The PBM Problem Exposed: Why 1–3% of Members Drive 60% of Costs

In this recap episode, host Lester Morales breaks down the powerful conversation with Rachel Strauss — widely known as the “PBM Princess” and one of the clearest, boldest voices exposing how pharmacy benefit managers (PBMs) really work.

Rachel spent much of her career inside a leading PBM that didn’t play the traditional rebate and spread-pricing games. Today, she’s on a mission to educate employers, advisors, and everyday consumers on the hidden mechanics of drug pricing — and why most people have no idea what they’re actually paying for.

In this recap, Lester dives into:

• The emotional, financial, and human cost of a broken pharmacy system

• How PBMs actually make money (and why the incentives are completely misaligned)

• Why a $10 copay tells you nothing about the true price of a drug

• The spread-pricing “black box” and how it hurts patients, employers, and local pharmacies

• The shocking reality: 1–3% of plan members drive up to 60% of total pharmacy spend

• Why employers can reduce costs by 50–70% on high-cost drugs using modern, patient-first strategies

• The false belief that “employees won’t understand change” — and how it delays real solutions

• Real-world paths to get the exact same medication for employees at zero cost

Rachel and Lester outline a simple but powerful truth: If the PBM profits when drug prices stay high, the game will never change.

This episode is a must-listen for employers, advisors, CFOs, HR leaders, and anyone who wants to understand why pharmacy costs are exploding — and what to do about it.

👉 Listen to the full conversation with Rachel Strauss in the main episode.