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Ever feel like your PBM has an answer for everything, except a straight one? Denied claims, mail-order mandates and mysterious "due diligence" delays are all too familiar for patients trying to access the medicines their doctors prescribed. Middlemen like PBMs decide what's covered, what it costs and where you... show more

PhRMA

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93,132 просмотров • 19 дней назад •via X (Twitter)

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Patients in the U.S. pay more for medicine than other countries. Here’s how addressing PBM middlemen, 340B hospital markups, and foreign freeriding can help fix that.

Patients in the U.S. pay more for medicine than other countries. Here’s how addressing PBM middlemen, 340B hospital markups, and foreign freeriding can help fix that.

PhRMA

774,662 просмотров • 1 год назад

A guy went viral this week telling people to use GoodRx to escape their insurance pricing. He is right that your insurance price is probably too high. He is wrong about what GoodRx is. GoodRx does not negotiate anything. It surfaces prices that pharmacy benefit managers already set. The same PBMs that built the price you are trying to escape. Express Scripts, OptumRx, CVS Caremark, MedImpact, Navitus. GoodRx has contracts with all of them. Follow the money on a GoodRx fill. You hand over the coupon. The pharmacy processes that claim through a specific PBM. The pharmacy then pays a per-prescription fee to that PBM. The PBM shares a slice of that fee back to GoodRx for sending you there. GoodRx has reported earning roughly 15% of your total prescription cost. So the PBM gets paid when you use your insurance, and the PBM gets paid when you use GoodRx to get around your insurance. Both roads lead to the same building. The scale of this is not small. In 2020 alone GoodRx accounted for about $3.4 billion in prescription revenue and collected nearly $500 million in fees from PBMs. Three out of four people using GoodRx already had insurance. They were paying premiums every month and still needed a coupon to afford their own medication. Sit with the shape of that. You pay a PBM premiums all year. That PBM sets a price so high you cannot use it. Then a company funded by that same PBM shows you a different price the PBM also set, and the PBM collects a fee on that transaction too. Express Scripts made GoodRx its exclusive discount card provider for commercial members. CVS Caremark runs its own version. These are not competitors sneaking around the PBMs. These are the PBMs opening a second register. Industry analysts have been blunt about why the two prices exist at all. Different PBMs have different contracted rates, legacy contracts do not reflect current market pricing, and the same PBM offers different rates to different clients. If the cash rate were easy to see, employers would demand it. The confusion is the product. GoodRx is better than overpaying, and if it is what you have, use it. I would rather someone save $40 than not. But understand you are not escaping the system. You are using the system's back door and paying a toll to the same people who locked the front one. There is a version of this where none of it applies. No PBM, no coupon, no fee routed to anyone. We buy the drug and sell it to you at our cost plus a flat fee. The price is the price, and nobody in the middle gets a cut. Head to look at the price checker, and see what your medication actually costs. See ya.

A guy went viral this week telling people to use GoodRx to escape their insurance pricing. He is right that your insurance price is probably too high. He is wrong about what GoodRx is. GoodRx does not negotiate anything. It surfaces prices that pharmacy benefit managers already set. The same PBMs that built the price you are trying to escape. Express Scripts, OptumRx, CVS Caremark, MedImpact, Navitus. GoodRx has contracts with all of them. Follow the money on a GoodRx fill. You hand over the coupon. The pharmacy processes that claim through a specific PBM. The pharmacy then pays a per-prescription fee to that PBM. The PBM shares a slice of that fee back to GoodRx for sending you there. GoodRx has reported earning roughly 15% of your total prescription cost. So the PBM gets paid when you use your insurance, and the PBM gets paid when you use GoodRx to get around your insurance. Both roads lead to the same building. The scale of this is not small. In 2020 alone GoodRx accounted for about $3.4 billion in prescription revenue and collected nearly $500 million in fees from PBMs. Three out of four people using GoodRx already had insurance. They were paying premiums every month and still needed a coupon to afford their own medication. Sit with the shape of that. You pay a PBM premiums all year. That PBM sets a price so high you cannot use it. Then a company funded by that same PBM shows you a different price the PBM also set, and the PBM collects a fee on that transaction too. Express Scripts made GoodRx its exclusive discount card provider for commercial members. CVS Caremark runs its own version. These are not competitors sneaking around the PBMs. These are the PBMs opening a second register. Industry analysts have been blunt about why the two prices exist at all. Different PBMs have different contracted rates, legacy contracts do not reflect current market pricing, and the same PBM offers different rates to different clients. If the cash rate were easy to see, employers would demand it. The confusion is the product. GoodRx is better than overpaying, and if it is what you have, use it. I would rather someone save $40 than not. But understand you are not escaping the system. You are using the system's back door and paying a toll to the same people who locked the front one. There is a version of this where none of it applies. No PBM, no coupon, no fee routed to anyone. We buy the drug and sell it to you at our cost plus a flat fee. The price is the price, and nobody in the middle gets a cut. Head to look at the price checker, and see what your medication actually costs. See ya.

