You’re listening to Radio Health Journal, the trusted news source for medicine, science and technology. I’m Elizabeth Westfield. I’m Mayan Vastabetancourt.
And I’m Greg Johnson. This week, why are we paying so much for prescription medication? The PBM market isn’t working as well as we’d like it to, and PBMs are no angels, but there are also a lot of other problems in how our health insurance system deals with prescription drugs. But first, why you need to be paying more attention to your hormones.
Women can become suicidal if they are having dramatic hormone shifts and not getting those properly treated. I mean, it’s not a luxury to really figure out what’s going on. All that and more this week on Radio Health Journal.
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Visit Skyrizzy.com or call 1-866-SKYRIZZY to learn more. We all have hormones that are constantly ebbing and flowing to regulate our needs throughout the day. This process is how we wake up, know when we’re hungry, why we feel energized and so much more.
Hormones are really the foundation of who we are. But when we experience extreme fluctuations, they can make us feel like a stranger in our own body. And though they affect both sexes, Dr. Julie Taylor says women tend to be more significantly impacted by the dramatic variations that occur.
You think about periods when teenage girls are just starting and how those hormones really change throughout the month. We think again about pregnancy and postpartum and those hormones are again having these dramatic shifts. And then again around perimenopause and menopause, their hormones are really fluctuating.
Men have hormonal issues as well, but they’re just not as dramatic of a shift as women experience. Taylor is a functional medicine physician and author of The Hormone Manual, a straightforward guide for every woman at every stage of life. Conversations around hormone regulation have become more mainstream, but there’s often so much information to sift through that many women may decide to ignore it altogether.
But Taylor says being ignorant of your body can have damaging repercussions. I have had women who come in in the depths of despair, depression, anxiety. Women can become suicidal if they are having dramatic hormone shifts and not getting those properly treated.
Women can have fibroids and cysts and heavy periods and migraines. You know, they can have physical manifestations of their hormonal issues as well as mental. Since hormones control so many of our body’s processes, Taylor says women need to start looking at them as the main suspect for any issues that arise.
So if we talk about teenagers, for example, you know, teenagers, if they’re experiencing migraines or they’re experiencing heavy periods, if they’re experiencing painful periods, if they’re experiencing PMS related to their cycle, I want them and their moms to really think about their hormones being the root cause of their symptoms rather than they need to get on birth control or they need to get on an antidepressant or they need to get on a tryptan for their migraines or they need to just take around the clock Advil for 72 hours to get through what they’re experiencing. We tend to just shy away from hormones and really, really ignore them. And almost consider them kind of like a four letter word.
They really affect so much of how we feel. And so when we’re having these different symptoms, especially when they’re related to the cycle, I really want women to think about their hormones as being the root cause. Years ago, Taylor had been treating a woman who just happened to mention her daughter’s mental health struggles.
The young girl had been admitted into a psych ward multiple times for suicidal thoughts. After digging deep, we discovered that every single time she woke up in the psych ward the very next day after being admitted, she started her period. And that was just such a compelling story to me that her hormones were completely impacting her mood.
They were causing her to be in severe depression. No one was figuring that out. No one was really analyzing that her period and her hormones were related to how she was feeling.
If hormones impact our lives so much, why aren’t they the first thing doctors consider when women come in with many common medical issues? In short, Taylor says it’s simply not something that they’re trained to do. There is not that education in medical school. There’s not that education in our training in residency.
So that’s the reason why doctors are not looking at hormones as a root cause. Really, the way that we learn how to be doctors is we learn how the body operates. We learn the anatomy.
We learn the physiology. We learn how disease happens and what that looks like. But we don’t learn about how to sort of look at the root cause of those symptoms.
We really learn how to treat those symptoms with medications. So if you have a symptom, what’s the medication to start? And then if that medication doesn’t work, what’s the next medication to start? What are the procedures involved that can treat those different things? And though many physicians can test hormone levels, Taylor says most don’t know what to look for and will send women away saying that their levels are fine when that’s the furthest thing from the truth. And it’s not that they don’t want to help.
It’s a lack of education. So I go to my doctor and I think that they’re going to have all the answers. But you’re barking up the wrong tree and you’re going to be frustrated because they likely very, very likely do not have the training to really analyze what you’re experiencing and to really do the tests that are required.
