Postscripts Rx
Conversations Beyond the Prescription. Where pharma, HCPs, life science and digital health solutions meets patients—after the script is written. Conversations on digital health, engagement, and real-world impacts that are re-writing the future of patient engagement.
Postscripts Rx
PBMs, Transparency, and the D2C Pivot
Prices that used to hide in the shadows are stepping into the light—and it’s changing how patients get their medicines. We dive deep into the PBM reckoning: why scrutiny is mounting, how California’s new law opens the books on rebates and reimbursements, and what more than 30 states signal for the future of drug access. From there, we chart the path pharma is taking to meet the moment—standing up direct-to-consumer channels, publishing clear cash prices for GLP-1s and insulin, and using digital tools to support patients at the exact moment they need guidance.
We unpack the incentives that got us here—spread pricing, formulary gatekeeping, and opaque negotiations—and then show how transparency reshapes behavior across the board. When a payer can see a cash price, the math behind rebates changes. When a patient can tap a support team, dose questions and refills don’t become barriers. And when adherence and symptom data flow securely into connected systems, trial churn falls and real-world evidence grows stronger. It’s not just a commercial pivot; it’s an outcomes strategy that relies on timely education, affordability support, and trust built one interaction at a time.
You’ll hear a clear game plan for leaders across pharma: align patient support, access, IT/security, and procurement around HIPAA-compliant, interoperable platforms; embed copay and affordability tools where decisions happen; and design companion experiences early so launches are patient-ready on day one. Over the next two to three years, transparency will be a differentiator, D2C will scale fast, and “digital” will simply be how care is coordinated. If you’re ready to lead in a post-PBM landscape—and prove it with measurable results—hit play, subscribe, and share your take. Your feedback helps us spotlight what’s working and where the industry should go next.
PostScripts Rx is not intended to constitute medical advice, nor is it intended to influence prescribing decisions or any other medical or clinical decision-making. All medical and clinical judgment and decision-making, prescribing decisions, and all related considerations remain exclusively the responsibility of providers and patients.
Welcome to Postscripts, the podcast exploring the latest innovations in patient access, support, digital tools, HCP engagement, and pharma marketing that we all hope drive better outcomes for patients. This podcast is for informational purposes only and does not constitute the giving out of any medical advice, nor should it be used to influence any clinical decision making. Patients should always consult their healthcare professionals. Welcome to the podcast. My name is Brian Carm from the MetaSafe team. Although any opinions expressed here are my own and not necessarily those of MetaSafe or its partners, we are seeing a tectonic shift in pharmacy benefit manager regulation this week. These are called PBMs, right? This is a seismic movement happening here in the U.S. healthcare landscape. It's centered around these increasingly scrutinized practices of the PBMs. In recent years, you may have seen state and federal legislators here in the U.S. have taken aim at the longstanding opacity and pricing power PBMs have held over pharmaceutical manufacturers, the payers, pharmacists, ultimately patients. These shakeups that we're seeing now really do promise a new era of pharmaceutical access, pricing transparency, digital engagement directly with patients and pharmacies, right? So California this week signed into law a significant bill that adds new oversight to PBM's pricing contracts and rebate clawbacks. More on that in a bit. So according to Fierce Healthcare, the bill requires PBMs to register with the State's Department of Managed Care, DMHC is what it's called, and opens them up to audits that bring transparency to consumer drug pricing and ensure payer negotiations. You should expect other states to follow suit. And in total, over 30 states already have introduced PBM regulation bills since 2023 alone. But what does it really mean for pharma marketing, patient engagement, and access strategies when you see this legislative momentum happening? And how can innovative digital tools like MetaSafe and others really empower pharma teams to seize this opportunity with direct-to-consumer and connectivity right to patients? But first, how do we get here? So PBMs originally were created to streamline prescriptions, make drugs more affordable through their formulary management, and really aggressive price negotiation on behalf of large communities of patients, right? Whether it be uh you know those from a simple insurance company or unions, et cetera, et cetera. So, however, over the past decades, PBMs really did evolve into powerful intermediaries. For example, today are the top three PBMs, which