captioning sponsored by wnet >> sreenivasan: on this ed for saturday, august 11: in our signature segment, how pharmaceutical middlemen could impact how much you pay forcr presiption medication. and charlottesville, one year later. next, on pbs newshour weekend. >> pbs newshour weekend is made possible by: bernard and irene schwartz. sue and edgar wachenheim iii. the cheryl and philip milstein family. dr. p. roy vagelos and diana t. vagelos. the j.p.b. foundation. rosalind p. walter. barbara hope zuckerberg. corporate funding is provided by mutual of america-- designing customized individual d group retement products. that's why we're you c retiremepany.

additional support has beey: provided and by theorporation for public broadcasting, and by contributions to your pbs station from viewers lk e you. thu. ud from the tisch wnet sts at lincoln center in new york, hari sreenivasan. >> sreenivasan: good evening and thank u for joining us. in charlottesville, virginia today, on the weekend of the one year anniversary of the "unite the right" rally, there was a heavy police presence, and streets were blocked off as part of are-emptive state of emergency. a year ago, white supremacists and other so-called "alt right"a groupsed with counter- protesters. the events turned deadly when two state troopers were killed in a helicopter crash, and a cal ed into a crowd, killing counter-protester heather heyer. yesterday, heyer's mot visited a memorial at the site. >> i didn't come to this street for a week. first time i drove past here was ndright after the funeral, i screamed, it hit me so hard.

>> sreenivasan: last year's rally started with a night-time march, where protesters carried tiki torches and chanted nazi and white supremacist slogans. ( chanting ) >> sreenivasan: the protestsci began after th announced plans to remove a statue of confederate general robert e. lee. lawsuits over the statue continue, and it remains in a downtown park. last year, president trump drew criticism for not initially condemning the white supremacists. >> i think there's blame on both sides. >> sreenivasan: this morning, the president tweeted, "i condemn all types of racism and acts of violence. peace to all americans!" the organizer of last year's rally, jason kessler, was denied a permit to protest in charlottesville this year. as a result, he will be in washington d.c. tomorrow for a ."white civil rights" ral counr-protesters are also planning rallies there. we're joined now from charlottesville , nicole hemm assistant professor at the miller center at the university of virginia. she is also the hostf the

podcast "a-twelve," which deals inth last year's event charlottesville and the history behind it. thanks for joining us. so, let's talk about, really, wh happened in that year since. >> yeah, so, in the year since, there has been a lot of focus on trying to figure out, first of all, what went wrong last year. why was this event that was known about well in advance, whi was t so violent? why was there so little containment of it? but then, also, really a much broader push on issiues of te typremacy, racism, economic inequality in the and a real effort to try to address some of those underlying issues that have kept charlottesville sort of on a knife's edge for a few years now. >> sreenivasan: one of the things that even the city thloat ed at it and the reports that came out afterwards point out was that whle we all focused on the confederate statue and the specific event, this has been a kind of long time building last year, last

summer. >> that's right. locally, last summer was known as the "smmer of hate," because there were months of white nationalist rallies and protests in the city, and there was a lot of effort by antiracists and other activists in the city to try to figure out how to most effectively counter that. but from may 13, when richard spencer, who is a white nationalist, held the first torch light rally here at the anatue of robert e. lee, through to august 1d 12, there was real work at trying to counter this coming set of protests, but also to countermaller protests throughout the summer. >> sreenivasan: what are the changes that have taken place? i ean, there's kind of on two levels-- the changes, the preparations fr this specific weekend; and the kind of more systemic, and long-term chang. >> rght. so what we're seeing here this weekend is-- it's quite a tense atmosphere. there are lots and lots of police, as there were last year, but mowt of the dontown mall, most of the university is shut down. so there's a real sense that

