@DrDiGiorgio SF is objectively 80% cleaner since Lurie took over. Sure there are pockets, but representing SF as an epidemic of homeless is a tired and no longer true talking point
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Former Pharma Guy
2.7K posts
Former Pharma Guy
@FormerPharmaGuy
Former BioPharmaceutical SVP at Top 5 Pharma turned Investor // Commercialization and Market Access // Trying to learn for my own investing, not giving advice
San Francisco Katılım Eylül 2023
435 Takip Edilen424 Takipçiler
San Francisco spends $100,000 per homeless person per year.
Yet people will still claim the current methods aren’t working to control drug addiction and homelessness because we just don’t spend enough.
As if the barrier between their methods and success is just political will
Sarah Axelrath MD@DrSarahAxelrath
@DrDiGiorgio @MaxJordan_N I’m glad you asked. The current method of under-funding low-barrier treatment on demand and wraparound services and then asking “so how’s the current method working out?” like it’s some sort of gotcha hasn’t been particularly useful, I agree.
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@_Credible_Hulk Celsius is a great description of how water feels. Fahrenheit is a great description of how human beings feel.
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Why would I ever memorize what 32F and 212F are? What are celcius-brained people so obsessed with knowing the boiling point and freezing point of water???
Delusional Takes@DelusionPosting
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@DutchRojas NEJM study published in 2024 showed actual reimbursed charges for a cancer infusion were 4x at a hospital what they were in private practice. Totally broken system
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A hospital can bill $3,200 for a knee injection a physician does for $400. Same needle. Same drug. Same doctor. Different tax ID. That’s not medicine. That’s government sponsored arbitrage.
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@SBlake2000 @real_doc_speaks Pharma companies only capture 50% of the overall total expenditure of a drug. The markups along the way, with the hospital being by far the most egregious, serve no purpose or value and is passed totally on to the consumer
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@real_doc_speaks This is why health-care is really around 5% of GDP in terms of the actual value it is providing. NOT 20%!!
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All this money spent on a middleman!
Ed Gaines@EdGainesIII
@Aetna @CVSHealth top 6 made over $63M in ‘25. And I will say it again: there’s plenty of $ in the US healthcare system, and the issue is that it is misdirected away from hospitals & physicians who provide the Pt care. Health’s 6 highest-paid executives in 2025 beckerspayer.com/workforce/cvs-…
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@DutchRojas Friction is an intentional, cynical part of the system. Payers are the only thing keeping fax machines alive
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If the Marine Corps ran prior authorization, the denial rate would be zero and the turnaround would be four hours. Just saying.
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@real_doc_speaks Dude you took money from AbbVie. Did you forget openpayments exists?
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I will never be convinced by pharma bros that it is acceptable to overcharge patients for drugs.
Patients suffer and expire because of drug costs.
Former Pharma Guy@FormerPharmaGuy
@real_doc_speaks You will never be @DutchRojas
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@real_doc_speaks @DutchRojas He absolutely does. That was my point lol
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@DutchRojas adds a tremendous amount of value to every conversation.
Former Pharma Guy@FormerPharmaGuy
@real_doc_speaks You will never be @DutchRojas
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I didn't see mention of the patent thicket games that pharma plays.
Sell direct to employers and consumers and cut out the PBMs.
Former Pharma Guy@FormerPharmaGuy
@real_doc_speaks Let me do it for you: Middlemen manipulate the market, hospitals markup egregiously (sometimes 400%), patent laws are exploited, 340B killed private practice, ASP reimbursement makes it impossible to discount. “Drugs are too expensive because they cost a lot” is a low IQ answer
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Make healthcare management courses a requirement in med school
Real Doc Speaks@real_doc_speaks
Pharma needs to stop complaining about the PBMs and stop using them.
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You refuse to read the Rand Study report because it exposes the pharmaceutical industry for massively overcharging the US.
This isn't difficult. Pharma needs to give us the best price they do in other comparable countries.
Former Pharma Guy@FormerPharmaGuy
@real_doc_speaks Nope. Empirical. Define overcharging. What is the threshold for overcharging?
