Ben Gilbert: belief

Transcript context

…We're talking about a six-sided market. I don't think it's a sided market. There are two good diagrams that I'd found in the research that we'll put on the acquired twitter account and the threads account to get access to these visuals that I think are pretty good illustrations of the way the dollars flow and the way the product flows. You can imagine when there are this many middlemen in a transaction, it's really hard to have a functioning market to actually interpret demand signals and have them clearly flow all the way upstream and for the end consumer to really be treated as the customer versus just a statistic in a large aggregated basket. We've lost the plot in being able to actually have a functioning free market. Anyway, I want to do a little dive into each of the parties to understand what they do. The drug manufacturers like Novo Nordisk do all the R&D, and they do all the production. They also own the responsibility of the clinical trial. They work with partners to do this, but proving that the drug is safe and efficacious is up to them. There's the distributor wholesaler that does exactly what you think they do. They buy all the drugs from all the pharma manufacturers. They warehouse and distribute them. They actually do take risk. When I say they buy, they actually do buy them and hold them. They end up distributing them to the pharmacies. Pharmacies do exactly what you think they do. Those companies have gotten merged into PBMs in some cases. Thinking of CVS as just CVS is not really right anymore. It's CVS Caremark, so they're with PBM. There's the Walgreens Boots Alliance, which the way they named it is all you need to know. The way to think about pharmacies is that there are a few big ones and that is what matters, even though there are many people interested in keeping a thriving, independent set of pharmacies out there. Then there's the PBM. Why does the PBM exist, the Pharmacy Benefits Manager? That's a good question.…

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