PBM on the Rocks

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 powerThe 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 throughWhy network adequacy gave MHA more leverage than Optum wanted anyone to know aboutA troubling "patient choice" workaround: facilities charging residents hundreds of dollars a month to use the pharmacy they actually wantA 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 enforcementNotable 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 disputeLearn more and get involved: TruthRx.org#PBMOTR #podcastMusic 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 RussellGuests: Greg Reybold, Monique Whitney, Lauren Young, Chris Hobart, & Kendra KorthauerIn This EpisodeH.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 PharmacyIn 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 PharmacyMusic 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 CounselMusic by cat_herding_diva & JuliusH | Mixing by Andre Barden | Production & Editing by Shannon Wightman-Girard