EP439: Fixing the Generic Drug Pricing Problem, Where Patients Pay More When They Use Their Insurance, With Luke Slindee, PharmD

Jun 6, 2024

In this discussion, Luke Slindee, a pharmacy consultant, unravels the tangled web of generic drug pricing and its impact on patients. He reveals how Pharmacy Benefit Managers (PBMs) profit from inflated costs, often making patients pay more even when insured. They explore innovative solutions like removing unnecessary price structures and the benefits of direct payment tools. Luke also touches on the broader implications of these pricing challenges on pharmacies and the services they provide, all while advocating for a system that prioritizes patient affordability.

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Intro

00:00 • 4min

Unpacking Generic Drug Pricing and Community Engagement

04:16 • 2min

Insights on Podcast Operations and Healthcare Engagement

06:25 • 2min

The Cash Pricing Conundrum

08:11 • 5min

Pharmaceutical Price Inflation and Its Impact

13:24 • 5min

Navigating Drug Pricing Challenges

18:51 • 10min

In Episode 439 of 'Relentlessly Seeking Value,' host Stacey Richter discusses the convoluted issues surrounding generic drug pricing with pharmacy consultant Luke Slindee.

To read the full article and show notes with links mentioned as well as a full transcript, click here.

They delve into the ways traditional Pharmacy Benefit Managers (PBMs) exploit the system to make immense profits, often leading patients to pay more even with insurance. The conversation explores various solutions, such as the removal of "Usual and Customary Prices" from PBM contracts, the advantages of bypassing insurance, and giving patients direct payment tools like health savings accounts.

Luke Slindee, with his extensive background in pharmacy and consulting, provides valuable insights into rebalancing the generic drug market to benefit patients, pharmacies, and plan sponsors alike. Additionally, the broader implications of these dysfunctional systems on pharmacy operations and staff conditions are discussed.

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08:12 Where do cash prices fall when pharmacies have contracts with PBMs?

08:39 What is a usual and customary price?

12:14 How is the usual and customary price affected by PBMs?

16:49 Should pharmacies be allowed to have two sets of cash prices?

17:14 Where does GoodRx fit into this because of the pharmacy/PBM dilemma?

19:06 What’s happening with Amazon and the anticompetitive contract lawsuit, and how does it relate back to pharmacy contracts with PBMs?

20:38 EP395 with Brennan Bilberry.

21:05 EP420 with Ge Bai, PhD, CPA.

23:27 Why is there a new wave of cash-only pharmacies?

24:02 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA, from Scripta.

25:41 What would allow the generic market to return to normal competitive pricing?

26:39 How does this dysfunction create a negative downstream effect?