PBMs

“My competitors had to suddenly contemplate, am I going to disclose what I'm making on spread pricing? Acquisition costs, three 40 B rebates, performance management fees, you know, like price protection. They have all these revenue streams and to break it out b…”

“No, cause that stuff's going to come down in price and now, you know, Lilly and Novo are smart now with their GLP ones. They're working around the PBMs and doing direct-to-patient, direct-to-company, and that was brilliant. That was really smart.”

“These PBMs and there's some group purchasing organizations like this. That should go away. And I think health is different than other commodities. It's probably has a much more important social role in deciding that the smallest, the little guy gets the worst …”

“In the first year, no formularies covered this. So it was really only for that cash payer. No insurance company picked it up, even though it was dramatically cheaper. Now it's about half of the volume, but still half not because that model of this margin sprea…”

“And these are these legacy companies, a great example of them is the PBMs, the Pharmacy Benefit Managers. Companies that were very innovative 40 years ago, So a PBM connects the pharmacy to the insurer. You know, 40 years ago or 30 years ago, they were great c…”

“Two thirds of actually our gross price goes to PBMs and insurance companies. So of the gross price that's often quoted, the net for us is about a third of that.”

“And there are three of them that dominate the industry with 80, 90% market share.”

“Humira is about 8000 dollars a month. Six to 8000 dollars a month. USIMRI is about 700 dollars a month. But they won't add USIMRI to their formularies because they don't want to use the revenue in the margin.”

“If five of the Fortune 50 companies walked away from the big three insurance companies and the big three PBMs, they'd have to change their business models, and immediately, immediately the entire healthcare system would change.”

“PBMs manage pharmacy benefits for two hundred and sixty-six million Americans, and that number's old. That's as of twenty-sixteen.”

“And through 2015 we got termination notices from all of the major PBMs, right, very obviously.”

“All the time you hear Americans, you know, close to you walking around complaining about Big Pharma, and you, what you hear them complaining about is Big Pharma. What they're actually complaining about that they don't know is Big PBM and Big Pharmacy.”

“There's this weird thing Americans created called PBM. Is it PBM, the pharmaceutical, the kind of, there's this Entity that basically sits between the insurers and pharmaceutical companies and aggregates orders and bargains. And this is like a, you know, multi…”

“The distributors, the drug distributors who control a lot of the markets don't take you that seriously. You don't get the financial breaks that much, much larger customers get unless you're reaching a certain scale. The PBMs certainly don't take you very serio…”