PBM Reform Podcast

By Pharmacy Podcast Network

Pharmacy benefit managers were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and ... more

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FAQs about PBM Reform Podcast:

How many episodes does PBM Reform Podcast have?

The podcast currently has 45 episodes available.

PBM Reform Podcast episodes:

April 15, 2025 PBM Transparency, Is It Real? | PBM Reform Podcast
An insider’s look at the games PBMs play to hid fees and tack profits for community pharmacies. What a true transparent PBM should look like and why it matters.
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43min
January 27, 2025 PBM Strategies for the State of Arizona | PBM Reform
Interview with the new CEO of the Arizona Pharmacy Association, Garet Turner
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50min
December 20, 2024Patients Before Monopolies Act | PBM Reform Podcast
In this critical episode of the PBM Reform Podcast, we are joined by two influential voices leading the charge against abusive pharmacy benefit manager (PBM) practices:
State Representative Jake Auchincloss – Congressman from Massachusetts’ Fourth District

Greg Reybold – Vice President of Healthcare Policy & General Counsel, American Pharmacy Cooperative, Inc.
Topics Discussed:
The "Pharmacists Fight Back Act" (HB 9096):
Legislation Overview:
The bill proposes a transparent pharmacy reimbursement model based on:
Market-based pricing benchmarked to the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee equivalent to each state’s Medicaid reimbursement or the lesser of 2% or $25.
Eliminating PBMs’ ability to restrict patient choice through network exclusions.

Ensuring rebate pass-throughs to patients directly at the pharmacy counter.

Prohibiting PBM practices that steer patients toward PBM-owned pharmacies, protecting community pharmacists and preserving patient choice.

Guest insights on how HB 9096 seeks to end exploitative PBM tactics and its potential impact on independent pharmacies nationwide.

The "Patients Before Monopolies Act":
Bipartisan Efforts:
Introduced by Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) to dismantle PBMs’ monopoly power.

Co-sponsored by Representatives Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN).
Key Goals:
Break up PBM ownership structures that lead to conflicts of interest.
Ensure fair reimbursement practices for all pharmacies, reducing patient drug costs and increasing healthcare access.
Discussion on the broader implications for federal programs and the pharmacy industry at large.

PBMs and Their Role in Driving Up Drug Costs:
Exploring how PBMs contribute to higher drug prices and diminished patient choice.
The detrimental effects of PBM practices on independent community pharmacies and patients enrolled in federal healthcare plans.

Call to Action:
Contact your legislators to express support for the Pharmacists Fight Back Act (HB 9096) and the Patients Before Monopolies Act.
Share this episode to spread awareness of the critical need for PBM reform.
Resources & Links:
Learn more about HB 9096 and its provisions:
https://www.congress.gov/bill/118th-congress/house-bill/9096
Support the Patients Before Monopolies Act:
https://www.drugtopics.com/view/long-awaited-pbm-reform-included-in-congress-end-of-year-spending-package

References:
Intro piece: "Senators Warren and Hawley introduce a bipartisan bill to break up pharmacy-benefit managers" via CNBC Television
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32min
December 13, 2024 PBM Reform at the State Level | PBM Reform
An update from NDPhA and PBM Reform initiatives.
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32min
October 23, 2024 Coverage is not Care with David Balat | PBM Reform Podcast
Openness. Competition. Transparency.
Unmask the twisted economics of the American health care system.
Price discovery — prior to care — allows patients to shop for care in a competitive market. It empowers them with the information they need to reduce their healthcare costs. And it encourages providers and insurers to compete for their business.

Report: Free2Care’s Rx for Reforming America’s Predatory Healthcare System A Physician-Led Roadmap to Patient-Centered Medical Care
https://free2care.org/files/report.pdf

The PBM-Insurer Mafia Comes for Community Pharmacies
UnitedHealth, CVS, and Cigna’s PBMs are using their market share and pull in Washington to drive one of the key levers to manage health care costs—independent pharmacies—out of business.
https://prospect.org/health/2024-03-21-pbm-insurer-mafia-community-pharmacies/

About David Balat:
David Balat is the founder of Healthcare Finance Specialists and has broad experience across the healthcare spectrum with special expertise in health care finance. He is a former seasoned hospital executive with over 20 years of healthcare industry leadership and executive management experience.

Balat has earned the privilege of being invited to testify before the U.S. House Committee on Oversight and Reform in Washington, D.C., and before various House committees in the Texas state Legislature. He is a published author and op-ed columnist in Newsweek, U.S. News & World Report, Real Clear Politics, and other news outlets. He is also an active speaker and commentator on matters of health policy, health care finance, and health care reform.

via decent.com
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30min
August 26, 2024 Pennsylvania Moves Forward with PBM Reform | PBM Reform Podcast
Pharmacy owner Tom DePietro, PharmD and Pennsylvania State Representative Jessica Behnam join the PBM Reform Podcast to discuss the major win for Pennsylvania tax payers and Pharmacy Care.

HB 1993 is the result of bipartisan efforts – led by state Rep. Jess Benham (D-36) – to ensure that Pennsylvanians are no longer being screwed and that access to local, independent pharmacies is maintained.

