Brigham Buhler

I think somewhat, yes. But I also think the insurance model is an obstructionist model. And so I can give you a different example with the opioid crisis. There were non-addictive, non-abusive pain creams. If somebody is going to be put on – they have an ACL surgery. They're in pain. I'm not here to say there's no need to ever have a pain pill. But in those instances, there were alternatives.

That are non-abusive, non-addictive. What are the alternatives? There were ketamine-based pain creams that were topicals that could not be diverted or you couldn't extrapolate the ketamine out of it and abuse it. So nobody ever got high or stimulated from it because it's a cream that you can't extrapolate the ketamine out of. So you could not abuse it. You couldn't divert it if you wanted to.

That are non-abusive, non-addictive. What are the alternatives? There were ketamine-based pain creams that were topicals that could not be diverted or you couldn't extrapolate the ketamine out of it and abuse it. So nobody ever got high or stimulated from it because it's a cream that you can't extrapolate the ketamine out of. So you could not abuse it. You couldn't divert it if you wanted to.

That are non-abusive, non-addictive. What are the alternatives? There were ketamine-based pain creams that were topicals that could not be diverted or you couldn't extrapolate the ketamine out of it and abuse it. So nobody ever got high or stimulated from it because it's a cream that you can't extrapolate the ketamine out of. So you could not abuse it. You couldn't divert it if you wanted to.

So it just works locally? Insurance within 12 months quit covering it because those creams cost hundreds of dollars, whereas an opioid is like I think $10 a month, right? And then the other thing you'll find is the pharmacy benefit managers who the insurance companies own have reimbursement deals on certain drugs.

So it just works locally? Insurance within 12 months quit covering it because those creams cost hundreds of dollars, whereas an opioid is like I think $10 a month, right? And then the other thing you'll find is the pharmacy benefit managers who the insurance companies own have reimbursement deals on certain drugs.

So it just works locally? Insurance within 12 months quit covering it because those creams cost hundreds of dollars, whereas an opioid is like I think $10 a month, right? And then the other thing you'll find is the pharmacy benefit managers who the insurance companies own have reimbursement deals on certain drugs.

So when you get a drug, it's not because it's the best drug or the most efficacious drug. It's because the PBM, pharmacy benefit manager, has negotiated a rebate and decided to place that drug on tier one or tier two based off their financial incentive in that drug. Testosterone has been on the market so long. It's compounded a million places.

So when you get a drug, it's not because it's the best drug or the most efficacious drug. It's because the PBM, pharmacy benefit manager, has negotiated a rebate and decided to place that drug on tier one or tier two based off their financial incentive in that drug. Testosterone has been on the market so long. It's compounded a million places.

So when you get a drug, it's not because it's the best drug or the most efficacious drug. It's because the PBM, pharmacy benefit manager, has negotiated a rebate and decided to place that drug on tier one or tier two based off their financial incentive in that drug. Testosterone has been on the market so long. It's compounded a million places.

There is no rebate for the big pharmaceutical companies or the big insurance companies on testosterone. Right. And so it's just an additional cost. And so the more they can obstruct things that cost money but don't pay dividends back to them, they'll put obstructions in the way.

There is no rebate for the big pharmaceutical companies or the big insurance companies on testosterone. Right. And so it's just an additional cost. And so the more they can obstruct things that cost money but don't pay dividends back to them, they'll put obstructions in the way.

There is no rebate for the big pharmaceutical companies or the big insurance companies on testosterone. Right. And so it's just an additional cost. And so the more they can obstruct things that cost money but don't pay dividends back to them, they'll put obstructions in the way.

So another example is not only did they shut down alternatives to opioids during an opioid crisis, they also cut lab reimbursements on toxicology screenings at the same time that we're on an opioid bender as a nation.

So another example is not only did they shut down alternatives to opioids during an opioid crisis, they also cut lab reimbursements on toxicology screenings at the same time that we're on an opioid bender as a nation.

So another example is not only did they shut down alternatives to opioids during an opioid crisis, they also cut lab reimbursements on toxicology screenings at the same time that we're on an opioid bender as a nation.

They got rid of the last safety net, which was if you come into a pain clinic asking for opioids, they're going to make you do a toxicology screen to make sure that you're not abusing other drugs, that you're not diverting the drug, that this medication is actually in your system. All of those reimbursements used to be covered by insurance companies, but they got rid of that.

They got rid of the last safety net, which was if you come into a pain clinic asking for opioids, they're going to make you do a toxicology screen to make sure that you're not abusing other drugs, that you're not diverting the drug, that this medication is actually in your system. All of those reimbursements used to be covered by insurance companies, but they got rid of that.

They got rid of the last safety net, which was if you come into a pain clinic asking for opioids, they're going to make you do a toxicology screen to make sure that you're not abusing other drugs, that you're not diverting the drug, that this medication is actually in your system. All of those reimbursements used to be covered by insurance companies, but they got rid of that.

And so as soon as they got rid of that, there was no checks and balances. And so it is layered. It's very nuanced. It's never as simple as yes or no. And I'm just – I'm telling you what I saw. I'm just trying to tell you what I saw. I'm not saying I have all the answers.