was CVS CareMark, Optim RX, and Express Strips, that control over 80% of the prescription drug market, according to the Drug Channels Institute. So this outsized influence allows a couple of things here. One, they can negotiate massive rebates with manufacturers, often keeping portions for themselves rather than passing the savings on to patients, right? They can also determine which drugs make the formularies. Despite clinical equivalency across the options, they may opt for the less expensive medication that has been on the market for a bit, as opposed to the new one that came out that has equivalency at even if it's a lower price, they can decide which is the winners and losers, right? They can utilize more spread pricing. So charging payers more than they reimburse the pharmacies because they want to keep a little bit for themselves, right? So that can all they can also restrict innovative therapies, right, from coverage, delaying access for patients. So these practices have contributed to a growing frustration among policymakers, patient advocates, and increasingly the pharma companies themselves looking to directly engage consumers with transparent pricing and streamlined access to therapies. You can imagine the pharma companies, especially here in the U.S., are getting pounded for the prices that they're charging, right? So you saw in May, the U.S. administration put out rules that they want most favored nation pricing for Americans so that no American pays more than anywhere else in the developed world for their medications. And especially for Medicare, Medicaid programs where they have to pay MOS and on these drugs, right? So the you saw that come to the fore. And what the pharma companies were saying is to the administration, and we know this, they actually said, listen, if you cut out the middleman here, the PBMs, we would allow it allow us to go right to the consumers for many of these medications, we can actually deliver that overnight, right? And so we actually saw, we now have D2C with some of the major pharma companies, particularly in the GLP1 space and insulin as well. You can buy medications very soon on Trump RX and other websites where the price will be listed there, and it'll be the equivalent that you can get elsewhere in the world, right? So that is pricing transparency. Now the point there is most people are not going to go to those websites and buy their medications here in the U.S. Why? Because they are already under either a policy with Medicare, Medicaid or their insurance company that they get through work to pay a$20 to$30 copay for those medications or$10, whatever it is, as opposed to buying a full price off of a website. The point, though, is the transparency of the prices are being shown, right? So that you can see the impact of a transparent price on what it would have with the negotiating power of a pharmacy benefit manager who's wants to charge$400 for that medication, where the payer may be like, well, I can get it off Trump RX for$200 right now. Why am I going to pay you? Well, we're going to give you a rebate for$200. Well, no, no, no. That's money out of my pocket that makes your books look better because you're seeing a higher revenue come in, but then you're just going to give it back to me, or you're going to give a portion back to me, and some of it maybe to the patient. That's where that transparency is really going to be most effective, right? So what you're seeing this fracking opening of the PBM black box, and the legislation is catching up, admittedly, right? So the inflation reduction act you may have seen a few years back, you recall it here in the U.S. as the insulin prices were going to be capped at, I think it was$35 per dose. That was part of the inflation reduction act at the federal level that really didn't make the headlines for Medicare in particular, pricing reforms, particularly on insulin, as I recall them. State action has been equally transformative. So California, this new law creates this transparency rules effective immediately, requiring the disclosure of rebate information and pharmacy reimbursements with enforcement via auditing rights by the government, right? From the Department of Managed Healthcare in California. States like Arkansas, Georgia, and New York are enacting similar provisions. This is coming from the Kaiser Family Foundation. This increased scrutiny gives pharma manufacturers the green light to accelerate direct-to-consumer sales models, right? Deliver on price transparency and therefore expand digital tools that empower patient control in understanding of their therapies, right? So let's talk about D2C, direct-to-consumer acceleration. Pharma is definitely going direct. These barriers are loosening on the PBMs. So for manufacturers, they're rapidly, you've seen they're unveiling direct-to-consumer models. Several major firms, Eli Lilly, Nobo Nordisk, and others, they've uh launched their D2C prescription access websites, particularly in the GLP1 space, alongside major list price reductions in, you know, insulin price caps, for example, right? So these are aiming to remove PBM