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In the presented remarks, the speaker engages the audience with a series of questions intended to reveal potential overlaps among health sector entities. The questions ask the audience to raise their hands if their companies own or control a health insurance division; if they also employ health care providers or own clinics, specialty pharmacies, or any other medical practice or pharmacy; if they own or control a pharmacy benefit manager (PBM); and if they lead a publicly traded company at which they have a legal responsibility to maximize shareholder value. These questions are designed to surface the breadth of influence held by large health care firms. The speaker asserts that the audience’s responses demonstrate a broader pattern: the largest health insurance companies are not limited to providing insurance alone. Instead, they are also involved in delivering medical services and operating pharmacies. The speaker notes that these entities diagnose and decide treatment for patients, indicating an active role in clinical decision-making beyond underwriting risk or processing claims. Further, the speaker highlights that these same large insurers are also PBMs, describing PBMs as “another form of middlemen managing drug benefits.” This point emphasizes a layered structure in which a single company can influence which drugs are preferred, covered, or reimbursed, thereby affecting patient access and pricing across the drug supply chain. The speaker concludes that these combined roles signify that large health insurers are “increasingly controlling every aspect of our health care system.” This characterization suggests a consolidation of functions—from coverage and care provision to drug benefit management—under a few dominant corporate entities. In summary, the speaker’s lines of inquiry and subsequent claims illustrate a perceived convergence: health insurance companies are simultaneously insurers, medical providers, pharmacies, and PBMs, and they are expanding their control over multiple facets of health care delivery and economics. The overarching assertion is that the largest players in the health care landscape occupy a multifaceted, integrated position that spans diagnosis, treatment decisions, pharmacy operations, and drug benefit management, contributing to a broader phenomenon of comprehensive control within the system.

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I'm your insurance company's pharmacy benefit manager. This medicine isn't covered because it's not profitable for me. Hope you feel better. Translation: I am the pharmacy benefit manager for your insurance company. This medication is not covered because it is not financially beneficial for me. I hope you feel better.

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I found something interesting for Elon and the Doge team regarding Medicare. In 2022, Medicare filled 85,000 prescriptions for Perfinidone at $8,000 each, totaling $680 million. At my cost-plus pharmacy, the same prescription is only $200. Filling all 85,000 prescriptions with me would only cost $17 million. Medicare is overpaying by $663 million annually because Pharmacy Benefits Managers (PBMs) get a percentage of the cost, incentivizing them to inflate prices. The easy solution is to cancel the PBM contracts and use actual costs. If you want to check if PBMs have been raising the cost of your medications, go to forestparkpharmacy.com and check our price to see how much you could save.

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The speaker's administration will implement "most favored nations" drug pricing, ensuring Americans pay the lowest price for drugs compared to other developed countries. Some prescription drug prices will be reduced almost immediately by 50% to 90%. Big Pharma must voluntarily comply or the federal government will ensure equal pricing. To accelerate price reductions, the administration will cut out the middlemen to facilitate direct drug sales to American citizens at the most favored nation price. The speaker believes the middlemen are worse than drug companies because they don't make a product but make a fortune.

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A businessman told the speaker that the same fat shot drug cost him $88 in London, but $1,300 in New York. He was stunned that the identical pill, made in the same plant by the same company, had such different prices. The speaker discussed this with drug company representatives. They argued for about half an hour, but ultimately the representative admitted there was no justification for the price difference.

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Brenzavvy, a drug similar to Jardiance or Farxiga, is not covered by insurance, prescribed by doctors, or carried by wholesalers because it is too cheap. Brenzavvy costs $60 at the speaker's pharmacy. Pharmacy benefits managers (PBMs) deny coverage because Brenzavvy's low price prevents rebates. Farxiga and Jardiance cost insurance payers $1,000 upfront with a 40% rebate. An HHS report stated PBMs get 23% on average for brand meds. After rebates, Farxiga and Jardiance still cost $600, with PBMs earning $138. With 8,000,000 prescriptions a year, PBMs make $1,100,000,000 off those two drugs. The speaker claims PBMs keep Brenzavvy off their lists to avoid losing a billion dollars annually. The speaker believes affordable healthcare is impossible with PBMs involved. The speaker encourages listeners to use forestpark.pharmacy to save money and to inform their bosses about potential savings.