Forest Park Pharmacy

14,102 просмотров • 16 дней назад

"[Doctors are] basically glorified sales reps for Big Pharma and hospitals are their front-facing sales departments." "When the incentives reward chronic illness more than lifelong health, you get exactly what we have today—a population sicker than ever... trained to outsource its health to a pill bottle." "Real health does not come from a hospital stay. It comes from... taking radical responsibility for your own body." "It starts in your kitchen, your habits, your choices... In the moment you decide you will no longer be a customer, but a caretaker of your own health." "The system isn't broken. It's doing exactly what it was designed to do." "And the moment you understand that is the moment you begin to take your power back."

"[Doctors are] basically glorified sales reps for Big Pharma and hospitals are their front-facing sales departments." "When the incentives reward chronic illness more than lifelong health, you get exactly what we have today—a population sicker than ever... trained to outsource its health to a pill bottle." "Real health does not come from a hospital stay. It comes from... taking radical responsibility for your own body." "It starts in your kitchen, your habits, your choices... In the moment you decide you will no longer be a customer, but a caretaker of your own health." "The system isn't broken. It's doing exactly what it was designed to do." "And the moment you understand that is the moment you begin to take your power back."

healthbot

21,869 просмотров • 7 месяцев назад

Should you ask an AI chatbot for health advice? AI chatbots seem to have the answer to everything, but they often hallucinate false information and come up with fake sources for it. But Doctor Sudheesha Perera and Professor Murali Doraiswamy say that there's some helpful things you can try to get more useful answers for your health related questions out of your AI. TIME tech reporter Nikita Ostrovsky explains their tips for this episode of AI, Explained by Humans. Read their full piece:

Should you ask an AI chatbot for health advice? AI chatbots seem to have the answer to everything, but they often hallucinate false information and come up with fake sources for it. But Doctor Sudheesha Perera and Professor Murali Doraiswamy say that there's some helpful things you can try to get more useful answers for your health related questions out of your AI. TIME tech reporter Nikita Ostrovsky explains their tips for this episode of AI, Explained by Humans. Read their full piece:

TIME

16,980 просмотров • 4 месяцев назад

🚨🇺🇸 MARK CUBAN EXPOSES PBM SCAM COSTING PATIENTS BILLIONS BEFORE SENATE Mark Cuban just testified before the Senate explaining how Pharmacy Benefit Managers are a bigger monopoly than Amazon, controlling drug access for 270 million Americans while driving prices up, not down: "PBMs auction off access to their formularies to the highest bidders. Drug companies pay rebates and fees so their drugs can be covered. The higher the list price, the more money PBMs make." A $600 drug costs the manufacturer $240 after rebates. Uninsured patients pay $600. Insured patients with deductibles also pay $600. The PBM pockets the difference. Cuban's solution: count cash payments toward deductibles, base out-of-pocket costs on net price, separate formularies from PBMs, and end specialty tiers. The U.S. is the only country using PBMs. That's why we have the world's highest drug prices. Source: CSPAN, Mark Cuban

🚨🇺🇸 MARK CUBAN EXPOSES PBM SCAM COSTING PATIENTS BILLIONS BEFORE SENATE Mark Cuban just testified before the Senate explaining how Pharmacy Benefit Managers are a bigger monopoly than Amazon, controlling drug access for 270 million Americans while driving prices up, not down: "PBMs auction off access to their formularies to the highest bidders. Drug companies pay rebates and fees so their drugs can be covered. The higher the list price, the more money PBMs make." A $600 drug costs the manufacturer $240 after rebates. Uninsured patients pay $600. Insured patients with deductibles also pay $600. The PBM pockets the difference. Cuban's solution: count cash payments toward deductibles, base out-of-pocket costs on net price, separate formularies from PBMs, and end specialty tiers. The U.S. is the only country using PBMs. That's why we have the world's highest drug prices. Source: CSPAN, Mark Cuban

