Dr Chalmers Path to Pro - Why Insurance Companies Want You on Drugs
Many people don’t realize how closely tied insurance companies are to the prescription drug business. By working with Pharmacy Benefit Managers (PBMs), they’re able to buy medications at large discounts and still profit creating a setup where there's little reason to cut back on prescriptions.
This system often leaves patients stuck in a cycle of taking more medications to manage side effects from others, while costs quietly rise for employers and the government. It sheds light on why staying healthy can feel like an uphill battle and why the system seems built to keep people dependent rather than well.
Highlights of the Podcast
00:03 - Why Insurance Companies Want You on Drugs
00:45 - The Role of Pharmacy Benefit Managers (PBMs)
02:51 - How the Costs Are Passed to Employers
04:16 - The Profit Motive Behind Drug Prescriptions
06:02 - The Cycle of Symptom-Driven Medication
08:57 - Functional Medicine as an Alternative
10:11 - Insurance Plans and HSAs
12:49 - The Long-Term Payoff of Healthy Habits
Dr. Matt Chalmers [00:00:03] So, I got a question. Why is it that I think that pharmaceutical companies are wanting everybody on meds, wouldn't the insurance companies do whatever they could to reduce costs and prevent people from being on medications and promote doctors who keep people off expensive medications and things like that? The answer is 100% no. So it's a little bit, it's little bit complicated. So let's walk back through what's actually going on. So. Uh what happened a while ago was that a middleman was created between the pharmaceuticals and the insurance companies these companies were called pharmacy benefit managers or pbms uh and the idea was that the pbm would negotiate between the pharmaceutical companies and the entrance companies and of PBMs would buy the medications. From the pharmaceutical companies and then sell them they'd get a deep discount because they're buying in bulk and then they'd sell them through pharmacies and the insurance companies would pay the pvms or the probably the pharmacy benefit managers well it didn't take very long for the insurance company to figure out that was a fantastic business model and the insurance companies literally bought or created their own pharmacy benefit managers and so what ends up happening is the insurance companies.
Dr. Matt Chalmers [00:01:20] Go to the pharmaceutical companies and they go look we're going to buy you know a billion dollars worth of drugs from you this year and they want a 40 50 60 percent discount otherwise you're going buy them from somebody else and so what ends up happening is the pharmaceutical makers go all right fine so they sell these drugs at this giant discount to the insurance company's pharmacy benefit manager company then what ends of happening is the insurance companies. Go to the doctors and they say, look, if you want these things covered on insurance, you're going to prescribe these drugs. And so if you don't prescribe these drugs, the drugs that you do prescribe will not be covered on insurance, your patients will be mad. And the doctors go, fine, whatever, drug A, drug B, they're basically the same. They both work. I'll use whatever drug you tell me is going to be covered by insurance. All right, cool. Well, then what happens is is the insurance company. Then pays the insurance company for the drugs that they're making. And so now all of a sudden, the the insurance company is making a 30 to 50 percent profit off all the medications that are sold. Then what happens is because of that, that dynamic and people are like, well they never just make insurance more expensive and no one would buy insurance. That's right. You don't buy insurance though. The vast majority of people, either the government pays for your insurance or the company you work for pays for your insurance.
Dr. Matt Chalmers [00:02:51] So most people don't pay for insurance, which is why when people do pay for insurance, they find out it's extremely expensive and they complain. But what ends up happening is at the companies, the insurance goes to them, they go, look, you know, we had to pay for all these different things and costs went up and these are how much the medications are. And so your premiums are now 30% more. And if you want to have offer insurance to your employees, this is what it's going to cost. So what ends up happening is that the insurance companies are getting paid higher premiums by the companies that everybody works for, and then what they're doing is they're buying drugs cheap, and then selling those drugs back to you on insurance, and they're telling the doctors that they can only prescribe the drugs the insurance company has purchased. So what is happening is that insurance companies not only want drugs prescribed, they want lots of drugs prescribed, and they want the most expensive drugs that they can get, they can get bigger discounts on prescribed. So what ends up happening is that. When you get prescribed a drug, that drug makes the insurance company money. Then the insurance committee goes to your employer, to the government goes, oh, I don't know what to tell you, but drug costs are up and, you know, as costs go up, we're gonna pass them on to you. So your insurance rates are now 20, 30% higher. Everyone goes, well, crap. I mean, prices go up. I get it.
