Discover and read the best of Twitter Threads about #PBM
Most recents (24)
a 🧵 In prep 4 today's 1pm @SenateHELP hearing on making #insulin affordable.
On graph: list price is roughly = net price (what pharma collects) + "rebates"/fees collected by Pharmacy Benefit Managers (#PBM) .
According 2 a 2021 @SenFinance "rebates" alone accounted for… twitter.com/i/web/status/1…
On graph: list price is roughly = net price (what pharma collects) + "rebates"/fees collected by Pharmacy Benefit Managers (#PBM) .
According 2 a 2021 @SenFinance "rebates" alone accounted for… twitter.com/i/web/status/1…
@SenateHELP @SenFinance @BernieSanders @SenBillCassidy @BoesingLoretta @NSmithholt12 @Free2CareHC @MsPattiPatti @nickjonas @tomhanks @VWOfficial @alldiabetesnews 2. With #PBM making most of the $ In the Insulin market (and for other meds) it's wild that there is little #transparency for PBM.
All of the red ovals show places where we cant see the $
Pic from our @Free2CareHC report: free2care.org/files/report.p…
All of the red ovals show places where we cant see the $
Pic from our @Free2CareHC report: free2care.org/files/report.p…
3. If @SenateDems and @SenateGOP and @USCongress and @POTUS want to remedy the cost of Insulin and other drugs, hopefully they won't make the same mistake they did with the Inflation reduction act, "USA will NEVER solve the drug pricing problem without PBM reform – and instead… twitter.com/i/web/status/1…
So what are #PBMs? Chances are, if your meds suddenly got changed by your insurer, or you’ve been waiting weeks on #priorauth for a med you need, or you pay $$$$$ for a drug in the US that is cheap overseas, you’ve already experienced a #PBM and didn’t even know… twitter.com/i/web/status/1…
That’s b/c #PBMs aren’t meant to be known, they’re meant to be a middleman in healthcare cutting in an extra layer of profit for them and an extra cost to you…wonder why #prescriptiondrug pricing makes no sense compared to prices in other countries? This is why.
Pharmacy Benefit Managers (PBMs) are third party entities paid by healthcare insurance companies to manage all things meds: the formulary (what is/isn’t covered), the price from manufacturer, and the cost (copay or “tier”) to the patient.
🧵#OurAMA finds widespread lack of competition in local markets across US where #PBMs provide services to commercial health insurers.
First analysis to examine variations in market shares/competition among PBMs at state/metropolitan levels.
Read: tinyurl.com/bdf8m258
First analysis to examine variations in market shares/competition among PBMs at state/metropolitan levels.
Read: tinyurl.com/bdf8m258
2/ AMA’s competition analysis presents national and local market insight on 5 different #PBM services performed for insurers:
•rebate negotiation
•retail network management
•claim adjudication
•formulary management
•benefit design
Read report here: ama-assn.org/system/files/p…
•rebate negotiation
•retail network management
•claim adjudication
•formulary management
•benefit design
Read report here: ama-assn.org/system/files/p…
3/ @AmerMedicalAssn President @JackResneckMD said:
“The AMA already has serious concerns about #PBM business practices that can have a detrimental impact on patients’ access to and cost of prescription drugs.”
“PBM markets require careful scrutiny…” See👇
“The AMA already has serious concerns about #PBM business practices that can have a detrimental impact on patients’ access to and cost of prescription drugs.”
“PBM markets require careful scrutiny…” See👇
#BREAKING: @FTC launches inquiry into prescription drug middlemen industry. Agency to scrutinize impact of vertically integrated Pharmacy Benefit Managers on the access and affordability of medicine: bit.ly/3mlNH1J #PBMs /1
FTC will launch an inquiry into the prescription drug middleman industry, requiring the 6 largest #PBMs to provide information and records regarding their business practices. /2
Agency will send compulsory orders to CVS Caremark; Express Scripts, Inc.; OptumRx, Inc.; Humana Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc. #PBMs /3
🔥A must-read: @oncologyCOA report on #PBMs
Some takeaways:
“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.”
Some takeaways:
“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.”
2/ “PBMs have done this by overwhelmingly abusing their responsibility to protect Americans from this country’s drug pricing crisis, instead exploiting the opacity throughout the nation’s drug supply chain to enrich themselves.”
