Tag: pharmacy benefit managers

$11M on a $996K Bill? Dave Chase of Health Rosetta Unpacks the Hidden Trap (Ep. 17)

$11M on a $996K Bill? Dave Chase of Health Rosetta Unpacks the Hidden Trap (Ep. 17)

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Most employers have no idea what’s really driving their skyrocketing healthcare costs, and it’s not just medical inflation. It’s the contracts they’ve already signed.

In this episode of The Benefit Whisperer, Ralph Weber sits down with Dave Chase, founder of Health Rosetta, to uncover the hidden clauses and incentives that enrich insurers, PBMs, and hospital systems at the expense of your people and your bottom line.

You’ll learn:

  • How one employer paid $4 million on a bill originally priced at $996,000, all because of contract loopholes

  • Why anti-steerage clauses prevent you from guiding employees to safer, higher-value care

  • How access to your own data is the single biggest predictor of plan performance

  • The dirty truth behind PBM rebates, offshore GPOs, and the 50+ revenue streams you never see

  • What it takes to cut your per employee costs by 35%, without compromising care

If you’re a CEO, CFO, HR leader, or benefits advisor ready to stop feeding a system that’s rigged against you, this is the episode to hear.

🔍 Learn more at thebenefitwhisperer.com

📞 Book a free consultation: bit.ly/4nNI4I3

Connect with Ralph Weber
LinkedIn: Ralph Weber
Email: ralph@thebenefitwhisperer.com

Connect with Dave Chase
Health Rosetta: healthrosetta.org
LinkedIn: Dave Chase

Podcast title card for The Benefit Whisperer featuring guest Benjamin Jolley. Text reads: “The $11 Drug That Costs Employers $6,000. Guest Benjamin Jolley.” Includes images of Benjamin Jolley in a white pharmacy coat and host Ralph Weber speaking into a microphone. The Route Three Insurance & Financial Services logo appears in the top left, with “Episode 11” labeled in the top right.
The $11 Drug That Costs Employers $6,000 (Ep. 11)

The $11 Drug That Costs Employers $6,000 (Ep. 11)

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In this episode of The Benefit Whisperer, Ralph Weber and pharmacist Benjamin Jolley delve into the complexities of prescription drug costs, focusing on how employers can navigate pharmacy benefits management (PBM) to save money. They discuss the significant savings achieved by New Jersey, the impact of drug pricing strategies, and the legal implications for employers regarding PBM contracts. The conversation emphasizes the importance of employers being proactive in managing their pharmacy benefits to avoid costly pitfalls and ensure fair pricing for medications.

Chapters

00:00 Introduction to Prescription Drug Costs
03:25 Conclusion and Future Considerations
Julie Selesnick on the Lawsuit that Should Terrify Every Employer and Why You Could Be Next (Ep. 10)

Julie Selesnick on the Lawsuit that Should Terrify Every Employer and Why You Could Be Next (Ep. 10)

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In this must-watch episode of The Benefit Whisperer, Ralph Weber sits down with ERISA attorney Julie Selesnick to unpack one of the biggest legal stories in employee benefits: the JP Morgan healthcare lawsuit—and why it should matter to every employer and plan sponsor.

Julie brings 25+ years of legal experience and explains:
✅ What the JP Morgan case is really about
✅ Why PBMs (Pharmacy Benefit Managers) are under bipartisan fire
✅ How employers unknowingly violate fiduciary duties
✅ Why your broker might be working against your best interests
✅ What you must do now to protect your business and employees

This episode is essential for:

  • CFOs, HR Leaders, and Benefit Managers

  • Business owners with self-funded health plans

  • Anyone responsible for healthcare plan compliance

🎯 Learn how to safeguard your company from costly lawsuits and build a benefits plan that actually works.

🔔 Subscribe now for insider insights, unfiltered truths, and actionable strategies to reduce healthcare costs and improve employee benefits.

👉 Contact Ralph Weber:
📧 Ralph@TheBenefitWhisperer.com
📞 832-924-3330
🌐 www.thebenefitwhisperer.com

00:00 Introduction to Healthcare Law and ERISA

03:01 The Impact of the CAA on Healthcare Plans

05:58 Legal Trends in Pharmacy Benefit Managers (PBMs)

08:53 Understanding the JP Morgan Lawsuit

12:04 Fiduciary Duties in ERISA and Non-ERISA Plans

14:56 Potential Ripple Effects of the JP Morgan Case

17:59 Lessons for Employers from Recent Lawsuits

23:55 Understanding Controlled Groups and ERISA

26:28 Best Practices for Health Plans

31:15 The Future of Healthcare Litigation

37:48 Advice for HR Leaders and CFOs

39:54 The Importance of Benchmarking in Healthcare

#JPmorgan #HealthcareLawsuit #ERISA #PBMs #HealthPlanCompliance #EmployeeBenefits #JulieSelesnick #TheBenefitWhisperer #RalphWeber #TransparencyInHealthcare

Podcast title graphic for The Benefit Whisperer featuring Benjamin Jolley, discussing prescription drug pricing, PBM corruption, and spread pricing.
The Billion Dollar Drug Scam (Ep. 8)

The Billion Dollar Drug Scam (Ep. 8)

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Why Are Prescription Drugs So Expensive? The Truth About PBMs, Spread Pricing & What Employers Can Do

In this eye-opening episode of The Benefit Whisperer, host Ralph Weber sits down with pharmacist and reform advocate Benjamin Jolley to expose the hidden forces behind America’s skyrocketing prescription drug costs. 💊

From shocking stories of $1,800 bills for $140 drugs to the disturbing influence of pharmacy benefit managers (PBMs) and their spread pricing schemes, this conversation breaks down complex systems with clarity—and urgency.

🔥 Highlights include:

  • Why the U.S. pays more for drugs than almost any other nation
  • How a New Jersey benefits plan saved $1 BILLION just by rewriting its contract
  • The dangerous power of vertically integrated PBMs like CVS Caremark
  • The recent bipartisan push by 39 state Attorneys General to break up monopolies
  • How employers and CFOs can protect themselves from being held personally liable

If you’re an employer, benefits administrator, policymaker—or just someone wondering why your prescriptions are so expensive—this is a must-watch.

📌 Chapters:
 0:00 – Welcome + Prescription Drug Teaser
 0:41 – Meet Benjamin Jolley
 1:00 – Why Prescription Costs Are So High
 4:00 – What Is Spread Pricing? (Shocking Example)
 8:00 – Silencing Critics: Non-Disparagement and Audits
 13:00 – What Should Employers Be Paying Per Member?
 17:40 – 39 Attorneys General Demand PBM Reform
 21:00 – New Jersey’s $1B Savings by Rewriting a PBM Contract
 25:00 – Closing Thoughts + How to Reach Benjamin