PBMs Drive Up Costs, UHC Exposed, & Ghost Networks

Hey all,

I wanted to provide a round up of my favorite healthcare investigative stories of 2024. These three stories showcase how big insurance companies are using deceptive tactics to take money from members, employers, and the government. Hopefully 2025 will be the year we address these problems head on.

Jacob Brody (Co-Founder & CEO, ZorroRx)

How PBMs Are Driving Up Prescription Drug Costs (NY Times)

A New York Times investigation published on June 21, 2024, revealed how pharmacy benefit managers (PBMs) often prioritize their financial interests at the expense of patients, employers, and taxpayers. The article detailed practices such as steering patients toward expensive drugs, overcharging payers, underpaying pharmacies, and delaying medication access, contributing to higher drug costs and reduced competition. Unsurprisingly, the PBM industry dismissed the report as biased—because when faced with a mountain of empirical data, their go-to move is to play the “alternative facts” card! Full Article

Healthcare’s Colussus (Stat News)

STAT News’ ongoing investigative series, Health Care’s Colossus, exposes how UnitedHealth Group has leveraged its vast physician network to maximize profits and consolidate power. By analyzing documents, data, and conducting interviews with clinicians, the series reveals how the company has transformed healthcare into an “assembly line,” treating patients as commodities to be monetized. Predictably, UnitedHealth's only public response was to dismiss the story as biased and inaccurate, while failing to provide data that supported their assertions—a familiar pattern in their communications.

Trapped In His Insurer’s Ghost Network (Propublicla)

Max Blau’s reporting exposed inaccuracies in health insurance provider directories, known as “ghost networks,” which misled patients about available care options. The investigation emphasized the systemic misrepresentation by insurers and its detrimental impact on mental health care access. This is a familiar story for most Americans who have sought mental health care covered by their insurer. Full Article