FYI: A clarification 🧵on a misleading new @medicarepayment chart of brand-name drugs in #Medicare Part D.
Many have misunderstood these data & misrepresented the findings, which say nothing about net drug prices.
Read on for my explanation of what’s really going on.
1/14
Many have misunderstood these data & misrepresented the findings, which say nothing about net drug prices.
Read on for my explanation of what’s really going on.
1/14
Background: MedPAC seemed to show that in Part D, brand-name drug prices “net of rebates” grew by 7.5% per year from 2010 to 2020
But this chart is not what it appears to be…
drugch.nl/3Kq5j5S
2/14
But this chart is not what it appears to be…
drugch.nl/3Kq5j5S
2/14
Summary: Contrary to some claims, we can't conclude anything about net prices from the chart above.
In fact, Medicare Part D's "net brand-name drug prices" (as defined by MedPAC) can be increasing, while net prices received by manufacturers can be decreasing.
Here's why.
3/14
In fact, Medicare Part D's "net brand-name drug prices" (as defined by MedPAC) can be increasing, while net prices received by manufacturers can be decreasing.
Here's why.
3/14
Mr. Scott of @pcmanet, the lobby group for #PBM has been called one of The Hill newspaper’s “Top Association Lobbyists” each year from 2015 to 2020.
Yesterday he spoke at the @FTC hearing on how mergers are affecting healthcare. Let's dissect what this lobbyist said 🧵1/6....
Yesterday he spoke at the @FTC hearing on how mergers are affecting healthcare. Let's dissect what this lobbyist said 🧵1/6....
Scott of @pcmanet told @FTC that there were over 70 #PBM.
True, but from DrugChannels, we can see that SIX PBM control 95% of the prescription drug claims in the US
THAT is one WAAAAAY conslidated market! 🧵2/6
True, but from DrugChannels, we can see that SIX PBM control 95% of the prescription drug claims in the US
THAT is one WAAAAAY conslidated market! 🧵2/6
The lobbyist Scott of @pcmanet told @linakhanFTC that #PBM were the only players in the market that saved money on prescription drugs.
Whatever you are "doing " to "save 💵"
it ain't working.
Meanwhile #PBM and associated co are at the top of the fortune 500. 🤔 🧵3/6
Whatever you are "doing " to "save 💵"
it ain't working.
Meanwhile #PBM and associated co are at the top of the fortune 500. 🤔 🧵3/6
@thedailybeast The Affordable Insulin Now Act “ does not lower the price of insulin by one penny,” said @LloydDoggettTX
He's right.
It's a cap on the copay only.
Americans, including the uninsured will STILL pay 800% more than they should for insulin and many other drugs.
🧵1/6
He's right.
It's a cap on the copay only.
Americans, including the uninsured will STILL pay 800% more than they should for insulin and many other drugs.
🧵1/6
@thedailybeast @LloydDoggettTX 🧵2/6 👀who the profiteers are in the Insulin Cartel
Net price is approx what the big 3 manufacturers pull in.
List price= net price + 💵 #PBM make
PBM are responsible for lion's share of cost of insulin, which will not ⬇️ with this bill.
Uninsured will still pay 800% ⬆️ BOO!
Net price is approx what the big 3 manufacturers pull in.
List price= net price + 💵 #PBM make
PBM are responsible for lion's share of cost of insulin, which will not ⬇️ with this bill.
Uninsured will still pay 800% ⬆️ BOO!
@thedailybeast @LloydDoggettTX 🧵3/6 The 3 @PhRMA companies making most of the insulin also profiteering... it cost about $6 to make and they charge $50...They became the big 3 because the #PBM can legally collect #kickbacks. These co bought their way onto PBM controlled formulary buckscountycouriertimes.com/story/opinion/…
Another way to look at the 🇺🇸 HC spend:
70% of physicians owned by a hospital or corporation
Hospital systems own many clinics
This makes hospital costs really important to examine.
70% of physicians owned by a hospital or corporation
Hospital systems own many clinics
This makes hospital costs really important to examine.
It's REALLY important to know hospital prices!
Even though the last 2 US administrations have a rule on hospital price transparency, only 15% of hospitals are complying.
Rest are hiding their prices
If you are hiding something you must have sumptin to hide!
Rest are hiding their prices
If you are hiding something you must have sumptin to hide!
1) Good evening.
Tonight's #CVS Caremark #PBM topic:
Prior authorization & filing exemptions for patients. Caremark is touting this to clinicians as a way patients currently on #Eliquis can remain on it after Jan 1. It's complete BS.😲 Here's why---->
THREAD
Tonight's #CVS Caremark #PBM topic:
Prior authorization & filing exemptions for patients. Caremark is touting this to clinicians as a way patients currently on #Eliquis can remain on it after Jan 1. It's complete BS.😲 Here's why---->
THREAD
2) CVS Caremark's 'Executive Escalation Team' has been working with me to explore ways I & other patients can remain on Eliquis. I will use myself as example. I've been stable on Eliquis for 8 years. Here's what my exemption process will look like:
3) trial and failure of warfarin will not be required as a condition for approval (whew...did warfarin for 10 years & I NEVER want to go back!)
1. In today's op ed in @CourierTimes , The head of TRG healthcare tells us that #PBM provide better access at a lower price.
When you are done laughing, 🤣
read all his unsubstantiated claims here: theintell.com/story/opinion/…
When you are done laughing, 🤣
read all his unsubstantiated claims here: theintell.com/story/opinion/…
2. I am so glad to learn more about TRG healthcare
They help to create Mergers and consolidations
with places like @BeaumontHealth
Read more here: trghealthcare.com/services/align…
They help to create Mergers and consolidations
with places like @BeaumontHealth
Read more here: trghealthcare.com/services/align…
3. Patients DO NOT use BIG #PBMs + mail order for affordability and ease.
They use them because the BIG PBM are merged with the insurance and the mergers themselves leave patients with few choices and damaged goods. TY @CynthiaMcFadden @NBCNews nbcnews.com/specials/milli…
They use them because the BIG PBM are merged with the insurance and the mergers themselves leave patients with few choices and damaged goods. TY @CynthiaMcFadden @NBCNews nbcnews.com/specials/milli…
My recent Op Ed got the attention of @AARP HQ in Washington DC.
Here in rebuttal they state I am fueled by Big Pharma.
Let me be clear
I take no 💰 to advocate.
I am fueled by the need to create an affordable sustainable medical landscape.
Here in rebuttal they state I am fueled by Big Pharma.
Let me be clear
I take no 💰 to advocate.
I am fueled by the need to create an affordable sustainable medical landscape.
👀 when disgruntled members sued the AARP for not acting in their interest, AARP lawyers said there is no requirement for the AARP to “act with the interests of [members] in mind.”
Why act for members when United healthcare pays you? commitmenttoseniors.org/aarp-says-its-…
Why act for members when United healthcare pays you? commitmenttoseniors.org/aarp-says-its-…
AARP opposed drug 'rebates' going direct to seniors.
(They are not rebates, they are KICKBACKS!)
Instead the money could flow to PBM like Optum who are owned by AARP top funder, United HC.
This was against the wishes of 3/4 of AARP members dispatch.com/opinion/201907… #boycottAARP
(They are not rebates, they are KICKBACKS!)
Instead the money could flow to PBM like Optum who are owned by AARP top funder, United HC.
This was against the wishes of 3/4 of AARP members dispatch.com/opinion/201907… #boycottAARP
1. ALL Ivy league institutions have a hospital associated with the university offering vaccine.
ALL Ivies requiring vaccine for ALL students despite recent #COVID19 outbreaks for which they did testing and have records. thedp.com/article/2021/0…
ALL Ivies requiring vaccine for ALL students despite recent #COVID19 outbreaks for which they did testing and have records. thedp.com/article/2021/0…
2. Even b-4 vaccine mandates at Ivy league schools, most incentivizing students who were card carrying #covid19 vax recipients to get a vaccine, by lifting mask requirements for vaccinated but not for those who had immunity from recent infection.