Taylor says the proper lab work isn’t just a simple blood test. Not only does the physician have to know the right tests to order, but they have to be able to accurately read the results as it pertains to each woman’s individual needs, not just a standard range set on paper. The exact process will look different for each patient, depending on which stage of life they’re in.
If they’re still having a cycle, then I look at their hormones based on their cycle. So sort of the tests that need to be done are very specific tests that are based on the menstrual cycle. So usually they’re done in the luteal phase of the cycle, which is after ovulation and before the period starts.
And if you think about it, that’s when most women have their symptoms is like that week before the period begins. You know, they’re feeling depressed, they’re not sleeping as well, they’re anxious, you know, their energy’s low, you know, they’re moody, whatever it is. Once those tests come back, Taylor can identify any imbalances or other hormonal issues.
She says that in many cases, the main culprit is low progesterone. Progesterone is my favorite hormone because it really impacts mood and it impacts sleep. And those are really kind of the biggest symptoms oftentimes that women come in with.
I can’t sleep or I’m just depressed all the time and I don’t know why. Progesterone is our natural antidepressant. You think of postpartum women.
What is their symptom? If you really have postpartum, it’s depression. You have postpartum depression. So when we are pregnant, we are flooded with progesterone.
It is what is sustaining the pregnancy. And oftentimes miscarriage is actually due to low progesterone. But a lot of times that’s not adequately evaluated.
So women are suffering from miscarriage and they don’t know why. So postpartum depression is due to that lack of progesterone. You’ve just kind of delivered all of your progesterone through that placenta and now you’re at a deficiency.
So some women, they have enough of a reserve and they’re fine. Other women, they’re not fine. And so that progesterone, if you supplement with progesterone for those postpartum depressed women, they are able to get out of their depression.
For women who are going through perimenopause or are menopausal, they’re having a decline of various hormones, including progesterone, estrogen and testosterone. So testosterone is a big one for women. I mean, we typically think of testosterone as a male hormone, but we make more testosterone than we make estrogen.
So testosterone is super powerful for us. And when our testosterone declines, it causes low libido and low muscle mass and low energy and low motivation and just like not feeling like you want to do anything. So testosterone replacement is amazing for women.
Since most women have to seek out a specialized physician to get this accurate testing and analysis done, it can feel like a luxury. And depending on their health insurance, hormone replacement therapy may not be included in their plan. And that out-of-pocket expense may keep them from pursuing this option.
However, Taylor argues that just because it hasn’t been included in the set standard like primary care physicians, this knowledge is necessary. It’s not a luxury to really figure out what’s going on. I mean, it’s kind of like, you know, the concept of getting a chest X-ray maybe versus like getting a CT scan or an MRI.
Like if you really need that CT or MRI, you’re going to do it because you know you have to. So I think this concept of like a luxury, I mean, it’s kind of the difference of again, like some women are truly suicidal. I mean, women around menopause have a higher risk of suicide, suicidality than basically any other stage of their lives.
Women are getting divorced around 50 all the time. I mean, it’s a high, high incidence of that. So it’s not a luxury.
It’s just that we think we’ve been disillusioned. We’ve been kind of coerced into thinking that it’s a luxury. But I think that the other flip side of that is if you don’t get your hormones managed, then you’re just on a bunch of other medications that are just treating the symptoms.
So it’s not really a luxury. It’s your life. It’s the difference between constant anxiety or constant depression or constantly not feeling good versus not.
Taylor says this idea is especially true for women going through menopause. More often than not, they’re told that they just have to suffer with the extreme mood swings, hot flashes and other symptoms that drastically affect their quality of life. But in reality, Taylor says a majority of these symptoms can be addressed.
You don’t have to just suffer. I think that that’s been sort of a misconception for a really long time, you know, and taking that on as women, you know, we’ve taken it on that like this is just our lot and this is just how it is. If you think about periods and heavy periods, you know, women changing their tampon every two hours and they just think like, this is just oh, doesn’t everybody go through this? You know, this is just kind of how it is.
This is just how it is for me. But that’s not normal. It’s important to note that managing hormones can be a long process, and it’s one that will change as women age and enter different stages of life.
Still, Taylor believes it’s not just a worthwhile journey, but a necessary one. They’re complicated. They’re complex.
It’s not like, you know, we knock it out of the park like easily, you know, hormones take a lot of work to manage. And it’s not like just because you start on a treatment, that’s the treatment that you’re going to have for the next 20 years. I mean, hormones are constantly fluctuating.
