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118. PBM Reform Explosion: What Just Happened — And What It Really Means
Trying to make sense of the recent PBM reforms and their significance? I map them in this podcast and what it really means? It is game-changing.
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, Marc maps all the recent PBM and drug price reforms and tells you about their significance? It is game-changing.
Key Takeaways:
The recent FFY 2026 Appropriations Bill had major PBM reforms.
They included 100% rebate pass-through and transparency and reporting in the employer market.
In Medicare Part D, PBMs must adopt flat-fee compensation that is de-linked from rebates and utilization.
Important reporting and transparency in Part D as well.
Group purchasing reform could be next on lawmakers' list.
A Federal Trade Commission settlement with Cigna's Express Scripts PBM has many similar reforms.
Express Scripts is also adopting a brand net pricing model that will run in parallel with a traditional rebate model.
Various initiatives from the Trump administration will also dramatically impact drug price. These include reforms of the drug channel and most-favored nation pricing.
The developments are game-changing, but it will take time for reforms to set in and impact every line of business.
Connect With Marc:
Marc on LinkedIn
Marc on Twitter
THL Podcast
Resources:
THL's Newsfeed
THL's Blog
The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
View all episodes
By Marc S. RyanTrying to make sense of the recent PBM reforms and their significance? I map them in this podcast and what it really means? It is game-changing.
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, Marc maps all the recent PBM and drug price reforms and tells you about their significance? It is game-changing.
Key Takeaways:
The recent FFY 2026 Appropriations Bill had major PBM reforms.
They included 100% rebate pass-through and transparency and reporting in the employer market.
In Medicare Part D, PBMs must adopt flat-fee compensation that is de-linked from rebates and utilization.
Important reporting and transparency in Part D as well.
Group purchasing reform could be next on lawmakers' list.
A Federal Trade Commission settlement with Cigna's Express Scripts PBM has many similar reforms.
Express Scripts is also adopting a brand net pricing model that will run in parallel with a traditional rebate model.
Various initiatives from the Trump administration will also dramatically impact drug price. These include reforms of the drug channel and most-favored nation pricing.
The developments are game-changing, but it will take time for reforms to set in and impact every line of business.
Connect With Marc:
Marc on LinkedIn
Marc on Twitter
THL Podcast
Resources:
THL's Newsfeed
THL's Blog
The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance