Concerned PharmD 🇺🇸

766 posts

Concerned PharmD 🇺🇸 banner
Concerned PharmD 🇺🇸

Concerned PharmD 🇺🇸

@ConcernedPharmD

Pharmacist. Advocate. PBMs (middlemen) profit while people ration meds. If you’ve overpaid or been under-reimbursed, you’re not alone— and I’m fighting for you.

Katılım Haziran 2024
162 Takip Edilen209 Takipçiler
Sabitlenmiş Tweet
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
A PBM-free or transparent fixed-fee healthcare model in the U.S. would conservatively save $90–130 billion per year—representing 14–20% of total prescription drug spending. These savings come not from rationing care or suppressing innovation, but from eliminating opaque middlemen who profit from rebate distortions, spread pricing, and formulary manipulation. #EndPBMs #PBMReform #PatientsOverProfit Here’s the analysis:
English
12
61
256
183.8K
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
@mcuban The system is built for max profit under the guise of “bringing our heart to your health,” then raping your doctor and/or pharmacy, over billing at every level, which in turn—increases your premium
English
0
0
1
11
Mark Cuban
Mark Cuban@mcuban·
Most hospitals don't know their costs. Things I've asked for that made them roll their eyes : A BOM for surgeries P&L for each insurance carrier P&L for Medicaid or Medicare business Why do they need consultants for everything. Why doesn't their CSuite know how to do any of it Why do they use GPOs when prices are insane Why do they work with carriers that underpay, late pay, deny everything, waste docs time with denial committees run by 97 yr old pediatricians. Why do they make no effort to sell direct to employers (excluding those on costpluswellness.com to avoid all the carrier abuse , and avoid being sub prime lenders for patient OOP Why do they abuse 340b Why do facilities fees exist Why do they abuse site neutrality Why do they abuse patients with charge master based bills Why do they not push for standard contract templates to reduce admin. Why do they accept so many different ins plans Anyone want to add more And for context, remember I think the biggest insurance companies are worse
Vexity@xVexity

@mcuban Because reimbursement is often set below cost. Medicare—especially Medicaid—pay fixed rates that frequently don’t cover staffing, infrastructure, and 24/7 care. Hospitals can’t refuse those patients so the gap gets made up elsewhere.

English
241
331
2.8K
341.9K
Mark Cuban
Mark Cuban@mcuban·
Everyone wants me to rip on TrumpRx. Reality is, it’s saving patients money on IVF and a few other drugs. A lot of money. IMO, anything that saves patients money is a win. And they truly do have some great people that are making smart moves. You just don’t know their names. Chris Klomp. Mark Atalla, Abe Sutton and so many more. When you talk to them, and see the work they put in, it’s obvious they are focused on trying to do the right thing for patients. Don’t forget they didn’t give the insurance industry a price increase they wanted, and those stock prices got crushed. TrumpRx is just getting started. @costplusdrugs is just getting started.
NBC News Health@NBCNewsHealth

Americans are furious about drug prices. The Trump administration’s answer? A new website. But more than a month after its launch, the site, TrumpRx.gov, remains small — offering discounts on just 54 prescription drugs. nbcnews.com/health/health-…

English
202
526
6K
375.3K
Concerned PharmD 🇺🇸 retweetledi
Mark Cuban
Mark Cuban@mcuban·
Crazy? The pharmacy has to buy the bagel for $400 from a big wholesaler, then get rebates to try to get their cost down to the $7. Which they can only do if they buy 90 plus percent of their generic bagels from their big primary wholesaler. If they buy generic bagels elsewhere, like @costplusdrugs does, and it exceeds 10 pct of their total buys from the wholesaler, they get hit with chargebacks and fees that wipe out any chance of making money on bagels . Which means they pay more for generic bagels. Which means customers pay more for bagels because everyone lists the price at $400 And the wholesalers use that $400 RETAIL price for the starting point of their WHOLESALE pricing. By doing this, the PBMs get to use the $400 price as their starting point for pricing as well. In any other industry other than this bizarro bagel world, the wholesalers would compete for the best price from the bagel manufacturers and then compete for the business of pharmacies. It’s the most upside down bizarre business I have ever seen
Rep. Jake Auchincloss 🟧@RepAuchincloss

If bagels cost $7 in one market and $400 at another across the street, you’d ask the grocery managers some tough questions. Well, that’s Rx drugs under the control of the pharmacy benefit managers — the middlemen of drug pricing. You don’t see it directly b/c of their insurance games, but you’re paying for their price-gouging through your premiums and co-pays.

