Thucydides Nuts me-retweet
My wife and I own Forest Park Pharmacy, and we don't accept insurance. None of it. That decision is exactly why we could fix what happened to a patient today.
A family came in wanting to transfer their kid's antibiotic to us. The child had already STARTED the course. Then, mid-treatment, the insurance company decided the last 14 tablets suddenly needed a "prior authorization" before the other pharmacy could hand them over. A sick kid, halfway through an antibiotic, and the answer was "please hold."
The drug is linezolid. It's a generic. It's been generic for over a decade. It treats serious gram-positive infections — the kind you do NOT want to stop antibiotics in the middle of, because an interrupted course is how you breed resistant bugs and end up right back where you started.
So why the hold-up on a cheap, common generic? Follow the fake math.
Insurance and the PBMs behind them price drugs off a number called AWP — "Average Wholesale Price." People in my industry have another name for it: "Ain't What's Paid." It's a benchmark number, not a real-world cost. On paper, the AWP for just those last 14 tablets is about $2,500.
My cash price for the same 14 tablets? $18.
Read that again. The system that's supposedly "protecting" this family from cost is the same system that inflated an $18 medication into a $2,500 line item, then slapped a prior auth on it to "review the expense" THEY invented. They manufactured the problem, then billed everyone for the privilege of solving it — and made a sick kid wait while they did it.
This is the whole game. When a drug is priced honestly, there's nothing to "manage." When it's priced off a fantasy benchmark, you get spread pricing, PA paperwork, pharmacy phone trees, and delayed treatment — all dressed up as cost control.
Here's the part nobody tells you: roughly 90% of prescriptions are low-cost generics. For the vast majority of what people pick up every day, running it through insurance does two things — raises the real cost and risks delaying your care. That's it. That's the value-add.
That's why we fired the insurance companies. No middleman deciding your kid can't finish their antibiotics on schedule. No fake prices. Just the real number, on the shelf, today.
The medication was always cheap. The insurance was the expensive part.
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