PBM on the Rocks

Host Chris Hobart and the cocktail crew sit down with Joe Shields, CEO of Transparency Rising (formerly Transparency Rx). The coalition now has 24 member companies, including more than a dozen transparent, pass-through PBMs that are fighting spread pricing and the Big Three's grip on the market.

Joe ran New Jersey's parole board and worked for three governors before he took on PBMs. In this episode he covers:

• Transparency washing: PBM executives testified under oath that they pass through 100% of rebates. The next day, CVS settled for $43 million with an Illinois teachers' and community college plan, and it kept the contract.

• Rebate aggregators: offshore GPOs, safe harbor games, and why pharmacy data traveling to Dublin should worry everyone.

• The CAA and the coming DOL rules: why they work as one continuum, and why PCMA's sudden love for a law it opposed doesn't add up.

• "Market-derived income": the consultant revenue stream buried in 10-Ks that may explain the Big Three's 93–95% retention rates.

• PCMA's record ad spend: taking pharma's money while blaming pharma for drug prices.

Plus: Monique gets "unregistered" from a PBM conference, Andrew is fresh off an elk hunt, UnitedHealthcare's AI calls a pharmacy to refill a prescription for a deceased patient, and Chris defends the honor of gorillas everywhere.

Hosts: Chris Hobart, Andrew Russell, Monique Whitney, and Kendra Korthauer

Special Guest: Joe Shields, CEO Transparency Rising

Music by JuliusH | Production & Editing by Shannon Wightman-Girard

Host Andrew Russell, PUTT Executive Director Monique Whitney, and cocktail crew regulars Chris Hobart and Kendra Korthauer dig into a patient access story that's flown under the radar: a mid-year contract dispute between long-term care PSAO/GPO MHA and PBM giant Optum. Joining them are two long-term care (LTC) pharmacy owners who lived it firsthand - Matt Ansay, PharmD (Streu's Pharmacy, Green Bay, WI) and Philip Hommerding, PharmD (Hunt Silver Lake Drug and Gift, MN).

In this episode:

• How closed-door, long-term care pharmacy differs from community pharmacy - blister packs, after-hours delivery, and PSAO bargaining power

• The MHA/Optum dispute blow-by-blow: a mid-cycle contract termination, arbitration, patient and facility chaos, and the misinformation pharmacies say they had to fight through

• Why network adequacy gave MHA more leverage than Optum wanted anyone to know about

• A troubling "patient choice" workaround: facilities charging residents hundreds of dollars a month to use the pharmacy they actually want

• A wider look at Optum's banking operations, enforcement gaps in state PBM reform laws, and more Optum "#$@!"

• A preview of PUTT's September 23rd Virtual Summit on PBM laws enforcement

Notable quote: "These patients don't get to walk or make choices with their feet." - Philip Hommerding, PharmD, on what LTC patients face when caught in the middle of a contract dispute

Learn more and get involved: TruthRx.org

#PBMOTR #podcast

Music by JuliusH | Production & Editing by Shannon Wightman-Girard

Fresh off a marathon stretch on Capitol Hill, the PBM on the Rocks crew gathers to unpack two major wins for independent pharmacy: the House Oversight Committee markup of the Pharmacists Fight Back Act (H.R. 6610) and a Senate Armed Services subcommittee hearing on the TRICARE pharmacy program. Greg Reybold walks through what the 6610 markup vote actually means, why the CBO scoring process is the next big hurdle, and what he learned going toe-to-toe with Express Scripts and DHA on the TRICARE data. The crew also traces the bill's journey from its first introduction in 2024 to a coalition letter that pulled in 62+ organizations in under a week - and reflects on how grassroots pressure, persistence, and a few lucky airplane seat assignments made it possible.

Host: Andrew Russell

Guests: Greg Reybold, Monique Whitney, Lauren Young, Chris Hobart, & Kendra Korthauer

In This Episode

• H.R. 6610 clears markup. The Pharmacists Fight Back Act (Federal Employee Health Benefits version) passed a recorded vote out of House Oversight, with all but two members in favor. A rare showing for a bill at this stage.

• From 2024 to now. The group looks back at the bill's first introduction, the early fight to land 50 co-sponsors, and how Chairman Comer's decision to co-lead H.R. 6610 with Rep. Auchincloss and hold a markup hearing has moved it further than almost any comparable pharmacy bill in recent memory.

• A coalition builds fast. Sixty-two-plus organizations - state pharmacy associations, unions, business groups - signed a letter of support in about a week, a sign of how much the conversation around PBM reform has shifted since 2024.

• TRICARE under the microscope. Sen. Elizabeth Warren used her one hearing as ranking member to focus on the TRICARE pharmacy program. Greg breaks down what the data showed: TRICARE families paying far more in cost-sharing at mandatory mail order than the same drugs cost through Express Scripts' commercial contracts in states like Georgia and West Virginia, where PBM markup reporting is public.

• Fines with teeth. The 6610 substitute raises penalties for PBM violations from $10,000 to $10 million per violation.

• What's next for scoring. Greg explains why a CBO score is the next milestone for 6610, why drug pricing bills are notoriously hard to score, and how Chairman Comer entered successful state-level rebate-sharing and NADAC-plus data into the record to counter industry talking points ahead of that process.

• H.R. 6609: the Medicare/Medicaid companion bill still needs a push. The group discusses why it hasn't seen the same momentum out of Energy and Commerce and what might change that with six months left in this Congress.

