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A pharmacy in Hancock, Maryland just closed its doors after 21 years. Their reason? "These PBMs are killing us." Let me show you exactly how that happens — because it's not what most people think. A pharmacist posted an audit on a prescription he filled back in December. Here's...

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Forest Park Pharmacy

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10,310 просмотров • 1 месяц назад •via X (Twitter)

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Tennessee just did what Congress can't. They passed a law to break up the health insurance giants. Specifically, they made it illegal for pharmacy benefit managers — the companies in charge of pharmacy insurance — and pharmacies to be owned by the same company. That makes perfect sense. For example: CVS Caremark is the PBM, and CVS is the pharmacy. So if you have Aetna insurance, you have CVS Caremark as your PBM, and they're going to do everything they can to make sure you use CVS as your pharmacy. Aetna, Caremark, CVS — all the same company. That causes all kinds of incredibly obvious problems that this law hopes to fix. If your insurance company is in charge of approving your medication, deciding how much to pay for it, AND deciding who gets that money — while also being the pharmacy that gets paid at the end — guess what happens to prices? They go up. Governor Lee signed the law last week. CVS immediately filed a federal lawsuit because they said it will force them to close all 136 stores they have in Tennessee. Let that sink in. I'm not sure most people realize what that says about CVS and health insurance in general. They had to choose between owning the middleman (the PBM) or the healthcare provider (the pharmacy). Without hesitation, they chose the middleman. The biggest pharmacy chain in the country — with a store on every corner — would drop all 136 of their Tennessee locations in a second if it means keeping their middleman business. It is more profitable for them to be a health insurance middleman getting between you and your healthcare than it is to actually provide the healthcare. That is the problem with healthcare in America. We have made the middleman so powerful that they've taken complete control of the entire system. Three PBMs — Caremark, Express Scripts, and OptumRx — handle around 80% of all prescriptions in this country. How on earth can we expect healthcare to work well and remain affordable if that's where the money is? We all auto-pay our insurance straight out of our paycheck before we even see the money. And not surprisingly, they're keeping a ton of it. That's why we fired them. And they can't file a lawsuit to stop us. That lets us offer fair, transparent prices. No PBMs. No insurance games. No hidden markups. You see the cost, you pay the cost.
2:32

Tennessee just did what Congress can't. They passed a law to break up the health insurance giants. Specifically, they made it illegal for pharmacy benefit managers — the companies in charge of pharmacy insurance — and pharmacies to be owned by the same company. That makes perfect sense. For example: CVS Caremark is the PBM, and CVS is the pharmacy. So if you have Aetna insurance, you have CVS Caremark as your PBM, and they're going to do everything they can to make sure you use CVS as your pharmacy. Aetna, Caremark, CVS — all the same company. That causes all kinds of incredibly obvious problems that this law hopes to fix. If your insurance company is in charge of approving your medication, deciding how much to pay for it, AND deciding who gets that money — while also being the pharmacy that gets paid at the end — guess what happens to prices? They go up. Governor Lee signed the law last week. CVS immediately filed a federal lawsuit because they said it will force them to close all 136 stores they have in Tennessee. Let that sink in. I'm not sure most people realize what that says about CVS and health insurance in general. They had to choose between owning the middleman (the PBM) or the healthcare provider (the pharmacy). Without hesitation, they chose the middleman. The biggest pharmacy chain in the country — with a store on every corner — would drop all 136 of their Tennessee locations in a second if it means keeping their middleman business. It is more profitable for them to be a health insurance middleman getting between you and your healthcare than it is to actually provide the healthcare. That is the problem with healthcare in America. We have made the middleman so powerful that they've taken complete control of the entire system. Three PBMs — Caremark, Express Scripts, and OptumRx — handle around 80% of all prescriptions in this country. How on earth can we expect healthcare to work well and remain affordable if that's where the money is? We all auto-pay our insurance straight out of our paycheck before we even see the money. And not surprisingly, they're keeping a ton of it. That's why we fired them. And they can't file a lawsuit to stop us. That lets us offer fair, transparent prices. No PBMs. No insurance games. No hidden markups. You see the cost, you pay the cost.

Forest Park Pharmacy

33,253 просмотров • 2 месяцев назад

🚨 To Elon Musk and the DOGE team looking at Medicare: Pharmacist says - Cancer Medicine Imatinib costs them $7 to buy. They add $10, so you're out the door for $17 - When Medicare pays for this drug, IT COSTS THEM $2,400 - This drug was filled 250,000 times in 1 year costing Medicare $600 million “If every one of those scripts was filled at our pharmacy instead of through Medicare, it would've cost $4 million. That means that we are $596 million cheaper than the insurance. That's crazy.” “So why are they paying this much for that medication? Well, insurance companies pay a middleman, the pharmacy benefits manager, and that person decides how much that medication's gonna cost” - 3 Pharmacy Benefits Managers control over 90% of all prescription pricing in America - Pharmaceutical companies bought all 3 Pharmacy Benefits Managers They set their own pricing, Medicare pays ASTRONOMICAL prices and taxpayers pick up the bill. This is a racket.
1:25

🚨 To Elon Musk and the DOGE team looking at Medicare: Pharmacist says - Cancer Medicine Imatinib costs them $7 to buy. They add $10, so you're out the door for $17 - When Medicare pays for this drug, IT COSTS THEM $2,400 - This drug was filled 250,000 times in 1 year costing Medicare $600 million “If every one of those scripts was filled at our pharmacy instead of through Medicare, it would've cost $4 million. That means that we are $596 million cheaper than the insurance. That's crazy.” “So why are they paying this much for that medication? Well, insurance companies pay a middleman, the pharmacy benefits manager, and that person decides how much that medication's gonna cost” - 3 Pharmacy Benefits Managers control over 90% of all prescription pricing in America - Pharmaceutical companies bought all 3 Pharmacy Benefits Managers They set their own pricing, Medicare pays ASTRONOMICAL prices and taxpayers pick up the bill. This is a racket.