Mario Nawfal

2,153,891 просмотров • 11 месяцев назад

If your thighs are weaker than your butt you'll feel the burn in them more than you do in your butt. This is one of the most common reasons people do glute exercise after glute exercise and still feel like their butt isn't growing. Bringing your quad and hamstring strength up to match your glutes changes everything about how effectively you can actually target and grow them. Follow for the training tips that help you actually feel your glutes working 🍑

If your thighs are weaker than your butt you'll feel the burn in them more than you do in your butt. This is one of the most common reasons people do glute exercise after glute exercise and still feel like their butt isn't growing. Bringing your quad and hamstring strength up to match your glutes changes everything about how effectively you can actually target and grow them. Follow for the training tips that help you actually feel your glutes working 🍑

FemboyFitness

18,225 просмотров • 4 месяцев назад

BREAKING: Hawaii lawmakers are trying to eliminate all religious vaccine exemptions. Michael Kane just revealed that “Governor Josh Green has a bill that might move forward where he’s trying to get rid of the religious exemption [and] take away choice.” Hear Dr. Kat Lindley break down how the pandemic changed everything—and why Pharma feels the need to pass stricter mandates now more than ever: “During the pandemic … the role of doctor has changed.” “You had doctors who were like … you have to get the Covid vaccine.” “Then some patients had side effects … some of them even had a major event, and they would go to the doctor, and the doctor was like: no, you have to get your booster.” “Patients are starting to question their doctors.” “This whole relationship between Pharma and medical providers has really attacked patients’ choice.” “And we lost … informed consent.” “The balance is shifting—which it should be.” “Patients need to be in charge of their own health.” Teachers for Choice Dr. Kat Lindley Children’s Health Defense

BREAKING: Hawaii lawmakers are trying to eliminate all religious vaccine exemptions. Michael Kane just revealed that “Governor Josh Green has a bill that might move forward where he’s trying to get rid of the religious exemption [and] take away choice.” Hear Dr. Kat Lindley break down how the pandemic changed everything—and why Pharma feels the need to pass stricter mandates now more than ever: “During the pandemic … the role of doctor has changed.” “You had doctors who were like … you have to get the Covid vaccine.” “Then some patients had side effects … some of them even had a major event, and they would go to the doctor, and the doctor was like: no, you have to get your booster.” “Patients are starting to question their doctors.” “This whole relationship between Pharma and medical providers has really attacked patients’ choice.” “And we lost … informed consent.” “The balance is shifting—which it should be.” “Patients need to be in charge of their own health.” Teachers for Choice Dr. Kat Lindley Children’s Health Defense

Health Freedom Defense Fund

14,307 просмотров • 8 месяцев назад

Your doctor's visits shouldn't feel like a speed run. Dr. Mark Benden from Texas A&M Public Health and his team are developing AI agents that handle the admin work so your doctor can spend more time actually being your doctor. The goal isn't to replace humans, it's to free up their time. Read more: #TAMU #AggieResearch

Your doctor's visits shouldn't feel like a speed run. Dr. Mark Benden from Texas A&M Public Health and his team are developing AI agents that handle the admin work so your doctor can spend more time actually being your doctor. The goal isn't to replace humans, it's to free up their time. Read more: #TAMU #AggieResearch

Texas A&M University

10,801 просмотров • 1 месяц назад

Your data is more valuable than you think. Alex Zaidelson encourages everyone to think twice before handing their information to AI platforms and big tech. Privacy starts with knowing where your data goes and who can access it. The best time to protect your data is before it's too late.

Your data is more valuable than you think. Alex Zaidelson encourages everyone to think twice before handing their information to AI platforms and big tech. Privacy starts with knowing where your data goes and who can access it. The best time to protect your data is before it's too late.

Secret Network

13,723 просмотров • 1 месяц назад

In America, one health care company can own: Your doctor Your pharmacy Your insurance AND the middleman between your pharmacy and insurance. That means more profits for giant companies and higher costs for you. That's not right — and I have a bill to stop it.

In America, one health care company can own: Your doctor Your pharmacy Your insurance AND the middleman between your pharmacy and insurance. That means more profits for giant companies and higher costs for you. That's not right — and I have a bill to stop it.

