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EP423: Maximizers and the "the Drugs Aren't Covered" Schemes Employers Use to Save Money (or Not) on Pharmacy Benefits, With Joey Dizenhouse
Episode 423 of 'Relentless Health Value' features a conversation with Joey Dizenhouse about the tactics employed by PBMs and pharmacy benefit schemes to manage drug costs, often leading to misaligned incentives. Joey outlines how maximizer programs work, differentiating between spread and transparent models, and the potential consequences for plan sponsors and patients.
The discussion dives deep into copay assistance programs and the complex dynamics behind drug pricing and patient access. Key advice for plan sponsors includes applying purchasing discipline, understanding program structures, and being aware of the broader implications on patients.
=== LINKS === đź”— Show Notes with all mentioned links: https://cc-lnk.com/EP423
✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe
đź«™ Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe
🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1
🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b
đź“ş Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue
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06:21 How was the first iteration of maximizers conceived?
10:59 "I'd always encourage you to come back to the underlying incentives."
11:18 What does maximizer acceleration look like?
12:24 What are the two kinds of maximizers?
12:43 What is the spread model for a maximizer?
13:02 What is the transparent model for a maximizer?
15:26 "Ask the questions: How do you make money? Prove it!"
15:56 EP419 with Andreas Mang.
16:25 How might Pharma be making more money with maximizers?
26:14 What is the "it's not covered" approach?
32:29 "The right kind of program has been properly narrowed."
33:51 Is there a purpose that some of these programs can serve, issues aside?
35:57 How does a free drug program actually cost money?
View all episodes
By Stacey Richter
4.9
231231 ratings
Episode 423 of 'Relentless Health Value' features a conversation with Joey Dizenhouse about the tactics employed by PBMs and pharmacy benefit schemes to manage drug costs, often leading to misaligned incentives. Joey outlines how maximizer programs work, differentiating between spread and transparent models, and the potential consequences for plan sponsors and patients.
The discussion dives deep into copay assistance programs and the complex dynamics behind drug pricing and patient access. Key advice for plan sponsors includes applying purchasing discipline, understanding program structures, and being aware of the broader implications on patients.
=== LINKS === đź”— Show Notes with all mentioned links: https://cc-lnk.com/EP423
✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe
đź«™ Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe
🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1
🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b
đź“ş Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue
=== CONNECT WITH THE RHV TEAM === âś LinkedIn https://www.linkedin.com/company/relentless-health-value/ âś Threads https://www.threads.net/@relentlesshealthvalue/ âś Bluesky https://bsky.app/profile/relentleshealth.bsky.social âś X https://twitter.com/relentleshealth/
06:21 How was the first iteration of maximizers conceived?
10:59 "I'd always encourage you to come back to the underlying incentives."
11:18 What does maximizer acceleration look like?
12:24 What are the two kinds of maximizers?
12:43 What is the spread model for a maximizer?
13:02 What is the transparent model for a maximizer?
15:26 "Ask the questions: How do you make money? Prove it!"
15:56 EP419 with Andreas Mang.
16:25 How might Pharma be making more money with maximizers?
26:14 What is the "it's not covered" approach?
32:29 "The right kind of program has been properly narrowed."
33:51 Is there a purpose that some of these programs can serve, issues aside?
35:57 How does a free drug program actually cost money?
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