Generic Compliance Ratios, Pass-Through Contracts, and Other Pharmacy Plumbing, With Mark Cuban and Cora Opsahl
Summary
Host Stacey Hensley interviews Mark Cuban and Cora Opsal to expose pharmacy supply chain inefficiencies. They discuss how generic compliance ratios and opaque PBM pricing models, like inflated AWP discounts, drive up costs for patients and employers. The episode highlights the disparity between cash prices and insurance reimbursements, using imatinib as a key example. Listeners learn how to negotiate pass-through contracts and demand transparency to protect plan assets.
Topics discussed
Introduction: Mark Cuban, Cora Opsal, and the mystery of pharmacy margins
Sponsor acknowledgments and show credits
Wholesaler consolidation and the Imatinib pricing example
Discount theater: Why AWP and WAC are misleading reference prices
Generic compliance ratios and how they trap pharmacies
High deductibles, specialty tiers, and patient out-of-pocket costs
Employer RFPs and the disconnect between reimbursement and billing
Pass-through PBM contracts and the black box of math
The failure of consultants and the limitations of PBM audits
Negotiating for data transparency and leveraging Cost Plus Drugs
Mark Cuban's endorsement of the Relentless Health Value podcast
Listen ad-free on Castria