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The administration will secure "most favored nations" drug pricing, meaning Americans will pay the lowest price for drugs paid in other developed countries. Some prescription drug prices will be reduced almost immediately by 50 to 90%. Big Pharma will either abide by this principle voluntarily, or the federal government will ensure Americans pay the same price as other countries. To accelerate price reductions, the administration will cut out the middlemen and facilitate the direct sale of drugs at the most favored nation price directly to American citizens. The middlemen are considered worse than the drug companies because they don't make a product but make a fortune.

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A businessman told the speaker that the same fat shot drug cost him $88 in London but $1,300 in New York. The drugs were identical, made in the same plant by the same company. The speaker discussed this with a representative from the drug companies, who admitted there was no justification for the price difference.

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Politicians have long promised to eliminate the discrepancy between drug prices in the U.S. and Europe. This was a key issue for Bernie Sanders, but previous leaders haven't acted on it. Politicians make these promises knowing they likely won't have to fulfill them. The reason is that Congress is heavily influenced by the pharmaceutical industry. There is at least one pharmaceutical lobbyist for every congressman, senator, and Supreme Court member.

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We're paying too much for drugs compared to other countries, and existing laws make it hard to lower costs. The middlemen in the drug industry are profiting significantly without adding value. We're going to eliminate these middlemen to reduce drug prices to unprecedented levels. This topic dominated our discussions with executives and others involved.

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Medicare overspent on dimethyl fumarate in 2022, paying $590 million for a drug I offer at $65 per prescription. This discrepancy highlights how Pharmacy Benefits Managers (PBMs) inflate drug costs to increase their profits. Medicare's PBM charged them $3,800 per prescription when the real price is only $65. This PBM price gouging cost Medicare $580 million on just this one drug. The solution is simple: eliminate PBM contracts to save money. Also, your insurance likely uses a PBM, overcharging you too. Check if you're overpaying for your medications at fourthparkpharmacy.com to use our price checker.

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Speaker 0 expresses frustration over a price discrepancy in a prescription transaction. The core facts cited are: a medication that costs $4 to dispense, when billed to the insurance, results in the patient being charged $97.06. Speaker 0 repeats the puzzling situation: “We have a claim for a prescription that costs less than $4. The insurance wants to charge the patient $97.” The concern is the patient’s likely reaction: they will be yelled at and blame CVS for the high price set by their insurance, even though the dispensing cost is described as less than $4. Speaker 0 highlights the misalignment between the pharmacy’s dispensing cost and the amount the patient is asked to pay after insurance processing, indicating a breakdown in the expected pricing flow from the pharmacy to insurance to patient. The dialogue underscores the emotional and reputational pressure on the pharmacy staff when patients perceive the price as excessive, regardless of where the markup originates. The closing sentiment, “Love you CVS,” signals a mixture of familiarity and exasperation with the CVS system or process involved in this pricing scenario, though the exact sentiment toward CVS is not elaborated beyond that line.

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A common asthma drug costs almost $500 in America, but less than $40 in The United Kingdom. The speaker highlights the significant price difference, noting one person paid a small amount for the same shot in the UK. The weight loss drug Ozempic costs 10 times more in The United States than in the rest of the developed world, according to the speaker, who questions the reason for this disparity.

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I've identified wasteful spending in Medicare, specifically with generic Cialis, or Tadalafil. In 2022, Medicare spent $237 million on this drug, averaging $481 per prescription across 492,000 prescriptions. However, at my pharmacy, the same prescription costs only $14 without insurance. That means it would only cost $7 million to cover the entire country at my pharmacy's pricing. The overcharge of $230 million for just this one drug is due to pharmacy benefits managers (PBMs). PBMs manage all pharmacy-related aspects for Medicare, deciding coverage, copays, government costs, and pharmacy payments. They've essentially decided on a 3000% markup. It's time to fire the PBMs and bring prices back to reality. To check the markups on your prescriptions, visit forestparkpharmacy.com and use our price checker.

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The FTC sued the largest three PBMs. The FTC accuses these three companies for artificial inflating insulin prices, investigating their rebate system. There were marked up specialty drugs for cancer, HIV, and other conditions by over $7,300,000,000. One of the companies actually countersued the FTC over false and defamatory statements. PBMs own the insurance companies, and the pharmacies. Caremark owns CVS. Express Scripts owns a home delivery pharmacy. Rx owns Optum home delivery pharmacy, so they can ship directly to your house. Control of 80% of all the medications in The US comes from three of the biggest PBMs. In reality, the PBMs are not just the middleman. Since they've merged with the insurance companies and the pharmacies, now they're the actual gatekeepers of medicine.

