Encore! EP288: The "Big Three" PBMs Spinning Up GPOs—What? With Mike Schneider

In this encore episode, Stacey Richter talks with Mike Schneider about the "Big Three" PBMs — Express Scripts, Optum, and CVS Caremark — spinning up their own group purchasing organizations (GPOs) to negotiate rebates with pharma companies. Traditionally, GPOs negotiated volume discounts on drugs and supplies for hospitals and providers; now these new PBM-owned GPOs, several based overseas in places like Switzerland and Ireland, are the entities negotiating rebates directly with pharma — sidestepping domestic rebate pass-through rules aimed at PBMs. WHAT YOU'LL LEARN ✅ Why the "Big Three" PBMs each set up their own GPO — Ascent (Express Scripts), an Ireland-based Optum operation, and Zinc (CVS Caremark) ✅ How these new GPOs differ from traditional GPOs, and why they now sit between PBMs and pharma companies for rebate negotiations ✅ Why an executive order requiring PBMs to pass through rebates to patients doesn't apply to GPOs, especially ones based overseas ✅ How the "Big Three" PBMs compete with each other and how employers choose between them ✅ Why one of the biggest beneficiaries of the rebate system as a whole may be the government itself WHY THIS MATTERS The PBM world as a whole is not very transparent, and moving rebate negotiations into GPO entities — some based in Switzerland and Ireland — makes that transparency problem worse, not better. It's a tangled web: rules designed to force PBMs to pass rebates through to patients don't say anything about GPOs having to do the same. MENTIONED IN THIS EPISODE Encore! EP216 with Chris Sloan: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 02:48 What does a GPO add to a PBM? 05:23 Rebates vs driving more revenue. 10:39 PBMs vs safe harbors. 12:25 The net impact on the commercial side. 14:07 PBMs vs pharmaceutical manufacturers. 14:54 How the "Big Three" PBMs compete with each other, and how employers would choose between them. 15:56 What the net-net is here. 18:06 How PBMs are shifting their models. 20:42 How GPOs may be making things even less transparent. 21:31 "The PBM world as a whole is not very transparent." 25:00 "One of the biggest beneficiaries of this whole rebate [system] is the government." 25:46 "The question is, 'Who's paying those costs?'" 26:02 Encore! EP216 with Chris Sloan. 27:00 A better way to move money from Pharma to employers and plan sponsors. 28:04 "Put your money where your mouth is."