everything needs to be stopped beforehand. there's actually been a lot of legal work done to ensure that this year doesn't look liklast year. so part of that is that white nationalist groups have entered into an agreement we city not to come back in groups of two or more with weapons. so that has made theciy a little safer, in a sense, this year. ere's also been connuing work to try to do a better job rlottesville's history. i mean, the statues of the confederatcertainlies here in the city only tell one part of the city's history, and notal the truer story of the city's history, which is that at the time of the end of the civil war, charlottesville wasn't a city conquered but a city liberated. 52% of the population was enslaved at that time. so pple have been working pretty hard to try to bring more of that history to the ty, including bringing back a monument to chavirlottesville's im of lynching. >> sreenivasan: all right,

nicole hemmer, grfort of virginia, joinings via skype today. thanks so much. >> thank you so much for having me: >> sreenivasvestigators in seattle, washington want to know how an airline employee stole an empty horizon air turboprop arplane last night at seattle- tacoma internationport. 29-year-old richard russell, who is being described as "suicidal," flew nearly 90 minutes on a joyride before crashing into a small island inh puget sound. before the crash, russell told an air traffic controller that he was, "jt a broken guy, got a few screws loose." representative chris collins g hisw york is suspend re-election campaign.e threpublican congressman was ins cted wednesday on chargeof insider trading, related to a biotechnology firm where h served on the bocod. llins initially said he would continue his campaign, but now says he will only fi out his term, and, "continue to fight the meritless agarges brought nst me." the new york state republicanci party says no on has been made on whether there will be a replacement for collins on the november ballot.th

death toll from last sunday's devastating earthquake that struck indonesia has risen, and so has the island of lombok. auorities now say that 387 people died in the disaster, and rescue teams are continuing to search forven more victims. the earthquake was so powerful that scientists y the island of lombok has risen by as much as ten inches in some aces. 390,000 people are still homeless on the island. for the second day, tens of thousands of romanians rallied against government corruption. the demonstrations in bucharest were peaceful today. yesterday, more than 450 people were injured, including dozens o police officers, as protestors triedoss security lines outside government buildings, and threw rocks and bottles. riot police used water cannons and tear gas. the demonstrations areeing organized by romanians who work outside the country. they say wagesn romania are too low, and are demanding the resignation of the government. fireghters are making progre battling a wildfire in southern

california. water- and fire-retardant dropping planes are helpg save homes near the "holy" fire burning in the cleveland national forest southeast of los angeles.ca a resident has been charged with intentionally setting the fire, which started monday in holy jim canyon. the fire has now burned more than 33 square miles. as >> sreen: if you have health insurance, and it comes with a prescription drug plan, chances are, it's managed by something caed a "pharmacy benefit manager." most people aren't aware of how these pharmaceutic middlemen play a huge role in what prescription drugs you take, and the price you pay for th. as the nation grapples with soaring health care costs, the role pharmy benefit managers play is attracting more scrutiny. newsho weekend's megan thompson reports.

>> reporter: a few years ago, marc falkowitz of philia volunteered to manage the affairs of his 91-year-old aunt. moshe had dementia, and had into long-term care, so falkowitz helps with things like npaying for her prescript drugs. >> and the bill comes to me, and i pay it out of her ecking account. >> reporter: last year, while picking up a prescription a major drug chain, falkowitz happened to be complaining about high drug pres, when the pharmacist gave him a tip.rm >> the pist sort of came around the counter, and took me off to the side, and says, "you might find it cheaper mewhere else." "what? what? what could you mean?", you know? >> reporter: so falkowitz did some research online. his aunt was taking eighri gedrugs for things like dementia and high blood pressure.yi she was close to $103 in insurance co-pays for those drugs every month. falkowitz found he could get those ex if he paid out of pocket at an independent pharmacy, not using his nt's insurance plan at all. that's nearly 40% less.