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Politicians have long promised to address the discrepancy between drug prices in the U.S. and Europe. This issue was central to Bernie Sanders' presidential campaigns. However, these promises were never fulfilled because Congress is heavily influenced by the pharmaceutical industry. There is at least one pharmaceutical lobbyist for every member of Congress, the Senate, and the Supreme Court.

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We're continuing our investigation into Medicare overspending, and today we found Aripiprazole. In 2022, Medicare spent $1.5 billion on this drug, with 7.2 million prescriptions at an average cost of $208. However, at my pharmacy, without insurance, the same medication costs only $12. Filling all those prescriptions at my pharmacy would only cost $86 million. That means over $1.4 billion was wasted due to pharmacy benefits managers (PBMs) using inflated prices and directing patients to pharmacies they own. The solution is simple: cancel the PBM contracts, eliminate the made-up prices, and get back to reality. To see how much you've been overcharged, visit forestparkpharmacy.com and use our price checker to see your potential savings.

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Americans pay significantly more for prescription drugs than other countries, sometimes up to 10 times more. Pharmaceutical companies generate two-thirds of their profits in the U.S., effectively making Americans subsidize healthcare in other countries. The administration is introducing a "most favored nation" pricing model, ensuring the U.S. pays the lowest price available globally for drugs. For example, a breast cancer drug costing over $16,000 in the U.S. is a fraction of that price in Australia and Sweden. Similarly, an asthma drug costs almost $500 in the U.S. but less than $40 in the UK. The plan involves directing investigations into foreign nations that block drug products unless they accept low prices, and the U.S. will defend drug companies from unfair pricing demands. The administration aims to cut out middlemen and facilitate direct drug sales at the most favored nation price. If companies don't comply, the U.S. will use its trade powers and open the market to safe, legal drug imports.

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Trump recently announced plans to break up pharmacy benefit managers (PBMs), which are often misunderstood. PBMs were created in the 1970s to help lower prescription drug costs but have since been acquired by major insurance companies, turning them into profit centers. Instead of negotiating lower prices, PBMs negotiate higher costs to receive kickbacks from drug manufacturers. For example, 30% of the cost of drugs like Ozempic goes to PBMs as kickbacks. UnitedHealthcare generated $373 billion in revenue last year, with 60% from its PBM. While insurance companies may not have as high profit margins as big pharma, they use various methods to obscure their profits. Overall, health insurance companies generate significantly more revenue than pharmaceutical companies, highlighting the hidden influence of PBMs in the healthcare system.

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I'm on day five of helping to cut waste, and today I found that Medicare is overpaying for Aripiprazole. In 2022, this medication was dispensed 7.2 million times at an average of $208 each. Medicare spent $1.5 billion in one year on this one drug. At my pharmacy, without insurance, the same medication costs $12. Filling all 7.2 million prescriptions at my price would cost $86 million. That means over $1.4 billion was wasted due to Medicare's use of pharmacy benefits managers (PBMs). PBMs use an inflated price called AWP, pretend to discount it, and then send you to their pharmacies to collect the profits. This system is easily fixed by canceling PBM contracts, ditching the made-up prices, and returning to reality. To see how much you've been overcharged, visit forestparkpharmacy.com and use our price checker.

Keeping It Real

Luigi Mangione's Secret Motives EXPOSED and the Dark Side of Healthcare Power

Guests: Brigham Buhler

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The episode centers on the escalating outcry over healthcare’s structural failures, catalyzed by the case of Luigi Mangione and the broader critique of United Healthcare’s leadership. Brigham Feler, founder of Ways to Well, argues that the crisis is less about individual villains and more about a system that monetizes illness through opaque pricing, aggressive insurance practices, and monopolistic control by Pharmacy Benefit Managers and big insurers. He details how long approval times for surgeries like spinal procedures forces patients toward opioids, creates dependency, and exposes chronic pain patients to a brutal, dehumanizing process that prioritizes profitability over healing. Feler connects the patient experience to high-level incentives and incentives in the pharmaceutical and insurance sectors. He accuses United Healthcare of deploying AI denial programs that rejected up to 90% of claims, notes a DOJ probe into monopoly practices, and highlights how stock-driven decisions can deprioritize patient welfare. The conversation expands into the mechanics of price manipulation— rebates, middlemen, spread pricing, and the influence of PBMs owned by the major insurers—arguing that these schemes drive up costs for individuals, employers, and taxpayers while masking profits behind complex, opaque billing. The guests discuss real-world consequences: delayed care, debt, and bankruptcy amid a system that discourages preventative measures and suppresses alternative, lower-cost care models. The dialogue culminates in a practical call to action: regain sovereignty over health through cash-pay clinics and proactive, predictive care that looks “under the hood” at more than a handful of biomarkers. The hosts advocate for a shift away from sick-care to prevention, critique the incentives that discourage comprehensive testing, and present Ways to Well as a model aiming to democratize access to thorough blood work, personalized nutrition, and AI-assisted health planning. The episode closes on an urgent reminder that meaningful reform will require individuals seeking better care, as well as broader changes to how drugs, doctors, and insurers interact in a system widely perceived as prioritizing profits over people.