And what you need now is maybe not what you need in six months. So, again, the intricacies of treatment are complicated and they fluctuate. So it’s important to have those hormones managed and tested and all of that frequently.
But I think that women can feel better than ever. I mean, they don’t have to sort of accept their symptoms as their new normal. Taylor’s book, The Hormone Manual, is available now wherever books are sold.
You can find more information about Dr. Julie Taylor and all of our guests on our website, RadioHealthJournal.org. For more behind the scenes, follow Radio Health Journal on Facebook, Instagram and X. Our writer producer is Kristen Farrah. Our executive producer is Amira Zaveri. I’m Elizabeth Westfield.
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Picking up. Oscar. Last week, we introduced you to the world of pharmacy benefit managers.
Though many assume these negotiators are the cost of high, often unaffordable drug prices, our experts explained how they’re a small part of a much larger issue. However, that doesn’t make them completely free from criticism. Matthew Fielder argues that the rates insurers pay PBMs to negotiate is often much higher than necessary and can cut into the savings that are passed on to us, the consumers.
We’re in a situation where about 80 percent of the market is controlled by the three big PBMs. And that gives those PBMs quite a lot of leverage when they’re negotiating with their clients to say, you need someone to administer your drug benefit. You need someone to negotiate with manufacturers.
You need someone to negotiate with pharmacies. I’m, you know, one of three people who can provide those services. So pay up.
And so I think it is the case that PBMs are extracting more compensation from their clients than they should be able to extract. That’s probably not a huge amount of money relative to overall drug spending. You know, I think it’s probably on the order of several percentage points of our overall drug bill.
But that’s, you know, our overall drug bill is a lot of money. And so, you know, even if you could squeeze those profits a little bit, that’s potentially billions of dollars in savings a year. So I think my overarching view here is no, PBMs are not the reason we spend a lot of on prescription drugs.
But is there room to sort of squeeze PBMs profit margins and deliver some savings to payers and consumers? Probably yes. Fielder is a senior fellow in economic studies and in the Center on Health Policy at the Brookings Institution. But while pharmacy benefit managers are paid a lot on one end, Eric Levine, a principal at Avalere Health, says that their participation in other areas may even out the scales.
He recently published a white paper on PBMs, which shows that they can make a big impact through the clinical programs they operate, like automatic refill programs. A barrier to taking your drugs is not having the drug. So sometimes they’ll offer 30 day automatic refill programs, 90 day automatic refill programs.
So members have a constant supply of their maintenance medications. So there was one study that showed positive outcomes in, you know, there’s a measure called the medication possession ratio. So it’s kind of like has to do with does the member have the drug? And so the PBM found in this study participants who were in 30 or 90 day programs had better possession ratios than participants who were not in that program.
Levine’s paper estimates that PBMs can save their clients billions of dollars. The hope is that these savings get passed down to the consumers. But it’s unclear how much this goal becomes a reality.
One survey shows that 75 percent of employers who contract directly with PBMs find them to be at least moderately transparent about the savings. And so that means that when they’re doing these contract negotiations, they’re having those honest conversations with the PBM of saying, how much money are you saving me? How much am I seeing of that? Is that trickling down? What does that make my final premium? The premium being what the employer is paying to the PBM. And then the employer decides how much am I charging my employee versus how much am I paying? Levine and his colleagues found that up to 95 percent of rebates can get passed on from the PBM to their client.
Rebates are the discounts negotiated with drug manufacturers. However, just because they can be passed down doesn’t mean they always are. Furthermore, the clients, which are often employers and insurance companies, are able to decide if they want to pass on those savings to us, the consumers, or use the money somewhere else.
That’s out of the PBM’s control because they’re just in the contract with the client who’s saying, you know, maybe the contract’s like the PBM will pass through 95 percent of the rebates with the client. And that’s agreed upon. If the client doesn’t pass all that rebate on to the consumer, that’s not on the PBM to do because the contract is really just with the client, not with the end consumer.
So in an ideal world, the savings would trickle down to make life a little easier for everyone. But that’s not always what we see happen. And though it’s not always the fault of PBMs, they become a main focus for legislators.
Earlier this year, the Federal Trade Commission released a second interim staff report on its ongoing investigation into pharmacy benefit managers. It concludes that the big three PBMs, CVS, Express Scripts, and OptumRx have hiked costs for various lifesaving drugs. They’ve been able to increase revenue while the rest of the industry and consumers have seen a steady increase in drug costs.
In the wake of this report, Levine cautions that it’s important to have both sides of the argument to truly understand what the analysis is showing. I think it’s important to scrutinize and say, was the data analysis done correctly? Is it saying the right things and finding the right thing? So I feel like the FTC investigation is an important topic to be doing and certain in the sense of like understanding how the health system works. Is it being done correctly? I don’t know if I have the authority to say yes or no on that.
I just think that it’s important that we take an objective look, make sure that the full picture is being taken a look at. Still, legislators have been looking to pass laws centered around increasing transparency and PBM reform as a whole. But as some people wonder if we should get rid of this middleman altogether, Levine says that wouldn’t be a magic fix to America’s health care issues.
Well, what does a world without PBMs look like? An employer is going to have to go to Pfizer, go to Eli, go to every drug company and negotiate that contract with them. They’re going to have to process the claim, whether it’s the health plan who does it or maybe the health plan won’t do it. And they’ll be like, well, now I need to find a claims processor and now I need to find someone to help my members stay on drugs.
And so like by taking this one action based on the premise of like PBMs or evil, get rid of them. You’ve now created such disruption in the system. Maybe you’ve just added more cost because now an employer is managing all these different vendors, all these different functions.
So it’s very nuanced. And you just want to make sure you’re not creating a game of whack-a-mole in any of the actions taken. In general, Levine and Fielder agree there needs to be more education around pharmacy benefit managers so that we can make specific and impactful changes to the system.
So I don’t think the PBMs are saints by any stretch of the imagination. They wield a lot of market power and they’re using that to extract more profits than they probably should be able to earn if this market was working better. At the same time, I think they’re actually not responsible for most of the things that people don’t like about their prescription drug coverage.
And so I think we sort of need to hold two ideas in our head at the same time. The PBM market isn’t working as well as we’d like it to. And PBMs are no angels.
But there are also a lot of other problems in how our health insurance system deals with prescription drugs and that are probably actually like bigger contributors to the things that patients really don’t like about how their drug coverage works. And in a world where the title middleman has become somewhat of a negative label, Levine challenges the public to reframe their perspective. Calling them the middleman? Well, yeah, they are the middleman.
But is that a bad thing? Maybe, maybe not. Would you consider like Amazon the middleman? I mean, yes, Amazon is the middleman of your purchasing, right? Like I’m buying a phone charger from them. I’m buying a piece of furniture.
But like, do I want to be going to each individual store and doing that? Maybe not. Like, I like having a marketplace. You can find more information about Matthew Fielder, Eric Levine and all of our guests on our website, RadioHealthJournal.org. For more behind the scenes, follow Radio Health Journal on Facebook, Instagram and X. Our writer-producer is Kristen Farah.
Our production manager is Jason Dickey. I’m Greg Johnson. Radio Health Journal returns in just a moment.
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Research in the journal Science Translational Medicine reveals that harmful bacteria found in the microbiome can travel out of the gut and into surrounding tissues. But it’s not all bad news. The scientists believe this finding brings them one step closer to understanding what triggers and drives these diseases.
Should you be drinking one type of water over all the others? Grocery store shelves are packed with different brands of water, all promoting various advantages, from alkaline to electrolyte beverages. However, scientists say there’s really no benefit of drinking one over the other. Roger Fielding, a professor of biochemical and molecular nutrition, says the enhanced waters have no added metabolic benefit compared to regular water.
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I’m Mayan Vastabetancourt. Do Crohn’s disease or ulcerative colitis symptoms keep coming back? Tremphaya, gaselkomab, may help, with rapid remission achieved at 12 weeks and lasting clinical remission at one year. Some even saw visible improvement of their intestinal lining at 12 weeks and one year.
Tremphaya is a prescription medicine used to treat adults with moderately to severely active Crohn’s disease and adults with moderately to severely active ulcerative colitis. Serious allergic reactions and increased risk of infections and liver problems may occur Before treatment, your doctor should check you for infections and tuberculosis. Tell your doctor if you have an infection, flu-like symptoms, or if you need a vaccine.
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- Ask your doctor about Tremphaya today. Call 1-800-526-7736 to learn more or visit TremphayaRadio.com. Thank you for joining us this week, and every week, as we break down the science stories you need to know. You can find all of our past segments and guests on our website, RadioHealthJournal.org, or wherever you listen to podcasts.
Follow us on Instagram, Facebook, and X for daily content. And tune in next week for another edition of Radio Health Journal.
