DAVID VAN WINKLE DRE# 02017958

Former long time Registered Investment Adviser. DRE#02017958

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

The Federal Reserve is so far behind the 8 ball, rates should have been raised long ago. They’ve fueled inflation in every category and it’s not TRANSITORY.
#Fed

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

https://t.co/nFhxkjOJ3N #SFGiants

[Ben Verlander @BenVerlander]

I can’t stop watching this play

Absolutely unbelievable

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

@elonmusk

[Forest Park Pharmacy @ForestParkPharm]

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.

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

Common cause is the polite way of saying they finally admitted the tool never worked.

Forward guidance was sold as transparency. The whole premise of telling markets where rates are headed and they’ll do the anchoring for you only holds water if you can see the future. None of them can.

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

#SFGiants commentary as explained by The Athletic #MLB Power Rankings published today

Ranked #28
San Francisco Giants(27.0)
Record: 35-49
Last Power Ranking: 29
Something to watch for: The heat beneath Buster Posey’s seat
Perhaps you have heard: this Giants season is not going well. A team with a nearly $200 million Opening Day payroll has generated one of the worst records in baseball, with a run differential that suggests the Giants are as bad as their record says they are.
Posey, the future Hall of Fame catcher turned president of baseball operations, has not assembled a winning roster at the big-league level, and then refused to take questions about the team’s Pride Night fiasco. He will be trying to sell off pieces at the deadline, hoping to find a big return for a veteran pitcher such as Robbie Ray. That would help change the perception he currently faces, which is that despite his status as a franchise icon and member of the team’s ownership group, he may not be the best person to lead the baseball ops department. — McCullough

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

https://t.co/UpJ03PRSBb #SFGiants #Athletics

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

@NBCSGiants Please show the K zone, it’s missing

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

Ben, my take is the only real certainty in Oracle Park is that #SFGiants ownership has been perfectly content peddling a decade of .500 mediocrity.
Why fix what isn’t broken when you can slap a gourmet label on bologna and still sell out at Kobe prices? They simply don’t share the Dodgers’ burning hunger to win because why chase rings when the cash register already sings?

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

I’d trade nearly the whole #SFGiants for the #Athletics straight up, and that sentence should get someone fired. Arraez, Webb, Eldridge, Schmitt & Lee are safe. The rest can catch a flight — desk included

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

@DylanIsADragon Arraez is the best all-around hitter in #MLB. Failing to extend him 3 years right now would take a special kind of incompetence — the kind you usually have to inherit, not earn #SFGiants

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

#SFGiants Lee batting 7th seems odd, hitting .290 vs lefties. Here’s my lineup, still time to make these changes Tony

1. Luis Arraez
2. Matt Chapman
3. Casey Schmitt
4. Bryce Eldridge
5. Jung Hoo Lee
6. Rafael Devers
7. Willy Adames
8. Daniel Susac
9. Drew Gilbert

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

@CryptoNobler @Grok Is this true?

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

Perhaps the most striking stat is WAR.
Dubon 1.7
Devers at .1 almost zero
defined as just an ordinary replaceable player
#SFGiants

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

Dubón at $6mil
Devers at $31mil
Dubón outperforms
Braves had 4 former Giants in their starting lineup yesterday.
Team with the best record in MLB sees things that SF doesn’t
https://t.co/5jXef0YP4Q
#SFGiants #Braves

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

@GiantHotTakes Indeed, look at the #Athletics

[DAVID VAN WINKLE DRE# 02017958 @Turlock_Realtor]

@JamesRe53113261 @PavlovicNBCS Move Devers down as well, leaves too many stranded runners on base

[Richard Keltz @KeltzChroniclez]

Buster Posey said the Giants didn’t need a closer or relievers…damn shame #SFGiants

[Lisa Delaney @Delane63]

Ahhhhhhh man … Keaton outta gas…PAY THE MONEY FOR A FRICKIN CLOSER, BUSTER!!! #SFGiants