Dr. Matt Chalmers [00:04:16] All right, so we'll pay more premiums. It's what ends up happening is that the insurance community makes money on your premiums, then it sells the drugs to you and makes money off the drugs and that's kind of how the insurance companies are making money both on the pharmaceuticals and on the fact that they know you're going to have to take pharmaceuticals. So they sell you the ability to get pharmaceuticals at a discounted price then they buy the pharmaceutical and then they sell them back to you at an inflated price and you're like hey we're gonna give you 20% off this medication that we bought for 50% off. So they're still making a 30 margin, even though you've got insurance. So, you know, well done. This is actually one of the bigger issues that's going on with medicine right now, is that the goal of the insurance company should be to save money. And it is. And so what they did was they bought the third party that negotiates for drugs. Now they not only saved money on the drugs, but they're now making money on drugs. So, there is zero, zero benefit to the insurance companies if you get off drugs. In fact, there's a much higher incentive for the insurance company for you to be on drugs. And so, what do they do? They make sure that you take all the different medication. Oh, you know, we're going to go ahead with the lie that cholesterol causes heart attack. And so you need to be on a statin. Oh, statin drugs block all your hormone production, all your ATP production, they radically reduce energy, they create joint pain, they create mental confusion, they create erectile dysfunction, all these things. But don't worry because as your energy goes down, the pharmaceutical companies make a drug that, a bunch of drugs that increase energy. Cool.
Dr. Matt Chalmers [00:06:02] So what happens is the interns companies find a couple of they like they're gonna make big margins on And they tell the doctors they can only prescribe those so the doctor does but then what happens all this energy came up Well, how did you get this energy? You're pushing the body harder and it should be so what happens? We see blood pressure readings go up, but don't worry. They've got drugs for blood pressure Okay, and so but and aren't you glad you've got your insurance to pay for your statin drugs and your your your energy drugs And then your blood pressure drugs and you know that creates, you know Joint pain so we're taking all your air your insides and all your anti-inflammatories and that creates secondary problems And so now you're on four or five different medications and you're like well You know, I guess I have to be on these because the insurance company wouldn't pay for it unless I totally needed it But they're making money off of the drugs that you're taking and so everyone's making money off the drugs you're, taking besides you And so what ends up happening is that you get more and more sick and you pay more and more for the drugs that are keeping you sick. And everybody else in the equation, the docs, the hospitals, the pharmaceutical companies, and the insurance companies make tons of money off of you being sick. So when I talk about the system is trying to keep you sick, this is the system I'm talking about. And then how is this all legal? Well, you know, that's easy the pharmaceutical companies the insurance companies have lobbyists Who pay the politicians to make sure this whole thing stays legal? That's how it is.
Dr. Matt Chalmers [00:07:33] It's also called fascism When private enterprise and government collude together against the citizens, that is fascism. And so that's where we're at and so At the end of the day when we have started looking at the medical model We start looking at all the pharmaceuticals people are on and the general health of the populace. And then we're spending way more money than we've ever spent in insurance companies. And pharmaceutical companies are proposing record profits. We're also posting the worst health care outcomes ever in history for a developed nation. This is where we're at. This is why these things happen. And the sicker you get, what do you do? You go to the doctor and you go, give me a pill to make me feel better. And they go, here's a pill to make you feel better, it'll make your blood pressure high. We'll give you a drug for that, but that's going to make your erectile dysfunction issues. So we'll give me a drug. For that, that's gonna make you depressed. So I'll give you a drag for that. That's how it works. None of these things are based off physiology function. None of the things are based off of what your body needs to actually function. That's why you get worse and worse and worst and take more and more and more pills. And you hear these stories about people who decided to just go, screw it. I'm done with the medical model. I'm going to go see somebody like me or somebody who like is a nutritionist or someone who like puts the body back together from a physiological standpoint. They get them off all the medications. They change your diet. They work on their hormones. They work in their sleep and they work on their diet.
