The-Shift-Shapers-Podcast-(Rough-Comp-2)

Pharmacy costs are increasing exponentially – some estimate that they will soon represent more than a quarter of all plan spend. Yet this portion of the industry is so opaque that it is nearly impossible to accurately understand what, exactly, is being paid – and where those payments actually go. Our guest on this episode is Kent Thomas, founder of Pharmatrix, a marketing firm focused on creating a fiduciary-like environment where PBMs become fully transparent.

What You’ll Learn From this Episode:

  • Defining terms such as spread pricing, AWP, rebates, etc.
  • The challenges advisors face speaking with prospects and clients
  • Who controls the market today, and why that matters
  • Beyond prescribing – the importance of clinical expertise
  • How a “fiduciary-like” model works for everyone

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Is a PBM a gatekeeper and whose interests are they serving?

Renzo Luzzatti is an expert on how and why pharmacy costs are growing at an exponential rate and driving an ever-more significant portion of claims spend. He explains that there are multiple vantage points to consider if benefit advisors and fiduciaries are to gain a good overall understanding of the problem and its possible solutions.

We explore the rebates shell game and learn how advisors can arm themselves to make better recommendations to prospects and clients. The conversation also spotlights the starting line for this problem – the physician’s prescription pad and discusses who, if anyone, is educating the physician.

What You’ll Learn From this Episode:

  • What is driving pharmacy spend to such high levels.
  • Whether PBMs have an inherent conflict of interest.
  • The current role of the PBM and what that role should be.
  • Who’s educating physicians about pharmacy costs, choices, and efficacy.
  • The meaning of “specialty pharmaceuticals” and why they are being approved at a faster rate.
  • Potential solutions for fully-insured plans.
  • What advisors need to know.

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small