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

Relentless Health Value™

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?