Wall Street Apes

3,763,694 просмотров • 1 год назад

My wife and I own a pharmacy. Last month we spent days trying to pry one prescription loose from a company that did everything it could to hold onto it. The drug was everolimus. A generic. It treats cancer and protects transplant patients from rejecting their new organ. Not exotic. Not rare. A pill. The patient wanted it filled with us because we're cash-pay and cost-plus. No insurance. No PBM. No secret markups, no games. Our price was $318. That's not cheap by our standards — most of what we fill runs under $20 — but it was honest. Here's what that same prescription looked like on the other side of the counter. In 2023, Medicare was paying about $6,645 for it. That's roughly 21 times our price for the identical medication. Medicare spent around $240 million on everolimus alone that year. If they'd paid our price, they'd have saved roughly $230 million. On one generic drug. So how does an insurance company profit off a drug that expensive? Don't they pay for it? No. You pay for it. In your premiums. Their job isn't to spend less — it's to keep your healthcare dollars circulating inside their own companies. And the tool they use is called spread pricing. Spread pricing works like this: the middleman bills the health plan one price, pays the pharmacy a lower one, and keeps the difference. You never see it. On TRICARE, they pay an independent pharmacy like mine about $311 to fill everolimus. That barely covers our cost of the drug. Meanwhile the plan gets billed thousands. That gap — north of $6,000 on a single fill — is pure margin the middleman pockets. Now here's the part they'd rather you not think about. The pharmacy we were fighting was Accredo. Accredo is owned by Express Scripts. Express Scripts is the pharmacy benefit manager owned by Cigna. Same company, three masks. That nesting-doll structure isn't an accident — it's the whole design. When the pharmacy, the PBM, and the insurer are all one entity, they can shuffle money between their own pockets and call it whatever they want. The confusion is the product. And this isn't a story about one weird drug. It's the business model. The FTC has been digging into exactly this. In its January 2025 report on the three biggest PBMs — CVS Caremark, Express Scripts, and OptumRx — staff found those companies marked up specialty generic drugs by hundreds and thousands of percent when dispensing through their own affiliated pharmacies. Just those markups generated more than $7.3 billion above what the drugs actually cost to acquire, from 2017 to 2022. One in five of the specialty generics they studied was marked up over 1,000%. Some cancer generics: over 3,000%. On top of that, the FTC pegged spread pricing on those same drugs at another $1.4 billion. One example straight from the FTC's files: dimethyl fumarate, a multiple sclerosis drug. Costs about $177 to acquire. The PBMs paid their own pharmacies close to $4,000 for a 30-day supply. Same trick. Different drug. And they steer the profitable ones to themselves on purpose. Pharmacies affiliated with the big three took in 68% of specialty dispensing revenue in 2023 — up from 54% in 2016. The prescriptions marked up more than $1,000 disproportionately end up at their own pharmacies, not independents like mine. So when we called to transfer this patient's everolimus to be filled without insurance, it landed like we were asking them to set $6,000 on fire. Of course they stonewalled us. That's why we fired them. No insurance means no invisible $6,000 charge buried in a premium you can't itemize. It means the price you see is the price. Ours was $318. Theirs was thousands. Same pill.
2:52

My wife and I own a pharmacy. Last month we spent days trying to pry one prescription loose from a company that did everything it could to hold onto it. The drug was everolimus. A generic. It treats cancer and protects transplant patients from rejecting their new organ. Not exotic. Not rare. A pill. The patient wanted it filled with us because we're cash-pay and cost-plus. No insurance. No PBM. No secret markups, no games. Our price was $318. That's not cheap by our standards — most of what we fill runs under $20 — but it was honest. Here's what that same prescription looked like on the other side of the counter. In 2023, Medicare was paying about $6,645 for it. That's roughly 21 times our price for the identical medication. Medicare spent around $240 million on everolimus alone that year. If they'd paid our price, they'd have saved roughly $230 million. On one generic drug. So how does an insurance company profit off a drug that expensive? Don't they pay for it? No. You pay for it. In your premiums. Their job isn't to spend less — it's to keep your healthcare dollars circulating inside their own companies. And the tool they use is called spread pricing. Spread pricing works like this: the middleman bills the health plan one price, pays the pharmacy a lower one, and keeps the difference. You never see it. On TRICARE, they pay an independent pharmacy like mine about $311 to fill everolimus. That barely covers our cost of the drug. Meanwhile the plan gets billed thousands. That gap — north of $6,000 on a single fill — is pure margin the middleman pockets. Now here's the part they'd rather you not think about. The pharmacy we were fighting was Accredo. Accredo is owned by Express Scripts. Express Scripts is the pharmacy benefit manager owned by Cigna. Same company, three masks. That nesting-doll structure isn't an accident — it's the whole design. When the pharmacy, the PBM, and the insurer are all one entity, they can shuffle money between their own pockets and call it whatever they want. The confusion is the product. And this isn't a story about one weird drug. It's the business model. The FTC has been digging into exactly this. In its January 2025 report on the three biggest PBMs — CVS Caremark, Express Scripts, and OptumRx — staff found those companies marked up specialty generic drugs by hundreds and thousands of percent when dispensing through their own affiliated pharmacies. Just those markups generated more than $7.3 billion above what the drugs actually cost to acquire, from 2017 to 2022. One in five of the specialty generics they studied was marked up over 1,000%. Some cancer generics: over 3,000%. On top of that, the FTC pegged spread pricing on those same drugs at another $1.4 billion. One example straight from the FTC's files: dimethyl fumarate, a multiple sclerosis drug. Costs about $177 to acquire. The PBMs paid their own pharmacies close to $4,000 for a 30-day supply. Same trick. Different drug. And they steer the profitable ones to themselves on purpose. Pharmacies affiliated with the big three took in 68% of specialty dispensing revenue in 2023 — up from 54% in 2016. The prescriptions marked up more than $1,000 disproportionately end up at their own pharmacies, not independents like mine. So when we called to transfer this patient's everolimus to be filled without insurance, it landed like we were asking them to set $6,000 on fire. Of course they stonewalled us. That's why we fired them. No insurance means no invisible $6,000 charge buried in a premium you can't itemize. It means the price you see is the price. Ours was $318. Theirs was thousands. Same pill.

Forest Park Pharmacy

59,056 просмотров • 1 месяц назад

My wife and I own Forest Park Pharmacy, and we don't accept insurance. None of it. That decision is exactly why we could fix what happened to a patient today. A family came in wanting to transfer their kid's antibiotic to us. The child had already STARTED the course. Then, mid-treatment, the insurance company decided the last 14 tablets suddenly needed a "prior authorization" before the other pharmacy could hand them over. A sick kid, halfway through an antibiotic, and the answer was "please hold." The drug is linezolid. It's a generic. It's been generic for over a decade. It treats serious gram-positive infections — the kind you do NOT want to stop antibiotics in the middle of, because an interrupted course is how you breed resistant bugs and end up right back where you started. So why the hold-up on a cheap, common generic? Follow the fake math. Insurance and the PBMs behind them price drugs off a number called AWP — "Average Wholesale Price." People in my industry have another name for it: "Ain't What's Paid." It's a benchmark number, not a real-world cost. On paper, the AWP for just those last 14 tablets is about $2,500. My cash price for the same 14 tablets? $18. Read that again. The system that's supposedly "protecting" this family from cost is the same system that inflated an $18 medication into a $2,500 line item, then slapped a prior auth on it to "review the expense" THEY invented. They manufactured the problem, then billed everyone for the privilege of solving it — and made a sick kid wait while they did it. This is the whole game. When a drug is priced honestly, there's nothing to "manage." When it's priced off a fantasy benchmark, you get spread pricing, PA paperwork, pharmacy phone trees, and delayed treatment — all dressed up as cost control. Here's the part nobody tells you: roughly 90% of prescriptions are low-cost generics. For the vast majority of what people pick up every day, running it through insurance does two things — raises the real cost and risks delaying your care. That's it. That's the value-add. That's why we fired the insurance companies. No middleman deciding your kid can't finish their antibiotics on schedule. No fake prices. Just the real number, on the shelf, today. The medication was always cheap. The insurance was the expensive part.
2:07

