Concerned PharmD 🇺🇸

Pharmacist. Advocate. PBMs (middlemen) profit while people ration meds. If you’ve overpaid or been under-reimbursed, you’re not alone— and I’m fighting for you.

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

A PBM-free or transparent fixed-fee healthcare model in the U.S. would conservatively save $90–130 billion per year—representing 14–20% of total prescription drug spending.

These savings come not from rationing care or suppressing innovation, but from eliminating opaque middlemen who profit from rebate distortions, spread pricing, and formulary manipulation.

#EndPBMs #PBMReform #PatientsOverProfit

Here’s the analysis:

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@tjparker @Pharmassists A circular argument is a lost argument. You’re really just begging the question

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@tjparker @Pharmassists You can directly insert wholesalers into this chart. That’s a problem.

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@tjparker @Pharmassists That’s a purposely specific example. You know what I mean.

If that’s the true model, it’s set up to fail. And short sighted.

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@tjparker @Pharmassists Well when the wholesalers’ parent company is a direct competitor to the independent, that’s not how it ends up working

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@mcuban The system is built for max profit under the guise of “bringing our heart to your health,” then raping your doctor and/or pharmacy, over billing at every level, which in turn—increases your premium

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@mcuban A win is a win

[Mark Cuban @mcuban]

Crazy? The pharmacy has to buy the bagel for $400 from a big wholesaler, then get rebates to try to get their cost down to the $7. Which they can only do if they buy 90 plus percent of their generic bagels from their big primary wholesaler. If they buy generic bagels elsewhere, like @costplusdrugs does, and it exceeds 10 pct of their total buys from the wholesaler, they get hit with chargebacks and fees that wipe out any chance of making money on bagels .

Which means they pay more for generic bagels. Which means customers pay more for bagels because everyone lists the price at $400

And the wholesalers use that $400 RETAIL price for the starting point of their WHOLESALE pricing.

By doing this, the PBMs get to use the $400 price as their starting point for pricing as well.

In any other industry other than this bizarro bagel world, the wholesalers would compete for the best price from the bagel manufacturers and then compete for the business of pharmacies.

It’s the most upside down bizarre business I have ever seen

[ATAP @ATAPAdvocates]

"...These middlemen in the drug supply chain don’t discover new medicines. They don’t manufacture them. They don’t even physically dispense most prescriptions. Yet they rake in tens of billions of dollars each year by driving up costs for everyone else — especially patients battling cancer, HIV, heart disease, and autoimmune conditions..."
https://t.co/XER3tBDLEI

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

You mean that it’s “covered” — which was decided by the PBM, not the insurance.

Insurance companies do not manage their own medication formularies. None that I know of. They contract to third parties, PBM’s. They decide what gets covered, at what price, at what copay, and at what pharmacy.

The worst part? They’ll typically only “cover” medications that they get a rebate from the manufacturer for (ie pay-to-play)

The problem: these rebates are not paid by the MFG. The patient, insurance, employer, and taxpayer pay for these rebates—which largely line the pockets of the said PBM.

This creates multiple problems. The largest problem being that the cost of the medication is now more expensive (x + %rebate). This increases your cost, the pharmacies cost, the insurances cost, the wholesalers cost and reimbursement, your employers cost, the taxpayers cost, and most importantly—your copay. Then, big pharma gets to claim a tax-break for increasing the cost of your medication for this rebate.

There’s more to this nuanced problem. But, I’m not going to inundate you with facts. Instead, check out my profile to see how PBM’s are scamming you, me, taxpayers, the sick, and just about everyone in-between 🙂

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@WallStreetMav How can there be any competition when the competition determines the competitions reimbursement? @HawleyMO

[Mark Cuban @mcuban]

Cannibalism At The Pharmacy Counter https://t.co/b0a1fa9JvU

[KP, Pharm.D. @kpharmd12]

Time for every pharmacy/pharmacist on here to drop @Humana for 2026.

[Nisha Patel, MD MS, Dipl of ABOM, CCMS @DrPlantel]

Mitochondria are microscopic. You cannot diagnose “mitochondrial challenges” by glaring at a child in an airport. What you can do is prey on parents fears with pseudoscience, while ignoring the real crises our kids face, like gun violence, food insecurity, and lack of healthcare.

[Sarah Despres @sarahdespres]

Pay attention to this excerpt: “We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary.  I am not sure who the Secretary is listening to, but it is quite certainly not to us.”

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

Agreed.

Stop entering into contracts that will cause you to dispense underwater just to increase your *potential* patient population.

Adopt cash-only models. Develop a membership model. It’s being done around the country already.

Leave their networks. If patients lose access because a pharmacy leaves network, it creates patient pressure on employers, insurers, and PBMs.

This is something pharmacies rarely leverage but desperately need. Make this their problem, not ours.

Take our profession back, one pharmacy at a time

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

PBM’s increase list prices from the original price proposed by manufacturers. See insulin prices circa 2008.

Those rebates also get tacked onto the drugs acquisition cost. The PBM keeps a large portion of that rebate.

Moreover, manufacturers are not rebating anything out of the kindness of their hearts. In fact, raising the price of a medication, for a PBM rebate specifically, is a tax break for “big pharma”

In summary, rebates actually increase drug costs (proof if you simply google it), are incentivized by the government, and the “savings” are not actual patient savings— they’re largely pure PBM profit for “negotiating” their own rebate.

The result? Incentivizing higher drug prices through rebates and tax breaks.

Check out my profile for more information.

It’s worse than you know.

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

Cutting out middlemen (PBM’s) does lower costs.

The “coverage” people think they’re getting is mostly a shell game built to funnel profit, not savings.

@FTC @JusticeATR

[Matthew Herper @matthewherper]

If pharma companies just cut out all those annoying middlemen and sold medicines directly to consumers, wouldn't that cut the prices that people pay?

Yes, but... not so much, @elaineywchen finds. Because most consumers' drug costs are mostly covered by insurance, and they don't have hundreds of dollars a month to buy discounted drugs.

https://t.co/XgkJurCKHO

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@sterlingkoonce CVS will just find a judge to rule in their favor. Rite aid may get 1/5th of what they’re asking for, if they’re lucky.

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@TexasPharmD @tjparker @mcuban New models must be adopted, quickly.

They aren’t going anywhere, they make too much $ and have contractual strangleholds on the industry.

But ideally, conventional PBM’s can be phased out, eventually.

[Concerned PharmD 🇺🇸 @ConcernedPharmD]

@tjparker @mcuban Tell that to:

New Zealand (Pharmac, saving NZ30-50M/year)
UK (NHS/NICE, substantially lower drug $)
Germany (AMNOG, >20% discount on new drugs)
Canada (pCPA, C$50M saved on just 10 drugs/3yr)
Australia (PBS, lower $per-capita)
US VA (substantially lower drug $)