Wait, what’s a PBM (and how do they work)?

An Arm and a Leg

Society & Culture, Medicine, Health, Health & Fitness, Documentary

4.8 • 1.1K Ratings

🗓️ 6 July 2023

⏱️ 22 minutes

🔗️ Recording | iTunes | RSS

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Summary

If you’ve been told your insurance won’t cover your meds — or that you’re gonna have to pay an arm and a leg for them — you’ve met a PBM: a pharmacy benefits manager.

And: Experts say they play a big role in jacking up drug prices overall.

But how, exactly? We took a deep dive.

This episode first went out in 2019. We’re bringing it back because PBMs are in the news these days: Congress is targeting them, in an effort to to be seen doing something about prescription drug prices. And PBMs’ sometimes-rival, the powerful pharmaceutical industry lobby, is flooding the airwaves with ads attacking them.

There’s been a little news since 2019: Although Congress is still catching up, all 50 states have passed some laws pertaining to how PBMs work. We’ve got an update on that.

Here’s a transcript of this episode.

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Correction: A previous version of this episode misidentified the parent company of Express Scripts.

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Transcript

Click on a timestamp to play from that location

0:00.0	Hey there. You may have seen ads recently about access to drugs.
0:04.3	Here's one that starts with a woman trying to fill a prescription, but the pharmacist says,
0:08.2	I'm sorry this medicine isn't covered by your insurance. Yeah.
0:13.2	This guy in a blue suit comes up from behind the patient grabs her prescription slip.
0:17.1	I decide which medicine she can get.
0:19.7	Wait, you're not my doctor.
0:20.9	That's right. I'm your insurance company's pharmacy benefit manager or PBM.
0:26.5	And I don't make as much money as this one.
0:29.2	You might wonder, wait, what's a PBM exactly?
0:32.4	And also, why am I seeing this ad now?
0:35.2	And who's paying for this ad?
0:38.0	So PBMs are middleman companies that have a lot to do with which drugs we get access to,
0:43.4	how much we pay for them, and yeah, they're sharks.
0:46.5	And these ads are out there because Congress knows we're all mad about drug prices and access
0:51.3	to drugs and they're eager to be seen doing something about it.
0:54.6	And those ads are paid for by pharmaceutical makers.
0:58.1	Also sharks in direct competition with PBMs for the gazillions of dollars we spend on drugs
1:03.2	as a country. But PBMs and their role are a little more complicated.
1:08.4	So we are bringing back an episode from this show's very early day.
1:12.4	When we get to the end, we'll have some updates things I've learned since then.
1:15.9	Meanwhile, here's me four years ago starting to figure out how all this works.
1:21.5	So at the beginning of the year, my family switched to new health insurance plan.
	...

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