3. Why 'waste' vaccine on these students. They have immunity.
Why not send these vaccine doses to India or other countries with less resources? nature.com/articles/d4158…
Why not send these vaccine doses to India or other countries with less resources? nature.com/articles/d4158…
1. Check out another way #PBM are making bank:
Insurer owns PBM who owns specialty pharmacy
Specialty pharmacy= pharmacy dispensing 💊💉stored under temp + special conditions: Chronic disease patients really need good specialty pharmacies. But....
beckershospitalreview.com/payer-issues/h…
Insurer owns PBM who owns specialty pharmacy
Specialty pharmacy= pharmacy dispensing 💊💉stored under temp + special conditions: Chronic disease patients really need good specialty pharmacies. But....
beckershospitalreview.com/payer-issues/h…
2. Insurer can force patient to use their in-house specialty pharmacy... thus...Aetna makes pts use CVS, BCBS+Cigna makes pts use accredo, etc
Besides the whopping conflict of interest....
Besides the whopping conflict of interest....
3. ...there ⬇️ motivation 2 deliver 💉💊in quality manner so drugs actually work.
Cystic Fibrosis patients get sicker due to #PBM @ExpressScripts shoddy delivery of 💊
Migraine patients: same
Express Scripps don't care.
@amfmigraine @CF_Foundation @VP
nbcnews.com/specials/milli…
Cystic Fibrosis patients get sicker due to #PBM @ExpressScripts shoddy delivery of 💊
Migraine patients: same
Express Scripps don't care.
@amfmigraine @CF_Foundation @VP
nbcnews.com/specials/milli…
Even over dit hele drama rondom die @Sywert en zijn mondkapjes:
Waar ligt dit schandaal nu eigenlijk?
Bij deze man, of bij @MinVWS?
Zoals ik het lees, het laatste...
nos.nl/artikel/238117…
Waar ligt dit schandaal nu eigenlijk?
Bij deze man, of bij @MinVWS?
Zoals ik het lees, het laatste...
nos.nl/artikel/238117…
Even de feiten zoals ik ze begrijp:
@sywert is vorig jaar in een gat gesprongen wat ontstaan is door een meer dan bedroevende (of liever gezegd, totale afwezigheid van iedere vorm van) voorbereiding van het @MinVWS op een pandemie.
Er was helemaal niets. Geen #PBM. Niks.
@sywert is vorig jaar in een gat gesprongen wat ontstaan is door een meer dan bedroevende (of liever gezegd, totale afwezigheid van iedere vorm van) voorbereiding van het @MinVWS op een pandemie.
Er was helemaal niets. Geen #PBM. Niks.
Daarvoor is in eerste instantie een stichting opgericht en is hij de boer opgegaan.
Uiteindelijk is er een contract gekomen met @MinVWS ter waarde van 100.nogwat miljoen. Voor de levering van 40 miljoen mondkapjes.
Nu is er een #shitstorm, want @Sywert heeft geld verdiend.
Uiteindelijk is er een contract gekomen met @MinVWS ter waarde van 100.nogwat miljoen. Voor de levering van 40 miljoen mondkapjes.
Nu is er een #shitstorm, want @Sywert heeft geld verdiend.
@RobertKennedyJr
Patients, through no fault of their own, suffer with over 7000 rare diseases .
Parents, partners, siblings, friends of rare disease patients
know that @PhRMA is needed for innovative meds.
There is even a disease called Kennedy Disease.
rarediseases.org/rare-diseases/…
Patients, through no fault of their own, suffer with over 7000 rare diseases .
Parents, partners, siblings, friends of rare disease patients
know that @PhRMA is needed for innovative meds.
There is even a disease called Kennedy Disease.
rarediseases.org/rare-diseases/…
Check out the fortune 500.fortune.com/fortune500/
You don't get a Pharma company till #35, and J and J is top dog cause diversified with bandages and devices.
Next pharma co comes in at 64.
But you know who IS on fortune 500 top 10?
You don't get a Pharma company till #35, and J and J is top dog cause diversified with bandages and devices.
Next pharma co comes in at 64.
But you know who IS on fortune 500 top 10?
CVS in the top 10 of Fortune 500 @FortuneMagazine
CVS : 60% of it's revenue from it's #pbm
PBM= pharmacy benefit manager.
Optum, a PBM owned by @UHC also In the top 10 of Fortune 500
Remarkable info about PBM here from PPA board member @mass_marion medpagetoday.com/publichealthpo…
CVS : 60% of it's revenue from it's #pbm
PBM= pharmacy benefit manager.
