. Suzanne concludes the podcast by outlining another federal decision relating to a fiduciary breach claim of an employer group health plan.

Nearly one billion prescriptions are abandoned at the pharmacy counter every year, often because patients are blindsided by the cost.This week, co-host Halle Tecco is joined by Wendy Barnes, President and CEO of GoodRx, to discuss the chaos of prescription drug pricing, the murky world of Pharmacy Benefit Managers (PBMs), and how digital tools are changing patient affordability. They break down the layered system of manufacturers, payers, and pharmacies that creates inconsistent pricing, and explore the current push for greater transparency.We cover:The cascade of drug pricing: from initial manufacturer costs and rebates to payer and pharmacy contracts, which results in vast price variability for consumersWhat it would take to get to price transparency in drug pricingThe current pressures on PBMs, including efforts to ban "spread" and the practice of offshoring rebate contracting for tax advantagesWhy pharmacies haven't gone online like other areas of consumer goodsThe future of medication access, including the growth of pharma's direct-to-patient programs and the low current adoption of home delivery despite widespread retail pharmacy closures— About our guest:Wendy Barnes is the President and CEO of GoodRx. She has over 30 years of leadership experience across the pharmacy and medical benefit industry. Most recently, Wendy served as CEO of RxBenefits, where she led the company in providing pharmacy benefit support to more than 2,000 self-insured clients, representing over 3 million lives. Prior to that, she served as President of Express Scripts Pharmacy, overseeing operations for 100 million beneficiaries. Her leadership spans roles at Rite Aid, Premier Inc., and the U.S. Air Force, where she served as a Medical Service Corps Officer. She holds a B.S. degree in Biochemistry from the United States Air Force Academy and an M.B.A. degree from the University of Alaska Anchorage.—

Josh Golden, SVP of Strategy at Judi Health, returns to the Astonishing Healthcare podcast for a timely discussion about the world of drug pricing and what's shaking things up. Josh shares insights from his two decades of experience working with many of our country's largest employers and navigating [very heavy, sometimes scary] pharmacy benefit manager (PBM) contracts. He explains why the industry still relies on Average Wholesale Price (AWP) despite its known flaws, how Maximum Allowable Cost (MAC) lists have been used to drive hidden pricing arbitrage, and why the market is shifting so rapidly toward transparency and alignment.The discussion covers the need for plan sponsors to understand the true cost of pharmaceuticals and how four massive forces are colliding to form "lightning in a bottle" that will drive systemic change in the pharmacy ecosystem. As reforms across the state and federal levels pressure the industry to adapt, plan sponsors must seek forward-thinking PBM partners that prioritize transparent pricing and decisions that benefit the plan and lead to better care for members.HighlightsJosh emphasizes the sordid history of AWP manipulation and explains why it remains a predominant, yet deeply flawed, pricing benchmark in PBM contracts.PBMs frequently deploy MAC lists to extract hidden value, creating wide pricing variations for plan sponsors, pharmacies, and patients.The healthcare industry is moving toward cost-plus economics, making more realistic and reliable pricing benchmarks even more important.Four major trade winds are accelerating PBM reform: state regulations, retail pharmacy closures, transparent cash prices for expensive drugs like GLP-1s, and plan sponsor class action lawsuits.Related ContentWhat is NADAC & How Does It Differ From AWP?Why this benefit leader switched to a more modern, transparent PBMWhat Is the Role of a Pharmacy Benefits Manager (PBM)?Health Benefits 101: The Importance of a Transparent PBM ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.

