Rxman95

Tennessee independent pharmacists point out that independent pharmacies are closing at a greater rate than what CVS is threatening to close if #PBMReform bill passes. | @FOXNashville ow.ly/8Ve650YFCEg

You know who isn’t going to have long term stability? The pharmacies nationwide currently being forced to offer interest free 22-35 day loans to Medicare to keep the Medicare Drug Negotiation program running.

Humana Is Prioritizing Profits Over Patients It is absolutely unbelievable how the pharmaceutical middleman system works against the very people it’s supposed to serve. We just saw a massive shift in the market for Farxiga—a drug used by millions for diabetes and heart failure. Yesterday, the manufacturer’s exclusive rights ended, which triggered a staggering 95% price drop. We’re talking about a medication that used to cost $350 yesterday and is now available for under $20 today at our pharmacy. You would think a 95% decrease in cost would be a win for everyone, right? Especially for Medicare, which spends roughly $4 billion a year on this drug alone. This price drop could have saved them $3.9 billion annually. Instead, Humana responded by removing the generic version of Farxiga from their formulary entirely the very day the price dropped. Rather than passing these massive savings on to the patients, Pharmacy Benefit Managers (PBMs) chose to pull the plug. Why? Because PBMs are often built on a model that thrives on high list prices and back-end rebates. When the price hits the floor, their incentive to carry the drug disappears. This is exactly why we decided to move away from the traditional middleman model. When the market price of a drug drops, our patients see that savings instantly. There is no waiting period, no formulary games, and no hidden fees. If the drug goes cheap, you get it cheap. It's that simple. If you are tired of being overcharged or having your essential medications removed from coverage just as they become affordable, it is time to look at your options.

Same prescription medication. Same prescription insurance. Yet, we have 6 different prices over a 10-month span. Huh, wonder why that is? @CVSHealth care to comment?

If our government, @CMSGov, @DrOzCMS were really that serious about cracking down on the fraud, waste, and abuse in this country- we could start by overhauling the Medicare Advantage program. If the program continues to cost the government MORE money vs. traditional Medicare+Part D, then why do we keep funding them? Especially with all of the countless investigations into those MA plans and finding hundreds of billions of dollars worth of fraud with their shady practices. But by all means, let’s just go ahead and continue writing them huge checks to make sure the grift continues for a few more decades. Reliable non-industry analyses indicate that Medicare Advantage costs the federal government substantially more—roughly 14–22% more per enrollee in recent years, equating to $76–84 billion annually in extra spending—compared to covering the same beneficiaries under traditional Medicare (Parts A and B) plus a separate Part D plan where applicable. This gap stems largely from payment system features rather than superior efficiency in delivering core benefits.

PBMs never change. @Humana removed generic Farxiga from their formulary THE day it lost exclusive manufacturer rights which resulted in a 95% price DECREASE. $350 drug yesterday=covered (with brand copay.) Same drug today $10= pt go find something else for diabetes/heart failure

Well, ERISA strikes again. States keep running into the same wall on self-funded plan regulation, unable to beat preemption arguments. Sixth Circuit Rejects Tennessee Law on Pharmacy Benefit Managers news.bloomberglaw.com/health-law-and…

Did 400 more prescriptions last month, gross profit went down by 6k. Which other business is so cheap ie. you can buy a prescription for 12 cents. How much did the PBMs make on the Rx?

UnitedHealth Group pulled in $370B in 2024—and now its Optum arm employs more physicians than anyone else in the U.S. It’s not just the insurer. It’s also the PBM setting drug formularies and the employer of the doctor requesting approval. One company, every side of the transaction. Monopolistic control over the most lucrative, cash-flow-rich industry in the U.S.—one that directly shapes your health and wellbeing.

How much are 2 tablets of diazepam worth to a patient who needs to relax before a procedure? Apparently, to the insurance company @AmbetterHealth - it’s only worth 15 CENTS. Although I’m sure they are getting billed much higher than that, but their PBM CVS Caremark @CVSHealth, is only passing through this piddly amount to the pharmacy. **Side note: it costs the pharmacy 18 CENTS just for receiving this prescription electronically, as required by law. So, we already lost before we even touched the prescription. Thanks to the ACA, this plan will continue to churn out more bullshit claims like this.

