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Relentless Health Value
EP465: The Not Super Effective Contracting Industry Norm, Where Jumbo Plans and Others Wind Up Paying $10,000 for $50 Drugs, With Chris Crawford
Feb 27, 2025
Chris Crawford, CEO of RxSaveCard, dives into the murky waters of pharmacy benefits and inflated drug prices. He shines a spotlight on the hidden costs imposed by large Pharmacy Benefit Managers (PBMs) and discusses a significant lawsuit involving J&J. Crawford explains how aggregate discount guarantees often lead to higher prices for consumers, while cash-pay options can offer real savings. The conversation encourages transparency in drug pricing and highlights innovative tools that help both employers and employees navigate the complex pharmaceutical landscape.
34:15
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Quick takeaways
- Pharmacy benefits managers often overcharge for medications, leading to significant price disparities that burden plan sponsors and employees.
- Accessing cash payment options can drastically reduce drug costs, highlighting the need for greater awareness of pricing alternatives in healthcare.
Deep dives
Excessive Drug Costs
Many health plans are overpaying for drugs, with one instance highlighted where a pharmacy benefits manager (PBM) charged a plan over $10,000 for a medication that could be purchased for about $50 through cash payment options. This significant price disparity underscores how traditional insurance mechanisms fail at delivering cost-effective healthcare. The discussion raises an important point regarding the vast difference in pricing available to cash-paying individuals compared to those going through insurance. Such examples reflect a larger trend in the pharmacy benefit landscape, where many plan sponsors are faced with exorbitant bills for generics that can be obtained much cheaper without insurance.
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Discover
highlights
Listen to the best highlights from the podcasts you love and dive into the full episode