Podcast Timeline

01:42 HHS’s plan to remove safe harbor from the rebates that Pharma pays to PBMs to buy their way onto formularies.
01:53 Creating more transparency by eliminating the anti-kickback.
03:06 What the anti-rebates process flowchart looks like.
03:39 Changing the term from “rebate” to “charge-back.”
04:13 Charge-back at the point of sale rather than post-adjudication.
04:28 How putting the pharmacy in the middle of the transaction changes everything.
05:43 “From a cash flow perspective, this matters.”—Stacey
07:24 “Who is in charge of this payment workflow?”
09:31 “Why the switch?”
11:18 The potential players in the role of paying pharmacies: PBMs, wholesalers, the switches (McKesson), banks/fintech, government contractors.
12:33 The likelihood that this will spill over into commercial medicine.
15:10 Who considers himself a wholesaler?
16:44 Why PBMs want to maintain the status quo, and how that works.
18:37 “Where there’s variability, there’s variable profitability.”
20:25 How do you check that the patient is getting the charge-back amount they deserve?
21:36 Is it still possible to pay to be on a PBM’s formulary?
22:16 Can you ever get away from the pay-to-play formulary?
28:03 “If you think about it, who’s writing the checks at the end of the day?”
31:58 What questions should employers be asking right now?
34:24 The problem with implementing HHS’s primary goal.
35:30 The cause of the inflection point.
37:57 “We want to get back to transparency.”
41:01 “It’s all about optics of price.”
41:17 “Really what we should be focusing on is, ‘What are we solving for?’”
41:47 EP206: Turns Out, High-Deductible Plans Don’t Drive High-Quality, Cost-Effective Health Care, With Ashok Subramanian, CEO and Founder of Centivo. 
42:08 Why employers purchase office supply contracts more effectively than pharmacy benefit contracts.
44:33 Capital Rx and what they do.

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