Prescription drug prices in the U.S. haven’t just crept up, they’ve spiraled into a full-blown crisis. The reason isn’t just Big Pharma or bloated insurance plans.
The real culprits are PBMs (Pharmacy Benefit Managers), corporate middlemen so deeply embedded in the system that they now control which drugs are covered, how much patients pay, and whether your local pharmacy can even stay in business.
Doug Hoey, CEO of the National Community Pharmacists Association, has spent years fighting these opaque and unregulated players. Doug has seen firsthand how PBMs operate. Quietly extract billions from the system, manipulating formularies, steering patients into mail-order services they own, and using aggressive tactics like clawbacks to recoup payments months after a prescription is filled.
PBMs claim to reduce costs, but the opposite is happening. Patients are paying more, pharmacists are being pushed out of business, and entire communities are being left without access to care.
What are some of the sneaky tactics PBMs use? How can we fix the healthcare system so local pharmacies don’t go out of business and patients can access the care they need?
In this episode, Doug breaks down how PBMs became some of the most powerful and least accountable entities in healthcare, how their influence distorts medical decision-making, and what real reform could look like.
Things You’ll Learn In This Episode
-The Real Reason Drug Prices Feel So Broken
70% of your prescription cost isn’t for the drug itself. How are PBMs driving up the cost of medication?
-How PBMs Hijack Decisions From Your Doctor
What happens when a corporation’s rebate deal with a drug company matters more than your diagnosis?
-The Hidden Agenda Behind Mail-Order Prescriptions
Why are PBMs pushing you out of your local pharmacy and into their own delivery networks?
-The Pharmacy-Killing Practice No One Warned You About
What does it mean when PBMs “claw back” money months after a prescription was filled, and how does that put small-town pharmacies out of business?
-The Consumer Power That PBMs Don’t Want You to Use
What simple questions can you ask your HR department or local lawmaker that could help overhaul the entire system?