My wife and I own Forest Park Pharmacy, and we don't accept insurance. None of it. That decision is exactly why we could fix what happened to a patient today. A family came in wanting to transfer their kid's antibiotic to us. The child had already STARTED the course. Then, mid-treatment, the insurance company decided the last 14 tablets suddenly needed a "prior authorization" before the other pharmacy could hand them over. A sick kid, halfway through an antibiotic, and the answer was "please hold." The drug is linezolid. It's a generic. It's been generic for over a decade. It treats serious gram-positive infections — the kind you do NOT want to stop antibiotics in the middle of, because an interrupted course is how you breed resistant bugs and end up right back where you started. So why the hold-up on a cheap, common generic? Follow the fake math. Insurance and the PBMs behind them price drugs off a number called AWP — "Average Wholesale Price." People in my industry have another name for it: "Ain't What's Paid." It's a benchmark number, not a real-world cost. On paper, the AWP for just those last 14 tablets is about $2,500. My cash price for the same 14 tablets? $18. Read that again. The system that's supposedly "protecting" this family from cost is the same system that inflated an $18 medication into a $2,500 line item, then slapped a prior auth on it to "review the expense" THEY invented. They manufactured the problem, then billed everyone for the privilege of solving it — and made a sick kid wait while they did it. This is the whole game. When a drug is priced honestly, there's nothing to "manage." When it's priced off a fantasy benchmark, you get spread pricing, PA paperwork, pharmacy phone trees, and delayed treatment — all dressed up as cost control. Here's the part nobody tells you: roughly 90% of prescriptions are low-cost generics. For the vast majority of what people pick up every day, running it through insurance does two things — raises the real cost and risks delaying your care. That's it. That's the value-add. That's why we fired the insurance companies. No middleman deciding your kid can't finish their antibiotics on schedule. No fake prices. Just the real number, on the shelf, today. The medication was always cheap. The insurance was the expensive part.

Forest Park Pharmacy

538,276 просмотров • 1 месяц назад

Board Certified OBGYN exposes what they must go through just to get one prescription approved by health insurance companies “This is what doctors are dealing with in 2025. So my patient needs a medication, an indicated medication for her condition. So I send the prescription to the commercial pharmacy - The pharmacist tells me that this medication needs a prior authorization and sends me a fax with a 1-800 number - The 1-800 number leads me to a pharmacy benefit manager that wants to ask my npi, my date of birth, the patient's information, what kind of the prescription is, how long do they need it for. Only to tell me at the end of the phone call that I actually have to call the patient's insurance company to authorize the prior authorization for the needed medication - So I call the patient's insurance company and once again, I have to verify my information, the patient's information, the prescription information, what the patient needs it for, only for the insurance company to tell me that this is not how they do prior authorization - So they're going to have to fax me some forms that I'm not allowed to do a prior authorization on the phone - So then the fax comes through and I fill it all out. The patient's information, my information, my npi, what the prescription is, how long they need it for, clinical documentation. And now we sit and wait and see if the powers that be think that the patient actually needs the medication” “I went to school. I went to undergraduate medical school, 4 years of OBGYN residency, then went back and did an integrative medicine fellowship, all for these people to dictate how my patient gets cared for. Please know that your healthcare providers are fighting for you day in and day out on things we don't get reimbursed for.” US Healthcare Insurance executives need to be thrown in prison for what they’ve done to our healthcare system
1:35

Board Certified OBGYN exposes what they must go through just to get one prescription approved by health insurance companies “This is what doctors are dealing with in 2025. So my patient needs a medication, an indicated medication for her condition. So I send the prescription to the commercial pharmacy - The pharmacist tells me that this medication needs a prior authorization and sends me a fax with a 1-800 number - The 1-800 number leads me to a pharmacy benefit manager that wants to ask my npi, my date of birth, the patient's information, what kind of the prescription is, how long do they need it for. Only to tell me at the end of the phone call that I actually have to call the patient's insurance company to authorize the prior authorization for the needed medication - So I call the patient's insurance company and once again, I have to verify my information, the patient's information, the prescription information, what the patient needs it for, only for the insurance company to tell me that this is not how they do prior authorization - So they're going to have to fax me some forms that I'm not allowed to do a prior authorization on the phone - So then the fax comes through and I fill it all out. The patient's information, my information, my npi, what the prescription is, how long they need it for, clinical documentation. And now we sit and wait and see if the powers that be think that the patient actually needs the medication” “I went to school. I went to undergraduate medical school, 4 years of OBGYN residency, then went back and did an integrative medicine fellowship, all for these people to dictate how my patient gets cared for. Please know that your healthcare providers are fighting for you day in and day out on things we don't get reimbursed for.” US Healthcare Insurance executives need to be thrown in prison for what they’ve done to our healthcare system