English
114
314
2.3K
547.6K
Concerned PharmD 🇺🇸 retweetledi
ATAP
ATAP@ATAPAdvocates·
"...These middlemen in the drug supply chain don’t discover new medicines. They don’t manufacture them. They don’t even physically dispense most prescriptions. Yet they rake in tens of billions of dollars each year by driving up costs for everyone else — especially patients battling cancer, HIV, heart disease, and autoimmune conditions..." capecoralbreeze.com/opinion/letter…
English
0
5
14
327
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
You mean that it’s “covered” — which was decided by the PBM, not the insurance. Insurance companies do not manage their own medication formularies. None that I know of. They contract to third parties, PBM’s. They decide what gets covered, at what price, at what copay, and at what pharmacy. The worst part? They’ll typically only “cover” medications that they get a rebate from the manufacturer for (ie pay-to-play) The problem: these rebates are not paid by the MFG. The patient, insurance, employer, and taxpayer pay for these rebates—which largely line the pockets of the said PBM. This creates multiple problems. The largest problem being that the cost of the medication is now more expensive (x + %rebate). This increases your cost, the pharmacies cost, the insurances cost, the wholesalers cost and reimbursement, your employers cost, the taxpayers cost, and most importantly—your copay. Then, big pharma gets to claim a tax-break for increasing the cost of your medication for this rebate. There’s more to this nuanced problem. But, I’m not going to inundate you with facts. Instead, check out my profile to see how PBM’s are scamming you, me, taxpayers, the sick, and just about everyone in-between 🙂
English
1
0
2
22
Wall Street Mav
Wall Street Mav@WallStreetMav·
“Why do eyes and teeth each require their own medical insurance? Aren’t they part of the body also? Should health insurance just cover the entire body?” 🔊
English
708
3.4K
17.2K
210K
Wall Street Mav
Wall Street Mav@WallStreetMav·
“Sen. Josh Hawley says U.S. health insurers are running a racket controlling the system by owning pharmacy benefit managers and now moving to buy up the largest pharmacies.” Senator Josh Hawley says US Health Insurance companies are involved in Racketeering The biggest insurance companies bought the Pharmacy Benefits Managers and are now buying the biggest pharmacies “The problem is there is no competition. It's a racket. It's a total racket” “Why shouldn't we be breaking you guys up? I mean, this looks like classic monopolist behavior. The patients are getting screwed.” “Don't you think the competition we really need is to break up this alliance between insurance companies and PBMs? The biggest 3 PBMs are owned by the biggest insurance companies. You're like one huge giant pharma industry; a giant pharma series of monopolists Why is it a good idea for the biggest PBMs to be owned by the biggest insurers? And now you're buying up pharmacies as well. Why should we allow that? Why should insurance companies PBMs also own pharmacies.”
English
313
2.4K
5.8K
128K
Concerned PharmD 🇺🇸 retweetledi
Nisha Patel, MD MS, Dipl of ABOM, CCMS
Mitochondria are microscopic. You cannot diagnose “mitochondrial challenges” by glaring at a child in an airport. What you can do is prey on parents fears with pseudoscience, while ignoring the real crises our kids face, like gun violence, food insecurity, and lack of healthcare.
Acyn@Acyn

RFK JR: I’m looking at kids as I walk through the airports today...and I see these kids that are just overburdened with mitochondrial challenges, inflammation—you can tell from their faces, movements, and lack of social connection

English
825
6.9K
30.5K
1.1M
Concerned PharmD 🇺🇸 retweetledi
Sarah Despres
Sarah Despres@sarahdespres·
Pay attention to this excerpt: “We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary.  I am not sure who the Secretary is listening to, but it is quite certainly not to us.”
DrDemetre@dr_demetre

