In this episode of Healthcare Matters, join Dr. Robert Popovian and Ben Blanc as they delve into the issue of patient steering by Pharmacy Benefit Managers (PBMs). With firsthand accounts from guests Lou Tharp, Executive Director and Co-Founder of GHLF, and Dr. Anne Sydor, Director of Research Development at GHLF, the discussion highlights how PBM-owned pharmacies and policies like accumulators and maximizers limit patient choice and inflate out-of-pocket costs.

Tune in to learn more about the complex dynamics behind these practices, the impact on patient care, and the ongoing legislative efforts to protect patient rights.

Among the highlights in this episode:

03:01: Dr. Popovian explains the role of Pharmacy Benefit Managers (PBMs) in patient steering and their financial motivations for directing patients to PBM-owned pharmacies over independent ones

04:59: Lou shares his personal experiences with patient steering, explaining the challenges he faced with PBMs and his advocacy efforts that led to local policy changes

09:23: Dr. Sydor recounts the challenges she faced ensuring her son's medication continuity as he transitions to college, highlighting the barriers imposed by insurance companies regarding prescription fills

13:18: Lou discusses his negative experiences with at-home drug delivery due to PBM’s policies

15:26: Dr. Sydor criticizes the inefficiencies and customer service issues within PBMs, sharing her frustration with the lack of access to simple, generic medications due to PBM's mail order requirements

20:20: Dr. Popovian discusses state-level anti-steering legislation and federal initiatives aimed at reforming PBM practices, including a significant bill that proposes prohibiting PBMs from owning pharmacies to reduce conflicts of interest and promote patient care over profits

23:27: Dr. Popovian shares some final thoughts

If you want to use GHLF's interactive tool to explore health care premium cost trends state by state and learn more about patient assistance programs, visit: https://ghlf.org/copay-assistance-protection/

To learn more about House Committee on Oversight and Accountability Chairman James Comer’s call on the CEOs of the three major PBMs, go to: https://oversight.house.gov/release/chairman-comer-calls-on-pbm-executives-to-correct-hearing-testimony/

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: rpopovian@ghlf.org

Ben Blanc, Associate Director, Digital Production and Engagement at GHLF: bblanc@ghlf.org

A podcast series produced by Ben Blanc.

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.