middlemen and women uh from their administrative burdens of from just the pharma administrative burdens if they don't even have to go through the middle and then negotiate that way, right? Also offer transparent pricing structure aligned with consumer expectations, okay? Build stronger brand loyalty and medication inherence through the digital touch points with patients. You can imagine if you're a patient, you may be in a you may put in a place where, hey, we're gonna charge you, we're gonna take you down and have this less expensive medication. And you as a patient want to fight for, no, no, I want to stay with the brand I'm on. I know the supply chain, I know it's made in the USA, for example. I know it's I already have a care team that I talk to at the tap of a button on my digital app that I can talk to anyone at the brand name, brand team, or you know, patient support team if I have any questions. If I go off the medication, that's not gonna be available. So that type of brand loyalty and patient connection with pharma to really kind of reverse what some patients think about pharma companies now and really turn into a positive brand loyalty could be a very interesting market, especially with that digital connectivity that circumvents the PBM managers and has patients, doctors, and pharma all in the same place, right? So it does really, for pharma companies, think about it, it really depends on pairing those digital strategies and platforms that keep patients really engaged, informed about their journey, especially as patients now become the primary buyer rather than just payers or providers, right? So pharma is really meeting the empowered patient. As you see patients assume greater ownership over their healthcare choices, pharma companies are digitally enabling that shift. You see platforms like MetaSafe and others already leading this type of revolution where you've got, you know, you've got even voice agents that can contact a patient on MetaSafe and ask a linear question, do a symptom check, do an appointment check, everything like that. It's all integrated about the process of managing their journey and helping out that way. And you can think of the options to really seek provider support at the tap of a button. So if you can imagine digital support tools where, hey, I have a question about my medication, I need a refill, or for some reason I like whatever I want to tap to contact my support team right now. Boom, done. And that support team can be a pharma-based support team that has answers questions about, yeah, I'm supposed to take my medication out 45 minutes before I dose. This one's been sitting out for an hour and a half. Is that okay to take? Let me just talk to my support team right now. Those type of questions. Really get that loyalty going, right? You know, and and what can happen is these so you're seeing personalized, even white-labeled, if need be, communications, bi-directional communications with digital pharma companies and doctors really offer support at critical moments in that treatment journey, all the way from titration and onboarding to the renewal of the script and uh refill, right? So when you see, once these PBM, we'll call them blockages are removed, pharma firms can just use digital tools to really deliver price transparency through in-app pricing information, right? You might want to, hey, by the way, this this medication is available for$239 a month. You might want to check, see what you're getting charged for it. Granted, it's a$30 copay for you, but if you it's on top of what else is going into it, that's gonna be apparent. Like, oh, the my insurance company charges$400 for something they get$239 for, which most patients are gonna say, well, that's trickling down into my premiums, right? So that's gonna be interesting. You could attach the copay cards, right? So the manufacturer's savings cards, copay assistance within digital journeys, right? So copay cards already exist, but now you have it within your app. And if you're asking questions, saying, Well, yeah, I'm thinking of going to this other medication, or I want to tell, well, here's a copay card that makes you revenue neutral, you know, cost neutral by staying with us and your loyal team, right? You can do it in the moment. Obviously, pharma companies can track patient inherence and provide real-time insights into the therapy effectiveness, or even what's discontinuation, right? So those triggers of discontinuation, if you've got that direct relationship with the patient, why did you switch to the generic? Or why did you come off of, well, my pharma company, my insurance company told me to, or you know, I was getting whatever, what whatever reaction, or I'm just off of it, it did its work. You're gonna have the data a lot more effectively and direct one-on-one, right? So this data-driven impact can really just bring clarity and with adherence and really does give great outcomes for the pharma companies to use and some of their other conversations they're having with, say, efficacy conversations with the federal government. So you see the shift to D to C and digital