Optum, a PBM owned by @UHC also In the top 10 of Fortune 500
Remarkable info about PBM here from PPA board member @mass_marion medpagetoday.com/publichealthpo…
Het kan me eigenlijk vrij weinig schelen of die man het niet weet, of doet alsof hij het niet weet.
In beide gevallen is hij niet geschikt voor zijn functie.
Maar laten we het even langslopen, zullen we?
In beide gevallen is hij niet geschikt voor zijn functie.
Maar laten we het even langslopen, zullen we?
Om te beginnen het aantal mensen dat "immuun" is door ziekte. Ik weet niet zo goed waar het getal van 4 miljoen vandaan komt eerlijk gezegd. Sanquin meette 2.3 miljoen in januari.
nu.nl/coronavirus/61…
nu.nl/coronavirus/61…
Rond hetzelfde moment rondde #vDissel dat af naar boven, richting de 3mln. Dit zei het RIVM erover.
In dit licht is het maar zeer de vraag of we nu 4mln halen. We missen namelijk een stukje cruciale informatie.
rtlnieuws.nl/nieuws/nederla…
In dit licht is het maar zeer de vraag of we nu 4mln halen. We missen namelijk een stukje cruciale informatie.
rtlnieuws.nl/nieuws/nederla…
AHA!!! We all know that BCBS Is the biggest individual Health Care Insurance donor to congress over the past 20 years, right? opensecrets.org/federal-lobbyi…
2. How did BCBS get so rich? They were originals.
@BCBSAssociation the insurance co with the LONGEST In house owned #PBM: Prime theraputics
PBM are the insurers cash cows. 💵🐄
@Cigna revenues tripled when they bought Express Scripps. 60% of @CVSHealth revenues from PBM
@BCBSAssociation the insurance co with the LONGEST In house owned #PBM: Prime theraputics
PBM are the insurers cash cows. 💵🐄
@Cigna revenues tripled when they bought Express Scripps. 60% of @CVSHealth revenues from PBM
It's all on their website under history: primetherapeutics.com/en/about/histo…
Beste zorgverleners,
Ik zie veel tweets en zelfs hele draadjes voorbij komen waarin de meest foute, kortzichtige, egoïstische en soms ronduit schandalige uitspraken worden gedaan over #vaccinaties door uw collega’s.
Ik ga daar niet rechtstreeks op reageren. (sorry @kobus5)
Ik zie veel tweets en zelfs hele draadjes voorbij komen waarin de meest foute, kortzichtige, egoïstische en soms ronduit schandalige uitspraken worden gedaan over #vaccinaties door uw collega’s.
Ik ga daar niet rechtstreeks op reageren. (sorry @kobus5)
Waarom niet?
Omdat ik mezelf daarin niet vertrouw. Ik ben eerder zo’n discussie aangegaan en mijn zelfbeheersing verloren. Dat leidt af van de discussie, en dat wil ik niet. (plus dat ik tegen de verkeerde uitviel, wil ik ook niet).
Omdat ik mezelf daarin niet vertrouw. Ik ben eerder zo’n discussie aangegaan en mijn zelfbeheersing verloren. Dat leidt af van de discussie, en dat wil ik niet. (plus dat ik tegen de verkeerde uitviel, wil ik ook niet).
Maar ik wil toch snel een paar punten te weerleggen. En u verzoeken er in uw discussies rekenschap mee te houden dat de mensen die u zo makkelijk aan de kant schuift (of hun geliefden) hier ook meelezen.
Waar komen de 4000 extra medewerkers verpleeghuizen (269k --> 273k) vandaan? Zijn er in de eerste ronde 4.000 aanvragen meer binnen gekomen dan verwacht? Of had u het in eerste instantie niet goed inzichtelijk?
Zelfde vraag voor medewerkers gehandicaptenzorg (+70k, +40%) en medewerkers wijkverpleging en Wmo (+38k, +25%)
Dit is wel meer dan een mistelling. Wat is hier aan de hand? Wie bent u vergeten? Zijn niet de huisartsen, die zijn maar met ongeveer 12.000.
Dit is wel meer dan een mistelling. Wat is hier aan de hand? Wie bent u vergeten? Zijn niet de huisartsen, die zijn maar met ongeveer 12.000.
