PBM Reform: Bringing Clarity Back to Healthcare
Pharmacy Benefit Managers (PBMs) have enormous control over drug pricing, medication access, and pharmacy reimbursements. At Modern Medical Mafia, we believe healthcare should be transparent, fair, and accountable. Our mission is to expose how the current PBM system operates — and to promote models that prioritize patients, community pharmacies, and honest pricing.
What Is a PBM?
A Pharmacy Benefit Manager is a third-party administrator hired by insurers and employers to manage drug benefits. PBMs decide which medications are covered, what patients pay, which pharmacies can dispense drugs, and how pharmacies are reimbursed. What began as a tool for efficiency has grown into a complex system that often lacks transparency.
Problems with the Current PBM System
∙ Hidden Pricing: Patients and pharmacies rarely see how medication prices are determined — discounts, rebates, and spreads are opaque.
∙ Unfair Pharmacy Reimbursements: Many independent pharmacies struggle because reimbursements can be unpredictable and retroactive.
∙ Formularies Driven by Rebates, Not Care: Drug coverage decisions often prioritize financial incentives over what’s best for patients.
∙ Patient Uncertainty: Copays, availability, and coverage can change without notice, making it difficult for patients to know what they’ll pay or even if they’ll get their medication.
Why PBM Reform Matters
A reformed system can mean:
∙ Medication prices that patients and employers can trust
∙ Support for local independent pharmacies.
∙ Transparent billing and reimbursement practices
∙ More predictable and affordable drug access
∙ A healthcare system built on honesty, not corporate profit
About Modern Medical Mafia
Modern Medical Mafia is more than a docuseries; it’s a movement built by patients, pharmacists, and advocates who’ve seen the damage caused by opaque PBM practices.
modernmedicalmafia.com
We’re working to expose the truth, educate the public, and push for reform, because everyone deserves clear, fair access to medication. We share stories from families, pharmacists, and advocates who saw the truth.
Exposing Censorship in Healthcare:
A Must-Watch Interview on Silencing the Truth
DANIEL G. STRAUSE
The Auditor for Patients
Dan, a former public accountant, spent years performing audits to protect the public interest by verifying not only numbers but the truth behind them. For over 22 years, he’s partnered with independent pharmacies, witnessing firsthand how PBMs manipulate prices, mislead employers, and hurt patients.
After meeting Bil and Shanon, Dan saw how one family’s tragedy embodied a national crisis and realized his auditor’s skills were urgently needed in a broken health care system.
BIL SCHMIDTKNECHT
A Father’s Promise
Bil lost his son, Cole, to PBM formulary manipulation that made his life-saving asthma inhaler unaffordable. Cole suffered a severe asthma attack, cardiac arrest, and irreversible brain damage, forcing his parents to make the unthinkable decision days later.
The same insurance that failed Cole nearly failed Bil, who also suffers from asthma. Only the persistence of a local hometown pharmacist, who absorbed financial loss to help Bil prevented another tragedy. That pharmacist connected Bil and his wife, Shanon, with Dan Strause, beginning a mission that would change lives.
