July 17, 2025 • 11 mins
Antonio Ciaccia, President of 3 Axis Advisors breaks down who the "Middlemen" are and why drug prices are so inflated!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Speaking of chemistry, pharmaceuticals the big deal, not only because
it's big business and billions and billions of dollars, because
we need it. We need the pharmaceutical industry. Every day
it seems as if there's a new reason to treat
something with something, or a new something to treat whatever
it is you have, and sometimes it's a matter of desperation.
(00:21):
You absolutely have to have something. Being able to afford
or in short or not whatever it is you need
is an important part of being able to live your life.
Antonio Chacha joining us with president. He's the president three
Access Advisors, which has probably the most confusing logo on
the internet, by the way, But I want you to
(00:43):
know I was looking you up. I wanted to see
what what you were about with the company was about,
and I checked my glasses because your logo is kind
of backward and forward at the same time.
Speaker 2 (00:54):
Yeah, we tend to look at things differently, and we
are an atypical consultant in this world of drug pricing
where lies rule the day. We look under the hood
and try to find where drug pricing reality exists.
Speaker 1 (01:10):
Are we dealing when it comes to the cost of
these prescriptions and this Ohio Senate Bill two seventy six.
Are we dealing with lies? Are just are we dealing
with a bloated infrastructure that just creates profit at five
hundred different levels before it gets to you.
Speaker 2 (01:26):
Well, you're definitely right on the ladder. For those that
are unfamiliar, I've talked about on this program before, in
the United States, we have bogus inflated drug prices and
that should come to st shock, right. We've seen the
headlines for years that the costs of medicines continue to
go up. President Trump recently announced that he was trying
(01:48):
to lecture the pharmaceutical company saying, get your prices in
line with other countries across the nation. And so the
question is why do we have such dysfunctional pricing in
the United States whereas other countries do not. The simple
answer is often that the other countries use socialism and
(02:09):
they go to drug companies and they say this is
going to be the price. Deal with it. It's not
always that simple. In the US. We have an addiction
to discounting that other countries do not have. And what
I mean by that is is the price in the
US that the drug companies set isn't the price, it
(02:31):
is the starting point for a series of rebates in
discounts that, according to Drug Channels Institute, is worth three
hundred and fifty six billion dollars. So let me say
that again. Underneath the bloated list prices of medicines in
the United States, there are three hundred and fifty six
billion dollars of discounts that drug companies are rolling off
(02:55):
the top. So the question then is when you're up
at the pharmacy counter or your employer is helping to
contribute to buy those medicines or the Medicaid program or
Medicare program of buying those medicines on our behalf, your
access to that three hundred and fifty six billion dollars
pot of money will be the difference between overpaying and
(03:16):
getting a much better deal in the US.
Speaker 1 (03:19):
Now, let me ask you, Antonio, is that money going
into the pockets? Is that money going into when you
got those you know, if you can't afford your medication,
spizer may be able to help. Are they using it
to fund that stuff? Is it paying for things like GoodRx?
Is Is it doing anything positive and productive or is
it just disappearing into corporate pockets?
Speaker 2 (03:40):
So both are true, right, So we use bogus inflated
drug prices and the rebates that roll off the top
to fund our Medicaid programs. We have something called the
Medicaid Drug Rebate Program, where Medicaid programs, which provide healthcare
to the poorest in every state, we use rebates to
help fund those programs. We use rebates to fund lower
(04:04):
premiums for our employers, so some of those drug maker
rebates go back to our employers. They also go to
members of the supply chain. For profits, we use rebates
to fund infrastructure. At the federal government, the rebates are
used as this giant flush fund right that in many
ways can help drug affordability, but in other ways can
(04:27):
be reappropriated and essentially arbitraged, meaning by low sell high
pocketed difference. Don't tell anybody anything about it. We see
this happening across the marketplace. There's a little program called
the three point forty B program, which is really boring,
I understand, but it's literally taking drug maker rebates and
(04:48):
then giving them the hospitals in federally qualified health centers,
with the idea being that those added that those discounted
drugs could be sold at massive markups, and the margin
or profits that are generated from those transactions can be
used to provide other health care services to patients who
can't otherwise afford their medicine. If you're listening to this,
(05:10):
I said a bunch of things that sound not too bad, right.
We're using these discounts to fund Medicaid, to provide health
care services to those who can't otherwise afford them. But
there is a reality that in order to create those discounts,
somebody has to overpay for their medicines. We have to
have inflated prices in order to generate the discounts that
(05:33):
are providing those values, and that back end rebate those discounts. Right.
