#24: Drugs In my Pocket (and I don't’ know what to do with then)

This week we are talking about “drugs”, specifically the world of PBMs with Dr. Lee Strandberg. Pharmacy Benefit Managers(PBM)  are the middlemen between your pharmacist and your prescription and your insurance company. Yep.. more middlemen.

If you have never heard of the term PBM, well you are not alone. Most people have no clue that they exist, how they work and how the cost or medications is controlled, negotiated or paid for. They are the one paying the pharmacist for your medication! While there are approximately 60 PBS, the 3 largest ones currently control 80% of the market.

We discuss both arms of the  pharmacy world- how the pharmacy acquires the medications and purchases them. Hang on as we  unravel the mysterious chain of events on how the pharmacy gets paid by the PBM and how they negotiate the prices with your insurance company.

We do get a little deep in the weeds on cost control and price negotiations, so pay attention. We only WISH that getting a Zpack  could be as simple as buying a head of lettuce from your local farmers market.

Dr. Lee Strandberg is our guest this week who intimately knows the ins and outs of the complex layers of the pharmacy world. He is a Professor Emeritus, Pharmacy Economics and Public Health Oregon State University and was Director, Managed Care pharmacy for SHS Plans from 2005-2011. He was appointed by Oregon Governor Kitzhaber to the OR Health Policy Board, Medicare-Medicaid Integration of Care and Services work Group which wrote part of the CCO and reporting structure. He was a committee member on the OR Evidence Based Review of Prescription Drugs Preferred Drug List. During the past 40 years he has presented papers, seminars and consulted on the impact of pharmaceutical use on health care costs and quality. He has been a consultant to governmental agencies in Australia and Canada. He currently works as a Pharmacy Director for Kannact, Inc.Don’t forget to reach out to MR Insurance Consultants where their goal is to assist physicians in obtaining the most comprehensive coverage available to fit their unique situation. Reach out for both excellent and quality service at doctorpodcastnetwork.com/mrinsurance

Disclaimer

All opinions expressed by the guest in this episode are solely the guest's opinions and do not reflect the opinions of May or Tim Hindmarsh MD or BS Free MD, LLC  or any affiliates thereof. The guest's opinions are based upon information they consider reliable, but May and Tim HIndmarsh, MD, BS Free MD  LLC, nor any affiliates thereof warrant its completeness or accuracy. The guest, May and Tim HIndmarsh MD, BS Free MD LLC, or any affiliates thereof are not under any obligation to update or correct any information provided in this episode. The guest's statements and opinions are subject to change without notice.

Links:

MR INSURANCE:

doctorpodcastnetwork.com/mrinsurance or phone 800-817-4522. 

PBM Basic Information:

https://en.wikipedia.org/wiki/Pharmacy_benefit_management

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