Patients Rising Rx with Terry Wilcox | PBM Reform with APCI

Terry Wilcox (0:05)

You are listening to the global network of podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network.

SPEAKER_2 (0:34)

Welcome to the PBM Reform Podcast, where we dive deep into the world of pharmaceutical benefit management, cutting through the noise to uncover the truth. Since 2019, we've been your go-to source for the latest on how PBMs impact patient care, drug pricing and the very future of pharmacy. Here, we champion the role of pharmacists, the most knowledgeable advocates for medication safety and expertise.

Join us as we expose and generate discussions that are reshaping healthcare and explore how we build a better payment system, which focuses on advancing pharmacy care.

Todd (1:19)

Hey, welcome back to another episode of the PBM Reform Podcast. When I think of where PBMs have come and gone, and shout out to Dom Meff of Greensburg, Pennsylvania, the late Dom Meff. He taught me about PBMs back in 2012-ish, 2013

Dom helped to set up one of the very first PBMs around the steel industry, for US Steel. And even back then, with the flat administrative fee at $0.10, $0.20, $0.25 a claim, he admitted of how much money, hand over fist, even after fees and after expenses, the PBM model was making. And now we jettison into the future. This would have been like the 70s, 80s. Now we come into, it's 2026

We don't have to describe necessarily as much as we used to, to a senator, to a state representative, what a pharmacy benefit manager is and or what it does. But we still know that they're getting in the way of patient care. They're getting in the way of physician decisions. They're getting in the way of pharmacists delivering care, delivering expertise and intelligence. They're definitely getting in the way of keeping pharmacies open because of the collapse of hundreds and thousands of pharmacies that have closed over the last five years because of PBM practices. My guest today, CEO of the Patients Rising organization, you can find them at patientsrising.org, is Terry Wilcox. I'm so glad you're here with me, Terry. Welcome to the PBM Reform Podcast.

Terry Wilcox (3:16)

Thank you, Todd. It's nice to be here.

Todd (3:19)

You are a podcaster, so I love getting podcasters on the show. Talk to our listeners about your background and your mission at Patients Rising and what you do, and then also share your podcast.

Terry Wilcox (3:32)

Well, Patients Rising is an organization where we're really focused on getting advocates and patients and caregivers in the room where policy decisions are made. That's one of our, you know, that's one of our biggest missions because patient voices and patient stories are the things that move the needle the most.

We founded Patients Rising 11 years ago, and you can find it at patientsrising.org. We've been around, we work on, like I said, you can see right up there, we have our Policy Center, and we have our Learning Center, and both of those things, the Policy Center is where all of the policy issues and things that we're working on live, and the Learning Center is where we educate advocates. We also, like I said, we have a podcast, it's called State of the Patient Podcast, it's hosted by me, and we also have a very active blog, and we have a private community. So there's many ways to get engaged with Patients Rising, and you can find all of that, like I said, on the website at patientsrising.org.

Todd (4:33)

Thank you for that. I'm gonna have a link in our show notes to patientsrising.org.

The reason why I'm excited that you're here today, you're, you know, when I'm out there advocating for...

As much as I'm for the patient, it's through the intermediary. It's the pharmacist, it's the pharmacy, and that's what I'm advocating for. That's what I'm positioning. That's what I'm talking about. But when you boil that down, it does come back to the patient. It comes back to the patient's family. It comes back to the social determinants of health and the impact on living, eating, rent, being able to stay in just what we take advantage of because of the expense of medication, because of the expense of health care. So Patients Rising is much bigger than just what we focus on. We're kind of like a piece of health care. You guys are the whole enchilada where it's like, hey, the patient's going through this, this and this, and we need the patient's voice to rise more so that it becomes about them again, rather than the administration, rather than about the insurance carrier. And this is flip-flopped.

I don't know how old you are. Don't tell me, don't tell our listeners. I always say how old I am. But the reason why I always mention that is to framework the listeners that might be the millennial, that might be the Gen Z, that don't really remember back in the day. But I remember when the physician was really at the center of health care and they were able to say things that would get done. And now it's been jacked up. It's been, and now it's whack. Where it's the insurance provider, they own the hospitals, they own the pharmacies, they own the physicians, they own, you know, they own too much. And it's perverted health care. I have a book actually here called Healing the Health Care System by Gil Bash, one of my dear friends. He's the global health and purpose chair at Finn Partners, which is a huge PR agency. And this book talks about exactly what we're going to talk about today. And that is, why is our health care system constantly putting the systems first and the patient gets to be last? And it's an upside down pyramid. But when did it, from your perspective and your experience, Terry, when did that start taking place? Like, when did you see the shift starting to happen, where the pyramid started flipping?