Abdul El-Sayed — What's Brewing? Pharmacy Benefit Managers

Welcome to my coffee house. Here, we explain the systems that keep picking our pockets, power incorporations, and breaking our politics. Of course, I'm Abdul Al Said, running for US Senate in Michigan, and we wanted to offer a space to talk a little bit more in depth about some of the ways these challenges work. Why is it that our healthcare system is so broken, why is it that we pay so much for prescription drugs? Why are corporations so damn greedy? No one's easy. But I wanted to do it over some coffee. So, what's brewing today? PBMs, pharmacy benefit managers. The middlemen, you didn't know you needed to hate. One of the worst things about living in America is how expensive prescription drugs are, 'cause here's the thing about it. So many of these medications, that are modern miracles, they were invented based on research that you and I, the taxpayer paid for. So why do we have to pay so much on the back end? Well, there's a lot of reasons for that, but there is one that I want to highlight today. PBMs. You might have heard these letters of pharmacy benefit managers. Now, let me explain how this works so that you understand just how evil the existence of these organizations really is. A pharmacy benefit manager exists to address the fact that you have multiple players in the system of coordinating who gets what medications and who pays for them. So you, the patient, you're told by your doctor that you need so and so medication. Now, your insured by some private health insurance company. That private health insurance company has to buy the medication on your behalf from a pharmaceutical company, but then buy it through a pharmacy. There's a lot of moving parts. So you, your insurer, the pharmaceutical company, and the pharmacy. PBMs were invented to try and coordinate this problem. How do you make sure that ensure covers a medication, buys it from the pharmaceutical company through a pharmacy, and that put them in a position where they were the ultimate middleman. standing between you, pharmaceutical companies, insurance companies, and pharmacies. They realize something, that if you're the middleman, you're in a position to eat some of everybody's lunch. They can charge you a little bit more, charge the insurance companies a little bit more for organizing a formulary, charge the pharmaceutical companies a little bit more, and then charge the pharmacies a little bit more too. And what happens is when they're skimming off the top of the whole system, at the end of the day, every single one of those dollars comes from your pocket. So let's think about this from your perspective. You go to the doctor. The doctor says that you need novlog, you then go to your pharmacy, and get the novlog. But there's a whole back end set of transactions that has to happen. Your insurance company had to pay Nova NorDisk for a medication that went to your pharmacy, that you then paid some co pay or deductible for. It's a complicated financial transaction, and who sits in the middle of the whole thing, that PBM? That PBM is skimming off the top of every single piece. It's skimming off the top of your transaction with the pharmacy, the pharmacy's transaction with Novo, and the insurance company's transaction with Novo Nordisk as well. Who pays all of that? You. In the end, your insurance company bills you a premium every two weeks or four weeks so that this whole thing can happen. We all end up paying so that a PBM that doesn't actually need to exist to coordinate all this makes a bunch of money off the top of a transaction that had to happen just so that you could get the insulin you needed to survive. And imagine what happens when you think of that transaction times millions across our entire healthcare system. It's just part of the leaching corporate system that makes our healthcare system so much more expensive. See, it's not just that they're skimming from the pharma companies and the insurance, 'cause who pays all of them? You! You have to pay your premium and deductible to the insurance company. You, at the end of the day, have to be buying the prescription drug, and you are also the one who's buying from the pharmacy. So it all comes from your back pocket. These companies shouldn't exist. Hear me out here. All they do is coordinate information, and in the year of our Lord 2026, with the existence of an internet, coordinating information is really not that hard. So I think we just should ban the middleman. There should not be pharmacy benefit managers. We don't need to have them. And at the end of the day, I think that would mean keeping more money in your pocket and bringing down the prices of prescription drugs. And, oh, yeah, you know what would solve this problem entirely? Medicare for all. So that's why we need to ban the middleman. Until then, let's keep brewing