Dr. Matt Chalmers [00:08:57] All of a sudden these people go, I've off all my drugs. I've lost all this weight. I feel amazing. It's because I changed my diet started exercising and got off the medications. And so that's kind of where you're at. So what I would recommend, and take a look at all your stuff, work with your insurance specialist to figure all this stuff out. But I would look at doing a higher deductible, and everything depends upon what you and your family need, if you've got special needs or whatever. Bye. Obviously, all these things are different. The goal that I would look at, though, is finding a higher deductible plan with an HSA, a Health Savings Account. So you can spend that money anywhere, here or any other office, any functional medicine place, and figure out your health. The path that I have found most successful for people is to do, we have three month plans. And we bring people in and like, look, I'm going to teach you how to be healthy. I'm going to teach you how what foods you need to eat for your body. I'm gonna teach you what your hormones need to be. I'ma teach you to decrease your stress. We're gonna work on mindset and mind work steps. We do a holistic plan to get everybody kind of back where they need to be. So we talked about what we would I do what people like me do versus what the system does. This is what we're talking about.
Dr. Matt Chalmers [00:10:11] So Again, your doctors are doing the very best they can with the education they've got and the tools they have available to them and then the structure of what they are legally allowed to do and what prescriptions they have to write. Like if you wanna have blood pressure med, there's 20 of them out there, but these four are covered by insurance. So you're gonna write something that's, you know, $200 a month or $10 a month, right? And so that's how a lot of the doctor offices operate. So the doctors are doin' the very best they could to save you money, make you healthier, do all the things. The problem is that the entire system is set up to keep you as sick as possible on as many pharmaceuticals as possible so that the insurance company, the pharmaceutical companies, and the hospitals can make as much as they possibly can. So that's where it is. And, you know... Good, bad, or indifferent, that's how the system has developed and that's where it's at. So if you want to get off of that cycle, if you want to go off the cycle of being a guinea pig, being a whatever, taking all the medications and making everybody rich while destroying your finances and your health, that your call. Knock it out. Have a great time. If you're looking for something else, I would start looking for functional medicine docs, work with guys like me.
Dr. Matt Chalmers [00:11:26] A lot of people just come in and pay me just to quarterback their care. Take a look at my neuro stuff, my cardiac stuff, my hormone stuff, my sleep stuff, my dietary stuff, my exercise stuff. Make sure everything's kind of where it's supposed to be. And if you want a good quarterback, I would find somebody who does that. That is one of those big things. It's funny, speaking of health and fitness and that type of thing, I've got a bunch of guys coming in, wealthier guys coming and they just want to get in shape. Because what they found out is you can buy a for anyone can buy a Ferrari or Lamborghini, anyone can, you know, take big vacations, but not everybody can be jacked. And so that's the new thing. Instead of you know buying the $50,000 watch or the $250,000 car, they're like, I want to be I want to be jack like that's the thing because you can't buy that you have to build that. And that's what's kind of being healthy and being in good shape is now becoming more and more popular. If you look at some of the top CEOs besides Musk, look at Bezos, look at Zuckerberg, look those guys 10 years ago versus today. They've all gotten in shape because you can't buy, you can steal, and you can beg for a nice body. You've got to build it. So that's kind an interesting piece as well. You know, just kind of take a look at where you're at. Take a look where you are going, you and your family, and figure out where you want to go and what path you want a walk.
Dr. Matt Chalmers [00:12:49] The path of being healthy and being in shape and that sort of thing is a little bit more difficult to start because you have to change some habits and you got to start actively doing some stuff. But it's going to be substantially cheaper and it's gonna increase massively bigger quality of life and longevity of life. So it's kind of what you want. That's the answer to the question of why is it that insurance companies aren't doing more to reduce the amount of drugs or the cost of drugs being sold is because they're the ones profiting off of medications.
Dr. Matt Chalmers [00:13:23] So if you guys have any other questions, just have questions at chalmerswellness.com. Go ahead and look up pharmacy benefit managers, pbns. Google some of that, do some research on that. It is I mean, it's not bright and sunny, but it will give you a lot of information about why it is the system set up the way it is. And I'll give you little bit more indication on why I keep saying that the system is built off of keeping you sick so that they can make more money. That's just it if you if you're like, oh I knew that go ahead and read the pvm stuff Go into the look into that because when you talk to people about it This is one of those things that you know the big piece of information people don't know Is that their insurance company makes more money off selling you drugs than it does off of the premiums? And you think that the insurance companies want you off the drugs, okay. All right. Well, let's just take a look at it Anyway, thanks for your time. You guys have a fabulous day and uh talk to you later
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