Those are all opportunities for a litany of intermediaries and
middlemen in the supply chain to put their hands in
that three hundred and fifty six billion dollar cookie jar
and leave the end consumer with a bloated tab at
(05:54):
the pharmacy counter.
Speaker 1 (05:55):
This is Antonio Chachi, president of three Access Advisors, essentially
a heal health care advocacy, advocacy and action organization here,
and what you're saying, as I'm trying to listen very closely,
it seems to be not only about prescription medication. This
is a problem for us on many different levels in
(06:17):
this country where essentially it's about the show, not about
the go. We need to show this money so we
can show this funding when essentially, if you just cut
the crap, everything would cost less, is what it comes
down to. But we have to show this money coming
in from you know, these charges in order to show
(06:38):
ourselves funding these various programs of benevolence towards people. And
it's it's kind of artificial, it's it's a lot of
flash and.
Speaker 2 (06:46):
Smoke, absolutely, and it creates a serious problem of winners
and losers. Right, So let's go back to the medicaid programs.
In three forty b by federal law, those programs are
supposed to get the biggest discounts off medicines. That sounds great, right,
who doesn't want the best discounts. Well, unfortunately, whenever somebody
(07:09):
gets the best price, everybody else is getting a worst price.
So if our addiction to discounts essentially insulates manufacturers from
having to compete on lowering their prices, like everything else
in the rest of the market, where buyers and sellers compete,
ultimately for sales, and in doing so, the sellers have
(07:31):
to compete by either increasing quality or lowering the price.
That doesn't happen in the drug industry because of exemptions
to federal anti kickback laws and this addiction to discounting.
So you have drugs like insulin, as an example, which
over the last few decades up until twenty twenty four,
where skyrocketing and their list prices over time, you had
(07:51):
drugs that had gone from essentially very affordable to hundreds
of dollars per file. Well, if you look under the
hood of those list prices is what you found is
that the actual discounts on those drugs were increasing faster
than the actual list prices of those drugs. That's a
fancy way of saying that while the list prices were
(08:12):
going up, the actual cost, the amount that the manufacturers
were bringing in, was actually going down. The problem became
is that those who were reliant on insulin were walking
up to the pharmacy counter often and seeing the fake
price and not the real price. And so you had
influence that diabetic patients that were rationally their insulin largely
(08:36):
because of this distorted environment that exposed them to inflated
prices without any benefit of the discounts and toty.
Speaker 1 (08:45):
Let me ask you. I know our time is limited here,
and I'm sorry to say that because I have a
feeling you and I could go a couple hours. What
about the end of the course, middleman, And I'm speaking
largely of the hospitals. The two hundred dollars aspirin, the
eighty dollars alcohol swab, this stuff like that. Does this
Senate they'll do anything to address that? Or is it
(09:06):
all more at the corporate distribution and creation levels.
Speaker 2 (09:11):
No. Essentially, what lawmakers have been trying to do is
to say, look, we think that this the value of
these discounts is really good, and we want to keep
expanding a hospital's access to those discounts. But again, under
the three P four EB program, the entire premises is
(09:32):
that we provide deeply discounted drugs to hospitals and FQHCs
and people that we want to support. Right, But the
idea is that they get those drugs at a massive discount,
sell them at a massive markup, and then pocket the
difference with the hope that they spend those dollars on
something that is also a value, and there's controversy as
to whether or not they're reinvesting those dollars as they're
(09:53):
supposed to.
Speaker 1 (09:54):
Well, yeah, but the hospitals are showing tens of millions
of dollars in profit every year. These healthcare sitt systems
as that they've become, are you know, in my opinion,
at least just as offensive as the middleman at the
corporate creation pharmaceutical level.
Speaker 2 (10:10):
Yeah. So it's not too dissimilar from what pharmacy benefit
managers or PBMs have been doing in the marketplace as well,
which is, again, buy a medicine very low, sell it
very high, and pockets a difference. Years ago here in
Ohio they found that that was worth two hundred and
forty five million dollars in just one year of our
Medicaid program, where PBMs were engaged in a practice called
(10:31):
spread pricing. I know this is going to be complicated
for the listener because we've gone through acronyms and numbers,
et cetera. The underlying thing to remember is that in
a world of floated and bogus inflated prices, maximizing your
exposure to discounts as the end payer, is going to
be integral to ensure that you're able to afford those medicines.
(10:53):
All of these things that we're talking about, whether it's PBM,
spread pricing, three forty B markups, all of those things,
those are intended to compromise that access to discounting, and
it ends up costing our system in the patients who
need those medicines more. And even if those discounts can
be used for good, at the end of the day,
(11:14):
we're still left with increasingly bloated prices and greater risk
profile in terms of accessing those medicines affordably.
