Healthcare in Crisis: The Truth About PBMs with Dr. Madelaine Feldman

Dr. Mattie Feldman, rheumatologist and healthcare policy expert, exposes how Pharmacy Benefit Managers have evolved from administrative entities into powerful forces that control medication access, often prioritizing profits over patients.• Pharmacy Benefit Managers (PBMs) originally handled prescription coverage but now control what medications doctors can prescribe and patients can access• The "big three" PBMs—CVS Caremark, OptumRx, and Express Scripts—now control 80-85% of all prescriptions in the United States• PBMs often prefer higher-priced medications because they generate larger rebates, contributing to rising drug costs• Vertical integration has created conflicts of interest where the same companies own insurance plans, PBMs, specialty pharmacies, and sometimes even drug manufacturing• Utilization management tools like step therapy and prior authorizations have become barriers between doctors and patients• PBMs force patients to use mail-order specialty pharmacies that often provide inferior care compared to community specialty pharmacies• Legislators are working on bipartisan bills like "People Before Monopolies" that would require PBMs to divest from pharmacy ownership• Patient stories and advocacy are crucial for creating meaningful change in the healthcare systemShare your pharmacy access or medication challenges with us by emailing [email protected] to help drive policy change.Support the show