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PBM Reform Podcast: Daily Summaries Delivered
by Pharmacy Podcast Network
Pharmacy benefit managers were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and health plans. Over time, PBMs have been allowed to operate virtually unchecked. A lack of transparency in PBM practices has led several states to implement licensure/registration, fair pharmacy audit, or generic drug pricing legislation to try to level the playing field for pharmacies and patients. by the NCPA https://www.ncpanet.org/advocacy/state-advocacy/pbm-reform This Podcast is focusing on discussions & interviews about PBM Reform & those and Business of Pharmacy professionals leading this much needed reform.
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- 4 days ago52 min
Follow the Money, Expose the System, Demand Accountability | PBM Reform with APCI
What happens when the prescription drug pricing system becomes so complicated that employers, patients, and pharmacists struggle to determine where the money goes? In this special edition of the PBM Reform Podcast, host Greg Reybold welcomes nationally recognized drug pricing expert Antonio Ciaccia for an unfiltered conversation about pharmacy benefit managers (PBMs), hidden financial incentives, and the growing movement toward meaningful reform. Ciaccia has spent years investigating the economics of prescription drug distribution, helping uncover hundreds of millions of dollars in questionable Medicaid drug spending and exposing the financial mechanisms behind inflated drug prices. His latest work with 3 Axis Advisors raises important questions about whether conventional PBM contracts deliver the savings they promise. An October 2026 analysis compares Mark Cuban Cost Plus Drug Company's published prices with traditional PBM pricing arrangements. Another June 2026 report examines how retrospective rebates, pricing benchmarks, and administrative arrangements create financial risks for employers and health plans. Ciaccia has also described three forces capable of driving PBM reform: legislation, litigation, and market-based competition. As he told Drug Topics, borrowing a familiar expression from Greg Reybold: “Pressure busts pipes.” In This Episode Why PBM pricing transparency remains essential for employers, patients, and pharmacies. What recent drug pricing research reveals about hidden costs and contractual complexity. How cost-plus pharmacy models challenge traditional PBM economics. Why independent pharmacies continue facing reimbursement and cash-flow pressures. Whether federal reform and marketplace competition can produce lasting accountability. How pharmacists, employers, and policymakers can demand measurable results. The future of pharmacy benefits depends on more than promises of reform. It demands transparency, accountability, and evidence that savings actually reach the people paying for healthcare. Join Greg Reybold and Antonio Ciaccia as they follow the money and examine what's next for PBM reform.
- Oct 9, 202646 min
PBM Impact on Independent Pharmacy Owners | PBM Reform
A patient's copay unexpectedly jumped to nearly $500. Upon investigation, it was discovered his plan design had changed, penalizing him for using our pharmacy. He was now facing higher costs or needing to switch to a chain or mail-order pharmacy.