Speaking of chemistry, pharmaceuticals the big deal, not only because
it's big business and billions and billions of dollars, because
we need it. We need the pharmaceutical industry. Every day
it seems as if there's a new reason to treat
something with something, or a new something to treat whatever
it is you have, and sometimes it's a matter of desperation.
(00:21):
You absolutely have to have something. Being able to afford
or in short or not whatever it is you need
is an important part of being able to live your life.
Antonio Chacha joining us with president. He's the president three
Access Advisors, which has probably the most confusing logo on
the internet, by the way, But I want you to
(00:43):
know I was looking you up. I wanted to see
what what you were about with the company was about,
and I checked my glasses because your logo is kind
of backward and forward at the same time.
Speaker 2 (00:54):
Yeah, we tend to look at things differently, and we
are an atypical consultant in this world of drug pricing
where lies rule the day. We look under the hood
and try to find where drug pricing reality exists.
Speaker 1 (01:10):
Are we dealing when it comes to the cost of
these prescriptions and this Ohio Senate Bill two seventy six.
Are we dealing with lies? Are just are we dealing
with a bloated infrastructure that just creates profit at five
hundred different levels before it gets to you.
Speaker 2 (01:26):
Well, you're definitely right on the ladder. For those that
are unfamiliar, I've talked about on this program before, in
the United States, we have bogus inflated drug prices and
that should come to st shock, right. We've seen the
headlines for years that the costs of medicines continue to
go up. President Trump recently announced that he was trying
(01:48):
to lecture the pharmaceutical company saying, get your prices in
line with other countries across the nation. And so the
question is why do we have such dysfunctional pricing in
the United States whereas other countries do not. The simple
answer is often that the other countries use socialism and
(02:09):
they go to drug companies and they say this is
going to be the price. Deal with it. It's not
always that simple. In the US. We have an addiction
to discounting that other countries do not have. And what
I mean by that is is the price in the
US that the drug companies set isn't the price, it
(02:31):
is the starting point for a series of rebates in
discounts that, according to Drug Channels Institute, is worth three
hundred and fifty six billion dollars. So let me say
that again. Underneath the bloated list prices of medicines in
the United States, there are three hundred and fifty six
billion dollars of discounts that drug companies are rolling off
(02:55):
the top. So the question then is when you're up
at the pharmacy counter or your employer is helping to
contribute to buy those medicines or the Medicaid program or
Medicare program of buying those medicines on our behalf, your
access to that three hundred and fifty six billion dollars
pot of money will be the difference between overpaying and
(03:16):
getting a much better deal in the US.
Speaker 1 (03:19):
Now, let me ask you, Antonio, is that money going
into the pockets? Is that money going into when you
got those you know, if you can't afford your medication,
spizer may be able to help. Are they using it
to fund that stuff? Is it paying for things like GoodRx?
Is Is it doing anything positive and productive or is
it just disappearing into corporate pockets?
Speaker 2 (03:40):
So both are true, right, So we use bogus inflated
drug prices and the rebates that roll off the top
to fund our Medicaid programs. We have something called the
Medicaid Drug Rebate Program, where Medicaid programs, which provide healthcare
to the poorest in every state, we use rebates to
help fund those programs. We use rebates to fund lower
(04:04):
premiums for our employers, so some of those drug maker
rebates go back to our employers. They also go to
members of the supply chain. For profits, we use rebates
to fund infrastructure. At the federal government, the rebates are
used as this giant flush fund right that in many
ways can help drug affordability, but in other ways can
(04:27):
be reappropriated and essentially arbitraged, meaning by low sell high
pocketed difference. Don't tell anybody anything about it. We see
this happening across the marketplace. There's a little program called
the three point forty B program, which is really boring,
I understand, but it's literally taking drug maker rebates and
(04:48):
then giving them the hospitals in federally qualified health centers,
with the idea being that those added that those discounted
drugs could be sold at massive markups, and the margin
or profits that are generated from those transactions can be
used to provide other health care services to patients who
can't otherwise afford their medicine. If you're listening to this,
(05:10):
I said a bunch of things that sound not too bad, right.
We're using these discounts to fund Medicaid, to provide health
care services to those who can't otherwise afford them. But
there is a reality that in order to create those discounts,
somebody has to overpay for their medicines. We have to
have inflated prices in order to generate the discounts that
(05:33):
are providing those values, and that back end rebate those discounts. Right.
Those are all opportunities for a litany of intermediaries and
middlemen in the supply chain to put their hands in
that three hundred and fifty six billion dollar cookie jar
and leave the end consumer with a bloated tab at
(05:54):
the pharmacy counter.
