Friends with Benefits 1: Mike Miele on PBMs, GLP-1s, and Drug Pricing

Welcome to the first episode of our new “Friends With Benefits” series on The EOB Podcast. Julie Selesnick and Justin Leader bring in one of the smartest people they know in the healthcare benefits industry — Mike Miele, FSA, MAAA, Senior Vice President of Insured Services at Capital Rx — to talk about the topic everyone in benefits is arguing about right now: pharmacy benefit managers (PBMs). Mike pulls back the curtain on how PBMs actually work, how rebates shape the entire drug pricing ecosystem, and why employers often have far less visibility into their pharmacy spend than they think. Along the way the group dives into GLP-1 drugs like Ozempic and Wegovy, exploding pharmacy trends, rebate economics, and the uncomfortable truth about who really controls drug formularies. Topics include:

• The real story behind PBMs and pharmacy rebates
• Why GLP-1 drugs are driving pharmacy trend
• The economics behind drug formularies and rebate deals
• Why employers struggle to get transparent pharmacy data
• How plan sponsors can better manage pharmacy spend

If you’re an employer, HR leader, benefits advisor, or healthcare industry insider, this episode will help you understand the forces driving prescription drug costs — and what questions you should actually be asking. And yes… this episode also launches our new segment: Friends With Benefits. More industry insiders are coming. Follow for more straight talk on healthcare benefits, pharmacy, and employer health plans.