Healthcare stays expensive because the system hides prices and quality from the people paying for care, especially employers. We talk with Katie Talento about how CAA 2026 transparency and Department of Labor fiduciary rules could expose PBM practices, reshape contracting, and give plan sponsors real leverage if enforcement follows.• Why invisible prices and invisible quality break the healthcare market • How incentives and lobbying protect opacity across hospitals, PBMs, insurers and drugmakers • Why Washington lacks ERISA and employer-plan expertise • What CAA 2026 changes for PBM disclosures and fiduciary responsibility • How “check the box” compliance can fail without enforcement • How employers can use machine readable files plus claims data for network analysis • Why cash-pay and direct contracting get blocked by network contract provisions • What near-term reforms could bend the cost curve, including stronger HSA and ICHRA modelsYou can find me at katytolento.com

Mississippi Today health reporters Gwen Dilworth and Sophia Paffenroth review what the Legislature did (or didn't) accomplish with PBMs, Medicaid, abortion drugs and other health policy issues this session.

This time on CodeWACK! What challenges do employers face when providing health coverage to their employees? And what role do health insurers and Pharmacy Benefit Managers—prescription drug middlemen known as PBMs—play in shaping costs, coverage, and access to care? To find out, we spoke with Chuck Melendi, who has more than three decades of experience in healthcare leadership, advocacy, and industry strategy. He spent 25 years at Johnson & Johnson, where he tackled issues including drug pricing, payer negotiations, policy, and commercial strategy. Chuck retired from Johnson & Johnson in early 2025 and went on to launch Disruptive Dialogue, a podcast and consulting platform where he shares insights from inside the U.S. healthcare system – while exploring ideas for reform. This is the first of a two-part series.

We're back with our monthly rundown of the top headlines in health tech!Today, Halle flies solo to share the biggest stories that shaped Q1, from the rising pressures on PBMs to how consumers are using AI.Stories covered:What's happening to PBMs (it's not pretty)New data from Rock Health on consumer use of AISocial media companies find liable for addictive designHealthcare hiring is slowing as efficiency becomes the focusHave we finally bent the healthcare cost curve in the United States?—The Heart of Healthcare podcast was nominated for a Webby award! We'd so appreciate if you could create a quick account and vote for us here. —

This time on CodeWACK! What challenges do employers face when providing health coverage to their employees? And what role do health insurers and Pharmacy Benefit Managers - prescription drug middlemen known as PBMs—play in shaping costs, coverage, and access to care? To find out, we spoke with Chuck Melendi, who has more than three decades of experience in healthcare leadership, advocacy, and industry strategy. He spent 25 years at Johnson & Johnson, where he tackled issues including drug pricing, payer negotiations, policy, and commercial strategy. Chuck retired from Johnson & Johnson in early 2025 and went on to launch Disruptive Dialogue, a podcast and consulting platform where he shares insights from inside the U.S. healthcare system – while exploring ideas for reform. This is the first of a two-part series.  Check out the Transcript and Show Notes for more! 

On this episode of the Astonishing Healthcare Podcast, we sit down with return guest Bridget Mulvenna, Vice President of National Business Development at Judi Health, to break down the biggest pharmacy drivers of 2026. Bridget offers insights into how plan sponsors and benefits brokers and consultants can strategically evaluate pharmacy benefit managers (PBMs) by looking beyond unit costs and focusing on drug mix - formulary decisions and the shift to biosimilars, prior authorization approval rates, the generic dispensing rate (GDR), and much more.The discussion covers the growing need to understand what challenges employer plan sponsors face, and why bringing a consultative approach to the table to help solve them is so important. How will moving to a biosimilar-first approach lower net drug costs for plan sponsors? How can a plan cover GLP-1s given their evolution and greater price transparency, expanding clinical indications, and direct-to-plan pricing models? And of course, Bridget shares her views on the sudden acceleration of state and federal PBM reform. As new legislation forces the industry to adapt, plan sponsors must seek forward-thinking platforms already aligned with the changes to provide better pricing and care for members.HighlightsBridget emphasizes the financial advantages of adopting a biosimilar-first approach, which can significantly lower net drug costs for plan sponsors despite smaller rebate checks.GLP-1s are transformative medications - price transparency, expanding clinical indications, and direct-to-plan pricing models will influence future plan designs.Evaluating PBMs beyond unit costs is critical: formulary management, prior authorizations, and other clinical programs have the greatest impact on total pharmacy spend.The rapid acceleration of state and federal PBM reform is astonishing, and alignment with future proof organizations is essential, because there's more to come.Related Content6 recommendations for PBM procurement and Rx benefits optimizationAH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd FioriniReplay - PMPM vs Clinical Guarantees: A Pharmacist and an Actuary Explain How to Create Predictability Around Pharmacy SpendAH064 - Empowering Plan Sponsors: Data Access & Analysis, with Bridget MulvennaFor more information about Judi Health and this episode, please visit Judi Health - Insights.