- Oct 5, 202634 min
Patients Rising Rx with Terry Wilcox | PBM Reform with APCI
This is part one of a two part conversation with Terry Wilcox, Co-Founder and CEO of Patients Rising. Find out what Patients Rising is doing for advocacy and change to better our patients by visiting https://www.patientsrising.org/about-patients-rising
- Sep 24, 202630 min
Iowa’s PBM Reform Breakthrough: Inside Senate File 383 | PBM Reform with APCI
Guest: Iowa State Representative Brett Barker, PharmD — District 51 Guest Host: Todd S. Eury, Pharmacy Podcast Network Regular Host: Greg Reybold — on special assignment Sponsored by: American Pharmacy Cooperative, Inc. (APCI) Iowa has delivered one of the most significant state-level victories in the continuing fight for pharmacy benefit manager reform. On this episode of the PBM Reform Podcast, guest host Todd S. Eury sits down with Iowa State Representative Brett Barker, PharmD, a practicing pharmacist and representative of Iowa House District 51, for an inside look at the passage of Senate File 383 and what the new law could mean for independent pharmacies, employers, patients and the future of PBM regulation across the country. Representative Barker brings a rare perspective to the discussion. In addition to serving in the Iowa Legislature, he is a pharmacist and pharmacy executive who understands firsthand the financial pressures facing community pharmacies. Barker served as one of the House floor managers for SF 383 as the legislation moved through the Iowa General Assembly. The legislation cleared the Iowa House by a 75–15 vote after previously passing the Senate 36–14. Governor Kim Reynolds signed SF 383 into law on June 11, 2025, and its primary provisions became effective July 1, 2025. SF 383 establishes substantial new requirements governing pharmacy benefit managers and their relationships with pharmacies, health plans and other payors. Among its provisions, the law addresses PBM reimbursement practices, pharmacy contracting, pass-through pricing, pharmacy appeals and disputes, network participation and protections intended to prevent discriminatory treatment of pharmacies. One of the central themes of the legislation is greater transparency and accountability surrounding the flow of prescription-drug dollars. The law defines and establishes requirements involving pass-through pricing, in which payments made by a third-party payor to a PBM for prescription drugs correspond to payments made to the dispensing pharmacy, including applicable professional dispensing fees. During the conversation, Todd and Representative Barker explore: Why PBM reform became such an urgent issue for Iowa pharmacists and patients. What community pharmacies were experiencing financially before SF 383. How pharmacists, pharmacy owners and advocacy organizations helped educate Iowa lawmakers. The political battle surrounding the legislation and what ultimately helped generate bipartisan support. Why PBM reimbursement methodology is central to pharmacy sustainability. The importance of giving pharmacies meaningful mechanisms to challenge reimbursement and contractual disputes. The role Representative Barker's pharmacy background played in explaining PBM economics to fellow legislators. The opposition lawmakers encountered while attempting to move PBM reform forward. What other states can learn from Iowa's strategy. Why pharmacists need greater representation inside state legislatures. Whether Iowa's legislation could become a model for broader PBM reform nationwide. Governor Reynolds described the legislation as an effort to bring greater accountability to PBMs and noted when signing the bill that Iowa was joining a growing number of states pursuing similar reforms. For independent community pharmacists, the Iowa experience demonstrates something increasingly important: PBM reform is no longer simply a pharmacy reimbursement debate. It is becoming a healthcare access, competition and patient-care issue being fought state by state. Representative Barker's story also highlights another major theme of the PBM Reform Podcast — the importance of pharmacists becoming directly engaged in public policy. When pharmacists bring their clinical knowledge, business experience and patient relationships into state government, they can help lawmakers understand how policies written hundreds of miles away ultimately affect whether a pharmacy can keep its doors open. Iowa's passage of SF 383 represents a major milestone in that movement. About Our Guest Brett Barker, PharmD, represents Iowa House District 51. He earned his Doctor of Pharmacy degree from the University of Iowa and has worked extensively in community pharmacy. His professional background gives him firsthand insight into pharmacy operations, prescription-drug reimbursement and the challenges facing independent pharmacies. About the PBM Reform Podcast The PBM Reform Podcast examines pharmacy benefit manager pr
- Aug 25, 202642 min
Winning Hearts, Minds, and Policy with Strategic Communications | PBM Reform
