Jeryd

@mcuban Can you build a web site / service with a RSS feed to automatically produce this?

And a thank you to Denver and all cities and states that make their contracts available. It’s the only way to make things better.

The city of Denver makes it’s PBM contract available online. So I grabbed it and had Claude look at it and answer a simple question “Where are they getting ripped off” Here is it’s response: Denver is getting hit in six places, and the contract says so out loud. This is a self-funded City & County of Denver plan (4,051 employees / 8,554 participants, 1/1/2023–12/31/2025, $80M max) where the only stated pharmacy fee is… nothing. The medical admin fee is $45.13 PEPM. There is no PBM admin fee. That’s your first tell — the pharmacy program is priced entirely in the dark. 1. Spread pricing, written into the contract three separate times. Section A7 (Claims Processing): on mail, specialty and retail, United retains the difference between what it reimburses the network pharmacy and what Denver pays. It’s repeated in the General Conditions of the Pharmacy Financials exhibit and again in the Specialty Pharmacy Discount Guarantee conditions. So the AWP-discount guarantees describe what Denver pays — not what the pharmacy receives. The delta is Optum’s revenue, uncapped and unreported. For a public entity, that’s the whole ballgame. FTC found the Big 3 generated an estimated $1.4 billion of spread income on specialty generics alone. 2. Rebates: 100% retained, replaced with a fixed per-script number. Section A8: United keeps 100% of pharmacy rebates and pays Denver a fixed brand-script guarantee instead — $740.43 retail / $1,020.22 mail in 2023, rising to $885.02 / $1,105.10 by 2025. The contract then says explicitly that any rebates above the fixed amount are United’s to keep. Manufacturer rebate administration fees are folded into the guarantee, meaning they’re netted against what Denver was already owed rather than paid over. Denver has no idea what the actual rebate yield is, and no contractual right to find out. 3. The Rebate Credit clause is the biosimilar killer. If Denver moves to a biosimilar, an authorized alternative, or a lower-WAC brand, United gets credited toward its rebate guarantee for the manufacturer revenue it would have earned had Denver stayed on the high-rebate originator. Translation: United is financially indifferent to Denver buying the cheaper drug. Denver’s savings on ingredient cost get clawed back through the rebate math. 4. Your five clauses — all present, all in United’s favor. Specialty Drugs are defined as “Prescription Drugs available at United’s Specialty Pharmacy.” That’s a circular definition: whatever Optum stocks is specialty. Then: “United reserves the right to change the designation of a drug from specialty to non-specialty based on market conditions.” Then: specialty dispensed inside United’s specialty network is excluded from the retail and mail guarantees. Specialty dispensed outside it gets swept into the retail guarantee. Specialty rebates are “included in retail.” The specialty guarantee itself is 20.7% off AWP composite — and any specialty drug not on United’s list is guaranteed at only 14.0%. United controls the list. Every new high-cost launch defaults to the 14% bucket. And spread is retained on top of the discount either way. 5. Medical-benefit specialty has no guarantee at all. “Specialty drugs typically covered under the medical benefit (physician’s office, ambulatory, home infusion), and/or transitioned to the pharmacy benefit, are excluded from all guarantees.” That’s the buy-and-bill oncology and infusion book — the most expensive spend in the plan — with zero pricing accountability. On medical drug rebates Denver gets 80%, United keeps 20% plus float interest, and an unnamed subcontractor takes an undisclosed cut on top. 6. The lock-in clauses, which are the reason you can’t fix any of the above. Denver may not negotiate with any manufacturer for rebates or direct purchase — doing so forfeits earned-but-unpaid rebates. All pricing guarantees require United as exclusive mail provider. Terminating pharmacy services early means United keeps every pending and future rebate.

@mcuban Thank you. I think there needs to be more of this - Calling out public organization on their (wasteful? unwise?) decisions.

@feifei_qiu @paulg I cant wait.

@paulg The next generation is living a different life. Imagine no phones.

Jessica: Imagine what it was like when there were no ATMs. 17 yo: I've never used an ATM in my life.

@damo_sheff @Michelle71966 Your kinda a dick.

@Michelle71966 How old is he? Both my parents are 78 and have no problems with modern technology. That’s because they’ve taken the time to learn, along with the rest of us, as it’s slowly been introduced over the years. I have zero sympathy for people who haven’t learnt and are now struggling.

