EP423: Maximizers and the “the Drugs Aren’t Covered” Schemes Employers Use to Save Money (or Not) on Pharmacy Benefits, With Joey Dizenhouse

Unpacking Pharmacy Benefit Management: Maximizer Programs and Patient Impacts with Joey Dizenhouse

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Episode 423 of 'Relentless Health Value' features a conversation with Joey Dizenhouse about the tactics employed by PBMs and pharmacy benefit schemes to manage drug costs, often leading to misaligned incentives. Joey outlines how maximizer programs work, differentiating between spread and transparent models, and the potential consequences for plan sponsors and patients. The discussion dives deep into copay assistance programs and the complex dynamics behind drug pricing and patient access. Key advice for plan sponsors includes applying purchasing discipline, understanding program structures, and being aware of the broader implications on patients.

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06:21 How was the first iteration of maximizers conceived?

10:59 “I’d always encourage you to come back to the underlying incentives.”

11:18 What does maximizer acceleration look like?

12:24 What are the two kinds of maximizers?

12:43 What is the spread model for a maximizer?

13:02 What is the transparent model for a maximizer?

15:26 “Ask the questions: How do you make money? Prove it!”

15:56 EP419 with Andreas Mang.

16:25 How might Pharma be making more money with maximizers?

26:14 What is the “it’s not covered” approach?

32:29 “The right kind of program has been properly narrowed.”

33:51 Is there a purpose that some of these programs can serve, issues aside?

35:57 How does a free drug program actually cost money?