Wall Street Apes

415,175 просмотров • 1 год назад

WOAH 🚨 Pay attention to this American pharmacist exposing that some cheap, very effective drugs, HAVE BEEN BANNED form being prescribed because they’re too cheap So instead of the cheap option, drugs that cost $1,000+ are allowed for certain treatments (INSANE) “The most insane examples of why drugs cost so much is a drug called Brenzavvy. You almost certainly haven't heard of it, but you've probably heard of similar drugs like Jardiance or Farxiga. The reason you haven't heard of Brenzavvy, though, is because no insurance companies will cover it. Most doctors won't prescribe it, and most wholesalers won't even carry it. When I tell you why our entire healthcare industry is turning its back on this proven drug in one of the most critical classes in existence, you are going to be furious. They are shunning Brenzavvy because it's too cheap. I'm not being hyperbolic or sensational. I mean it literally. At my pharmacy, Brenzavvy costs $60 bucks. When they took that price to the pharmacy benefits managers, or PBMs, that's the people in charge of deciding what's covered on your insurance, they all said no, because Brenzavvy can't do a rebate at a price that low. Farxiga and Jardiance, the other Drugs in the SLGT 2 class with Brenzavvy, cost insurance payers $1000 bucks each prescription up front. Then they get a big, probably like 40% rebate later. So that's a $400 rebate, and that is a huge selling point for the PBMs to prove how important they are. The PBMs get a piece of that rebate, and they get a percentage of the final price. An HHS report from last year said that the PBMs get 23% on average for for brand meds. After the rebate, Farxiga and Jardiance still cost $600. 23% of that is $138 for the middleman. Those drugs get dispensed 8 million times a year, which means the total they make in a year off of those two drugs is $1.1 billion. They don't make the drug, they don't prescribe it, they don't dispense it, they don't sell it. They only have to do one thing to make that money. Keep Brenzavvy off their list. If they let in a drug that costs 1/10 of the price and doesn't pay rebate, they literally lose a billion dollars a year. To me, that's the clearest example of why we will never get affordable health care in America. As long as we have PBMs involved, they can't afford to save you money.“ So while this might not be an outright ban, meaning illegal to create, for all purposes it is a ban. Because if the insurance companies won’t cover it, their doctors won’t prescribe it and nearly all wholesalers won’t carry it, that means the insurances companies and PBMs are effectively banning medication in America so they can make maximum profits. Billions a year on a single Medicine, when there are much cheaper options available for the customer This is organized crime. This is racketeering
2:27

WOAH 🚨 Pay attention to this American pharmacist exposing that some cheap, very effective drugs, HAVE BEEN BANNED form being prescribed because they’re too cheap So instead of the cheap option, drugs that cost $1,000+ are allowed for certain treatments (INSANE) “The most insane examples of why drugs cost so much is a drug called Brenzavvy. You almost certainly haven't heard of it, but you've probably heard of similar drugs like Jardiance or Farxiga. The reason you haven't heard of Brenzavvy, though, is because no insurance companies will cover it. Most doctors won't prescribe it, and most wholesalers won't even carry it. When I tell you why our entire healthcare industry is turning its back on this proven drug in one of the most critical classes in existence, you are going to be furious. They are shunning Brenzavvy because it's too cheap. I'm not being hyperbolic or sensational. I mean it literally. At my pharmacy, Brenzavvy costs $60 bucks. When they took that price to the pharmacy benefits managers, or PBMs, that's the people in charge of deciding what's covered on your insurance, they all said no, because Brenzavvy can't do a rebate at a price that low. Farxiga and Jardiance, the other Drugs in the SLGT 2 class with Brenzavvy, cost insurance payers $1000 bucks each prescription up front. Then they get a big, probably like 40% rebate later. So that's a $400 rebate, and that is a huge selling point for the PBMs to prove how important they are. The PBMs get a piece of that rebate, and they get a percentage of the final price. An HHS report from last year said that the PBMs get 23% on average for for brand meds. After the rebate, Farxiga and Jardiance still cost $600. 23% of that is $138 for the middleman. Those drugs get dispensed 8 million times a year, which means the total they make in a year off of those two drugs is $1.1 billion. They don't make the drug, they don't prescribe it, they don't dispense it, they don't sell it. They only have to do one thing to make that money. Keep Brenzavvy off their list. If they let in a drug that costs 1/10 of the price and doesn't pay rebate, they literally lose a billion dollars a year. To me, that's the clearest example of why we will never get affordable health care in America. As long as we have PBMs involved, they can't afford to save you money.“ So while this might not be an outright ban, meaning illegal to create, for all purposes it is a ban. Because if the insurance companies won’t cover it, their doctors won’t prescribe it and nearly all wholesalers won’t carry it, that means the insurances companies and PBMs are effectively banning medication in America so they can make maximum profits. Billions a year on a single Medicine, when there are much cheaper options available for the customer This is organized crime. This is racketeering

Wall Street Apes

107,917 просмотров • 1 год назад

This is a big one 🚨 US Pharmacist found another “Massive way for DOGE and Elon Musk to cut” Medicare costs - Medication is called Abiraterone, Medicare pays $3,400 for each prescription - At a pharmacy that doesn’t take insurance it ONLY COST $96. (Medicare mark up 3441%) - Medicare filled this prescription 442,000 times in 2022 - That means they paid $1.5 billion for that drug in one year alone - If every single one of those 442,000 was filled at the no insurance price, it would cost $42 million - Medicare is wasting $1.458 BILLION by overpaying on only one drug in just one year Again, this is a $1.458 BILLION DOLLAR MARKUP TO TAXPAYERS ON ONE SINGLE DRUG EVERY YEAR “How is that possible? There's a middleman called the pharmacy benefits Manager, that's Express Scripts, Optum or CVS Caremark. They tell Medicare how much to pay, but guess what? They also own pharmacies. Golly, I wonder why medications are so expensive. Let's cancel those middleman contracts and bring prices back to reality.”
1:29

This is a big one 🚨 US Pharmacist found another “Massive way for DOGE and Elon Musk to cut” Medicare costs - Medication is called Abiraterone, Medicare pays $3,400 for each prescription - At a pharmacy that doesn’t take insurance it ONLY COST $96. (Medicare mark up 3441%) - Medicare filled this prescription 442,000 times in 2022 - That means they paid $1.5 billion for that drug in one year alone - If every single one of those 442,000 was filled at the no insurance price, it would cost $42 million - Medicare is wasting $1.458 BILLION by overpaying on only one drug in just one year Again, this is a $1.458 BILLION DOLLAR MARKUP TO TAXPAYERS ON ONE SINGLE DRUG EVERY YEAR “How is that possible? There's a middleman called the pharmacy benefits Manager, that's Express Scripts, Optum or CVS Caremark. They tell Medicare how much to pay, but guess what? They also own pharmacies. Golly, I wonder why medications are so expensive. Let's cancel those middleman contracts and bring prices back to reality.”

Wall Street Apes

285,559 просмотров • 1 год назад

Dr. Caleb Masterson say health insurance companies are openly breaking laws in Alabama He explains some of his patients situations with insurance companies - “I had an insurance company tell a patient that no authorization for the procedure was required, the procedure was performed, and then the patient was denied the care because the procedure was never authorized. So the patient got charged the entire cost of the procedure” - “I had another patient who is supposed to be due an answer to an insurance claim within 30 days of submission. If they do not reply within 30 days, that's breaking Alabama law. And that claim is currently at the 65th day, so its insurance can be breaking the law.” - “Then I had an insurance company deny care to a patient that they had previously approved. So a patient qualified for surgery based on medical necessity, they had met all the criteria for surgery, they underwent surgery, then the patient had that surgery denied. The patient submitted that information to the insurance company and said, Hey, look, this was already pre-approved. And they said, We reversed our decision and the patient had to pay.”
1:06

Dr. Caleb Masterson say health insurance companies are openly breaking laws in Alabama He explains some of his patients situations with insurance companies - “I had an insurance company tell a patient that no authorization for the procedure was required, the procedure was performed, and then the patient was denied the care because the procedure was never authorized. So the patient got charged the entire cost of the procedure” - “I had another patient who is supposed to be due an answer to an insurance claim within 30 days of submission. If they do not reply within 30 days, that's breaking Alabama law. And that claim is currently at the 65th day, so its insurance can be breaking the law.” - “Then I had an insurance company deny care to a patient that they had previously approved. So a patient qualified for surgery based on medical necessity, they had met all the criteria for surgery, they underwent surgery, then the patient had that surgery denied. The patient submitted that information to the insurance company and said, Hey, look, this was already pre-approved. And they said, We reversed our decision and the patient had to pay.”