Last year, his independent pharmacy spent $13 million on brand-name drugs for patients processed by the three biggest Pharmacy Benefit Managers (PBMs) which earned a profit margin of 0.01%.In this episode, Halle speaks with Alec Ginsberg, owner and fourth-generation pharmacist at C.O. Bigelow, the oldest surviving apothecary–pharmacy in the United States. Alec is fighting against the forces squeezing independent pharmacies and charting a course for the future of the pharmacist.We cover:How the roll-up of PBMs, health plans, and retail pharmacies changed everythingWhat led him to remove his pharmacy's Rx-filling robotThe dramatic decline of independent pharmacies along with the closures of big box pharmacy storesThe one health policy he would put in place today to save independent pharmaciesThe history of the pharmacist's role and what's nextWhat he really thinks about compounding pharmacies and the Hims vs. Novo lawsuit—About our guest: Alec Wade Ginsberg is the fourth-generation pharmacist, owner, and Chief Operating Officer of C.O. Bigelow Apothecary, America's oldest pharmacy, founded in 1838 and still operating in New York City's West Village. With a Doctor of Pharmacy degree from the University of North Carolina Eshelman School of Pharmacy, Alec bridges the clinical world of pharmacy with the realities of modern consumer culture.At Bigelow, he oversees the brick-and-mortar beauty retail and pharmacy operations, navigating everything from prescription drug shortages to the pressures of today's PBM-dominated marketplace. Beyond the counter, Alec is the founder and writer of Drugstore Cowboy, a weekly newsletter that dissects the intersection of drugs, business, and consumer culture — making the hidden mechanics of the U.S. healthcare system both understandable and entertaining for thousands of readers.His work has been featured across national media, and he's become a trusted voice for translating complex pharmaceutical issues — from GLP-1s to compounding to drug pricing — into plain English. Alec's mission is simple: to make Americans smarter about the pills in their cabinets and the system that puts them there.—Show notes:Drugstore Cowboy - Alec's free and super interesting newsletterC.O. Bigelow - The Nation's Oldest ApothecaryVirtual GLP-1 startups: Pill mills or the future of obesity care?—

This episode's Community Champion Sponsor is Ossur. To learn more about their ‘Responsible for Tomorrow' Sustainability Campaign, and how you can get involved: CLICK HEREEpisode Overview: The prescription journey has become one of healthcare's most frustrating operational bottlenecks – fragmented pricing, disconnected systems, and zero transparency when it matters most.Our next guest, Joseph Kleiman, is transforming this broken experience as President of Buzz Health.With over 25 years building and scaling businesses, Joseph brings a rare combination of operational execution and strategic vision to one of healthcare's toughest challenges.What started 15 years ago as BuzzRx – a pharmacy discount platform – has evolved into a comprehensive pricing transparency engine embedded directly into clinical workflows.From provider systems to pharmacies to payers, Joseph shares how Buzz Health is delivering real-time cost visibility across the entire prescription ecosystem.Join us to discover how upstream pricing intelligence is reducing friction, improving adherence, and making medication affordability actionable at the point of care. Let's go!Episode Highlights:Joseph Kleiman emphasizes solving real healthcare problems by staying close to patients, pharmacies, payers, and PBMs before building solutions.Buzz Health evolved from BuzzRx discount cards to RxCompare technology, embedding real-time prescription pricing across the entire healthcare ecosystem.Successful pricing transparency requires minimal IT lift through API integrations that work alongside existing legacy systems without disruption.Moving pricing intelligence upstream to the doctor's office gives patients actionable cost information before leaving the waiting room.The future prescription ecosystem will integrate vouchers, copay cards, and health plan rates into one centralized transparent pricing engine.About our Guest:Joseph Kleiman is President of Buzz Health, where he leads the company's strategy, partnerships, and operations to help expand access to more affordable prescription medications and improve price transparency across the healthcare ecosystem. With more than 25 years of experience building and scaling businesses, including BuzzRx as Chief Financial and Operating Officer, Kleiman has a strong track record in strategic planning, operational leadership, and growth. Previously, he founded the consulting firm Projixx, served as Chief Operating Officer of 944 Media, and co-founded Bullseye Wireless.Links Supporting This Episode: Buzz Health Website: CLICK HEREJoseph Kleiman LinkedIn page: CLICK HEREMike Biselli LinkedIn page: CLICK HEREMike Biselli Twitter page: CLICK HEREVisit our website: CLICK HERESubscribe to newsletter: CLICK HEREGuest nomination form: CLICK HERE

