Dr. Robert Popovian and Conner Mertens dive into the problematic practices of Pharmacy Benefit Managers (PBMs) that prioritize profits over patient access to affordable medications. Focusing on the case of a generic asthma medication offered at a discount yet overlooked by PBMs, the hosts explore the deep-seated issues of misaligned incentives in health care. They also discuss innovative solutions to bypass the traditional pharmaceutical distribution system, aiming to enhance patient access and affordability.

Join our hosts as they explore the complexities of health care economics and the path towards a more equitable system.

Among the highlights in this episode:

02:21 : Our hosts discuss the problematic practices of PBMs, such as refusing to cover cheaper, generic medications for profit motives

03:08 : Dr. Popovian explains how rebate systems influence PBMs to prefer higher-priced brand-name drugs over generics, leading to misaligned incentives that do not favor cost savings for patients or employers

04:36 : Our hosts touch upon how PBMs exclude drugs from formularies, not for efficacy reasons but for profit, impacting patient access and savings negatively

05:49 : Dr. Popovian speaks on the potential benefits of pharmaceutical companies selling directly to consumers, bypassing PBMs and insurers, and how it could save patients money and increase access

10:01 : Our hosts discuss how direct-to-consumer sales, and other models like direct sales to health providers or employers, could challenge the current pharmaceutical distribution system dominated by PBMs

13:09 : Dr. Popovian and Conner discuss the importance of seeking ways to make health care more accessible and affordable

14:27 : Conner shares his thanks and reflections as he says goodbye to the series

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: rpopovian@ghlf.org

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: cmertens@ghlf.org

A podcast series produced by Ben Blanc, Manager of Programs & Special Projects at GHLF.

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.