falkowitz manages a medical practice and deals with insurance plans all the time. he says it was a total surprise. >> i-- i-- i just couldn't understand it. this is a foreign concept. never, never did it dawn on me, if you pay cas do not submit ney.nsurance, you save i pay all this money for insurance. what's it for? r orter: so why was falkowitz paying nearly $103 for $65 worth of drugs? where was that extra $38 going? one ssibility is that the agney went to what's known as a pharmacy benefit m, or p.b.m. >> p.b.m.s are designed to help health plans and insurers manage prescription drugs. >> reporter: rutgers law school professor michael carrier is an expert on the pharmaceutical industry. he explains that p.b.m.s act as middlemen between the insurance plans, drug makers and pharmacies. he says most consumers have no idea there's a p.b.m., not an insurance company, managing

their prescription drug plans. >> there are three main p.b.m.s that take up 85% of the market. you have express scripts, you have cvs caremark, and you have optumrx. >> reporter: the three big p.b.m.s brought more than $300 billion in revenue last y ar. but carrier says tgan with tra modest role in the ind >> so, in the late '60s, early '70s, p.b.m.s started in giving plastic drug cards to consumers so they could go to the pharmacy, they didn't haer a trail of pit made it easier to get prescription drugs. through the years, though, they have gotten re and more power. >> if a patient has insurance, it's going through the p.b.m.s. >> reporter: howard jacobson has been a pharmacist in long, island, new yor 40 years. he says the p.b.m. dictates the amount of the co-pay he collects and how much he's reimbursed. and, he says a few years ago, he started noticing something strange on transactions every clw and then. it's called a "back." >> so, here's another claim.

it's an inexpensive drug. you see the actual cost of the medicine is only $1.61. >> reporter: jacobson showed us a recent transaction for the diabetes drug metformin. it cost him $1.61 to acquire the patient's dose. he says, if the paent paid out of pocket, he would have sold it to them for $4.00. his profit would have been $2.39. but the patient used an, insurance pld there was a middleman: the p.b.m. old jacobson to charge a $10.84 co-pay. r let him keep $1.93. and it took $8.91 self. you could have sold it to them afor $4; instead, they pa $10.04 co-pay. >> right. >> reporter: but until recently, jacobson couldn't bring this up unless the customer asked.ec he says that'sse many of his contracts with the p.b.m.s contained provisions that prohibited h from pointing out that they could get their prescription cheaper if they

didn't go through their insurance plan. pharmacists call them "gag auses." >> it was difficult, actually. we're dealing with patients every day. we know them personally. why should anyone have to pay more money than is necessary? >> reporter: jacobson says he's never ally sure how much money he'll be reimbursed by the p.b.m., an amount that's been steadily decreasinover the years. he says, sometimes, he actually loses money on a sale. u >> iimately getting paid $9.06. now this particular drug actually cost $60 and change. lost $50 on that prescription. r orter: jacobson says, so far, he makes enough profit on other tansactions to keep the pharmacy afloat. he feels he can't object to the system because the big p.b which control a majority of the market, will just tell him "too bad." >> "if you want our patients in this particular network to be able to come to your pharmacy, these are the terms. take 'em or leave 'em." >> reporter: pharmacists like

howard jacobson aren't the only ones who are critical of p.b.m.s. >> we're very much eliminating the middlemen. the middlemen became very, very rich. right? >> reporter: in may, presint trump announced his plan to lower prescription drug prices. he put many players in the crosshairs: drug makers, wholesalers, insurance m.companies, and p. and, he criticized a practice called "rebates." >> our plan will end the dishonest double-dealing that allows the middleman to pocket rebates and discounts that should be passed on to consumers and patients. >> reporter: so how do so-called rebates work? in addition to managing businesn invoconsumers, pharmacies and insurance plans, p.b.m.s also broker deals between drug makers and insurance plans. for instance, they help decide which drugs will be covered by the plan. isthe list of covered drug called a "formulary." in a bid to get a drug on a plan's formulary, drug companies metimes pay p.b.m.s.

these payments are known in the busines"rebates," and they can total millions of dollars. p.b.m. o say they pass mo this money on to insurers, who say they use the money to lower co-pays and premiums f patients. other issue that we've been hearing a lot about, that the president about, is something called rebates. that sounds like a good thing. >> so,t certainly does sound like a good thing. rebate is money back, it could lower price for the consumers. the problem is that, ithis opaque wor, where we have no idea what these contracts say, rebates actually can increase price. >> reporter: michael carrier says because these business deals are secret, it's not clear w much of the payment is being used to reduce patients' costs, and how much is being pocketed.b by the.s and insurers themselves. carrier also says this systemti could be infla drug prices, hecause drug makers have incentive to increase the price of the drug in order to afford the payment to the p.b.m. >> by increasing the price of