Gov. Josh Shapiro last week joined Pennsylvania Insurance Commissioner Michael Humphreys, members of the General Assembly and local pharmacists at Thompson Pharmacy in Blair County for a ceremonial bill signing of bipartisan reforms in the 2024-25 budget. The reforms aim to increase oversight of pharmacy benefit managers (PBMs), the hidden “middlemen” of the pharmaceutical supply chain who largely go unchecked and unregulated as they negotiate the price of prescription drugs, passing the costs down to Pennsylvanians.

Shapiro recently signed House Bill (HB) 1993 into law, providing stronger protections for commercially insured patients in the commonwealth and increasing regulatory oversight of PBMs.
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52min
June 05, 2024 Broken Insurance & the Loss of a Son | PBM Reform Podcast
Special Guests:
Shanon Schmidtknecht & Loretta Boesing

Cole Schmidtknecht was a 22-year-old young man living in Appleton, Wisconsin who loved video games and sports. His parents Bil and Shanon described him as an inspirational free spirit with a love for being heard. Cole was diagnosed with severe asthma at only a year old. He had just recently moved out on his own with opportunities to chase his dreams, until his life was cut short earlier this year. “January 10th,, he went to the pharmacy to get his prescription and was told it was no longer covered by his insurance,” said Shanon.

He was told there was no alternative option and no generic drug would be covered. Cole didn’t know how to respond and couldn’t cover the extreme out-of-pocket cost of his Advair inhaler on a $19/hour income. An inhaler-dependent patient left the Walgreens Pharmacy with no medication. Five days later he suffered an extreme asthma attack and was taken to the hospital. He arrived at the Emergency Room lifeless and spent the next six days in the ICU on a ventilator.

“We were told he’s never going to wake up again,” said Bil.

A generic version of Advair only costs $15-$20. What happened to Cole is happening all over the country, according to Hometown Pharmacy co-founder Dan Strause.

“Unfortunately, we see even the state plan now no longer will allow for the generic, they force people into the brand. Why? It’s not hard to figure out it must be about the profit margin. Unfortunately, they’re making people decide between life-saving medicine [and paying bills, even though] the cost of the actual item is so low,” said Strause.

“We find this absolutely wrong, its infuriating we should all be angry, and we hope you tell your legislators this needs to be addressed sooner than later,” said Strause.

Hometown Pharmacy had to close a location in St. Germain partially due to the influence of PBMs. A pharmacy benefit manager acts as a middleman between drug manufacturers and pharmacies.

In the last state legislative session, the pharmacy benefit manager regulation bill wasn’t brought to a vote. The bill was designed to create transparency in the system and prohibit the PBMs’ control over the pharmaceutical industry as a whole.

“We’re very frustrated that it never got a chance to be voted upon,” said Strause.

Strause said there is a lot of speculation as to why the bill didn’t make it to the floor.

“In politics, there’s a lot of moving parts and we believe that the recent vote for Wisconsin mapping is part of it, because there’s a lot of energy and focus with what the next election is going to be and of course elections are very expensive, and you have to fund those elections.

Strause believes that money from lobbying groups associated with PBMs have a strong influence on lawmakers.

“Unfortunately, it means that money and influence is a significant factor in us passing bills especially ones that affect all of our lively hoods and our health,” said Strause.

Bil and Shanon said after learning of PBMs and the tactics that cost them their son they were angry and decided it was time to speak up.

“I don’t want you to ever have to imagine, I don’t want anyone to ever have to experience this,” said Shanon.

Their goal is to share Cole’s story and raise awareness.

“We just kind of feel like this is now our fight to fight for him. If we can prevent it for one other person just that alone would be a little solace or a little something I know we can never have our son back, he’s gone,” said Bil.

Cole’s situation is not the only one, and this could happen anyone. Everyday life saving medications are becoming inaccessible to patients who need them.

“We need our senators and our congressmen to help this process that’s why they’re there in office for our complaints, our concerns our needs and the games that are played are just costing lives,” said Bil.

From Shauna Johnson on Mar 11, 2024 via wjfw.com 3217 County G Rhinelander, WI 54501

Reference Webiste:
https://patientprotector.us/home
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1h
April 26, 2024 If You Can't Beat Them, Don't Join Them? | PBM Reform
The PBM Reform Podcast on the Pharmacy Podcast Network, with your host, Breck Rice! Breck has had the privilege of being around and working with pharmacies for over 20 years! He loves community pharmacies and will do everything in his power to help them be successful. It’s a privilege to be involved in reforming the industry he loves. Today's guest is Kyle McCormick, owner of Blue Berry Pharmacy, in Pittsburg Aria, PA.

Kyle beats the PBMs by not joining them! He runs a cash-pay-only pharmacy, with no PBM contracts. Kyle believes that if more pharmacies would kick out the PBMs they would have to change their unfair ways and give better reimbursements.
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31min
April 08, 2024 The Role PBMs has in Driving Up Drug Costs for Patients | PBM Reform
Interview with Howard Danzig, President of Employers Committed to Control Health insurance Costs.
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33min
March 07, 2024 What is Congress doing to help with PBM Reform? | PBM Reform
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30min

FAQs about PBM Reform Podcast:

How many episodes does PBM Reform Podcast have?

The podcast currently has 45 episodes available.

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