Jim Teegarden

@ginny_crisp @nurees1987 @mcuban Follow Dr. Adam Fein. He covers this well.

That whole category is its own ethics problem. The plan deliberately denies coverage so the member gets routed to manufacturer PAPs or foundation grants designed for the uninsured. The plan books savings. The AFP vendor takes a cut of them. The member sits in the middle with delays and re-applications every cycle. Worth flagging for self-funded employers: this is a live ERISA fiduciary question, not a settled best practice.

Copay accumulators: a program that takes the manufacturer's copay assistance, keeps it off your member's deductible, and routes the value back to the PBM. It's probably in your contract. It's probably not labeled that clearly.

@kpharmd12 A good time for this again- Visit an independent pharmacy regardless of your $$ situation- Ask the cash price on your generic meds. You may be pleasantly surprised. Plus, you will support YOUR community. Not someone making $MM per month.

Only ones standing in my way of achieving my goals are PBMs.

@Commpharmacy Questions are big opportunities!

🚑 Community pharmacies are often the first place patients turn with health questions — including during urgent situations. Join us June 3 at 9 p.m. ET for the next Community Connected webinar, a CPESN® initiative, focused on first aid awareness and the growing role pharmacies can play in community preparedness and early response. Discover ways your pharmacy team can deliver accessible first aid education, support timely care, and help build safer, healthier communities through patient-centered services. 🔗 Register now: register.gotowebinar.com/register/72692…

@JMozloom beckershealthcare-news.com/portal/wts/ue%…

CVS sues Tennessee to halt law that could close pharmacies. Wow, the ink on the law isn’t dry yet and CVS is suing to block it. No surprise. usatoday.com/story/money/20…

@kpharmd12 q one should keep in mind that- Being "controlled" by a lobbyist is not inherently considered fraud, but it crosses into illegal territory—

Let’s hope this gets across the finish line. This is not the time for dicking around and having more hearings. Monopolistic powers affect everyone who uses insurance. Literally everyone now thanks to the ACA.

@sterlingkoonce @kpharmd12

@kpharmd12 Mind boggling I thought he was smarter than this.

You can’t be serious about reducing healthcare costs or helping to increase pharmacy access by meeting with GoodRx. They make their money off the backs of patients and pharmacies, alike. Often times, they make more money on a prescription than the pharmacy dispensing it.

@Pharmassists That little canister will survive really well in a hot mailbox!

Just found out today Humana now only covers brand Ventolin instead of a much cheaper Albuterol. Feel bad for the patients that can't breath but I'm not filling that at a loss. Guess they will have to wait for mail order. Yay for more ER visits!

@Pharmassists @BSGPharmD @isinthedetails @Humana Time to get @mcuban to make some noise about this!

@BSGPharmD @isinthedetails @Humana If it makes you feel better they are paying Walmart 3-4x more on those same generics.

@Humana every single independent pharmacy in the nation deserves to get an answer to why you have slashed reimbursements across the board and refuse to pay cost on any brand name product. We are all having to make the decision to stop taking humana and the customer is hurt.

@BoesingLoretta If you don’t have an independent pharmacy close by, I’m sure there will be one in your state that can offer a solution.

@BoesingLoretta A good time for this again- Visit an independent pharmacy regardless of your $$ situation- Ask the cash price on your generic meds. You may be pleasantly surprised. Plus, you will support YOUR community. Not someone making $MM per month.

Has it happened to you or your loved one? "According to the Kaiser Family Foundation, 43% of adults worry about affording their #medications, and nearly 3 in 10 are forced to delay prescriptions, ration doses, or go without entirely." Some find that the cash price is lower than the price their insurance is charging. Others uncover that a generic medication is available but were not provided that option at the #pharmacy counter as they walk away empty-handed. Some are not here today due to price gouging. It is time to #stopPBMabuse. Pharmacy benefit managers or #PBMs set up a system that sometimes leaves patients paying the highest price they can get away with charging when #patients are paying with insurance. Patients should always have the option to choose the pharmacy that best meets their needs, that is properly staffed to be able to assist them when issues arise, and pharmacies should be reimbursed fairly. Level the field. patientvoicesinpharmacy.com

@kpharmd12 Permission to share and wear everyone out with this story…..

I was poking around into Genoa Healthcare Pharmacies operating in Ohio. In case you didn’t know, Genoa is a subsidiary of United Health Group. There are currently 45 Genoa Healthcare Pharmacies in Ohio; and more than 750 in operation nationwide. On Genoa’s website, they heavily promote InsideRx pharmacy discount cards. Guess who owns them? Evernorth- aka Express Scripts, aka Cigna So… if we don’t think that PBMs are in cahoots with each other- think again! That’s my rabbit hole for today. Thanks for listening to me rant.

@kpharmd12 @AmbetterHealth $15.00 US Cash it out

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.

@kpharmd12 @SilverScriptPDP @Aetna @CVSHealth It’s time to implement the FACILITY FEE just like BIG hospitals.

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.

@sterlingkoonce @IndyRxVoice If the meds a generic, the patient should make their life simpler- Ask the cash price on your generic meds.

@IndyRxVoice Because it’s probably their own mail order or pharmacy and they don’t want to provide proof of their own illegal patient steering.

Why haven’t insurance companies implemented showing in the early fill rejection as to which other pharmacy filled the prescription ??? Do you know how much time this would save everyone trying to track down where it is to reverse it

@sterlingkoonce @IndyRxVoice No doubt! And the med is lost on a mail/delivery truck.

@kpharmd12 A good time for this again- Visit an independent pharmacy regardless of your $$ situation- Ask the cash price on your generic meds. You may be pleasantly surprised. Plus, you will support YOUR community. Not someone making $MM per month.

Going to start asking a patients additional questions after we ask them if they would like counseling today… “Would you like to know how much your insurance company is paying your pharmacy for your prescriptions today” “Would you like to know how your pharmacy is going to survive on a negative reimbursement today” “Would you fill your prescription for a 15 cent profit margin, not including labor and overhead costs”

@CrazyRxMan Dogs really do smile

Later things were much better!

Vala looked worried about her first visit to the vet.

@CrazyRxMan And I will always think, Valium

Her name is Vala.

@CrazyRxMan Great facial features

What do you think of my new puppy?

@CrazyRxMan @grok You are hoping to find a patient with a good ❤️

Hey @Grok, why does AI always put a stethoscope on the pharmacist’s neck when we ask it to create a picture with a pharmacist in it? Pharmacists don’t use stethoscopes.