“PBMs, to me, they are like the appendix of the healthcare system. At one point in time, they might have served some purpose, but it was so long ago that people can't remember what the heck it was. And turns out when you remove them from the equation, software can do exactly what they would have done historically…”
Invest Like the Best (Patrick O'Shaughnessy) · Money & Markets · November 2026
Context
Asked for an example of healthcare working when the patient is the customer, Zach Reitano points to cash-pay GLP-1s sold directly by drugmakers. His claim is that cutting out pharmacy benefit managers lowers prices while manufacturers still earn more.
Transcript
…of our expenses. And we pay through our taxes and we play through suppressed wages with our employer. And so you then look and say, okay, well, where is healthcare working? Where does it feel really good? And it feels really good where it's cash pay, where the patient is the customer. Do you
have a favorite example of that?
…they go up six, seven, eight percent year over year over year. And so the patent cliff, my hope, and I think you're already starting to see this, more middlemen that do absolutely nothing are getting removed from the process. So they are able to capture the same, if not more, gross profit while prices come down. If you look at Lily's earnings, prices come down, volume far outstrips it. And PBMs, to me, they are like the appendix of the healthcare system. At one point in time, they might have served some purpose, but it was so long ago that people can't remember what the heck it was. And turns out when you remove them from the equation, software can do exactly what they would have done historically. And so you even see with GLP1s, PBM goes away, insurance company largely goes away. People can debate that and whether or not it should and what they should cover. But for cash pay purposes, PBMs and insurance companies go away. Prices go from $1,300 to $149. And the people making the drugs are making more money. And so you can see that where it's working, the patient is in control and ethic.…
love to use Roe as just a great example since you know all the data like the back of your hand. Give us a sense of the lineup of products right now and what the pie chart looks like today. What percent are they spending on each of the majority?
Yeah, I have to. So we have four main categories. Roe is the leading provider of GLP1s in the country. Cardiometabolic Health is a number one category, then sexual health, dermatology, and fertility. And the fastest growing part of the business is GLP1s. And oftentimes people will say, as this has…
So I actually would love to spend a few minutes on each of the four driving leading categories, obviously starting with GLP1s. Why have you been so effective? What has made you the leader? Why don't people just go to these new direct services that the ARMA companies have? What is it about Roe that…
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