Many pharmacy leaders focus on legislation and lobbying. Why is strategic communication on social media equally important? Dr. Maurice PharmD joins Breck Rice on this episode of the PBM Reform Podcast. eKSsdTHlSWcgEnRjIkQv
- Aug 17, 202653 min
TRICARE and the Fight for Military Pharmacy Access | PBM Reform with APCI
The PBM Reform Podcast, sponsored by APCI, welcomes John Vinson, PharmD, Chief Executive Officer of the Arkansas Pharmacists Association, for a timely conversation with host Greg Reybold about the management of the TRICARE pharmacy benefit. Express Scripts administers pharmacy benefits for TRICARE, the Department of Defense healthcare program serving more than 9 million active-duty service members, military retirees, and family members. In fiscal year 2023 alone, TRICARE spent more than $8 billion on prescription medications. Greg and John examine concerns surrounding Express Scripts’ administration of the program, including shrinking pharmacy networks, reduced patient choice, questionable contractor reporting, specialty-drug delivery oversight, and the consequences for independent and rural pharmacies. A 2025 Government Accountability Office investigation found that: TRICARE’s minimum network requirement fell from 50,000 to 35,000 pharmacies. The network had approximately 13,165 fewer pharmacies in late 2024 than in late 2022. An estimated 380,000 beneficiaries may have been forced to find another pharmacy. The Defense Health Agency relied heavily on contractor-submitted reports that contained inaccuracies. DHA had not consistently audited the data used to evaluate beneficiary access. GAO’s two corrective recommendations remain open as of August 2026, although DHA has begun adding reporting and auditing requirements. The episode also addresses higher 2026 prescription copayments. For most non-active-duty beneficiaries, home-delivery copays are now $14 for generic formulary drugs, $44 for brand-name drugs, and $85 for non-formulary medications. At retail network pharmacies, the corresponding 30-day copays are $16, $48, and $85. Greg and John discuss whether PBM-driven network reductions represent true savings—or simply transfer costs, inconvenience, and access barriers to military families and the community pharmacies serving them. Key discussion points Express Scripts’ role in administering the TRICARE pharmacy benefit Pharmacy network contraction and beneficiary disruption Access challenges facing rural communities and military families Inaccurate contractor data and insufficient federal oversight Specialty-pharmacy delivery and monitoring concerns Rising 2026 copayments and pressure toward mail order Arkansas’ leadership in challenging PBM vertical integration The need for transparency, accountability, adequate reimbursement, and patient choice Important clarification: TRICARE is administered by the Department of Defense and is distinct from healthcare and pharmacy services operated by the Department of Veterans Affairs. Sponsored by APCI — American Pharmacy Cooperative, Inc. Sources: U.S. Government Accountability Office, TRICARE’s 2026 pharmacy-benefit update, official 2026–2027 pharmacy costs.
- Jul 31, 202646 min
Pharmacists Fight Back: Federal PBM Reform Advances | PBM Reform with APCI
PBM Reform Podcast Sponsored by American Pharmacy Cooperative, Inc. (APCI) Host: Greg Reybold Special Guest: Ben Mudd, PharmD, Executive Director, Kentucky Pharmacists Association Momentum for meaningful pharmacy benefit manager reform is building in Washington. In this episode of the PBM Reform Podcast, host Greg Reybold welcomes Dr. Ben Mudd, Executive Director of the Kentucky Pharmacists Association, to examine the bipartisan Pharmacists Fight Back Act, H.R. 6610, and what its advancement could mean for patients, pharmacists, employers, and the future of independent pharmacy. On July 22, 2026, the House Committee on Oversight and Government Reform reported the legislation favorably following a committee markup. Introduced by Chairman James Comer of Kentucky and Representative Jake Auchincloss of Massachusetts, the bill would establish new requirements for pharmacy benefit managers participating in the Federal Employees Health Benefits Program. The proposed reforms would require participating PBMs to provide fair pharmacy reimbursement, apply manufacturer rebates toward reducing beneficiaries’ prescription drug costs, prohibit patient steering to PBM-affiliated pharmacies, increase transparency, and establish penalties for noncompliance. Greg and Ben discuss why the Federal Employees Health Benefits Program could become an important proving ground for broader PBM accountability and how federal action may influence commercial plans, state legislation, and future healthcare policy. Episode Discussion The conversation explores: Why H.R. 6610 has attracted bipartisan support How PBM reimbursement practices threaten independent pharmacy sustainability The impact of patient steering and PBM-affiliated pharmacy networks Why manufacturer rebates should directly reduce patients’ prescription costs What “fair reimbursement” must include