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
People like my brother, who got addicted to opioids and lost his life because the system chewed him up and spit him out and let him down. How did he get addicted to opioids? He had an ACL surgery in high school, like so many kids, and the insurance companies are incentivized to prescribe opioids.
That's the article that came out the other day, and that's what I'm trying to explain about the danger of these middlemen called the pharmacy benefit managers. They're not middlemen at all. They're profit centers for the big insurance companies. And so even on opioids, You could have been prescribed a non-addictive, non-abusive pain cream after your surgery.
It's a topical that uses non-abusive, non-addictive ketamine, but in a topical form. You can't consume it. You can't eat it. You don't get high. There's no physiological high from it, but it works. It's very efficacious. Why would the insurance companies not prescribe that over a highly addictive side effect riddled opioid?
The answer is the insurance companies were getting rebates on these opioids. If you look this up, you can do the research. They made hundreds and hundreds of millions of dollars right beside Purdue Pharma, but they floated through all of it unscathed.
So what happens is we'll go back to like a product. Well, here's another hot topic. Insulin will be a great example. Insulin's been out 40 years. Why is insulin six times more expensive than it was when it launched? The pharmaceutical companies are not making more than they did when they launched it. Eli Lilly's actually making less per vial than it ever made on insulin.
Where is all that extra money going? That money is going to the pharmacy benefit manager. So UnitedHealthcare owns Optum. Optum is a pharmacy benefit manager that negotiates rebates or kickbacks with the pharmaceutical companies. So when it came to opioids, they go to Purdue Pharma and they say, okay, Purdue, I'm just gonna use simple math for my small brain. If it's $100 a month, they say, Purdue,
If Purdue wants to charge $50, they'll say, charge $100 and give us a $50 rebate. And so then United will show you, the patient, that your opioid cost them $100 that month or whatever the prescription drug is. Prescription drug A cost them $100. They never paid the $100 because they got a $50 rebate. So they paid $50.
What people don't realize is 80% of your health plan in America, 80% of American's health plan is covered by their employer. Most people are getting their health plan through their employer. So at the end of the year, these big insurance companies meet with your employer and say, Bobby Sue was on this opioid all year long. It cost us $100 a month. That's $1,200 a year.
We've got to raise your co-pays, your deductibles, and your out-of-pocket expenses because it's really running up our costs. But in reality, they never paid that. Then where this gets more sick and twisted A lot of people don't understand this. Medicare and Medicaid after Obamacare has all been outsourced to the big insurance companies.
So 60% of UnitedHealthcare's profits are coming from Medicare and Medicaid. And how do they negotiate the Medicare and Medicaid prices? They negotiate it by looking at the average wholesale price in America and saying, we want a discount.
that average wholesale price is a price because they set the market but they didn't pay that price does that mean is this making sense so just follow the dollars okay 100 a month they didn't pay the hundred they paid 50. they tell the employer they paid the hundred at the end of the year that employer is going to get hit with the cost going into the following year all of those co-pays deductibles all that goes up then you the patient get hit and so when they decide
what drugs to put on a formulary, what drugs they're going to cover. It has nothing to do with the efficacy and what is best for the patient. It has everything to do with who gave them the biggest rebate. And they incentivize you to go to those drugs by lowering your copay and deductible on those drugs. So with opioids, they made it very easy to get an opioid because it was getting a rebate.
But they made it very difficult to get a non-addictive product like a pain cream. And then eventually they just said, we won't cover pain creams at all. You're going to have to take an opioid. Then to go even deeper, that's just the prescription. And this is what happened to your brother. This is 100% what happened to my brother and what happened to millions and millions of Americans.
And it's still happening to this day. And so I'll paint a picture for you. Imagine being a young kid with a spine issue. And you're in pain. And this particular spine issue causes the sensation of burning and fire shooting into your hands, your feet, your extremities.
And the worst of it all, a large percentage of these male patients with this spine issue experience burning and fire in their genitals. Fire and pain shooting into your genitals and extremities. in the insurance model with United Healthcare, you're going to have to go to a primary care first. That's gonna take two months to get in with that primary care.
You're dealing with this pain and suffering the whole time. Now, you get in with the primary care, they go, whoa, got six minutes with you. This is out of my wheelhouse. I'm gonna refer you to a specialist. You go to a specialist. That's going to take months. Oftentimes you have to argue with the insurance, right? Deny, delay, depose.
You're going to argue with that insurance company begging them to allow you to go to a specialist. Your primary care may even have to get on the phone and get a prior auth and negotiate it for you. Now you finally get in with a specialist. Specialist says, I want to order an MRI. A lot of times the insurance companies will deny the MRI or delay it. So now you've got a battle for that.
That's going to be another three or four months. The gist of it is the average spine patient takes six to nine months before they ever really even get an answer. And then they've got to negotiate to get into the surgery. And now you finally get the day in the sun where you're finally feeling like you're going to get relief and you're going to get that surgery that you desperately needed.
But the whole time they've been selling you opioids to keep your pain level down because that's the only option you have. So now... You get your approval and you say, I found the best surgeon in the country. I want to go to this guy. That's not how it works. The insurance company tells you who you're allowed to go see. And they say, yeah, he's not in our network.
You've got to go to this other doctor. And then that doctor botches the surgery. It wasn't the surgeon you wanted. You waited nine months to get this thing done. And that surgeon messes up your surgery. That's what happened to this kid, Luigi. Can you imagine how he could have lost his mind and gone crazy?
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