Join us on the latest episode, hosted by Jared S. Taylor!Our Guest:  Karthik Ganesh, Chief Executive Officer at OnMed.What you'll get out of this episode:Karthik Ganesh describes healthcare as both his profession and his vehicle for making the world better.His 26-year career spans health plans, PBMs, value-based care, consulting, and tech-enabled care delivery.At OnMed, he focused on amplifying product strengths while neutralizing blind spots rather than reinventing what already worked.He believes AI should empower clinicians and improve workflows, while the human element remains the last mile in care.OnMed's work in underserved communities is showing strong adoption, with many patients identifying the care station as their medical home.To learn more about:Website https://www.onmed.com/ Linkedin https://www.linkedin.com/company/onmedcarestation/Our sponsors for this episode are:Sage Growth Partners https://www.sage-growth.com/Quantum Health https://www.quantum-health.com/Show and Host's Socials:Slice of HealthcareLinkedIn: https://www.linkedin.com/company/sliceofhealthcare/Jared S TaylorLinkedIn: https://www.linkedin.com/in/jaredstaylor/WHAT IS SLICE OF HEALTHCARE?The go-to site for digital health executive/provider interviews, technology updates, and industry news. Listed to in 65+ countries.

Your benefits plan may be getting more expensive for reasons unrelated to better care. In this episode of Sharkpreneur, Seth Greene interviews Chris Hamilton, Partner at Hotchkiss Insurance and a healthcare industry expert, who explains why employer health costs keep skyrocketing. He breaks down how misaligned incentives in traditional plans drive inflation and why mid-market employers often have far more control than they realize. You'll hear practical, modern strategies such as self-funding, direct agreements, and transparency tools that can improve coverage while reducing total costs for both companies and employees. Key Takeaways:→ Traditional compensation structures can incentivize higher premiums rather than better outcomes for employers and employees.→ When insurers own PBMs and other components, pricing can become a circular profit engine that justifies ongoing rate hikes. → If you reduce the underlying cost of care, the premium required to fund the plan naturally drops.→ The same procedure can vary dramatically in price across facilities, with no reliable correlation to quality. → Employers can contract directly with hospitals and concierge physicians to simplify access, improve care, and reduce both company and employee financial burdens. Chris Hamilton is a Partner at Hotchkiss Insurance in Texas, where he leads the employee benefits consulting practice. He specializes in managing healthcare and insurance costs to improve benefits coverage, reduce expenses, and enhance employee health outcomes. With over a decade of experience in corporate finance, Chris has advised clients across various industries, including private equity and oil & gas. In his free time, he enjoys traveling, working out, attending live music events, and spending time with family. Connect With Chris:Website: https://hotchkissinsurance.com/YouTube: https://www.youtube.com/@chrishamiltonbenefitsinsiderLinkedIn: https://www.linkedin.com/in/chamilton/