What happens when the prescription drug pricing system becomes so complicated that employers, patients, and pharmacists struggle to determine where the money goes?

In this special edition of the PBM Reform Podcast, host Greg Reybold welcomes nationally recognized drug pricing expert Antonio Ciaccia for an unfiltered conversation about pharmacy benefit managers (PBMs), hidden financial incentives, and the growing movement toward meaningful reform.

Ciaccia has spent years investigating the economics of prescription drug distribution, helping uncover hundreds of millions of dollars in questionable Medicaid drug spending and exposing the financial mechanisms behind inflated drug prices.

His latest work with 3 Axis Advisors raises important questions about whether conventional PBM contracts deliver the savings they promise.

An October 2026 analysis compares Mark Cuban Cost Plus Drug Company's published prices with traditional PBM pricing arrangements. Another June 2026 report examines how retrospective rebates, pricing benchmarks, and administrative arrangements create financial risks for employers and health plans.

Ciaccia has also described three forces capable of driving PBM reform: legislation, litigation, and market-based competition.

As he told Drug Topics, borrowing a familiar expression from Greg Reybold: “Pressure busts pipes.”

• Why PBM pricing transparency remains essential for employers, patients, and pharmacies.
• What recent drug pricing research reveals about hidden costs and contractual complexity.
• How cost-plus pharmacy models challenge traditional PBM economics.
• Why independent pharmacies continue facing reimbursement and cash-flow pressures.
• Whether federal reform and marketplace competition can produce lasting accountability.
• How pharmacists, employers, and policymakers can demand measurable results.

The future of pharmacy benefits depends on more than promises of reform. It demands transparency, accountability, and evidence that savings actually reach the people paying for healthcare.

Join Greg Reybold and Antonio Ciaccia as they follow the money and examine what's next for PBM reform.

A patient's copay unexpectedly jumped to nearly $500. Upon investigation, it was discovered his plan design had changed, penalizing him for using our pharmacy. He was now facing higher costs or needing to switch to a chain or mail-order pharmacy.

This is part one of a two part conversation with Terry Wilcox, Co-Founder and CEO of Patients Rising. Find out what Patients Rising is doing for advocacy and change to better our patients by visiting https://www.patientsrising.org/about-patients-rising