My resignation letter from CDC. Dear Dr. Houry, I am writing to formally resign from my position as Director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), effective August 28, 2025, close of business.   I am happy to stay on for two weeks to provide transition, if requested. This decision has not come easily, as I deeply value the work that the CDC does in safeguarding public health and am proud of my contributions to that critical mission. However, after much contemplation and reflection on recent developments and perspectives brought to light by Secretary Robert F. Kennedy Jr., I find that the views he and his staff have shared challenge my ability to continue in my current role at the agency and in the service of the health of the American people. Enough is enough. While I hold immense respect for the institution and my colleagues, I believe that it is imperative to align my professional responsibilities to my system of ethics and my understanding of the science of infectious disease, immunology, and my promise to serve the American people.  This step is necessary to ensure that I can contribute effectively in a capacity that allows me to remain true to my principles. I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.  The recent change in the adult and children’s immunization schedule threaten the lives of the youngest Americans and pregnant people.   The data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership.  This lack of meaningful engagement was further compounded by a “frequently asked questions” document written to support the Secretary’s directive that was circulated by HHS without input from CDC subject matter experts and that cited studies that did not support the conclusions that were attributed to these authors.  Having worked in local and national public health for years, I have never experienced such radical non-transparency, nor have I seen such unskilled manipulation of data to achieve a political end rather than the good of the American people. It is untenable to serve in an organization that is not afforded the opportunity to discuss decisions of scientific and public health importance released under the moniker of CDC.  The lack of communication by HHS and other CDC political leadership that culminates in social media posts announcing major policy changes without prior notice demonstrate a disregard of normal communication channels and common sense.  Having to retrofit analyses and policy actions to match inadequately thought-out announcements in poorly scripted videos or page long X posts should not be how organizations responsible for the health of people should function.  Some examples include the announcement of the change in the COVID-19 recommendations for children and pregnant people, the firing of scientists from ACIP by X post and an op-ed rather than direct communication with these valuable experts, the announcement of new ACIP members by X before onboarding and vetting have completed, and the release of term of reference for an ACIP workgroup that ignored all feedback from career staff at CDC. The recent term of reference for the COVID vaccine work group created by this ACIP puts people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy to a director hamstrung and sidelined by an authoritarian leader.   Their desire to please a political base will result in death and disability of vulnerable children and adults.  Their base should be the people they serve not a political voting bloc. I have always been first to challenge scientific and public health dogma in my career and was excited by the opportunity to do so again.  I was optimistic that there would be an opportunity to brief the Secretary about key topics such as measles, avian influenza, and the highly coordinated approach to the respiratory virus season.  Such briefings would allow exchange of ideas and a shared path to support the vision of “Making America Healthy Again.”  We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary.  I am not sure who the Secretary is listening to, but it is quite certainly not to us.  Unvetted and conflicted outside organizations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources.  At a hearing, Secretary Kennedy said that Americans should not take medical advice from him.  To the contrary, an appropriately briefed and inquisitive Secretary should be a source of health information for the people he serves. As it stands now, I must agree with him, that he should not be considered a source of accurate information. The intentional eroding of trust in low-risk vaccines favoring natural infection and unproven remedies will bring us to a pre-vaccine era where only the strong will survive and many if not all will suffer.  I believe in nutrition and exercise.  I believe in making our food supply healthier, and I also believe in using vaccines to prevent death and disability.  Eugenics plays prominently in the rhetoric being generated and is derivative of a legacy that good medicine and science should continue to shun. The recent shooting at CDC is not why I am resigning.  My grandfather, who I am named after, stood up to fascist forces in Greece and lost his life doing so.  I am resigning to make him and his legacy proud.   I am resigning because of the cowardice of a leader that cannot admit that HIS and his minions’ words over decades created an environment where violence like this can occur.  I reject his and his colleagues’ thoughts and prayers, and advise they direct those to people that they have not actively harmed. For decades, I have been a trusted voice for the LGBTQ community when it comes to critical health topics.  I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision. Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world. The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest. I want to express my heartfelt gratitude for the opportunities for growth, learning, and collaboration that I have been afforded during my time at the CDC. It has been a privilege to work alongside such dedicated professionals who are committed to improving the health and well-being of communities across the nation even when under attack from within both physically and psychologically. Thank you once again for the support and guidance I have received from you and previous CDC leadership throughout my tenure. I wish the CDC continued success in its vital mission and that HHS reverse its dangerous course to dismantle public health as a practice and as an institution.  If they continue the current path, they risk our personal well-being and the security of the United States. Sincerely, Demetre C. Daskalakis MD MPH (he/his/him)

English
623
5.1K
24.6K
783.9K
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
Agreed. Stop entering into contracts that will cause you to dispense underwater just to increase your *potential* patient population. Adopt cash-only models. Develop a membership model. It’s being done around the country already. Leave their networks. If patients lose access because a pharmacy leaves network, it creates patient pressure on employers, insurers, and PBMs. This is something pharmacies rarely leverage but desperately need. Make this their problem, not ours. Take our profession back, one pharmacy at a time
English
0
0
1
33
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
PBM’s increase list prices from the original price proposed by manufacturers. See insulin prices circa 2008. Those rebates also get tacked onto the drugs acquisition cost. The PBM keeps a large portion of that rebate. Moreover, manufacturers are not rebating anything out of the kindness of their hearts. In fact, raising the price of a medication, for a PBM rebate specifically, is a tax break for “big pharma” In summary, rebates actually increase drug costs (proof if you simply google it), are incentivized by the government, and the “savings” are not actual patient savings— they’re largely pure PBM profit for “negotiating” their own rebate. The result? Incentivizing higher drug prices through rebates and tax breaks. Check out my profile for more information. It’s worse than you know.
English
0
0
0
24
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
Cutting out middlemen (PBM’s) does lower costs. The “coverage” people think they’re getting is mostly a shell game built to funnel profit, not savings. @FTC @JusticeATR
Matthew Herper@matthewherper