My dad is now living with me and it has been a real eye opener as to how hard the modern world has become for the elderly. He is a highly intelligent man, fully switched on and yet he's seemingly faced with tech roadblocks with everything he tries to do. How anyone living alone

@carlrichell For what it's worth, I really like cosmic. I used it on fedora. Also made my own screensaver daemon for it. It's like I'm reliving my youth. Lol

COSMIC has been out for seven months and a lot has happened in that short time. The blog was written as a six month progress report but Frosted Glass took a tad bit longer to refine and I really wanted it in there 😅 system76.com/blog/post/cosm…

@oprinmarius @Cloudflare Im annoyed that those are not region locked.

@Cloudflare Dismissing the cookie banners! We should have a browser level toggle to reject all cookies except session cookies!

If you could automate one minor, annoying daily Internet task completely, what would it be? #CloudflareChat

@Codie_Sanchez Software. Everything can be written from scratch now with minimal effort.

Businesses I’d avoid like the plague in 2026: - Retail - Hotels - Vineyards - Consulting - Restaurants - Amazon FBA Anything you’d add?

@edmond4822 @PeteHegseth @USArmy good luck using drones in the jungle

@PeteHegseth @USArmy Ground troops days are over you fool. Everyone uses drones now. What is the point of having soldiers on the ground when a tiny drone blows them up.. dont be an idiot.

“The legendary @USArmy jungle training has returned to Panama…” lineofdeparture.army.mil/Journals/Infan…

@krystiangebis @pashmerepat It feels a lot like gate keeping.

@pashmerepat Absolute legend for saying that. Pleasantly suprised - just the other day i finished some firmware support that was missing and i wondered if i’d get bitched out if i opened a PR lol

Absolutely beautiful rant about AI in Linux Kernel from Linus yesterday: I realize that some people really dislike AI, but this is an area where I'm willing to absolutely put my foot down as the top-level maintainer. Linux is not one of those anti-AI projects, and if somebody has issues with that, they can do the open-source thing and fork it. Or just walk away. AI is a tool, just like other tools we use. And it's clearly a useful one. It may not have been that "clearly" even just a year ago, but it's no longer in question today. There are other questions around AI (like what the economy of it will actually look like in the end), but "is it useful" is no longer one of those questions. Anybody who doubts that clearly hasn't actually used it. Yes, it can also be a somewhat painful tool, both for maintainer workloads and just from a "it keeps finding embarrassing bugs" standpoint. But the solution is not to put your head in the sand and sing "La La La, I can't hear you" at the top of your voice like some people seem to do. The solution is to make sure those LLM tools _help_ maintainers instead of just causing them pain. There's no question on that side. We're not forcing anybody to use it, but I will very loudly ignore people who try to argue against other people from using it. And no, AI isn't perfect. But Christ, anybody who points to the problems at AI had better be looking in the mirror and pointing at themselves at the same time. Because it's not like natural intelligence is always all that great either. The kernel project has been and will continue to be about the technology. Sure, the social angle of working on open source is important and often a very motivating part of the project, but in the end that's a side benefit, not the _point_ of the project. This is *NOT* some kind of "social warrior" project, never has been, and never will be. In the kernel community we do open source because it results in better technology, not because of religious reasons. And so we make decisions primarily based on technical merit. Not fear of new tools. Linus

@LukeCB14 I would love to see a story like this. Just do something like the Vex won in D1/D2 timeline and things got reset for D3. Some things are the same, some are different.

I think my dream scenario for a Destiny continuation would be a retelling of Destiny 1 & Destiny 2, which then leads into a "Destiny 3" in one big "forever game". I think having the entire story in one game which can be played start to finish would be incredible. They'd also have the opportunity to tweak classic experiences to improve the gameplay or storytelling such as: - Improving Destiny 1 campaign mission structure (perhaps merging multiple missions into one for legendary campaign missions) - Adding dungeons as supplemental content to Destiny 1 storylines - Restructuring campaigns that have too much busy work, such as Shadowkeep & Beyond Light. - Fixing stories by pulling aspects from seasons (looking at you Lightfall) Honestly I feel like there's just so much potential in this, and I think would be a great middle ground between people who want D3, people who want a D1 remake and people who want a D2 classic. Obviously, I'm no game dev so I have no clue on the logistics of something like this. I just know I'd LOVE something like that.