As a practicing community pharmacist, I would also enjoy a payment increase from Medicare Advantage plans… But we all know that isn’t going to happen. It’s a race to the bottom for payments for pharmacies. Thanks @CMSGov @DrOzCMS We pharmacists appreciate you giving $13 Billion to the same companies who are running our businesses into the ground.

As a restaurant owner I am forced to charge an additional sales tax and meals tax for every purchase. If I make a good product that people are willing to pay for, the government profits off of my labor. The more I make, the more they make. In fact, the government makes more off of my business than I do. How does that make sense? They also don’t pay me a dime to collect their tax. What’s even more wild is if I don’t pay them the tax I collect for them by a certain day each month, they charge me interest & penalties. Tell me how this is any different from the mafia. Small businesses should ban together and refuse to collect their taxes.

1/6 As an independent community pharmacy, PCMA’s claims about PBM “value” ring hollow. The Big 3 PBMs control ~80% of the market and pay us below acquisition cost on many drugs, plus retroactive clawbacks and DIR fees that destroy our margins. This isn’t value—it’s extraction.

#HugANewspersonDay 📰 We're grateful for the journalists who dig deeper, ask the hard questions, and shine a light on the truth behind PBMs. Your commitment to honest, transparent reporting helps patients, pharmacists, and employers see what's really happening. Thank you 💙

UnitedHealth Exposed: How the Insurance Monopoly is Bleeding America Dry The veil is being lifted on the profit-driven tactics of the American health insurance industry. In a recent Congressional hearing, Representative Greg Murphy (R-NC) laid out a devastating case against UnitedHealth Group, identifying them as the "worst actor" in a consolidated market that prioritizing shareholder returns over patient outcomes. The numbers are staggering. The four largest health insurance companies generated more than $1.1 trillion in revenue in 2024 alone. UnitedHealth leads the pack, outperforming its nearest competitor by over $400 billion. This isn't just growth; it’s a stranglehold on the entire healthcare ecosystem. UnitedHealth has expanded far beyond simple insurance. Through its various subsidiaries, it now owns: Doctor’s offices Home health services Pharmacies Surgery centers By controlling both the provider and the payer, they have created a "profit-first, patient-last" vertical integration model. This allows them to manipulate the system to their advantage, often at the expense of the taxpayer. The Department of Justice is currently investigating UnitedHealth for alleged Medicare Advantage billing and coding fraud. Evidence suggests that in 2021, United added diagnoses to patient records for conditions that were never treated by a doctor. This "upcoding" triggered an estimated $8.7 billion in extra payments from the government. Nationally, Medicare Advantage organizations were paid nearly $50 billion for diseases that were diagnosed but never actually treated—a total waste of taxpayer funds. As insurance companies consolidate power, the cost of care continues to skyrocket. The average annual premium for a family of four has reached a staggering $27,000. This burden is unsustainable and could have been prevented by fostering true competition in the marketplace. The current system is broken. Insurance companies have a stranglehold on Washington D.C., but the tide is turning. We don't have to wait for Congress to find the "perfect" solution. By removing the insurance middleman and moving toward fair and transparent pricing, we can restore medical freedom and ease the financial burden on American families. It is time to break up these monopolies and put healthcare decisions back in the hands of patients and their providers.

Uncovered this law school gem from 2019. Still going seven years later.

@kpharmd12 @redlgb1969 @Jeffery1313 He has blocked me! 😂

Sending this to mail order’s biggest cheerleader @Jeffery1313

How can every independent say the same exact thing in every state but the Pbms say it isn’t them? At what point is it about does anyone in our government actually help us? How much profits do they actually need? Why can’t anyone see that the real reason costs are high is the pbm?

Two back to back claims for two very different drugs: doxycycline and oxycodone. One claim from @SilverScriptPDP and one from @Aetna: Both plans under the thumb of @CVSHealth Except, in both claims they both have the exact same payment amounts. Both have patient co-pays of $1.61. Something is definitely off. Sounds strangely like a price fixing scheme to me.