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@real_doc_speaks Let me do it for you: Middlemen manipulate the market, hospitals markup egregiously (sometimes 400%), patent laws are exploited, 340B killed private practice, ASP reimbursement makes it impossible to discount. “Drugs are too expensive because they cost a lot” is a low IQ answer
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@real_doc_speaks Nope. Empirical. Define overcharging. What is the threshold for overcharging?
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rand.org/pubs/research_… Everything you need to know is in this report.
The US pays 2.78 times what other countries pay for drugs and 4.28 times more for brand name drugs.
Former Pharma Guy@FormerPharmaGuy
@real_doc_speaks Define overcharging. Conceptually, not empirically or anecdotally
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@real_doc_speaks Define overcharging. Conceptually, not empirically or anecdotally
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@FormerPharmaGuy I think it is naive to assume that Pharma can continue to overcharge the US for brand-name drugs.
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Pharma has always used this threat to justify overcharging the US.
People are tired of the game.
Former Pharma Guy@FormerPharmaGuy
@real_doc_speaks People will literally die if this happens. You will never see a rare disease drug again. There will be no incentive to push for better survival outcomes in cancer. You gotta be smarter than this
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@real_doc_speaks @DrDiGiorgio @DutchRojas @HeathVeuleman @mass_marion So you agree there is a level of organization and a physician lobby…
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@FormerPharmaGuy @DrDiGiorgio @DutchRojas @HeathVeuleman @mass_marion The AMA is great at lobbying for licensing fees for CPT codes and that is it!
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Doctors are great at venting and we all think we are the smartest one in the room.
The reality is:
• We aren't organized
• We don't have a lobby
• We are not at the table in DC
We need to change this ASAP! @DutchRojas @HeathVeuleman @mass_marion @DrDiGiorgio
Dana Corriel, MD@DrCorriel
Whose hands are holding you back from controlling your own life and career? At the end of the day, it may be your own hand that’s doing that. It’s fine to continue venting about what’s broken in healthcare, but let’s pick ourselves up, brush ourselves off, and create meaningful changes that will impact our field positively. For both ourselves and for our patients.
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@independentMDs Not statins, but in office administered drugs very much so
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An MD doesn't realize MDs make no money by prescribing meds?
Andrew Zywiec, M.D.@AndrewZywiecMD
This is actually unbelievable. Doctors are now trying to convince you to take statins and other drugs for absolutely NO reason. Not even an "abnormal" lab anymore. Seems the rest of the medical field is taking a page out of the vaccine playbook to make endless money.
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@DrDiGiorgio @real_doc_speaks @DutchRojas @HeathVeuleman @mass_marion Its a fair point, but doesn’t mean its not a powerful org. It would be much bleaker for physicians if the AMA didn’t exist. FWIW I’m on your side. Drs should be getting rewarded handsomely. Bring back private practice
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@FormerPharmaGuy @real_doc_speaks @DutchRojas @HeathVeuleman @mass_marion AMA is so powerful that physician reimbursement has declined 50% since the 1990s…
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@real_doc_speaks PBMs DONT PURCHASE DRUGS HOW COULD THEY GET A DISCOUNT. Do you know what a PBM is?
The other two points would absolutely work
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If PBMs were serious about negotiating prices, the following would occur:
• They would negotiate a discount and not a rebate
• They would not charge drug companies money for
formulary access
• They would be paid a flat fee for services
Ruth Sharps@TheRebelAmerica
@kpharmd12 You know, it’s easy to blame one part of the system, but PBMs are also part of how prices get negotiated in the first place. If that goes away or gets disrupted, it could actually hurt patients more. They handle a lot of the BTS work that most people don’t see.
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@real_doc_speaks The cost of healthcare (including drugs) is absolutely too high. But your proposed solutions show a fundamental and populist tainted naivety
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@FormerPharmaGuy The price of drugs is definitely too high in the United States and there’s too many people who ration or skipped their medications. Because of that there will be changes.
The PMs are definitely coming under fire as everybody can see the true intent of their business model.
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Patent thickets are unAmerican!
Former Pharma Guy@FormerPharmaGuy
@BignaultJon @real_doc_speaks That is literally a price control. It is uniquely unamerican, would be ruled unconstitutional, political suicide for anyone who supports it. Targeting drug prices directly is a slippery slope. PBMs, Hospitals, and and other entities that mark up are where you need to look
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