to protect pharmacy access How enforcement provisions and financial penalties could improve accountability Kentucky’s role in advancing pharmacy and PBM reform The connection between federal legislation and state-level advocacy What pharmacists should communicate to legislators and patients The remaining steps required before H.R. 6610 can become law Dr. Mudd brings the perspective of a practicing community pharmacist and association executive who has worked extensively in pharmacy advocacy. A graduate of the University of Kentucky College of Pharmacy, he practiced in both chain and independent pharmacy settings before assuming leadership of the Kentucky Pharmacists Association. Ben is running for Kentucky State Senate position this November. Lear more about his platform and issues most important: https://www.votemudd.com/meet-ben Key Takeaway PBM reform is no longer simply an industry debate. It is a patient-access, healthcare-affordability, pharmacy-choice, and community-infrastructure issue. The Pharmacists Fight Back Act represents a significant federal effort to separate PBM compensation from practices that may increase drug costs, restrict patient choice, and financially disadvantage independent pharmacies. The legislation’s advancement is an important milestone—but pharmacists must remain informed, engaged, and vocal as the bill moves through the legislative process. Subscribe to the PBM Reform Podcast for continuing coverage of legislation, regulation, litigation, and advocacy shaping the future of pharmacy benefit management and community pharmacy. The PBM Reform Podcast is sponsored by American Pharmacy Cooperative, Inc., supporting independent pharmacies and advocating for a more transparent, competitive, and patient-centered prescription drug marketplace.
- Jun 2, 202648 min
Transparency, Auditing, and the PBM Shell Game | PBM Reform Podcast
In this episode of the PBM Reform Podcast, host Greg Reybold, Vice President and General Counsel at APCI, welcomes Josh Golden, Senior Vice President of Strategy at Judi Health and a nationally recognized voice in Pharmacy Benefit Manager reform. With more than 20 years of healthcare consulting experience, Golden brings deep expertise in vendor procurement, contract negotiation, plan design, and benefit strategy for large employers, government entities, and unions. Together, Reybold and Golden examine the financial models behind today’s PBM industry and why true transparency remains so difficult for employers, plan sponsors, patients, and pharmacies. The conversation explores how current PBM arrangements often benefit the PBMs more than the employers paying for coverage or the patients relying on their prescription benefits. Golden explains why auditing PBM contracts, rebate structures, spread pricing, administrative fees, pharmacy networks, and formulary decisions is essential to understanding the real economics of prescription drug benefits. This episode also addresses a growing concern in healthcare: PBM steering behavior. Are patients being quietly pushed toward specific formularies, specific pharmacies, and restricted networks that operate like closed networks without being clearly disclosed? Reybold and Golden discuss how this behavior can limit patient choice, disadvantage independent pharmacies, and distort the stated goal of lowering drug costs. The discussion also tackles the role of federal reform efforts, including whether the Appropriations Act represents meaningful PBM accountability or whether it risks becoming another layer in the broader shell game surrounding PBM reform. Finally, the episode asks one of the most important questions in pharmacy policy today: should PBMs own pharmacies? If vertical integration is promoted as a way to lower drug costs, where is the proof — and who actually benefits? Transparency, Auditing, and the PBM Shell Game | PBM Reform Josh Golden is the Senior Vice President of Strategy at Judi Health (a prominent healthcare technology and benefit management firm closely associated with Capital Rx) and a nationally recognized thought leader in Pharmacy Benefit Manager (PBM) reform. With over 20 years of healthcare consulting experience, Golden specializes in vendor procurement, contract negotiation, and plan design consultation for large employers, government entities, and unions.
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About PBM Reform Podcast
Pharmacy benefit managers were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and health plans. Over time, PBMs have been allowed to operate virtually unchecked. A lack of transparency in PBM practices has led several states to implement licensure/registration, fair pharmacy audit, or generic drug pricing legislation to try to level the playing field for pharmacies and patients. by the NCPA https://www.ncpanet.org/advocacy/state-advocacy/pbm-reform This Podcast is focusing on discussions & interviews about PBM Reform & those and Business of Pharmacy professionals leading this much needed reform.
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