If pharma companies just cut out all those annoying middlemen and sold medicines directly to consumers, wouldn't that cut the prices that people pay? Yes, but... not so much, @elaineywchen finds. Because most consumers' drug costs are mostly covered by insurance, and they don't have hundreds of dollars a month to buy discounted drugs. statnews.com/2025/08/19/dir…

English
1
3
14
542
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
@sterlingkoonce CVS will just find a judge to rule in their favor. Rite aid may get 1/5th of what they’re asking for, if they’re lucky.
English
0
0
1
24
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
@TexasPharmD @tjparker @mcuban New models must be adopted, quickly. They aren’t going anywhere, they make too much $ and have contractual strangleholds on the industry. But ideally, conventional PBM’s can be phased out, eventually.
English
0
0
0
36
TexasPharmD
TexasPharmD@TexasPharmD·
@ConcernedPharmD @tjparker @mcuban I agree with TJ that PBMs aren't going anywhere. You either have them as they exist now or you have alternative PBMs like what Cost Plus Drugs essentially is in its current form.
English
1
0
1
33
TJ Parker⚡️
TJ Parker⚡️@tjparker·
One way to know someone in healthcare is early on the curve / has no idea what’s actually wrong is to blame a single player in the ecosystem for any specific problem. It’s never just the payer, pbm, health system, provider, pharma, employer, etc.
English
12
8
89
14.5K
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
@tjparker @mcuban Tell that to: New Zealand (Pharmac, saving NZ30-50M/year) UK (NHS/NICE, substantially lower drug $) Germany (AMNOG, >20% discount on new drugs) Canada (pCPA, C$50M saved on just 10 drugs/3yr) Australia (PBS, lower $per-capita) US VA (substantially lower drug $)
English
2
0
0
115
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
Agreed. We need to remove them entirely. A PBM-free model isn’t fantasy, it already exists worldwide and even here in the U.S. Rutgers estimates ~$100B in potential savings. PBMs raise costs at every level: • Manufacturer • Wholesaler • Pharmacy • Patient • Taxpayer • Insurer & Employer Contracting PBMs for “formulary management” to begin with is short-sighted. They don’t save money, they extract it. The catch? Insurance will only cover your script if you run it through their PBM. That’s not choice, it’s coercion.
English
2
0
2
332
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
@tjparker @mcuban That must be included in any reform, but that’s not all. PBMs are killing competition through under-reimbursement, clawbacks, and contractual chokeholds. Vertical integration doesn’t expedite care. It raises costs at every level. Incentives are aligned for profit, not patients.
English
1
0
2
297
Concerned PharmD 🇺🇸
Concerned PharmD 🇺🇸@ConcernedPharmD·
Sure, pharma and employers play roles. But pharma sets higher prices to chase PBM rebates and formulary placement. Employers rely on PBM “savings” reports that are mostly smoke and mirrors, not actual plan savings. PBMs? They designed the game and profit at every level. Reform them first and the rest of the system starts to untangle itself.
English
1
0
4
361
TJ Parker⚡️
TJ Parker⚡️@tjparker·
@mcuban Employer benefits (or at least thinks they do) and pharma is at least half the reason we are where we are now. Don’t own either of them.
English
2
0
8
858
Concerned PharmD 🇺🇸 retweetledi
KP, Pharm.D.
KP, Pharm.D.@kpharmd12·
Two different patients, two vastly different outcomes: Patient #1 presents prescription for oxycodone/acetaminophen 5/325mg #12 tablets. Sent to insurance and we were paid 91 cents. Patient copay $0 We took off insurance and patient was willing to pay a fair cash price…. Patient #2 had a prescription for atorvastatin 20mg #90 tablets. Sent to insurance and we were paid 78 cents. Patient copay $0 Again, took prescription off insurance and charged a fair cash price… Patient calls insurance company to complain why they were “overcharged” for their medication that should have been $0. Insurance tells the patient that it was our mistake and we should re-bill the claim. I obliged, and offered them their money back with a caveat… this will be the final time I will be filling this medication for you. If this patient would have called us first instead of ratting me out to their insurance company, things might have played out differently. The gloves are coming off- if your insurance company fails to pay me an adequate amount- you can pay cash OR leave. The choice is up to you.
English
15
7
93
4.2K