18. The PBM transparency movement is rising for good reason.

Episode Teaser:

The drug and PBM transparency movement is rising due to the opaqueness and exorbitant prices in the current system.  It is something we need to embrace and push along.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through the Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode of the Healthcare Labyrinth Podcast, Marc discusses the rise of the transparency movement for drug pricing and pharmacy benefit managers (PBMs). 

Listen in as he tells you about all the innovative actors and barriers that players face in bringing about greater transparency and accountability in drug pricing. We need to seize the initiative and push these reforms along.

Key Takeaways:  

Drug pricing is anything but transparent.  Consumers and even players in the drug channel don’t even understand all the moving parts and what prices are actually paid.

Three current pharmacy benefit managers control 80% of all transactions in the drug world today – CVS Health’s Caremark, Cigna’s Express Scripts, and United’s Optum Rx.

Transparent PBMs use fixed transparent prices for each drug and an administrative fee for its services.

There are a number of actors forcing changes in the drug price and transparency world – regulators, legacy PBMs, transparent PBMs, health plans and employer groups, and innovators and disruptors like Mark Cuban.

Mark Cuban’s Cost Plus Drug Company cuts out the wholesaler, PBM, and pharmacy to go direct to the drug makers as well as to the consumers.  It has created a unique value proposition.

Cuban and transparent PBMs can have success with generics and biosimilars but face barriers on brand drugs. Brand drug makers and PBMs like the rebate arrangements and margins they generate.

The Medicare drug price negotiations could lead to pricing in the brand world much like we have in the generic world.  This could speed transparency reforms.

We need to seize the initiative and push hard on bringing transparency to the drug world.

Connect with Marc

Marc on LinkedIn

Marc on Twitter

THL Podcast


THL’s Newsfeed

THL’s Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now