Dan Munro

Stunning stats: Before "2007, people in the US never purchased more than 7M guns in a single year. By the time Barack Obama left office, the US was purchasing almost 17M guns a year." In 2020 US consumers "bought almost 23M guns in a single year." propublica.org/article/ryan-b…

... and breaking up conglomerates lowers healthcare costs how? That's right - it doesn't. As Uwe Reinhardt so famously said - "it's the prices stupid" - and this legislation (like so much before it) does absolutely NOTHING to address uncapped commercial pricing.

@mcuban @HawleyMO @SenWarren @POTUS Easy to endorse - and makes for great headlines - but breaking up healthcare conglomerates won't bend the national cost curve because it completely avoids the really (*really*) hard part. Pricing reform.

Great job @HawleyMO & @SenWarren LOVE THIS. Anyone in Congress that doesn’t support this, doesn’t want lower cost healthcare for Americans. This is a no brainer. Let’s hope @POTUS puts his weight behind this

@ahier Hard to believe it's been 10 yrs ;-)

@DanMunro was brilliant at this event

Classic Post by @ahier ::: . . . The Health Data Analytics Hype Cycle ahier.blogspot.com/2014/03/the-he…

@paulkeckley The complexity is a feature - not a bug. If you can't understand it - you can't question it. Pharma chart is a pretty good example ...

Is Affordable Care Act a major issue in Campaign 24? Only ? in 2 hr debate last night came 101 min after start. 3 min reply from 2 candidates and move to Warp Speed. Clearly, campaigns will dodge healthcare because issues are complex & require adult discussion & objective facts.

@mfcannon Well I did write a book ... and Chapter VI - The Original Sin - is on #ESI. But 32pgs on *just* the tax exclusion? Whoa ;-) ... only b/c we need to END #ESI - not *just* the tax exclusion. WE need employers out of #HC biz. Contributors sure - but not *active* players.

@DanMunro If reforming health care isn’t worth 32 pages of your time… 🤷🏻‍♂️

A problem the government created 100 years ago (and has since made no serious effort to fix): cato.org/policy-analysi…

@akiffpremjee @JamesGLeckie ... not with brand name ... and that's the biggest spend. ... also dependent on whether formulary is open or closed.

@DanMunro @JamesGLeckie Yeah I remember - regulation needed I’m not saying that I’m just saying that to get on formulary you have to be competitive

@akiffpremjee @JamesGLeckie Not convinced. Pharma still has to tier pricing. Owning the PBM that does that makes it easier - not harder.

@DanMunro @JamesGLeckie Vertical integration with insurance and pharmacies makes this harder because now they have incentive to keep them instead of letting them maximize revenues for the whole sector like you said

@akiffpremjee @JamesGLeckie ... all part of the WHOLE healthcare system - which has been designed to support tiered pricing. PBMs are the delivery mechanism for tiered Rx pricing. Point being - it's a MUCH larger issue than just targeting Rx/PBMs. hc4.us/oneprice

@DanMunro @JamesGLeckie Oh 100% agree that PBMs (those with rebates especially) need to go And I think they need to go because it’s a black box and opaque and we don’t actually know (but seems like you’re saying we do) how much money is moving through them and where it’s going

@akiffpremjee @JamesGLeckie ... which has *some* implications for generics - not for brand. ... and you do remember the Daraprim/Pharma Bro story - right?

@DanMunro @JamesGLeckie Lol uncapped meaning they have to be competitive to actually get on the formulary They can increase the list price but if too expensive they won’t sell or be added Also pricing happens in bundles not individual drugs But yes not capped by regulation but by market

@akiffpremjee @JamesGLeckie The real issue is that PBMs exist at all. Their only function is to deliver tiered pricing (as a way to *maximize* revenue for the whole sector). For payers (and others) that has big value - even if it's a relatively small part of #NHE. Name one other country with a PBM? 2/2

@akiffpremjee @JamesGLeckie PBMs make money - and there's pretty good visibility into the category - even if there's variability between entities. I'm just saying that targeting them as a *primary* source of Rx high pricing is misguided. 1/2

@akiffpremjee @JamesGLeckie Where's the cap?