• Members going public. Lawmakers including Rep. Rich McCormick, Rep. Diana Harshbarger, Rep. Nikki Budzinski, and Rep. Raja publicly voiced support following the vote. A sign, the crew argues, that PBM reform has become an easier sell on the Hill than it was even two years ago.

PBM Problems, Self-Insured Contracts, & Taking Back Control of Independent Pharmacy

In this blockbuster episode of PBM on the Rocks, we’re thrilled to welcome a special guest who needs no introduction: Mark Cuban.

Known for shaking up industries and challenging the status quo, Mark joins our Cocktail Crew for a candid conversation about the opaque world of PBMs. The conversation dives deep into how PBM practices are hurting employers, back office challenges facing independent pharmacies, and the potential of artificial intelligence to streamline operations and cut costs for small businesses.

Music by JuliusH | Production & Editing by Shannon Wightman-Girard

Join the PBM OTR Cocktail Crew as they dive deep into the harsh realities facing independent pharmacies as we close out 2025. From the necessity of "side hustles" just to keep the lights on, to the dark side of AI in prior authorizations, the landscape is shifting rapidly. They’ll also unpack the upcoming reintroduction of the Pharmacists Fight Back Act in the 119th Congress, and take a look behind the curtain at prescription discount cards and how they actually work. If you're frustrated by rising insurance premiums, opaque pharmacy contracts, or the closure of your local drugstore, this episode is for you.

Special Guests: John Farina, AHF & Matt Ansay, Streu’s Pharmacy

Music by JuliusH | Production & Editing by Shannon Wightman-Girard

Welcome back to part two of our special live crossover episode with PBM on the Rocks and The PUTTcast! 

In this conclusion to our live Summit day recording, we dive deeper into the critical issues facing the pharmacy industry today. The discussion picks back up on the front lines of PBM reform, exploring reform’s real-world impact on patients and independent pharmacies, then shifts to a powerful and often-debated topic: the case for unionization in pharmacy. But it's not all serious business. Maurice Shaw (The Dr of Comedy) and Shane Jerominsky (The Accidental Pharmacist) bring their unique perspectives as pharmacists and comedians to point out the comedic moments found in everyday pharmacy life - reminding us that laughter can be a powerful tool for coping with the immense pressures of the pharmacy profession.

Special Guests: Maurice Shaw, PharmD, Shane Jerominsky, RPh, & Greg Reybold, APCI VP of Healthcare Policy & General Counsel

Music by cat_herding_diva & JuliusH | Mixing by Andre Barden | Production & Editing by Shannon Wightman-Girard

Join co-hosts Jeremy Counts and Lauren Young as The PUTTcast teams up with the PBM OTR Cocktail Crew for Part 1 of our special live crossover episode! 

We're breaking down the biggest moments from the 2025 PUTT Virtual Summit, and diving deep into the ever-changing world of PBM reform. This powerhouse discussion features an incredible lineup of guests who share their unique perspectives on the latest legislative battles, grassroots advocacy, and what independent pharmacy owners are facing on the front lines.

Special Guest: Greg Reybold, VP of Healthcare Policy & General Counsel, APCI

Music by cat_herding_diva & JuliusH | Mixing by Andre Barden | Production & Editing by Shannon Wightman-Girard

Join Lord Dr Jeremy and the PUTT Cocktail Crew with special guest Nebraska pharmacist and pharmacy owner Dave Randolph, RPh, as they dive into the critical issues shaping the future of pharmacy and healthcare. From the power of building coalitions for effective state-level advocacy, to the importance of subject matter education for legislators, and the dangers of so-called "pharmacy industry innovation" led by tech bros with no pharmacy background, this episode is packed with no holds barred conversation and insights for anyone who cares about local community pharmacy.

Music by JuliusH | Production & Editing by Shannon Wightman-Girard

Welcome Back to PBM on the Rocks!

Join Lord Dr. Jeremy and the PUTT Cocktail crew with special guests John Farina (AHF) & Kris Rhea (Pharmacy Marketplace) as they unpack the summer's most significant state and federal legislative updates, explore the CVS Omnicare lawsuit verdict, and discuss its ripple effects on independent pharmacies including retaliatory actions by PBMs.

From shedding light on the critical role of independent pharmacies in our healthcare system - including the challenges they face with pharmacy MAC appeals, and the innovative solutions being developed to help them recover lost funds - to discussing how middlemen are draining resources from the American economy without delivering value - this episode is a must-listen for anyone passionate about reform, independent pharmacy advocacy, and the fight against PBM overreach in our healthcare system.

Music by JuliusH | Production & Editing by Shannon Wightman-Girard

North Carolina’s House Bill 163 would require pharmacies to be reimbursed at NADAC (National Average Drug Acquisition Cost) plus a fair dispensing fee, which would protect NC pharmacies - ensuring they can stay in business and continue providing critical care to patients. As usual, PBMs are spreading misinformation designed to scare patients and lawmakers by mislabeling these reforms as “taxes” and falsely claiming reforms will increase premiums.

Join the PUTT cocktail crew with NC pharmacy owners Wes Hickman, PharmD, & Stephen Joyce, RPh (PUTT board member) as they break down the benefits of HB 163, dispel the myths that PBM deceptions create, and discuss the importance of building strong relationships - because when it comes to pharmacy issues and helpful reform legislation, pharmacists really are the smartest people in the room.

Music by JuliusH | Production & Editing by Shannon Wightman-Girard