So speaking of that, what are the most interesting findings in your most recent report?

So one of the big pillars of the US pricing system is the need to cash in on savings from generic drugs.

Look, I don't think it's any surprise to anyone that in the United States, we bear the burden of the highest prices for medicines in the world.

And there are many reasons for that.

But at the core is we have a patent system where we tell big pharma, hey, we're going to give you a patent that essentially insulate you from competition.

And we'll give you that because we want to entice you to bring new products to market.

And manufacturers get those patents and then we put up with those high prices.

But how can we navigate this and figure out where the actual best prices are going to be for the drugs that we need to buy?

it.

An audit investigation uncovered $245 million that those PBMs were taking out of the middle of the Ohio Medicaid program.

And most of that money was being taken on generic drugs.

Similarly, a few years later, Michigan also discovered similar problems where a PBM is operating on behalf of their Medicaid program, we're doing the exact same thing.

So the idea of it is this, brand drugs are the ones that we call big pharma, right? Those are the ones that have the patents and charge the big list prices.

We give them those patents and allow them to charge those prices with an idea that eventually that patent will expire and generic manufacturers will come in and get the recipe for the drug, if you will, and start competing to lowering the underlying cost.

And that usually works.

So that would be from your report here that one of these generic cancer drugs priced at more than $12,000, even though it's $100 through another pharmacy, there's that discrepancy because people are doing what you just said.

And why is that still an outlier?

It's all, look, everything in the system, before we sit here and end the tape and say, oh, the PBMs are the problem.

No, the problem is the prices, right? If the prices weren't so high, we wouldn't have to rely on conflicted intermediaries who are publicly traded companies to altruistically and charitably give us a deal.

That's not their business model.

What really works is true competition that lowers the actual prices of drugs.

So you don't need a negotiator and the tolls that you have to pay at their proverbial toll booth in order to access rational pricing.

The reason that Mark Cuban or the reason that Day's Pharmacy in Cincinnati or Freedom Pharmacy in Columbus are able to offer prices that are a fraction of what you can find through traditional pharmacies and their PBMs and insurance companies they work with is because they live in an entirely different galaxy where they don't set sky-high prices with the goal of them being negotiated, but that the prices that you see at the counter are as is and final, just like everything else we buy in most retail marketplaces.

all right so we generally look at other states and that is the great uh part of america one of the many many things of course and that is the petri dish of experimentation they do it west virginia it works everyone rushes to copy it why aren't we rushing to copy it

Talk a little bit about that food chain's impact, negative impact, on not only the pricing, but also the utilization and the prescribed part of the industry.

Yeah, so think of it this way.

We have a pricing problem in the United States.

In the US, we suffer from the burden of having the highest prices for medicines in the world, bar none.

There's no debate.

The US has the highest prices for medicines in the civilized world.

And in order to combat that problem, the US relies upon market dynamics.

Talk a little bit about that.