Healthcare is Hard: A Podcast for Insiders

In the first of a series of episodes exploring opportunities for innovation in the pharmacy space, Mark Cuban offered perspective from an outsider intent on disrupting the status quo. In this, the second episode, Dr. Troyen Brennan gives an insider point-of-view from someone who has studied and worked in the space for decades.

Dr. Brennan was Chief Medical Officer at CVS Health for nearly 14 years, and before that, Chief Medical Officer at Aetna for two years. He was also a practicing physician at Brigham and Women’s Hospital for 15 years where he was president of Brigham and Women’s Physician Organization. During that time, he was also Professor of Medicine at Harvard Medical School and Professor of Law and Public Health at the Harvard T.H. Chan School of Public Health. He is the former Chair of the American Board of Internal Medicine and has published six books and more than 600 articles offering his insight into the American healthcare system, and his ideas on how to improve it.

With extensive knowledge of how the industry has evolved, and an understanding for why many of the complexities in the industry exist, Dr. Brennan offers a unique viewpoint about where and how disruption in the pharmacy space can succeed. In his eyes, the idea of good and bad actors in the pharmacy space is a false narrative. With an historical perspective, he explains how industry processes were all sensible when they were first implemented, and how that viewpoint is critical to understanding and addressing some that may have become seemingly senseless over time.

A few of the topics he discussed with Keith Figlioli in this Healthcare is Hard episode include:

• Six ways PBMs have lowered cost. Dr. Brennan provides a history of pharmacy benefits managers (PBMs), why they were created in the late 1950s and how they have helped the pharmacy industry. He discussed his thoughts on the six things PBMs have done – and are still doing – to help control costs. These include expanding the use of mail order pharmacies, sourcing generic drugs, introducing tiered pricing, implementing prior authorization and utilization management, assembling pharmacy networks, and negotiating rebates.
• Flexibility of PBMs. When discussing the future role PBMs may or may not play in the industry, Dr. Brennan says he’s confident in the ability for big PBMs to adapt. He believes they’ve proven to be more flexible than other parts of the healthcare system and will continue to have significant influence as regulations evolve and disruptors enter the market. He says that Mark Cuban is having a good influence on the industry overall with Cost Plus Drug Company, but would bet on the ability of PBMs to adapt.
• The path to greater affordability. With new, life-changing therapeutics being introduced regularly and specialty pharmacy expected to become a significant portion of healthcare spending, Dr. Brennan discusses some of the potential options for ensuring these treatments are affordable. He believes entrepreneurs disrupting the space can help contribute, but regardless of the role they play, says government will ultimately have to step in with price controls. He points to the role government plays controlling the costs of hospital services and says it will eventually have to play a similar role in the pharmacy space.

To hear Dr. Brennan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.