The Complex Relationships Between PBMs, Pharmacies, and Plan Sponsors | Joey Dizenhouse, Healthtrust

In a recent podcast episode featuring Joey Dizenhouse, of HealthTrust, and host Mike Koelzer, they discuss the complexities of the PBM industry and the relationships between PBMs, pharmacies, and plan sponsors. Dizenhouse brings years of experience in actuarial science and insurance plan management to the conversation, providing valuable insights into the industry.

During the podcast episode, Dizenhouse emphasizes the importance of transparency in PBM contracts, removing hidden incentives, and aligning the PBM's incentives with the best interests of the plan and its members. His company offers transparent contracts that reimburse pharmacies at the exact amount that the plan pays for the drug, ensuring that plan sponsors are not overpaying for drugs while pharmacies are not losing revenue.

Dizenhouse also discusses the challenges posed by the rising cost of pharmacy expenses and the importance of establishing formularies that are based on clinical evidence, value-based pricing, and incentives for the use of lower-cost, therapeutically equivalent drugs. He notes that PBMs need to work with pharmacies and prescribers to ensure appropriate utilization and avoid waste.

Throughout the conversation, Dizenhouse emphasizes the importance of communication between PBMs, plan sponsors, pharmacies, prescribers, and patients. He suggests that pharmacists can play a critical role in bridging the gap between clinical and financial considerations, educating patients about cost-saving options, and helping them navigate the insurance claims process.

Overall, the podcast episode featuring Joey Dizenhouse provides valuable insights into the challenges and opportunities facing PBMs and the importance of transparency, appropriate utilization, and communication. Dizenhouse's expertise in actuarial science and insurance plan management adds depth to the conversation, highlighting the complexities of the PBM industry and the need for ongoing collaboration and innovation to ensure the best outcomes for all parties involved.

The Business of Pharmacy Podcast??is an interesting and entertaining weekly podcast discussion on the business of pharmacy. Hosted by Mike Koelzer, an independent pharmacist in Grand Rapids, Michigan, each episode covers a new topic relevant to pharmacists and pharmacy owners. Listen to a new episode every Monday morning.