Elizabeth Warren

131,358 просмотров • 1 месяц назад

The largest U.S. health insurance companies aren’t just insurers anymore. They own hospitals, employ doctors, run clinics, operate pharmacies, and control pharmacy benefit managers (PBMs) that decide which drugs you can get and how much you pay. In one revealing moment at a Senate hearing, executives were asked to raise their hands if their company: - Owns/controls a health insurance division - Employs providers or owns clinics/specialty pharmacies - Owns/controls a PBM - Has a legal duty to maximize shareholder value Almost every major hand stayed up. They diagnose, treat, dispense drugs, set prices, and decide coverage—all while legally obligated to prioritize profits over patients. One entity now controls almost every step of your healthcare journey. That’s not competition. That’s consolidation.

The largest U.S. health insurance companies aren’t just insurers anymore. They own hospitals, employ doctors, run clinics, operate pharmacies, and control pharmacy benefit managers (PBMs) that decide which drugs you can get and how much you pay. In one revealing moment at a Senate hearing, executives were asked to raise their hands if their company: - Owns/controls a health insurance division - Employs providers or owns clinics/specialty pharmacies - Owns/controls a PBM - Has a legal duty to maximize shareholder value Almost every major hand stayed up. They diagnose, treat, dispense drugs, set prices, and decide coverage—all while legally obligated to prioritize profits over patients. One entity now controls almost every step of your healthcare journey. That’s not competition. That’s consolidation.

Camus

198,808 просмотров • 8 месяцев назад

We spend more time in PDFs than we'd ever admit. Be honest. How many hours last week? And it's never the easy stuff. It's redacting a document line by line. It's hunting for one answer buried in 80 pages. It's reading the same paragraph four times because the contract won't just tell you what you need to know. That's the part nobody puts on their calendar. But it's the part that eats the day. So here's why I'm excited. I've been working with Foxit. And their AI assistant does the thing I always wished my PDF tool could do. You just ask. In plain English. "Redact every name in this file." "What are the payment terms in this agreement?" "Summarize section 7 for me." No menus. No hunting. No reading it four times. You ask, it answers. The document finally works for you instead of the other way around. That's not a small upgrade. That's hours back in your week. Your time is worth more than that. Visit and try it today. Your future self (and your next deal) will thank you.

We spend more time in PDFs than we'd ever admit. Be honest. How many hours last week? And it's never the easy stuff. It's redacting a document line by line. It's hunting for one answer buried in 80 pages. It's reading the same paragraph four times because the contract won't just tell you what you need to know. That's the part nobody puts on their calendar. But it's the part that eats the day. So here's why I'm excited. I've been working with Foxit. And their AI assistant does the thing I always wished my PDF tool could do. You just ask. In plain English. "Redact every name in this file." "What are the payment terms in this agreement?" "Summarize section 7 for me." No menus. No hunting. No reading it four times. You ask, it answers. The document finally works for you instead of the other way around. That's not a small upgrade. That's hours back in your week. Your time is worth more than that. Visit and try it today. Your future self (and your next deal) will thank you.

Leonard Rodman

44,562 просмотров • 4 месяцев назад

LinkedIn just started hiding AI-written posts. And their system catches them 94 percent of the time. But the answer is NOT to stop using AI. They announced this in May. If your post sounds like everyone else's, it doesn't get deleted. It just stops spreading. Your followers see it. Nobody new ever does. They're even flagging the way AI writes. Sentences like "it's not this, it's that"? Flagged. But most people missed one line in that announcement: using AI to HELP you write is totally fine. You just have to make it sound like you. Here are 2 things you can do: One, give your AI your own stuff. Upload your old posts, your client results, your stories, your data, your transcripts. Now instead of pulling generic advice off the internet, it's writing from YOUR experience. In your voice. Two, write about what people care about RIGHT NOW. I check AnswerThePublic to see the exact questions my audience is typing in this week then I write about those. The more you sound like yourself and talk about real problems people face, the more people will want to hear what you have to say.

LinkedIn just started hiding AI-written posts. And their system catches them 94 percent of the time. But the answer is NOT to stop using AI. They announced this in May. If your post sounds like everyone else's, it doesn't get deleted. It just stops spreading. Your followers see it. Nobody new ever does. They're even flagging the way AI writes. Sentences like "it's not this, it's that"? Flagged. But most people missed one line in that announcement: using AI to HELP you write is totally fine. You just have to make it sound like you. Here are 2 things you can do: One, give your AI your own stuff. Upload your old posts, your client results, your stories, your data, your transcripts. Now instead of pulling generic advice off the internet, it's writing from YOUR experience. In your voice. Two, write about what people care about RIGHT NOW. I check AnswerThePublic to see the exact questions my audience is typing in this week then I write about those. The more you sound like yourself and talk about real problems people face, the more people will want to hear what you have to say.