Speaker 1 (05:55):
This is Antonio Chachi, president of three Access Advisors, essentially
a heal health care advocacy, advocacy and action organization here,
and what you're saying, as I'm trying to listen very closely,
it seems to be not only about prescription medication. This
is a problem for us on many different levels in
(06:17):
this country where essentially it's about the show, not about
the go. We need to show this money so we
can show this funding when essentially, if you just cut
the crap, everything would cost less, is what it comes
down to. But we have to show this money coming
in from you know, these charges in order to show
(06:38):
ourselves funding these various programs of benevolence towards people. And
it's it's kind of artificial, it's it's a lot of
flash and.
Speaker 2 (06:46):
Smoke, absolutely, and it creates a serious problem of winners
and losers. Right, So let's go back to the medicaid programs.
In three forty b by federal law, those programs are
supposed to get the biggest discounts off medicines. That sounds great, right,
who doesn't want the best discounts. Well, unfortunately, whenever somebody
(07:09):
gets the best price, everybody else is getting a worst price.
So if our addiction to discounts essentially insulates manufacturers from
having to compete on lowering their prices, like everything else
in the rest of the market, where buyers and sellers compete,
ultimately for sales, and in doing so, the sellers have
(07:31):
to compete by either increasing quality or lowering the price.
That doesn't happen in the drug industry because of exemptions
to federal anti kickback laws and this addiction to discounting.
So you have drugs like insulin, as an example, which
over the last few decades up until twenty twenty four,
where skyrocketing and their list prices over time, you had
(07:51):
drugs that had gone from essentially very affordable to hundreds
of dollars per file. Well, if you look under the
hood of those list prices is what you found is
that the actual discounts on those drugs were increasing faster
than the actual list prices of those drugs. That's a
fancy way of saying that while the list prices were
(08:12):
going up, the actual cost, the amount that the manufacturers
were bringing in, was actually going down. The problem became
is that those who were reliant on insulin were walking
up to the pharmacy counter often and seeing the fake
price and not the real price. And so you had
influence that diabetic patients that were rationally their insulin largely
(08:36):
because of this distorted environment that exposed them to inflated
prices without any benefit of the discounts and toty.
Speaker 1 (08:45):
Let me ask you. I know our time is limited here,
and I'm sorry to say that because I have a
feeling you and I could go a couple hours. What
about the end of the course, middleman, And I'm speaking
largely of the hospitals. The two hundred dollars aspirin, the
eighty dollars alcohol swab, this stuff like that. Does this
Senate they'll do anything to address that? Or is it
(09:06):
all more at the corporate distribution and creation levels.
Speaker 2 (09:11):
No. Essentially, what lawmakers have been trying to do is
to say, look, we think that this the value of
these discounts is really good, and we want to keep
expanding a hospital's access to those discounts. But again, under
the three P four EB program, the entire premises is
(09:32):
that we provide deeply discounted drugs to hospitals and FQHCs
and people that we want to support. Right, But the
idea is that they get those drugs at a massive discount,
sell them at a massive markup, and then pocket the
difference with the hope that they spend those dollars on
something that is also a value, and there's controversy as
to whether or not they're reinvesting those dollars as they're
(09:53):
supposed to.
Speaker 1 (09:54):
Well, yeah, but the hospitals are showing tens of millions
of dollars in profit every year. These healthcare sitt systems
as that they've become, are you know, in my opinion,
at least just as offensive as the middleman at the
corporate creation pharmaceutical level.
Speaker 2 (10:10):
Yeah. So it's not too dissimilar from what pharmacy benefit
managers or PBMs have been doing in the marketplace as well,
which is, again, buy a medicine very low, sell it
very high, and pockets a difference. Years ago here in
Ohio they found that that was worth two hundred and
forty five million dollars in just one year of our
Medicaid program, where PBMs were engaged in a practice called
(10:31):
spread pricing. I know this is going to be complicated
for the listener because we've gone through acronyms and numbers,
et cetera. The underlying thing to remember is that in
a world of floated and bogus inflated prices, maximizing your
exposure to discounts as the end payer, is going to
be integral to ensure that you're able to afford those medicines.
(10:53):
All of these things that we're talking about, whether it's PBM,
spread pricing, three forty B markups, all of those things,
those are intended to compromise that access to discounting, and
it ends up costing our system in the patients who
need those medicines more. And even if those discounts can
be used for good, at the end of the day,
(11:14):
we're still left with increasingly bloated prices and greater risk
profile in terms of accessing those medicines affordably.
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