Wall Street Apes

46,070 просмотров • 6 месяцев назад

The fleecing of the American citizen, this woman has had ongoing issues with skin cancer each time she’s had a $500 co-pay until one day her physician’s filling Department informed her that her insurance was no longer covering the $1400 so she contacted the insurance company and they explained to her that there was a rider on her policy stating they were no longer covering skin cancer and cholesterol, so she called the billing office back and asked what was the self-pay, after a quick check they said the $500 was adequate payment for the procedure ??? Later that same day she picked up a prescription for estrogen patches and the pharmacist gave her a price of $70 with insurance so she inquired how much it would be without insurance and they told her $14 Outward appearances indicate that her physician, pharmacist as well as the insurance company were in essence double dipping the way I see it ? So many of us are on a fixed income and would much rather have the insurance company pay the $70 rather than pay $14 out of our pockets, is this where they live ? In these margins ?🤬 How can we trust a diagnosis from folks who operate this way ?
2:43

The fleecing of the American citizen, this woman has had ongoing issues with skin cancer each time she’s had a $500 co-pay until one day her physician’s filling Department informed her that her insurance was no longer covering the $1400 so she contacted the insurance company and they explained to her that there was a rider on her policy stating they were no longer covering skin cancer and cholesterol, so she called the billing office back and asked what was the self-pay, after a quick check they said the $500 was adequate payment for the procedure ??? Later that same day she picked up a prescription for estrogen patches and the pharmacist gave her a price of $70 with insurance so she inquired how much it would be without insurance and they told her $14 Outward appearances indicate that her physician, pharmacist as well as the insurance company were in essence double dipping the way I see it ? So many of us are on a fixed income and would much rather have the insurance company pay the $70 rather than pay $14 out of our pockets, is this where they live ? In these margins ?🤬 How can we trust a diagnosis from folks who operate this way ?

MAGA X Times Daily News 🇺🇸

40,714 просмотров • 3 месяцев назад

The Department of Justice just proved my point. Last week a supermarket pharmacy chain — Ahold Delhaize, the parent of Giant, Stop & Shop, Hannaford, and Food Lion — agreed to pay $40 million to settle False Claims Act allegations. The charge: they reported inflated "usual and customary" prices to Medicare Part D, Medicaid, and TRICARE, and in doing so made the government overpay on prescription after prescription. $32.9 million of that goes back to the feds, the rest to state Medicaid programs. Stay with me, because this sounds backwards until you understand the machinery. "Usual and customary" is just insurance jargon for your normal, everyday cash price — what a walk-in pays with no card, no plan, no middleman. That's the same price I've been talking about for days. And here's the part nobody outside the counter understands: if you accept insurance, that price MUST be high. It's not greed. It's survival. Insurers reimburse pharmacies at the LOWER of two numbers — your usual and customary, or their contract rate. So the second you post honest, low, transparent prices, you've capped your own ceiling. Every claim defaults to your low number. Meanwhile the reimbursement model itself is garbage: pharmacies eat zero-dollar and below-cost reimbursements every single day. The only way you stay open is the occasional script that pays well enough to cover the pile of losses. List your real prices and you kill the high payers — but you're still contractually bound to absorb the losses. So transparency, under an insurance contract, means you ONLY take losses. That's why discount cards exist. They're a separate program, not your U&C — a workaround. The catch is they charge the pharmacy fees that wipe out most of whatever profit was left. Which brings us right back to this case. Ahold did exactly what Walgreens and Kroger tried: list a high U&C for insurance, then run a separate "prescription savings program" with the real, lower prices on the side. DOJ's position is simple — that savings-program price WAS the usual and customary, and burying it is fraud. Walgreens paid $100 million. Kroger settled for $17 million. It's a pattern, and everyone who tries it gets shut down. Here's the kicker. This was a whistleblower case. A single pharmacist filed under the False Claims Act's qui tam provision — a Civil-War-era law that lets insiders sue on the government's behalf and keep a share of the recovery — and walked away with $6,083,587. So if you work at Amazon Pharmacy, you may want to take a hard look at that U&C. This is the whole reason we fired insurance. We don't accept it. We aren't bound by anyone's contract rate, we don't report a U&C ceiling to a PBM, and we don't bleed our prices through discount-card fees. It's the only honest way left to price a prescription lower than the ridiculous insurance prices.
3:06

The Department of Justice just proved my point. Last week a supermarket pharmacy chain — Ahold Delhaize, the parent of Giant, Stop & Shop, Hannaford, and Food Lion — agreed to pay $40 million to settle False Claims Act allegations. The charge: they reported inflated "usual and customary" prices to Medicare Part D, Medicaid, and TRICARE, and in doing so made the government overpay on prescription after prescription. $32.9 million of that goes back to the feds, the rest to state Medicaid programs. Stay with me, because this sounds backwards until you understand the machinery. "Usual and customary" is just insurance jargon for your normal, everyday cash price — what a walk-in pays with no card, no plan, no middleman. That's the same price I've been talking about for days. And here's the part nobody outside the counter understands: if you accept insurance, that price MUST be high. It's not greed. It's survival. Insurers reimburse pharmacies at the LOWER of two numbers — your usual and customary, or their contract rate. So the second you post honest, low, transparent prices, you've capped your own ceiling. Every claim defaults to your low number. Meanwhile the reimbursement model itself is garbage: pharmacies eat zero-dollar and below-cost reimbursements every single day. The only way you stay open is the occasional script that pays well enough to cover the pile of losses. List your real prices and you kill the high payers — but you're still contractually bound to absorb the losses. So transparency, under an insurance contract, means you ONLY take losses. That's why discount cards exist. They're a separate program, not your U&C — a workaround. The catch is they charge the pharmacy fees that wipe out most of whatever profit was left. Which brings us right back to this case. Ahold did exactly what Walgreens and Kroger tried: list a high U&C for insurance, then run a separate "prescription savings program" with the real, lower prices on the side. DOJ's position is simple — that savings-program price WAS the usual and customary, and burying it is fraud. Walgreens paid $100 million. Kroger settled for $17 million. It's a pattern, and everyone who tries it gets shut down. Here's the kicker. This was a whistleblower case. A single pharmacist filed under the False Claims Act's qui tam provision — a Civil-War-era law that lets insiders sue on the government's behalf and keep a share of the recovery — and walked away with $6,083,587. So if you work at Amazon Pharmacy, you may want to take a hard look at that U&C. This is the whole reason we fired insurance. We don't accept it. We aren't bound by anyone's contract rate, we don't report a U&C ceiling to a PBM, and we don't bleed our prices through discount-card fees. It's the only honest way left to price a prescription lower than the ridiculous insurance prices.