@AFpost Just raise the standards for T. If you dont make the cut, you get extra T.

Pete Hegseth says that TRT will be offered to soldiers over 30, creating the "High-T" military. Follow: @AFpost

@unusual_whales That's great! But the medical system needs to raise the level at what is considered deficient. The number should be what is needed to do the military job and not what is low in relation to the larger population. @grok help out here.

BREAKING: Department of War's Pete Hegseth has said that soldiers over age 30 to be screened for testosterone deficiency, per the Guardian

@SimonSwanch @unusual_whales It is, but if your number is significantly down, you can get assistance getting it up.

@unusual_whales Testosterone decline in your 30s is natural is it not?

@rseroter @antigravity still can't input sudo when trying to do system admin. gemini cli could do this.

I like the @antigravity updates this week. 🤩 Queued message configuration is important. The performance, stability, and usability improvements will keep you in a flowstate longer. antigravity.google/changelog CLI also got improvements: github.com/google-antigra…

@IanjhReynolds @InternetNewsAg2 @PalmerLuckey that is not going to happen.

@InternetNewsAg2 @ubermetroid @PalmerLuckey If you are deploying lethal systems that help war fighters you need clean code. Its got to go through multiple levels of review. No doubt they are doing this but curious as to the final human review given what was probably first is ai output. Prob a decline curve for review

Everyone who thinks AI slop will ruin code efficiency/performance is going to be so surprised when everything is absurdly well-optimized John Carmack style machine code.

@IanjhReynolds @PalmerLuckey Human review is just going to slow things down. Just do test based outcome focused coded. Who cares how it gets there.

@PalmerLuckey Wont Anduril systems still need some level of human review of production code given the sensitive nature of what is produced for war fighters?

@marty_kausas I use @msty_ai

i'm so sick of using claude code in a terminal i'm not coding. who has made a great app that i can use with any model?

@reactos @AotoriHibiki Can you get Destiny 2 working?

We previously shared Call of Duty working on #ReactOS. Call of Duty 2 works too, on real hardware! Video by @AotoriHibiki. youtube.com/watch?v=oxcIaC…

@mcuban @mcuban How is this not price fixing / monopoly? Is it is just legal?

It's not. Why ? Because 25 pct or more of a doctor's time is spent dealing with conglomerates that do all they can to make the doctor's care more difficult, and expensive, for both the doctor and patient. For every future agent we give AI doctors to deal with this friction, and to improve the quality of care, the conglomerates will have multiple adversarial agents doing all they can to delay and deny, to minimize their cost and maximize their float We see this already as the conglomerates use AI to find every possible way to manipulate contracts, and find ways to mislead, while hospitals hire companies for Revenue Cycle Management, who charge as much as 10 pct of revenue to have their agents try to do the reverse. It's the agentic version of Mad magazine Spy vs Spy I'll give you a further example. There isn't a single company, including yours, that knows the actual cost of the care they purchase for your employees and families. Not one. Cost is an important component of health care decision making. @a16z includes costs in defining its benefits. But you are blind to all but the total bill you pay. Your carrier, your ASO, your PBM, any company that touches the economics of care for your company is going to do everything they can to prevent you from using AI doctors or agents successfully If you want to see that change, stop working with the healthcare conglomerates. Write agents that define , optimize and contract directly with providers, to eliminate the uncessary middlemen. Feel free to use costpluswellness.com to train them. Until the conglomerates are disintermediated , HC in this country will continue to be fucked

@StephenFleming If we really cared about health drinking alcohol would be illegal.

Since this got some traction, I’ll repeat an unpopular position: If we really cared about keeping our kids alive on the roads, we’d swap the drinking and driving ages. Drink at 16, drive at 21. Would save thousands of lives per year. There’s no way I should have been entrusted with a 300hp, two-ton land missile at age 16. I’m lucky that I only got speeding tickets, and never hit anybody.

Yet another friend with a child turning 16 next week. Hasn’t gotten a learner’s permit. Zero interest in a driver’s license. I keep hearing this same story. What’s WRONG with these kids?!?! On my 16th birthday, my mom took me out of school to take my driving test. Same for everyone I knew. Even if you couldn’t afford your own car, you could beg the use of the family station wagon occasionally. Freedom. Independence. Heck, privacy on a date! Are these kids giving all that up for scrolling TikTok and an occasional Uber?