Modern Wisdom

Ex-Pharma Rep: Why American Healthcare Is So Broken

Guests: Brigham Buhler

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Chris Williamson discusses the primary cause of bankruptcy in America, which is healthcare costs, with Brigham Buhler. Buhler attributes the broken healthcare system to various factors, including diet, lifestyle, and the corporate capture of healthcare institutions. He highlights the alarming increase in approved food ingredients in the U.S. compared to Europe and criticizes the insurance model that prioritizes profits over patient care. Buhler explains that the healthcare system is designed to monetize chronic diseases, with insurance companies profiting significantly more than pharmaceutical companies. He emphasizes the lack of awareness among the public regarding Pharmacy Benefit Managers (PBMs) and their detrimental impact on healthcare access. He notes that the average American is often unaware of how insurance companies control treatment options and access to care. The conversation touches on the opioid crisis, where Buhler points out that while opioids are harder to access now, many individuals have turned to dangerous alternatives due to restrictions. He discusses the failures of the FDA and the collusion between regulatory bodies and pharmaceutical companies, leading to a lack of accountability and oversight. Buhler advocates for a shift towards preventative care and proactive health management, emphasizing the importance of metabolic health. He suggests that the future of healthcare lies in technology, AI, and personalized medicine, which can provide real-time feedback and encourage healthier lifestyle choices. He encourages individuals to take control of their health by seeking cash-pay clinics and comprehensive blood work, rather than relying solely on insurance-based systems. The conversation concludes with a focus on the need for systemic change in healthcare, driven by transparency and accountability, to improve health outcomes for Americans.

Tucker Carlson

Brigham Buhler: UnitedHealthcare CEO Assassination, & the Mass Monetization of Chronic Illness

Guests: Brigham Buhler

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Tucker Carlson discusses the recent murder of a health insurance CEO in New York, highlighting that 41% of younger people express support for the act, which reflects a deeper hostility towards insurance companies. Brigham Buhler emphasizes that while violence is never justified, the insurance industry contributes to a chronic disease crisis in America by prioritizing profit over patient care. He argues that insurance companies profit from delaying care and procedures, which exacerbates health issues. Buhler explains the evolution of health insurance, noting that it began as a means to provide consistent care but shifted to a profit-driven model with the rise of HMOs in the 1980s. He contrasts the personalized care of pre-HMO days with the current system, where doctors spend an average of just six minutes with patients due to insurance constraints. The conversation shifts to pharmacy benefit managers (PBMs), which Buhler describes as unnecessary middlemen that inflate drug prices through kickbacks. He cites examples of how PBMs manipulate drug costs, leading to higher expenses for patients and employers. Buhler reveals that a significant portion of health insurance profits comes from Medicare and Medicaid, with insurance companies negotiating prices based on inflated average wholesale prices. Buhler stresses the need for a shift towards preventative care, arguing that the current system fails to address the root causes of chronic diseases, which are often lifestyle-related. He highlights the importance of comprehensive blood work and proactive health assessments to prevent diseases before they develop. The discussion touches on the opioid crisis, with Buhler sharing personal experiences of how insurance companies incentivize the prescription of addictive medications over non-addictive alternatives. He argues that the healthcare system is designed to profit from chronic illness rather than promote wellness. Buhler expresses hope for reform, particularly with potential changes under Donald Trump and Bobby Kennedy, emphasizing the need for a healthcare system that prioritizes patient outcomes over profits. He advocates for cash-pay clinics that focus on preventative care, allowing patients to take control of their health without the interference of insurance companies.