Forest Park Pharmacy

13,335 просмотров • 1 месяц назад

American pharmacy owner saw Elon Musk’s post on X and has the answer “Elon Musk is asking, what is a pharmacy benefits manager? Well, that one's easy: When you go to pick up your medication and they say, that'll be $10,000. And then you say, oh, how much is it without my insurance? What's the cash price? And they say, that'll be $3. That's a pharmacy benefits manager.” “Now, when you go to the pharmacy and you say, Hey, can I get this for three months so I don't have to come here every single month to pick up the same medication? And they say, no, you gotta come back again in 28 days. That's the pharmacy benefits manager.” “So when you go to the pharmacy and you say, can you guys just mail this to me? They say, no, you gotta come into the pharmacy to pick this up. That's your pharmacy benefits manager.” “When you get a new prescription from your doctor and then the insurance company says, we're gonna need a prior authorization for this medication. That's your pharmacy benefits manager.” “You know when you go to pick up your medicine from the pharmacy you've been going to for 10 years, and suddenly they tell you you can't get it there anymore, you have to go to CVS. That's your pharmacy benefits manager.” “They're right in the middle making everything a huge pain and super expensive”
1:16

American pharmacy owner saw Elon Musk’s post on X and has the answer “Elon Musk is asking, what is a pharmacy benefits manager? Well, that one's easy: When you go to pick up your medication and they say, that'll be $10,000. And then you say, oh, how much is it without my insurance? What's the cash price? And they say, that'll be $3. That's a pharmacy benefits manager.” “Now, when you go to the pharmacy and you say, Hey, can I get this for three months so I don't have to come here every single month to pick up the same medication? And they say, no, you gotta come back again in 28 days. That's the pharmacy benefits manager.” “So when you go to the pharmacy and you say, can you guys just mail this to me? They say, no, you gotta come into the pharmacy to pick this up. That's your pharmacy benefits manager.” “When you get a new prescription from your doctor and then the insurance company says, we're gonna need a prior authorization for this medication. That's your pharmacy benefits manager.” “You know when you go to pick up your medicine from the pharmacy you've been going to for 10 years, and suddenly they tell you you can't get it there anymore, you have to go to CVS. That's your pharmacy benefits manager.” “They're right in the middle making everything a huge pain and super expensive”

Wall Street Apes

36,278 просмотров • 1 год назад

This woman goes to the pharmacy for a prescription for her sick children, she’s informed by the pharmacist but it’s not covered by her insurance, undeterred she asked the pharmacist well how much could it be, the pharmacist responds with the eye popping amount of $1100, then the pharmacist informs her that there’s a generic over-the-counter brand of the same medication for $18.99. The bigger question that goes unanswered here is : What about the people who do have insurance that covers this ? This is one of a multitude of reasons why we pay exorbitant insurance premiums for healthcare, we need comprehensive prescription reforms in this country, this is beyond nuts.
0:55

This woman goes to the pharmacy for a prescription for her sick children, she’s informed by the pharmacist but it’s not covered by her insurance, undeterred she asked the pharmacist well how much could it be, the pharmacist responds with the eye popping amount of $1100, then the pharmacist informs her that there’s a generic over-the-counter brand of the same medication for $18.99. The bigger question that goes unanswered here is : What about the people who do have insurance that covers this ? This is one of a multitude of reasons why we pay exorbitant insurance premiums for healthcare, we need comprehensive prescription reforms in this country, this is beyond nuts.

ℳ𝒜𝒢𝒜_𝒳_𝒯𝒾𝓂𝑒𝓈 𝒟𝒶𝒾𝓁𝓎 𝒩𝑒𝓌𝓈🇺🇸

113,471 просмотров • 3 месяцев назад

American Surgeon shows the actual letter from UnitedHealthcare DENYING a patient in emergency condition from receiving care “This is a woman who was in the emergency room with pulmonary embolisms” “I think we all knew this would happen. I had another patient come in and share with me that UnitedHealthcare denied her inpatient's day. So this is a patient who had shortness of breath and some chest pain, and she just knew that something wasn't right in her body. She had a family history of blood clots and she'd had a deep flap surgery a couple of weeks ago. She went to the hospital and they saw her and they found that she had a life threatening condition known as pulmonary embolisms. So she was admitted to the hospital and taken care of really well by the doctors there. And they ordered all the right things. After a couple of days, she was discharged. She got a letter from UnitedHealthcare explaining that they didn't agree with the level of her care and that they would not cover it. So I'm gonna share some of the language of that letter with you, and I want you to know that my patient that we talked about previously who had her surgery denied had almost exactly the same letter shared. So there's some troubling things in this letter. I think this term is really interesting. United is saying they reviewed the request for inpatient admission. So let's all just pause and consider that. This is a woman who was in the emergency room with pulmonary embolisms, and the doctor wasn't really requesting anything. They were saying this patient needs to be in the hospital. But an insurance company sees this as a request, and that's part of this prior auth environment that we're living in. So I think it's important as patients and as physicians to just acknowledge that this is our reality now. Someone can think that there's a good medical decision for you and can write orders and wanna do the right thing for you, but your insurance company is seeing that as a request and deciding whether or not they wanna do it. One of the criteria that this insurance company used to decide whether or not to accept or deny this request was whether it's medically necessary. And it's so interesting that we're letting insurance companies and the doctors who work for insurance companies determine what's medically necessary and not just the doctor in front of the patient in the emergency room. So this is a really bold statement from UnitedHealthcare for my patient. They say you did not have to be admitted as an inpatient to the hospital for this care. I think we all need to just reflect on that. An insurance company is telling a patient and her doctor that they disagree with the plan of care to keep that patient safe. I know that this is boiling down to whether it's an inpatient admission or an observation admission, and that's really about money. But what I wanna point out to you is they're making medical decisions. This insurance company is actually weighing in and disagreeing with a doctor who made a medical decision to admit this patient for her safety. So this specific sentence, when a doctor or facility treats a patient above the recommended level of care, we cannot cover it. What the heck? That's what we do. We go above and beyond as physicians. It's clear that insurance companies don't, and they're actually saying it here.”
2:35

