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🗓️ 1 August 2025
⏱️ 7 minutes
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Why do drugs like Ozempic cost $1500 in the U.S., but only $147 in Canada? Most people don’t know about the invisible middleman making more than 10 of the top drug companies combined.
Healthcare may seem like a broken system, but it’s actually not broken at all. It works great; it’s just not working for you. Pharmacy benefit managers use their contracts to make massive profits off of everyone.
PBMs may appear to be helpful. They negotiate lower prices for manufacturing companies, reduce out-of-pocket expenses, and handle logistics between employers and insurance companies.
Pharmacy benefit managers charge the employer a very high price and pay the pharmacies a very low price, pocketing the difference. This is known as spread pricing. PBMs decide which drugs your plan covers, how much you’ll pay out of pocket, which pharmacy you can use, and when or if you’ll get your medication.
Cheaper and better drugs are often denied if PBMs don’t get a big enough rebate. They can even force you to fill your prescriptions at specific PBM pharmacies for more profit.
Drug companies have to give PBMs a kickback or “rebate” to get their drugs covered by insurance companies. To afford this rebate, drug companies raise the list price, and PBMs promote the drug that gives them the most profit.
Pharmacy benefit managers own insurance companies and pharmacies. Three of the largest PBMs control 80% of the medications in the U.S. Surprisingly, PBMs don’t exist in other countries.
Dr. Eric Berg DC Bio:
Dr. Berg, age 60, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media.
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0:00.0 | Why does Ozambit cost $1,500 in the U.S.? |
0:03.2 | Yet in Canada, it's only $147. |
0:06.0 | Just imagine paying $1,500 for something, |
0:09.0 | yet your neighbor gets the exact same thing for $147. |
0:13.0 | This is a dirty little secret that doesn't involve the drug. |
0:17.0 | It doesn't even involve big pharma. |
0:19.0 | It involves an invisible middleman that you've never heard of. |
0:22.3 | That literally makes more than 10 of the top drug companies combined. What you're about to learn will explain why. Health care might seem to be a broken system, but it's not broken at all. It works perfectly. It's just not a system that's working for you. We're talking about a shadow system that has hijacked drug prices. And they are called the pharmacy benefit managers. |
0:46.3 | Think of it like this. So you go to a restaurant and you order a burger. Okay? And let's say that burger cost $15. But before your order goes through, |
0:55.9 | some guy steps in and says, hold on. If the restaurant wants to sell you that burger, they need to pay |
1:01.8 | me five bucks, and if not, you can't have the burger. Think of them as the toll bridge between |
1:07.6 | you and drug prices. But the PBM isn't just collecting the toll. |
1:12.6 | They're also controlling which cars can pass. |
1:15.6 | They own the bridge. |
1:16.6 | They set the price of gas. |
1:18.6 | They use their contracts to profit off of everyone crossing. |
1:21.6 | On the outside, the pharmacy benefit managers appear to be very helpful. They negotiate lower prices from the manufacturing |
1:30.5 | companies. They also reduce out-of-pocket expenses. And of course, they also handle the complex |
1:35.6 | logistics between employers and insurance companies. So the PBM charges the employer a very high |
1:42.5 | price. It pays the pharmacy a very low price, and it keeps |
1:46.7 | the difference, and that's called spread pricing. |
1:49.2 | Now that's the appearance, but let's really now get into the reality of what really happens. |
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