How Health Insurers Are Using Pharmacy Benefit Managers to Control Drug Prices

In episode 69, Lucas and Luna dive into the murky world of pharmacy benefit managers (PBMs) and how health insurers use them to negotiate drug prices behind the scenes. They focus on the case of Humana and its PBM subsidiary, CenterWell Pharmacy, and how vertical integration allows insurers to capture rebates while patients still face high out-of-pocket costs. The hosts break down the 'spread pricing' model, where PBMs charge payers more than they reimburse pharmacies, and discuss recent FTC scrutiny. They also explore how insurers use tiered formularies and prior authorization to steer patients toward preferred drugs. A concrete look at incentives that often run counter to patient savings. #HealthInsurers #PharmacyBenefitManagers #DrugPricing #Humana #CenterWell #SpreadPricing #FTC #VerticalIntegration #Formulary #PriorAuthorization #Rebates #OutOfPocketCosts #Economics #Healthcare #Insurance #Podcast #FexingoBusiness #BusinessPodcast Keep every episode free: buymeacoffee.com/fexingo