American Surgeon shows the actual letter from UnitedHealthcare DENYING a patient in emergency condition from receiving care “This is a woman who was in the emergency room with pulmonary embolisms” “I think we all knew this would happen. I had another patient come in and share with me that UnitedHealthcare denied her inpatient's day. So this is a patient who had shortness of breath and some chest pain, and she just knew that something wasn't right in her body. She had a family history of blood clots and she'd had a deep flap surgery a couple of weeks ago. She went to the hospital and they saw her and they found that she had a life threatening condition known as pulmonary embolisms. So she was admitted to the hospital and taken care of really well by the doctors there. And they ordered all the right things. After a couple of days, she was discharged. She got a letter from UnitedHealthcare explaining that they didn't agree with the level of her care and that they would not cover it. So I'm gonna share some of the language of that letter with you, and I want you to know that my patient that we talked about previously who had her surgery denied had almost exactly the same letter shared. So there's some troubling things in this letter. I think this term is really interesting. United is saying they reviewed the request for inpatient admission. So let's all just pause and consider that. This is a woman who was in the emergency room with pulmonary embolisms, and the doctor wasn't really requesting anything. They were saying this patient needs to be in the hospital. But an insurance company sees this as a request, and that's part of this prior auth environment that we're living in. So I think it's important as patients and as physicians to just acknowledge that this is our reality now. Someone can think that there's a good medical decision for you and can write orders and wanna do the right thing for you, but your insurance company is seeing that as a request and deciding whether or not they wanna do it. One of the criteria that this insurance company used to decide whether or not to accept or deny this request was whether it's medically necessary. And it's so interesting that we're letting insurance companies and the doctors who work for insurance companies determine what's medically necessary and not just the doctor in front of the patient in the emergency room. So this is a really bold statement from UnitedHealthcare for my patient. They say you did not have to be admitted as an inpatient to the hospital for this care. I think we all need to just reflect on that. An insurance company is telling a patient and her doctor that they disagree with the plan of care to keep that patient safe. I know that this is boiling down to whether it's an inpatient admission or an observation admission, and that's really about money. But what I wanna point out to you is they're making medical decisions. This insurance company is actually weighing in and disagreeing with a doctor who made a medical decision to admit this patient for her safety. So this specific sentence, when a doctor or facility treats a patient above the recommended level of care, we cannot cover it. What the heck? That's what we do. We go above and beyond as physicians. It's clear that insurance companies don't, and they're actually saying it here.”

Wall Street Apes

115,712 просмотров • 1 год назад

WOW 🚨 To Elon Musk and the DOGE team looking at Medicare: Pharmacist says - This medication is Pirfenidone - Medicare filled it 85,000 times in 2022 at an average cost of $8,000 per prescription - Normal cost without insurance ONLY $200 TO FILL - They spent $680 million on that one drug in just one year “However, at my pharmacy, which is a cost plus pharmacy, meaning we don't take insurance, that same prescription would only cost $200” “If we filled all 85,000 prescriptions, it would cost $17 million total. That means Medicare is overpaying by $663 million every year.” Good find TheRedPilledGirl
1:24

WOW 🚨 To Elon Musk and the DOGE team looking at Medicare: Pharmacist says - This medication is Pirfenidone - Medicare filled it 85,000 times in 2022 at an average cost of $8,000 per prescription - Normal cost without insurance ONLY $200 TO FILL - They spent $680 million on that one drug in just one year “However, at my pharmacy, which is a cost plus pharmacy, meaning we don't take insurance, that same prescription would only cost $200” “If we filled all 85,000 prescriptions, it would cost $17 million total. That means Medicare is overpaying by $663 million every year.” Good find TheRedPilledGirl

Wall Street Apes

2,008,165 просмотров • 1 год назад

2026: A patient reached out to me yesterday to let me know about a concerning interaction with a hospital system. The patient was scheduled for a therapeutic procedure, in advance of surgery. Arrangements were made and the patient paid their estimated portion of the cost. Then they received a call from the facility asking them whether they still had the same insurance. When the patient confirmed that nothing had changed, they received a warning from the facility that the estimate no longer applied and costs could go up…significantly. Why? Because the hospital system is renegotiating with the insurance company. Not because the clinical situation changed, not because the procedure became more complex…just because the patient is caught in the middle of a business negotiation without an advocate. So they called me. And I’m telling all of you. So we can help one another by insisting that patients come first. Always.
0:36

2026: A patient reached out to me yesterday to let me know about a concerning interaction with a hospital system. The patient was scheduled for a therapeutic procedure, in advance of surgery. Arrangements were made and the patient paid their estimated portion of the cost. Then they received a call from the facility asking them whether they still had the same insurance. When the patient confirmed that nothing had changed, they received a warning from the facility that the estimate no longer applied and costs could go up…significantly. Why? Because the hospital system is renegotiating with the insurance company. Not because the clinical situation changed, not because the procedure became more complex…just because the patient is caught in the middle of a business negotiation without an advocate. So they called me. And I’m telling all of you. So we can help one another by insisting that patients come first. Always.

Elisabeth Potter MD

55,057 просмотров • 7 месяцев назад

American healthcare worker tries to get a prescription approved for a patient who needs autoimmune medication The insurance company forced the prescription to go to their pharmacy and then has been denying it for 3 months, the patient desperately needs the medication “It doesn't require prior authorization, feedback that you agree or disagree with the physician's order. What do you need clearance for? The doctor sent a prescription. Isn't that clearance? That makes absolutely no sense to me — if you're gonna mandate the patient to your pharmacy, you needed to care for him. Three months is doing the exact opposite.” “You do realize this guy has an autoimmune disease and without us helping manage it, his joints are eroding and we're having to increase the steroid exposure. This man's health is being played with for no reason — this patient's been without care for months”
4:43

American healthcare worker tries to get a prescription approved for a patient who needs autoimmune medication The insurance company forced the prescription to go to their pharmacy and then has been denying it for 3 months, the patient desperately needs the medication “It doesn't require prior authorization, feedback that you agree or disagree with the physician's order. What do you need clearance for? The doctor sent a prescription. Isn't that clearance? That makes absolutely no sense to me — if you're gonna mandate the patient to your pharmacy, you needed to care for him. Three months is doing the exact opposite.” “You do realize this guy has an autoimmune disease and without us helping manage it, his joints are eroding and we're having to increase the steroid exposure. This man's health is being played with for no reason — this patient's been without care for months”

