Transparency, Auditing, and the PBM Shell Game | PBM Reform Podcast

About this episode

The episode discusses the complexities of PBM financial models and the challenges of achieving transparency in prescription drug benefits.

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…

People in this episode

Host: Greg Reybold

Guest: Josh Golden

Topics covered

• PBM reform
• healthcare consulting
• transparency
• auditing
• pharmacy benefits
• drug costs

Keywords

• PBM
• transparency
• auditing
• healthcare
• drug costs
• pharmacy benefits
• contract negotiation

Mentioned in this episode

Organizations: APCI, Judi Health

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