In this episode, we look at the PBM industry, which has been in the spotlight in recent months, and not necessarily in a good way. PBMs have been painted as the unnecessary "middle man" that is driving up the cost of drugs. But is this really the case? The PBM industry traces its roots back over 50 years, with an initial narrow focus on efficient benefits administration, creating systems that told pharmacies in real-time what each patient's specific insurance plan meant that customer was supposed to pay for a specific prescription. Over time, PBMs leveraged their intermediary role in the pharmaceutical supply chain to take on additional responsibilities, including pharmaceutical cost & clinical control, pharmaceutical dispensing, and disease management. Among the various stakeholders in the pharma supply chain, PBMs have the least interface with consumers and the general public, which often leads to confusion about the role PBMs play. In this discussion we hope to provide clarity on the various roles of PBMs and how PBMs interact with other stakeholders in the US healthcare system.

To discuss this topic, we are joined by Ronald Fox, who is currently a health care consultant, specializing in the PBM and health plan sectors. Previously, Ron spent over 21 years in the PBM industry, most recently serving as President of the Health Plan Division at Express Scripts, now part of Cigna's Evernorth division.  

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