AH008 - Ask the Right Questions to Future-Proof Your Pharmacy Benefit Plan, with Josh Golden

In this episode of the Astonishing Healthcare podcast, Justin Venneri interviews Josh Golden, who brings his extensive experience as a healthcare consultant and Senior Vice President of Strategy at Capital Rx to the discussion to highlight key questions that plan sponsors should ask to future-proof their pharmacy benefit programs. It is crucial to understand how PBMs make money and how much a plan sponsor is paying their PBM. The answer to the first part helps explain PBMs' behavior, and the answer to the second aids plan sponsors in their decision-making process. Josh explains the importance of a recent class action lawsuit as it relates to fiduciary responsibility and the pharmacy benefit plan and describes the conflicting fiduciary duties between plan sponsors and traditional PBMs. He also delves into the need for vigilant gatekeeping to control costs and ensure appropriate utilization of expensive medications and why states will continue to lead the way on PBM reform. Josh concludes with a truly astonishing, data-based observation regarding wasteful spending (hint: it can add up quickly)! Related Content Your PBM is the Problem Auto-Refill, Or Auto-Profit? Will Biosimilar Rebates Pass-Through?