If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.
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If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.
AH076 - PBM 'Boogeymen' & Stopping the Madness Out There, with Jeff Hogan
The Astonishing Healthcare Podcast
26 minutes 37 seconds
3 months ago
AH076 - PBM 'Boogeymen' & Stopping the Madness Out There, with Jeff Hogan
In this episode of the Astonishing Healthcare podcast, we discuss recent health policy news and how to bring greater transparency to health benefits programs with returning guest, Jeff Hogan, President of Upside Health Advisors. Building on our previous discussion with Jeff - How First-Movers are Taking Control of their Health Plans in 2025 - we shed more light on the “PBM boogeyman” narrative, explaining how opaque pricing structures and unhelpful provisions buried in contracts must be discovered. Jeff reviews attempts by states around the country to intervene and halt steering and other practices that negatively impact health plans and their members - from early medical reform efforts to recent PBM-focused legislation. He also notes Medicaid cuts are likely to have some "second-order effects" that impact commercial plans, and the mood in Washington, DC, overall is "dazed and confused," so we can't count on help at the federal level.
The Astonishing Healthcare Podcast
If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.
