Hannah Mamuszka and Lena Chaihorsky talk with Jane Cheshire Gilbert, the CPA who spent two decades running the health plan for the Teachers’ Retirement System of Kentucky (TRS) and became an unlikely pioneer in pharmacogenomics. Serving tens of thousands of retired teachers — many in their 80s and 90s, on an average of 15 medications — Gilbert treated genetic testing not as a clinical curiosity but as a fiduciary tool: if a plan is paying full price for a blood thinner or antidepressant a member’s body can’t use, everyone loses. She recounts building a program with Coriell Life Sciences and the Know Your Rx Coalition, testing roughly a third of the Medicare-eligible population, and a published study showing meaningful per-member savings and fewer hospitalizations. The conversation is candid about the rebate machine (which she used dollar-for-dollar to hold premiums down), why insurers wouldn’t pay for testing that saved them money, and her prescription for the next generation of purchasers: end direct-to-consumer drug advertising, require comparative-effectiveness research, and make real prices visible through reference-based pricing. Her closing line summarizes the whole show: “Mad is not a strategy.”
July 28, 2026
Episode 3: Mad Is Not a Strategy: The CPA Who Made The Case for Pharmacogenomics
