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Model N Senior Vice President Jesse Mendelsohn explores the hidden costs and realities of PBM-driven drug pricing and the growing challenges manufacturers face in ensuring contract compliance, formulary access and reimbursement accuracy.
In this Pharmaceutical Executive podcast episode of Pricing & Policy with Model N, Jesse Mendelsohn, senior vice president at Model N, joins host Mike Christel to offer a candid, expert-driven look at the pharmacy benefit manager (PBM) landscape, including the operational complexities confronting biopharma organizations and what these companies must understand to protect their revenue and expand patient access. Mendelsohn cuts through the spin to examine where PBM reform efforts are progressing and falling short, how payer vertical integration is compounding financial risk for manufacturers and why the onus increasingly falls on drugmakers themselves to police the data, the contracts and the dollars at stake.
01:32 – PBM scrutiny: Where it’s missing the mark
05:54 – Pharma’s chief PBM concerns
08:08 – Formulary compliance and transparency
12:00 – Data correlation and rebate accuracy
18:00 – Addressing multipayer-claim complexity
19:03 – Benefit-claim breakdowns: The 340B effect
20:14 – Why coordination issues persist
21:16 – Independent PBMs: Is their model game-changing?
26:01 – PBM reform potential and pace
29:09 – Future pressure points for manufacturers
This article was originally published in Pharmaceutical Executive.