@DanMunro @JamesGLeckie It just isn’t what I expected and not sure how they came to these numbers since rebates are hidden Uncapped MFG pricing doesn’t seem right because they need to compete to go on formulary so can’t infinitely go up Also most drugs are negotiated on a bundle basis not per drug

@akiffpremjee @JamesGLeckie Have to think of it as different lines of business - and yes - 6 PBMs own about 96% of the market. Not unlike GM making cars - and also owning GMAC Financing. Parent company is GM - but distinctly different LOBs/functions.

@JamesGLeckie @DanMunro Yeah but the only tricky part is that the big 3 PBMs are owned by the big 3 insurers and also run their own pharmacies so the piece of the pie is much bigger but they are just separating them into different slices Will look at article link because wonder how they calculated this

@akiffpremjee @JamesGLeckie Which part is confusing? Rx MFGs set pricing (which is basically uncapped). PBMs take a cut - which averages out to ~$5 for every $100 spent on an Rx ($2 for Brand name and $7 for generic). Point being - not much juice for squeezing PBMs.

@JamesGLeckie @DanMunro Can you link the original tweet - this is so confusing to me lol

@nickisnpdx @burtrosen ... and the chart that helps to visualize almost $730M - in one year (2022).

@burtrosen @DanMunro ask chatgpt how many lobbyists each of these groups have in washington: ama, aba, and pharma. u’ll see why it isn’t going to change. inertia, mass, force…..it’s a physics problem. it’s driving the expat decision for many. hat tip to the ones who have already jumped.

@JamesGLeckie @Robert_t_Orr But PBMs don't *really* increase pricing. MFGs set list pricing. Insulin is just one example of the gross-to-net bubble. MFGs are fully complicit in the opaque pricing casino.

@esmccalley @nickisnpdx @Gil_Bashe @HLTHEVENT @TCLawry @JohnNosta @ZGJR I dunno. I'm not aware of any serious (ie well-funded) efforts - and that's the real challenge b/c it's less about "discovery" and much more about enforcement. We have a very similar issue (albeit easier) w/ taxes and Congress can't even support the bone simple ROI there ;-(

@DanMunro @nickisnpdx @Gil_Bashe @HLTHEVENT @TCLawry @JohnNosta @ZGJR Not shocking. And thank you! Who is building fraudGPT for healthcare? I am loving my auto GPT agents! Report back from HLTH! 😉😂

Heading to @HLTHEVENT #HLTH2023? We should expect big things from keynote speakers and panelists. My 10 Predictions on hot topics for the Las Vegas mega meeting - from #AI to #DigitalHealth to #WomensHealth. @TCLawry @JohnNosta @ZGJR medika.life/when-it-comes-…

@esmccalley @nickisnpdx @Gil_Bashe @HLTHEVENT @TCLawry @JohnNosta @ZGJR Best I can tell - it's now in Deloitte's (offline) archive ;-( ... but I did cover it (w/ a link to the report) back in 2014. forbes.com/sites/danmunro… The OTHER stunner? Waste, fraud and abuse. $760-$935B /yr.

@DanMunro @nickisnpdx @Gil_Bashe @HLTHEVENT @TCLawry @JohnNosta @ZGJR Do you have the link to this paper? The downstream economic effect is pretty crazy when you factor in all the people leaving jobs to take care of loved ones. The impact to employers in MA alone is 2.1B. We MUST put these pieces together as a society. It is the cliff for the US.

@esmccalley @nickisnpdx @Gil_Bashe @HLTHEVENT @TCLawry @JohnNosta @ZGJR ... not at all ... just want the credit to fall where it's due ;-) ... and yes - caregiving (what Deloitte calls Supervisory care) is a book worthy topic - starting w/ indirect/imputed cost - which Deloitte estimated at $492B/yr (back in 2012/13?) ;-(

@DanMunro @nickisnpdx @Gil_Bashe @HLTHEVENT @TCLawry @JohnNosta @ZGJR Sorry for being dramatic Dan. Love your work! 🙌 You know….I am going deep into the caregiving space helping bring a new company to market. Holy cow the data on caregiving is SCARY. Seriously…