the drug, the manufacturer has more leeway to give a big rebate to the p.b.m., the p.b.m. is t happy,he drug is covered on the formulary. unfortunately for all of us, drug prices go up. >> it's, it's, it's rather a startling and perverse system that has, that has evolved over time. >> reporter: secretahealth and human services alex azar testified in june before the senate health committee about the president's drug pricing plan.th azar saiadministration is considering regulatory changes that would allow rebates to be scrutinized der federal anti- kickback laws. >> we may need to move toward a rebates, where mab.m.s receive no compensation from the very phompanies that they are supposed to be negotiating against. r orter: azar, a former pharmaceutical executive, also said he's heard reports ofth p.b.m.atening drugmakers. >> we've had several drug i companies cowho are-- want to execute substantial material reductions in their drug prices. they are finding hurdles from pharmacy benefit managers and

stributors, where they might say, "well, if you decreased your list price, i will take you off formulary, compared to your competitor who will have a higher list pre where i will make more money." i find that unconscionable.or >> rr: so, what do the pharmacy benefit managers have to say about all of this?>> ell, if we didn't save money, nobody would hire us. >> reporter: mark merritt is the president of the pharmaceutical care management association, an industry traderoup that represents the nation's largest p.b.m.s. he says, according to theirse ch, p.b.m.s can decrease drug benefit costs for patients by 30%. >> our clients bring p.b.m.s in because they want to make sure that benefits are good and that people have access to the drugs that they need. >> reporter: he objects to the accusations by secretary azar that p.b.m.s have anything to do with keeping drug prices high. >> yeah, that's inaccurate, and plus, the secretary's credit, he criticized everybody in health care, most of all the drug companies for their high t ices. and you have to stth that. drug companies set the prices. nobody else has anything to do with it.

>> reporter: merritt also defends the system of rebates. so the rebates go to the p.b.m., but how do we know that the rebates are then passed on to the consumer? >> what we do is, we send the rebate dollars up to the insurer, and they determine what they do with them. but that is really up to the health insurance plan, it's not the p.b.m. we have said repeatedly as an industry, we'd be happy to look at other models besidetes. all we want to do is get to the lowest net cost for our customers. if there's a better way to do it, a better way to get savings, r 'd be open to it. >> reporter: as e complaints from pharmacists, merritt says he thinks p.b.m.rs reimbuents are fair. and when it comes to clawbacks, lawsuits have been filed against optumrx and the insurers it workwith, accusing them of profiting from excessive co- pays. merritt sayshe practice is not something his p.b.m. trade organization condones. >> if it is happening, it should stop. and that's our position as an industry. we don't support it, in any way. >> reporter: in a statement tone hour weekend, optumrx said, "we believe lawsuits are without merit," and denied using

clawbacks at all. the two other big p.b.m.s, cvs caremark and express scripts, gealso said they do not enn clawbacks. avlegislators in 28 states banned clawbacks or gag clauses. members of coness are looking to do the same. a bill is currently pending iner pennsylvania, marc falkowitz lives. he hasn't used his aunt's health insurancto buy her medications in a year, and says he now shops around for his entire family's prescriptions-- although h finds it ridiculous that he even has to in the first place. >> i just think there's something so terribly wrong with the system.de it juses rational sense. >> sreenivasan: adolescentsha receive less2% of global health funding on average. read more at pbs.org/newshour. >> sreenivasan: firefighters are settinbackfires, dropping fire-retardant from planes, and hoping for a break in the hot dry conditio driving the

massive wildfires. but, there is another way to reduce future fires. 's not politically popular, but you can stop fires with fire. joining us now from portland for more on this controversial idea is oregon public broadcasting senior political reporter jeff mapes. thanks for joi mng us. so, tea little bit about what the scientists and the experts have been trying to do for years. >> yeah, this is not new at all. they're really saying that you , ve to fight fire with fi some degree, that this is, you know, sort of the pattern, thrticularly in the west, from centuries pastat fire is regularly swept through, kind of cleared out the udderbrush, a really sort of set an ecology that now has gone away, and we have very sense, ovs stocked forehat are more prone to burn, and then when you add in climate change, it creates real problems. >> sreenivasan: you know, there doesn't seem to be a lot of support for theea of