Neil Patel

12,378 просмотров • 1 месяц назад

Parents know what is best for their kids. It’s our God-given gift. Use that power in every part of their lives, from how they are educated to their health and well-being. Always trust your gut, because NO ONE will ever care more about your child than you do!

Parents know what is best for their kids. It’s our God-given gift. Use that power in every part of their lives, from how they are educated to their health and well-being. Always trust your gut, because NO ONE will ever care more about your child than you do!

Erika Donalds

10,847 просмотров • 5 месяцев назад

Start going much deeper and much more nuanced in your “prompts” with your 🤖 apps - too many still use ChatGPT like it’s Google search.. when it has much more power than that and can give you much more in depth answers and more importantly can be a working partner versus a quick tool .. hope this inspires more to use their voice - I think voice will be the main interface with ai 🤖 in the next decade & I hope this inspires someone to ask much more detailed questions and go much deeper with their details and nuances! What’s the longest prompt you’ve made so far ? What are u using these apps for so far?

Start going much deeper and much more nuanced in your “prompts” with your 🤖 apps - too many still use ChatGPT like it’s Google search.. when it has much more power than that and can give you much more in depth answers and more importantly can be a working partner versus a quick tool .. hope this inspires more to use their voice - I think voice will be the main interface with ai 🤖 in the next decade & I hope this inspires someone to ask much more detailed questions and go much deeper with their details and nuances! What’s the longest prompt you’ve made so far ? What are u using these apps for so far?

Gary Vaynerchuk

65,111 просмотров • 11 месяцев назад

An artist’s website shouldn’t feel like a static gallery. With Readdy Readdy, I built a site where the art literally speaks for itself ↓ It’s like a “GPT-4 moment” for websites — the page doesn’t just display your work, it talks to visitors, answers their questions, and even books sessions for you. It feels less like a website, more like having a full-time studio assistant online.

An artist’s website shouldn’t feel like a static gallery. With Readdy Readdy, I built a site where the art literally speaks for itself ↓ It’s like a “GPT-4 moment” for websites — the page doesn’t just display your work, it talks to visitors, answers their questions, and even books sessions for you. It feels less like a website, more like having a full-time studio assistant online.

COLAW

120,003 просмотров • 1 год назад

I’m excited to share some big news. I've been working on a book for quite some time — more than five years, in fact — though it's really based on more than three decades of research and experience. Today, I am thrilled to share that my new and first-ever book, Protocols: An Operating Manual for the Human Body, is now available for pre-order. I hear from you daily about your desire for the tools and protocols covered on Huberman Lab and elsewhere to be organized and distilled all in one place, in a clear and concise manner. This book is the culmination of years of research, hundreds of conversations with leading scientists, medical doctors, and researchers, and my own exploration of health and fitness. My aim with Protocols is to provide you with simple, powerful, and evidence-based solutions to your most common health challenges and to reach your goals. Designed to improve your mental health, physical health, and performance, these guidelines are customizable, allowing you to adapt them to your specific needs and to deliver effective results for men and women, young and old. It is truly meant for anyone interested in achieving better health and vitality. I’m super excited to share Protocols with you. Thank you for your support and thank you for your interest in science! Pre-order:

I’m excited to share some big news. I've been working on a book for quite some time — more than five years, in fact — though it's really based on more than three decades of research and experience. Today, I am thrilled to share that my new and first-ever book, Protocols: An Operating Manual for the Human Body, is now available for pre-order. I hear from you daily about your desire for the tools and protocols covered on Huberman Lab and elsewhere to be organized and distilled all in one place, in a clear and concise manner. This book is the culmination of years of research, hundreds of conversations with leading scientists, medical doctors, and researchers, and my own exploration of health and fitness. My aim with Protocols is to provide you with simple, powerful, and evidence-based solutions to your most common health challenges and to reach your goals. Designed to improve your mental health, physical health, and performance, these guidelines are customizable, allowing you to adapt them to your specific needs and to deliver effective results for men and women, young and old. It is truly meant for anyone interested in achieving better health and vitality. I’m super excited to share Protocols with you. Thank you for your support and thank you for your interest in science! Pre-order:

Andrew D. Huberman, Ph.D.

1,634,991 просмотров • 2 лет назад