Wall Street Apes

61,798 просмотров • 1 год назад

Board Certified Plastic Surgeon reveals that the massive medical bill totals insurance companies send to you are really “fictitious numbers” that don’t represent real money anyone is being paid He just did a surgery for a patient, the insurance company said the procedure cost $170,000. The patient gets a bill and thinks that’s coming from the doctors office, it’s not The bill is coming from the insurance company, on the $170,000 bill for the surgery his office only gets paid $2,000 So he says none of this makes any sense because none of these huge bills are actually ever paid to anyone “The procedure was approved by insurance and it led to, according to their billing statements, $170,000 claimed. The total hospital billing for which our practice was reimbursed, $2,000. So just amazing, the bizarre discrepancy. And where does the rest of it all go? Fortunately, you know, this patient doesn't account for nearly that amount for their payment because their insurance does cover a significant portion of that as well as it not actually total billed to that amount. But it just illustrates some of the madness that there is in healthcare billing practices, because one, nobody knows what the bills are before we do them, including doctors. We have no idea And then patients get this astronomical number that is really kind of a fictitious number that doesn't get represented by real money that anyone collects” This sounds like a racket and outright fraud. How do the insurance companies getting away with it
2:20

Board Certified Plastic Surgeon reveals that the massive medical bill totals insurance companies send to you are really “fictitious numbers” that don’t represent real money anyone is being paid He just did a surgery for a patient, the insurance company said the procedure cost $170,000. The patient gets a bill and thinks that’s coming from the doctors office, it’s not The bill is coming from the insurance company, on the $170,000 bill for the surgery his office only gets paid $2,000 So he says none of this makes any sense because none of these huge bills are actually ever paid to anyone “The procedure was approved by insurance and it led to, according to their billing statements, $170,000 claimed. The total hospital billing for which our practice was reimbursed, $2,000. So just amazing, the bizarre discrepancy. And where does the rest of it all go? Fortunately, you know, this patient doesn't account for nearly that amount for their payment because their insurance does cover a significant portion of that as well as it not actually total billed to that amount. But it just illustrates some of the madness that there is in healthcare billing practices, because one, nobody knows what the bills are before we do them, including doctors. We have no idea And then patients get this astronomical number that is really kind of a fictitious number that doesn't get represented by real money that anyone collects” This sounds like a racket and outright fraud. How do the insurance companies getting away with it

Wall Street Apes

1,095,975 просмотров • 1 год назад

Pharmaceutical companies marking up a drug 3,000% to Medicare. Meaning because they know taxpayers are paying for it, they’re charging 30x THE PRICE - Drug name Cialis - Medicare paying $481 per prescription - Cost without insurance $14 - Medicare filled this prescription 492,000 times in 2022 costing taxpayers $237 million dollars “Medicare is being overcharged by $230 million every year for only one drug.” “This happens because Medicare uses a pharmacy benefits manager to handle all things pharmacy for them. They decide what's covered, how much your copay will be, how much it'll cost the government, and how much they'll pay the pharmacy. With all that power, they've decided that we should pay a 3000% markup. What a great deal.”
1:21

Pharmaceutical companies marking up a drug 3,000% to Medicare. Meaning because they know taxpayers are paying for it, they’re charging 30x THE PRICE - Drug name Cialis - Medicare paying $481 per prescription - Cost without insurance $14 - Medicare filled this prescription 492,000 times in 2022 costing taxpayers $237 million dollars “Medicare is being overcharged by $230 million every year for only one drug.” “This happens because Medicare uses a pharmacy benefits manager to handle all things pharmacy for them. They decide what's covered, how much your copay will be, how much it'll cost the government, and how much they'll pay the pharmacy. With all that power, they've decided that we should pay a 3000% markup. What a great deal.”

Wall Street Apes

150,607 просмотров • 1 год назад

American Doctor doesn’t know what else to do A health insurance company cancelled her patients heart failure medication and keeps denying her prior authorizations “I f*cking can't today, I wasted an hour and 17 minutes of my time on the phone with an insurance company who decided that my patient no longer needs their heart failure medicine that they've been on for years. That is an old medicine, not remotely experimental. It's what everybody uses for heart failure patients in this situation. It's a medicine that saves the insurance company money in that if they pay for 36 patients to use it for three and a half years each, they'll prevent one heart failure exacerbation according to the number needed to treat for all of you methodology geeks out there. And you know, the total cost of all that medicine for 36 patients for 3 1/2 years is less than the cost of like, the first hour of a heart failure exacerbation hospitalization. So this makes no sense. — To go through that bullshit website and put in the information just to be told there's a duplicate prior authorization? I'm like, well, I'm the physician that wrote the prescription, so how about we delete that duplicate because it doesn't matter. And they're like, well, we can't do that. Why don't you talk to the insurance company? I'm like, sh*t, why didn't I think of that? Get back on the phone. Cannot get a single person on the phone for the insurance company. The phone tree directed me to the nurse advice line which patients are supposed to call to find out do I need to go in for my sore throat 3 times. And then I got forwarded to Express scripts. Totally different company. Not even my patient's pharmacy. How does that happen? My patient still doesn't have their meds. If you're wondering why you can never see your doctor, it's because your doctor's doing this bullsh*t This is a major contributor to burnout in primary care. — This makes no sense for anybody. And my patient still doesn't have their meds.”
2:19

American Doctor doesn’t know what else to do A health insurance company cancelled her patients heart failure medication and keeps denying her prior authorizations “I f*cking can't today, I wasted an hour and 17 minutes of my time on the phone with an insurance company who decided that my patient no longer needs their heart failure medicine that they've been on for years. That is an old medicine, not remotely experimental. It's what everybody uses for heart failure patients in this situation. It's a medicine that saves the insurance company money in that if they pay for 36 patients to use it for three and a half years each, they'll prevent one heart failure exacerbation according to the number needed to treat for all of you methodology geeks out there. And you know, the total cost of all that medicine for 36 patients for 3 1/2 years is less than the cost of like, the first hour of a heart failure exacerbation hospitalization. So this makes no sense. — To go through that bullshit website and put in the information just to be told there's a duplicate prior authorization? I'm like, well, I'm the physician that wrote the prescription, so how about we delete that duplicate because it doesn't matter. And they're like, well, we can't do that. Why don't you talk to the insurance company? I'm like, sh*t, why didn't I think of that? Get back on the phone. Cannot get a single person on the phone for the insurance company. The phone tree directed me to the nurse advice line which patients are supposed to call to find out do I need to go in for my sore throat 3 times. And then I got forwarded to Express scripts. Totally different company. Not even my patient's pharmacy. How does that happen? My patient still doesn't have their meds. If you're wondering why you can never see your doctor, it's because your doctor's doing this bullsh*t This is a major contributor to burnout in primary care. — This makes no sense for anybody. And my patient still doesn't have their meds.”

Wall Street Apes

248,584 просмотров • 1 год назад