AH105 - The Perfect Storm Driving the Future of Drug Pricing, With Josh Golden

Josh Golden, SVP of Strategy at Judi Health, returns to the Astonishing Healthcare podcast for a timely discussion about the world of drug pricing and what's shaking things up. Josh shares insights from his two decades of experience working with many of our country's largest employers and navigating [very heavy, sometimes scary] pharmacy benefit manager (PBM) contracts. He explains why the industry still relies on Average Wholesale Price (AWP) despite its known flaws, how Maximum Allowable Cost (MAC) lists have been used to drive hidden pricing arbitrage, and why the market is shifting so rapidly toward transparency and alignment.The discussion covers the need for plan sponsors to understand the true cost of pharmaceuticals and how four massive forces are colliding to form "lightning in a bottle" that will drive systemic change in the pharmacy ecosystem. As reforms across the state and federal levels pressure the industry to adapt, plan sponsors must seek forward-thinking PBM partners that prioritize transparent pricing and decisions that benefit the plan and lead to better care for members.HighlightsJosh emphasizes the sordid history of AWP manipulation and explains why it remains a predominant, yet deeply flawed, pricing benchmark in PBM contracts.PBMs frequently deploy MAC lists to extract hidden value, creating wide pricing variations for plan sponsors, pharmacies, and patients.The healthcare industry is moving toward cost-plus economics, making more realistic and reliable pricing benchmarks even more important.Four major trade winds are accelerating PBM reform: state regulations, retail pharmacy closures, transparent cash prices for expensive drugs like GLP-1s, and plan sponsor class action lawsuits.Related ContentWhat is NADAC & How Does It Differ From AWP?Why this benefit leader switched to a more modern, transparent PBMWhat Is the Role of a Pharmacy Benefits Manager (PBM)?Health Benefits 101: The Importance of a Transparent PBM ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.