engagement. It's a commercial strategy, not only commercial, but it's an outcomes strategy as well. You know, even patients using our platform, you know, have a much higher medication adherence rate. You know, we've seen 20% plus adherence rate over a 12-month period compared to those who aren't using uh the digital companion support. This can this can mean reduced hospitalization risk, improve persistence, and you know, pharma manufacturers are also leveraging, you know, digital solutions for clinical trials. Why? Because the number one problem that's good clinical trials is churn, right? You brought a bunch of patients in. For some reason they're not staying on the trials, so you can't measure them across, right? You get digital connectivity directly with that patient in a much more aggressive way to really keep in track on a day-to-day basis. You can significantly reduce those churns. We've seen those, you know, patient-reported outcomes and churn rates go down significantly with some clinical trial studies that we've done here at MetaSafe, right? And you can really enable the entire pharma org. It's not just a marketing challenge. You know, pharma digital evolution post-PBM reform can impact patient support teams, right? So new tools that increase touch points, supply adherence, right, uh programs, and monitor real-time escalation triggers can be done with the support teams, right? IT, security teams. They have to ensure HIPAA compliance, secure health data insights, integrate data pipelines into CRMs and real-world evidence systems, right? So as we go more to digital, those IT and security protocols must be met by major partners and vendors like ourselves that have been doing it and have experience doing it, right? Patient access teams, right? You're gonna want to coordinate copay, hub enrollment, affordability directly with patients, bypassing PBMs where feasible, right? Procurement, evaluate digital health partnerships for that team and uh integrations that are, you know, that are obviously compliant, have ISO security protocols and quality standards. That's gonna be key for the uh as we expand digitally with the pharma patient relationship directly, right? Then innovation and RD teams can consider that they're incentivized to support pipeline therapies with companion tools early in development, ensuring that patient readiness at launch, right? We're seeing this already where new medications may not be launching for six or ten months, but pharma companies are getting patients ready for that launch ahead of time before it's even available public, so they can identify them and talk to them in a way when the launch brand comes out more effectively, right? So as PBM oversight really expands federally and across states, expect a cascade of effects across pharmaceutical commercial and patient engagement models. These D2C channels are gonna grow rapidly through the next two to three years. Pricing transparency has become a commercial differentiator. Digital solutions are gonna become table stakes for meeting patient expectations. You know, it's interesting. I had someone say the other day, we used to call it uh online banking, and then it was, oh, it's mobile banking, right? And now we just call it banking, right? So when you're gonna have the same thing happen, the same go through with pharma companies. You know, it used to be uh, you know, medication management. Now it's just gonna be simply I don't have to manage it on my mobile devices, it's gonna be this is how I manage my treatment journey, right? All the way across. So it's just gonna be table stakes, right? So it's not just compliance driven, it's business driven. Pharma brands who are already embracing transparency, patient centricity, integrated tech are gonna be far better positioned right now in this post-BBM landscape. So if you're not how pharma can really lead in the post-BBM era, uh is you're seeing these shifts to really succeed. There's a couple of things they should do. Develop D2C pricing and access channels is armed with savings, offers, transparency tools. You already see this happening already, with some of the announcements. Then leverage digital platforms to keep patients informed, inherent, and connected in case there's any changes or trends that data that uh pharma companies are seeing and they can make interventions possible, right? Integrate that digital data into commercial and clinical roadmaps, right? Invest in patients-first technologies with secure interoperability and outcomes-driven metrics, right? So from brand teams to the C-suite, everyone has a role in enabling this transformation that's already coming, right? Because it's a new question, isn't whether pharma can engage patients digitally? It's how fast they can, how transparent say they will, and how well they can prove it works, right? So thank you very much for joining us on PostScripts. If you found this conversation valuable, follow or subscribe for more insights as we talk about the intersection of pharma tech and patient impact. Until next time, keep looking forward. The real work begins when those scripts are written.
