Tag: PBM contracts

Trust, But Verify: Why Your TPA May Be Selling Your Employees’ Data (Ep. 31)

Trust, But Verify: Why Your TPA May Be Selling Your Employees’ Data (Ep. 31)

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Ralph Weber welcomes back Ann Lewandowski to unpack one of the most overlooked threats in benefits: your data. This episode exposes how TPAs and PBMs can legally profit from “de-identified” plan data, why HIPAA offers false comfort, and what transparency should mean in 2025. If you’re a plan sponsor, this is essential listening.

00:00 The Importance of Trust in Benefits

02:35 Understanding Healthcare Operations and Compliance

05:12 Evaluating Individual vs. Group Health Plans

08:10 The Role of Fiduciaries in Employee Benefits

10:45 Identifying Misaligned Incentives

13:18 Trust but Verify: The Need for Transparency

16:08 Employee Trust and Data Privacy

18:56 Wellness Programs and Legal Risks

21:32 The Future of Wellness Litigation

24:16 Data-Driven Decision Making in Healthcare

Guest: Ann Lewandowski

Website: hcrebelalliance.com

Email: ann@hcrebelalliance.com

LinkedIn: linkedin.com/in/annlewandowski

 

Host: Ralph Weber

Website: FixMyBenefitsNow.com

Free Consultation: bit.ly/3WiO5zY

Email: Ralph@thebenefitwhisperer.com

LinkedIn: https://www.linkedin.com/in/ralphweber/

 

The PBM Princess: From Rebate Myths to Deception, How PBMs Hide True Rx Costs (Ep. 30)

The PBM Princess: From Rebate Myths to Deception, How PBMs Hide True Rx Costs (Ep. 30)

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On this episode of The Benefit Whisperer, Ralph Weber interviews Rachel Strauss, the “PBM Princess,” to expose how pharmacy benefit managers manipulate contracts, rebates, and definitions to extract margin from employers. They break down contract landmines, phony transparency language, weak audit clauses, and the real story behind “100% pass-through.”

If you’re an employer, broker, or benefits leader struggling to contain pharmacy costs, this episode is your roadmap to fighting back.

00:00 Understanding Pharmacy Benefits and PBMs

01:17 Contract Landmines and Definitions

03:58 Rebates and Their Implications

06:24 Guarantees and Risk in PBM Contracts

09:56 Audit Rights and Transparency

15:37 The Illusion of Pass-Through Pricing

18:39 Prior Authorization and Cost Management

23:06 Navigating High Deductible Health Plans

26:46 The Need for Transparency in Healthcare Pricing

Guest:
Rachel Strauss • rachelmstrauss.com
LinkedIn: linkedin.com/in/rachelmstrauss
Email: rachel@rachelmstrauss.com

Host:
Ralph Weber • ralph@thebenefitwhisperer.com
Phone: (832) 924-3330
Website: fixmybenefitsnow.com

Schedule a FREE consultation with Ralph: https://calendly.com/ralph-weber-routethree?utm_source=blubrry&utm_medium=emails&utm_campaign=ep30&utm_id=podcast