The PBM Trap: How “Savings” Are Costing You a Fortune PBMs (pharmacy benefit managers) were created with good intentions but became broken middlemen incentivized to push higher-cost drugs. Securing a big discount on an expensive drug looks more impressive than low-cost alternatives. Unfortunately, the system encourages over-prescription. 90% of doctors have no idea what the drugs they prescribe will actually cost you, and direct-to-consumer advertising (allowed only in the US and New Zealand) drives patients to demand expensive brand-name drugs they saw on TV. The solution? Incentivize patients (again!). Independent audit teams can proactively offer generic alternatives, and 80% of the time, doctors agree. Patients receive recurring savings directly in their bank accounts. And for companies: Read your contracts, align incentives with employees, and don&#x27;t accept the status quo. Healthcare may be weird, but we don&#x27;t have to be passive victims of it. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

News You Can Use: Special Edition with Phia Part 2 of 6 The PBM Trap

Healthcare NOW Radio Podcast Network - Discussions on healthcare including technology, innovation, policy, data security, telehealth and more. Visit HealthcareNOWRadio.com

# Full Transcript

**Podcast:** Healthcare NOW Radio Podcast Network - Discussions on healthcare including technology, innovation, policy, data security, telehealth and more. Visit HealthcareNOWRadio.com

## Participants

- **Dr. Nick** (None)
- **Adam Russo** (The FIA Group)

## Transcript

It's time to turn down the noise and tune into this special edition of News You Can Use. Your host is Dr. Nick, the incrementalist, a long-time innovator exploring incremental changes across various industries that can be applied in healthcare. Combining the powers of observation and real-world experience, Dr. Nick makes the case that innovations in healthcare can be accomplished incrementally, not just by moonshot events. Now, here is Dr. Nick.

In this week's special edition of News You Can Use on Healthcare NOW Radio, I sat down again with Adam Russo. He's the CEO and co-founder of the FIA Group. And this week we're focusing on another edition exploring the weirdness of healthcare in the United States. And if you haven't heard of PBMs, then I don't know, you must be sleeping under a rock and not doom scrolling every day. Adam, welcome to the show.

Thank you so much. It's a pleasure to be back on the show again. I'm surprised you brought me back after the last time. Oh, I think we had so much fun and it was such a great episode. I'm excited to do this again. So, PBMs, we certainly hear about them. They have a long history. I think they even have a history that, you know, potentially was intended to be good. I mean, that's my read of history, although I was never a good historian.

But they seem to have broken bad is the best that I can describe. Maybe for the benefit of the listeners, you could describe briefly what a PBM is and how they came about. So, you know, first I want to just make a comment about your definition of the healthcare industry in America. You said the word weirdness. I did.

And there's no better word. I mean, that's exactly what it is because any, you know, it's funny because in our country, people just assume this is how healthcare is supposed to be. And I'm sitting here going, if you brought an alien from out of space and landed him in America and said, okay, you're going to pay $1,000 a month for health insurance.

But before we pay a single dollar, you got a $8,000 deductible that you have to meet first. And then you could start and then we'll start paying the claims. However, there may be some sharing of those expenses as there is with pharmacy claims. You know, an alien would look at you and say, what kind of system is this?

And it all goes back to what you mentioned about the PBM world and how the intention was a good one. Right. And that's the same thing with all of healthcare, whether it's the No Surprises Act, whatever it might be. I think, you know, healthcare reform, Obamacare, the ACA, all the intentions are good, but people don't think about what the ramifications could be if we put certain things in place.

Right. And I...

News You Can Use: Special Edition with Phia Part 2 of 6 The PBM Trap

Transcript

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News You Can Use: Special Edition with Phia Part 2 of 6 The PBM Trap

Transcript

Built for investment professionals

Every day you wait, your competitors are findingedge in conversations you're not hearing.

Every day you wait, your competitors are finding
edge in conversations you're not hearing.