The “HOME TEAM” Gets Paid 160x MORE. Is That Fair? (Ep. 45)
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In this episode of The Benefit Whisperer, Ralph Weber examines Tennessee’s proposed legislation, SB 2040 and HB 1959, aimed at preventing pharmacy benefit managers (PBMs) from owning pharmacies.
An audit from the Tennessee Department of Commerce & Insurance found instances where a major PBM allegedly reimbursed its own pharmacy up to 16,000% more than independent pharmacies for the same drug. One example cited showed reimbursement of approximately $9,000 versus $57 for identical medication quantities.
Independent pharmacist and healthcare policy advocate Benjamin Jolley explains:
• The structure of SB 2040 and HB 1959
• How these bills mirror Arkansas Act 624
• The economic impact of PBM vertical integration
• What AWP and reimbursement pricing really mean
• Why small employers and self-funded plans could bear the cost
• Legal challenges surrounding similar legislation
This episode explores healthcare market concentration, employer plan costs, and patient access issues through a fact-based policy discussion.
If you’re responsible for healthcare spend, this conversation deserves your attention.
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🎙 Hosted by Ralph Weber
📌 The Benefit Whisperer