Brigham Buhler
speaker
1,533 appearances
6 recordings
5 series
first heard Oct 2024
last heard 27 Feb
Brigham Buhler’s voice in public audio — every appearance, attributed to the second.
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recordings per month · last 12 monthsRecordings per month over the last 12 months — 1 in all, peaking in Feb 2026 with 1.
Appearances
So those are the three checks and balances. An alternative, toxicology screen, pharmacogenetic test. Okay, within a year, the big five insurance company said, you, we're not covering any alternative to opioids. They can go back on an opioid. So there goes that safety net, corporate capture. Safety net number two. Now I have to put you on an opioid. I'm a pain practice. I need to talk screen you.
The federal government's telling me I should talk screen you. Within a year, insurance said we're not going to cover your toxicology screen. So now you took away my safety net to verify this patient's taking the medicine I'm prescribing, verify that this patient's not abusing the medicine.
And last but not least, you took away my only compass and map, my ability to pharmacogenetic test and make sure that I keep this patient in a safe place, gone. Insurance said we're not going to cover it.
That's where the plot thickens. What a lot of people don't realize because we focus so much on big pharma, The Senate House did a internal investigation into pharmacy benefit managers, okay?
And I don't want to get too deep in the weeds with your listenership, but PBMs were established in the 80s to be advocates for us, the American people, to help negotiate and drive down the cost of prescription drug care for me and you, for families, so we can afford these medications.
Well, they did work for us, but they got acquired in the 80s by the big five insurance companies. So United, Cigna, Aetna own these middlemen that Trump and Bobby keep talking about. They aren't middlemen at all. They're shell companies owned by the big insurance companies. Here's why that is important. Never once have you heard an insurance company brought up in all of the opioid crisis.
30% of the profits generated during the opioid crisis went to the insurance companies. They had kickbacks negotiated at their pharmacy benefit manager holding companies. So when I'm out there trying to get, let's say you have a child, they tear their ACL like my brother. I'm educating your doctor on, we should do these tests to make sure this kid doesn't abuse anything.
And we should write them a non-abusive drug. This is a 17 year old kid. Don't put them on an opioid. Insurance says, no, we're not covering that. Why? Because they're getting a kickback on your kid being on an opioid.
It shouldn't be. That's the point. It's insane. And they structured a deal where there was a gag clause where the U.S. government doesn't even have line of sight into how much money the insurance companies are making off of these PBMs. And so like why that's important. The insurance industry last year cleared a trillion dollars. Over a trillion dollars in revenue. That's how much they made.
Yes, in revenue. UnitedHealthcare alone, let's break that down, $373 billion was generated in revenue by UnitedHealthcare. 60% of that came from kickbacks at their pharmacy benefit manager. They're getting money on every drug that you're prescribed.
That's what I'm trying to ring the bell on.
You're correct. So what happened is these insurance companies that were supposed to drive down the cost of prescription drug care went to Big Pharma and sat at the table and instead of driving down our costs said, we have an idea. Why don't you mark up the cost? And Big Pharma's like, mark up the cost? Yeah, charge us 30% more.
We'll pass that bill on to the consumer, the employer and the taxpayer. And then we will hold that money at our PBM as a profit center. And so the reason Ozempic and these weight loss drugs are so expensive is roughly again, this isn't me saying it. This is a Senate House Finance Committee.
They uncovered about 30 percent of the profitability of most drugs is being held by the pharmacy benefit managers.
Because the insurance company controls what drugs go on formulary. So we, like even with children's medications, moms really fill the drugs that the insurance will cover. So then the insurance company doesn't cover the best drug, the most efficacious drug, the least side effect drug. That's what I was wondering. They cover the tier drug, tier one, two, three, or four.
How do they decide which drug gets tier one preferential treatment based off the rebate? Not based off what's best for you. So if I'm an opioid manufacturer, aka the Sacklers, and I agree to give 30% of the money to your holding company, you're going to put me on a tier one. And what does that mean? It means overnight, I get Medicare, Medicaid, governmental contracts.
Overnight, any mother, father, anybody who comes into a pharmacy to fill a drug is going to get steered towards my drug. And so I can make money. It's a pay to play system. But we're the ones fitting the bill. We fit the bill. The insurance company never pays that. And that's where it gets even more condolented. People go, well, if I'm an insurance company, why would I want to pay 30% more?
Because you don't. So let's just use simple math. Let's use a GLP-1. Let's say the weight loss drugs, $1,000 a month is on average what they're charging in the United States. We compound that drug for a couple hundred dollars mailed to your doorstep with a consult, with a nutritionist and a doctor. And that's how we'll do it if we prescribe it.
Because prescribing a weight loss drug without talking about diet, lifestyle, nutrition is like brushing your teeth while eating Oreos. It makes zero sense. And so we'll do all of that and mail it to your doorstep. Why are they charging $1,000? Well, if you base that 30% number from the Senate Finance Committee, that's about $300 a month potentially could be held at a PBM as a profit.
But they never paid the 1,000, right? They paid $700. Then at the end of the year, most people are insured by their employer. So like me, I insure over 300 people. At the end of the year, United comes to me and they go, hey, Brigham, Joe Bob cost us $1,000 a month. He's on Ozempic. That's $12,000. We've got to raise your rate by 20%. You've got to pay us $15,000 to insure Joe Bob next year.
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