Hannah Mamuszka and Lena Chaihorsky talk with Jane Cheshire Gilbert, a 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 ...