lighting something up etentionally, especially we see these pictures from around the west in states like california, whe you see evacuations, you see homes destroyed. >> yeah, exactly. i mean, there's aofouple things really that experts have talked about, one is making more use of controlled burns, prescribed fires. and those typically would not be at thwh time of the yeaen you're having the hot oast weather and the most dangerous conditions. this would tend to be more, at least in the west,in fall and spring. some parts of the country, for example, dwn in the south-- florida, et cetera -- down there, they burn a lot of acreage deliberately every year. they have more humidity. it's, you know, perhaps easier and then the other issue is, frankly, letting some fires burn if the conditions are right, if they're ice laiptedugh, and sort of let the fire do some of e work of cling out this dense overgrowth.as

justyear, there was a fire that came through near sisters, oregon, where they had done this thinning and prescribed burns, and once it reached that are it really helped knock down the fire. ertsi've talked to fire exp who say if that work had not been done, the town of sisters really would have been at the mercy of the weather, whethther fire would have swept through or not. >> sreenivasan: does what works in oregon rk in california? >> you know, california's a biat with a lot of different ecologies. i think that it really depends on what part of california you're talking about. certainly, there are areas that are morensely populated and moreifficult to do that in. but there's also a lot of areas of california where-- where you could use some of these methods as well. >> sreenivasan: all right, oregon public broadcasting's reporter, jeff mapes, thanks so much. >> you're welcome.

>> this is "pbs newshour weekend," saturday. re >>ivasan: and now to "viewers like you," your chance to comment on stories you've seen here on pbs newshour weekend.nd last weewe reported on a variety of new ways to determine whether someone is too high to drive, a marijuana.s legalize we began with a look at researc bene at massachusetts general hospital. >> reporter: jodi gilman is an assistant professor at harvard medical school, and a researcher with the hospital's center for addiction medicine.a >> the i that your brain looks different when you're intoxicated. what we're lookingor is a neural signature of being high. so we're looking at the brain when you're not high, and the brain when you're high, and trying to detect differences between those two brain states. police could test for alcohol in buthe system. with t.h.c., the

psychoactive ingredient marijuana, it can be in my system for weeks, and figuring out whether i'm impaired bcause of it is really difficult. we reived comments from acro the country, and with a wide range of perspectives. saon facebook, richard hot, "there are other things that are perfectly legal that impair driving even mor current studies suggest that hands-free phone conversations are twice as dangerous as weed, but that is legal in all 50 states." liz symonds wrote, "i feel like the rule of thumb should be thay consume anything that intoxicates you, just don't drive."ti and monica co commented, "any level of high is too high to drive!" and finally, "fed up redhead" wrote to us on our website, "this is a situation where the careless user makes life harder d r those using medical marijuana for a vadical problem. did it occur to anyone to develop a reliable test before ?ates passed their pot la course not." as always, we welcome youren co. visit us at pbs.org/newshour, on our facebook page, or tweet us

at @newshour. >> sreenivasan: join us tomorrow for coverage from charlottesville, virginia, where the community will holdal memo and from washington d.c., where a white nationalist rally and a counter-protest are planar the white house. that's all for this edition of pbs newshour weekend. i'm hari sreenivasan.ch thanks for wg. have a good nigh captioning sponsored by wnet captioned by media access group at wgbh access.wgbh.org >> pbs newshour weekend is made possible by:

bernard and irene schwartz. sue and edgar wachenheim iii. the cheryl and philip milstein family. dr. p. roy vagelos and diana t. vagelos. the j.p.b. foundation. rosalind p. walter. barbara hope zuckerberg. corporate funding is provided by mutual of america-- designing customized individual and group retirement products. that's why we're your retirement company. additional support has been provided by: and by the corpora opublic broadcasting, and by contributions to your pbs station from viewers like you. thank you. be more. pbs.

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