Ep #367: PBMs: Where There Is Mystery There Is Money - with Brian Butler

The ShiftShapers Podcast

This week’s episode features a conversation with Brian Butler, Vice President of Client Development at Flipt. PBMs use several tactics which drive up the overall costs of medical benefits. This expense is shouldered by members and employers, increasing pharmacy spend and pushing up plan costs. Innovating this model requires consumer empowerment to make intelligent health care decisions and advisors armed with specialty knowledge and data to impart to their clients.

What You’ll Learn From This Episode:

• 03:33 The scope of the financial impact of PBMs
• 06:52 PBM tactics that drive up cost unnecessarily
• 11:24 Empowering consumers with intelligent decisions
• 14:27 Advisors can deliver value with specialty knowledge and data
• 19:34 Future forecast and ushering disruptive solutions to the PBM problem

Quotes:

03:45 “You have roughly, you know, 500 billion dollars in drug spend with approximately a hundred to a hundred and twenty-five billion of that retained by middlemen. And there’s a variety of middlemen, it’s not just PBMs.”

05:05 “There’s definitely solutions to lower drug cost that can really be in almost a sponsored community effort to drive that revenue back into local communities.”

08:22 “While that zero dollar out of pocket cost you share as the member, your employer still picks up that remaining balance. And that remaining balance changes drastically.”

09:13 “It’s really important for me, as the consumer, to think about where am I going to fill this? It’s one of the highest cost, perhaps, medications or portions of spend in the health care benefit. And number two, are there any alternatives?”

12:30 “First and foremost is really leveraging technology to build a scalable solution and drive it directly to the member. Give them some incentives to participate in this consumerism model.”