Naar aanleiding van berichten op mijn tweets over de #Vaccinatiestrategie kreeg ik opmerkingen/ vragen in de trant van: ‘Waarom zou de gehandicaptenzorg voorrang moeten krijgen met het vaccineren?’ (1)
Maar het gaat niet om voorrang krijgen. Het gaat om keuzes die nu worden gemaakt in de #Vaccinatiestrategie die ten koste gaan van mensen met een verstandelijke beperking. Een draadje. (2)
De Gezondheidsraad heeft advies gegeven om allereerst de kwetsbare groepen te vaccineren (ouderen en mensen met een verstandelijke beperking) en hun zorgverleners. (3)
De bedoeling was >90% voor ouderen.
Heeft de @Gezondheidsraad expliciet benoemd. Drie keer al.
En toch stemt de Tweede Kamer in met het uitdelen van ALLE Pfizer vaccins die de eerste twee maanden binnen komen aan zorgmedewerkers. Voor er ook maar één oudere wordt geprikt.
Heeft de @Gezondheidsraad expliciet benoemd. Drie keer al.
En toch stemt de Tweede Kamer in met het uitdelen van ALLE Pfizer vaccins die de eerste twee maanden binnen komen aan zorgmedewerkers. Voor er ook maar één oudere wordt geprikt.
We gaan beginnen met het vaccineren van 643.000 zorgmedewerkers met ALLE vaccins die we de komende tijd van Pfizer gaan krijgen. En daar staan de huisartsen niet bij.
Ik kan echt wel meegaan met het gelijktijdig ook selectief prikken van vitale mensen in de curatieve zorg.
Ik kan echt wel meegaan met het gelijktijdig ook selectief prikken van vitale mensen in de curatieve zorg.
Ook dat is namelijk het advies van de @Gezondheidsraad. En ik snap dat ze dit geadviseerd hebben.
Maar dit is niet zeer selectief.
Dit is niet tegelijk.
Maar dit is niet zeer selectief.
Dit is niet tegelijk.
Dit weekend schreef ik een draad over de NLse strategie omtrent #vaccinatie. Die maakte nogal wat los.
Over de rechtvaardigheid om zorgmedewerkers met voorrang te vaccineren. Maar ook onduidelijkheid: wat levert het op?
Over de rechtvaardigheid om zorgmedewerkers met voorrang te vaccineren. Maar ook onduidelijkheid: wat levert het op?
Met andere woorden: hoeveel mensenlevens kost dit aan de ene kant (kwetsbaren en ouderen die later worden geprikt) ten opzichte van opbrengsten aan de andere kant (verminderen van uitval van zorgpersoneel waardoor meer mensen geholpen kunnen worden).
In mijn draad deed ik een hele grote aanname op basis van de IFR van ouderen (4-25%) tov gezondheidszorgmedewerkers (op basis van de cijfers tot nu toe 0,02%).
Die berekening sloeg nergens op, maar ging ook om een duiding van de risico’s, niet om de getallen.
Die berekening sloeg nergens op, maar ging ook om een duiding van de risico’s, niet om de getallen.
Dit doet, na alle discussie gisteren over #vaccinatie, bijna fysiek zeer.
Mijn condoleances aan alle gemeenschappen, families en gezinnen met het verlies van uw dierbaren. Ik hoop dat u de mogelijkheid heeft gehad afscheid te nemen.
dvhn.nl/groningen/Coro…
#CodeZwart
Mijn condoleances aan alle gemeenschappen, families en gezinnen met het verlies van uw dierbaren. Ik hoop dat u de mogelijkheid heeft gehad afscheid te nemen.
dvhn.nl/groningen/Coro…
#CodeZwart
Wij zaten in de ellende in maart. Onze overheid, @hugodejonge en @MinPres, heeft beloofd dit nooit meer te laten gebeuren
Dus nee, het is niet de bedoeling dat u de verzorgers prikt. U zou juist de mensen prikken die liggen te stikken in hun eigen lichaamsvocht.
Alleen. Alweer.
Dus nee, het is niet de bedoeling dat u de verzorgers prikt. U zou juist de mensen prikken die liggen te stikken in hun eigen lichaamsvocht.
Alleen. Alweer.