The Peter Attia Drive Podcast

#68–Marty Makary, MD: US healthcare system—why it’s broken, how to fix it, & how to protect yourself

Guests: Marty Makary

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In this episode of The Drive, host Peter Attia welcomes Dr. Marty Makary, a professor of surgical oncology at Johns Hopkins and a pioneer in minimally invasive pancreatic surgery. They discuss Makary's new book, "The Price We Pay," which addresses the broken U.S. healthcare system, focusing on medical errors, pricing failures, and the need for reform. Attia explains his decision to avoid ads on the podcast, opting instead for listener support to maintain trust and integrity in sharing valuable health information. He emphasizes the importance of empowering listeners with knowledge to make informed healthcare decisions. Makary shares his background, including his role in creating the surgical checklist, which has improved patient safety. He highlights the systemic issues in healthcare, such as the overwhelming complexity of medical billing and the predatory practices that lead to financial distress for patients. He cites alarming statistics, including that one in five Americans has medical debt in collections, and discusses the emotional toll this takes on patients and healthcare providers alike. The conversation touches on the culture of defensive medicine, where doctors order unnecessary tests to avoid lawsuits, contributing to rising healthcare costs. Makary argues that the focus should be on transparency and accountability in pricing, advocating for a shift towards a more patient-centered approach. They discuss the role of pharmacy benefit managers (PBMs) and the lack of competition in the pharmaceutical market, which leads to inflated drug prices. Makary calls for the elimination of kickbacks and the establishment of fair pricing practices in healthcare. Attia and Makary also explore the potential benefits of a single-payer system, acknowledging the challenges and concerns surrounding it. They emphasize the need for a collective effort to advocate for change in the healthcare system, urging healthcare professionals and patients to unite for reform. The episode concludes with Makary encouraging listeners to engage with their local healthcare systems and advocate for fair practices, highlighting the importance of restoring trust in medicine. He shares resources for individuals seeking to navigate the complexities of healthcare billing and pricing. Overall, the discussion underscores the urgent need for systemic change in the U.S. healthcare system, focusing on transparency, accountability, and patient advocacy.

Keeping It Real

The Disturbing Secrets Behind The Healthcare Industry - with Brigham Buhler

Guests: Brigham Buhler

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The episode features Jillian Michaels and Brigham Buhler discussing a healthcare system they view as corrupted by powerful entities in pharma and insurance. Buhler recounts his arc from a drug rep to founder of Ways to Well and Revive, detailing how Big Pharma and Big Insurance operate as a cartel that denies, delays, and obstructs patient care to protect profits. He argues that patients are frequently steered away from comprehensive, preventive health strategies toward expensive, disease-driven interventions, highlighting the tension between access to care and the realities of a business-first system. The conversation centers on how misaligned incentives drive up costs while undermining outcomes, from bloated drug prices to opaque rebate structures managed by pharmacy benefit managers (PBMs). They delve into compounding pharmacies as a double-edged sword: essential for affordable, personalized medications and often caricatured by critics, yet targeted by litigation from big manufacturers. Buhler explains the rigorous safety standards some compounding shops uphold, including sterile compounding and third-party validations, while noting the broader problem of 510(k) loopholes and insufficient human trials for many medical devices. The pair also scrutinize GLP-1s and the broader trend of overprescribing, arguing that root causes—nutrition, diet, lifestyle—are underexploited levers for health but underfunded by a system geared toward pharmacologic fixes and chronic revenue. They discuss the cost barriers to advanced diagnostics and preventive testing, pharmacogenetic testing, and the role of comprehensive panels in shaping personalized care. Buhler envisions a future where AI-driven monitoring, predictive testing, and cash-pay clinics like Ways to Well empower individuals to take sovereignty over their health, reduce dependence on insurers, and extend healthspan rather than merely chasing disease management. The dialogue also touches RFK, Casey Means, Callie, and a broader movement advocating diet, prevention, and autonomy, urging listeners to invest in proactive health strategies and to scrutinize the incentives shaping modern medicine. The episode closes with a practical note on affordability, stressing that deeper health insights need not be prohibitively expensive and that a comprehensive baseline can be attained for a few hundred dollars yearly. topics Big Pharma, Big Insurance, healthcare cartels, denials and delays, compounding pharmacies, 510k loopholes, FDA oversight, GLP-1s, preventive medicine, nutrition and lifestyle, predictive medicine, AI in healthcare, Ways to Well, Wastewell, pharmacogenetics, healthspan, RFK, Casey Means, Callie otherTopics Bayer and historical drug testing, opioid crisis, Sackler family history, insulin pricing and PBMs, shadow bans in media, the role of regulation in innovation, privacy concerns with AI health monitoring booksMentioned Bottle of Lies