Episode Title: Behind the PBM Curtain: Antonio Ciaccia Exposes the Game Show Notes:In this compelling episode of Real Pharma, hosts Na-Ri Oh and Ian Wendt welcome back Antonio Ciaccia, CEO of 46brooklyn Research and President of 3 Axis Advisors, for a hard-hitting discussion on the power and pitfalls of pharmacy benefit managers (PBMs). PBMs remain one of the most opaque and influential forces in healthcare—shaping drug prices, patient access, and payer negotiations—often under the guise of cost savings. Antonio, widely recognized as one of the most outspoken voices for transparency in the pharmaceutical supply chain, takes us deep inside the systemic problems that have led to distorted pricing models, misaligned incentives, and challenges for manufacturers, payers, and patients alike. Key Topics Covered: The Gross-to-Net Bubble: How rebates, discounts, and government distortions drive higher list prices and undermine value-based formulary design. PBM Consolidation & Vertical Integration: The impact of PBMs owning wholesalers, specialty pharmacies, and even repackaging themselves as drug companies. The 340B Program & Market Distortions: Why hospitals and covered entities are often incentivized to favor higher-priced drugs over clinically superior, cost-effective alternatives. Policy and Reform: What’s being done at the state and federal levels, including the FTC investigations, Medicaid reforms, and disruptive models like Mark Cuban’s Cost Plus Drugs. Burn It Down or Fix It? Antonio’s candid take on whether incremental improvements can save the current system or if structural overhaul is the only way forward. What Manufacturers Should Know: Strategies for navigating PBM-driven formularies, access barriers, and rebate-driven contracting. Antonio also shares actionable insights for payers, manufacturers, and policymakers on how to realign incentives and reduce inefficiencies that inflate costs without adding value. Why Listen:If you work in pharma, healthcare policy, or benefit design—or simply want to understand why your medications cost what they do—this conversation is a must-listen. Antonio’s expertise cuts through industry jargon and exposes the real forces driving the drug pricing crisis. Resources & Links: 46brooklyn Research – Data-driven analysis on drug pricing. 3 Axis Advisors – Market intelligence and consulting on drug pricing and PBMs. Related Episodes: 340B or Bust: Is This Program Failing the Sick