Greg Kramp, Pharmacist

[Ginny Crisp, PharmD @ginny_crisp]

DIR fees are the industry's best-kept secret. The PBM reimburses a pharmacy for a script, then quietly claws part of it back weeks later. Your plan never sees the clawback. The pharmacy eats it. The PBM keeps it. Ask your PBM what it collected in DIR last year and how much reached your plan. The pause before the answer is the answer.

[Representative Tarik Khan @RepTarik]

PBMs were supposed to lower costs. Instead, 3 mega corporations now control roughly 80% of the market while prescription drug prices rise and independent pharmacies struggle to survive.

[Greg Kramp, Pharmacist @GregOhyeah]

@datadriven_tdoc Yes the gender doesn’t matter. As others have mentioned this video doesn’t seem to show anything strange.

The ref is there. If say the girl called out refs would stop the match.

[Greg Kramp, Pharmacist @GregOhyeah]

@2moderateforsum @mcuban @costplusdrugs Truth. Drugs are like gasoline, milk, or eggs - easy to compare.

USA pays about 2-3x what other countries pay for meds, but about 10x for hospitalization / other healthcare.

[Greg Kramp, Pharmacist @GregOhyeah]

@goodgirlsdon8 @mcuban @redlgb1969 @costplusdrugs The independent pharmacy is mostly hurt by below cost reimbursement dictated by insurance. Cost plus is a growing trend away from insurance and is healthy for independent pharmacy.

Pharmacies also suffer when they make sales today and find out 90 days later they lost money.

[Greg Kramp, Pharmacist @GregOhyeah]

@TresyHQ @mcuban @costplusdrugs Fair question, but I think an easy answer. These medications are marked up so much by others that we have no real concept of the cost.

As volumes go up prices fall but more gradually.

We have shortages - like with our current system - because ins isn’t dynamic to supply chains.

[Dutch Rojas @DutchRojas]

The one subject every one of my favorite podcasts avoids is healthcare.

Sure, they talk about vaccines. They talk about peptides, longevity, and the latest medical device. Cool, bro. A new robot.

I do not care.

I care about the $30,000 disappearing every year before an American family receives a dollar of actual care.

I care about Medicare, insurers, and health systems extracting money from patients, employers, taxpayers, and physicians.

And increasingly, those are not separate institutions.

The insurer owns the physicians.
The health system owns the health plan.
The pharmacy benefit manager owns the pharmacy.

Everyone owns everyone, and the patient owns the bill.

Law makers talk about breaking up the insurance companies while protecting Certifiacte of Need laws in their own backyards and protecting their precious "non-profits".

And I would not care how large these organizations became if they won in an open market.

They did not.

They used government to restrict competition, protect reimbursement, block new entrants, and write rules that favor incumbents.

Then they spent nearly a billion dollars hiring lobbyists to keep it that way.

The lobbyists take their cut.
The lawmakers take the money.
The public elects the lawmakers.

And then people wonder why healthcare keeps getting more expensive.

Healthcare is not ignored because it is boring.

It is ignored because nearly everyone with a microphone is more comfortable discussing the symptoms than naming the people getting rich from the disease.

-Rojas out

[Greg Kramp, Pharmacist @GregOhyeah]

@Kimmassey236506 @bschermd https://t.co/r1DLK7YToE

[Greg Kramp, Pharmacist @GregOhyeah]

@Kimmassey236506 @bschermd I wonder if docs would send patients to a risk calculator. Some would call this shared decision making.

I’m not a doctor but I’ve heard these conversations could be time consuming but not reimbursed - no mechanism to bill for additional un-planned time.

[APCI @_APCI]

Independent pharmacies are not closing because their communities no longer need them.

They are closing because too many are being asked to fill prescriptions at a loss.

This Jamestown Press article shares the perspective of Tim Baker, who owned and operated Baker’s Pharmacy in Jamestown for more than 40 years before closing the business. His experience reflects what independent pharmacies across the country continue to face: reimbursement rates that often do not cover the actual cost of serving patients.

That is not sustainable. And when a local pharmacy closes, the loss is felt by the entire community.

Fair reimbursement is not just about keeping pharmacy doors open. It is about protecting patient access, preserving local care and making sure trusted community pharmacists can continue serving the people who depend on them.

Below-cost reimbursement is not a business model. It is a warning sign.

https://t.co/bUKISx2quR

[Michael Albert, MD @MichaelAlbertMD]

Doctors Aren't Burned Out from Overwork. We're Demoralized by Our Health System.

This is why I left the system. 🙏🏻 https://t.co/jmj7rB3X4H

[Greg Kramp, Pharmacist @GregOhyeah]

@PhillipCrowley2 @skumWgmi Wouldn’t it make more sense to divide by the number of Walmart employees, or the lower paid ones.

[skumm🧊 @skumWgmi]

I called to cancel my health insurance because I couldn't afford the premium.

The rep asked why.

I said $480 a month for a plan with a $6,500 deductible isn't insurance.

It's a monthly fee I pay to still go bankrupt if anything actually happens.

She didn't have an answer.

[Kyle McCormick 🫐💊 @kmccor2014]

The same reason that the government shouldn't get involved in generic medications. It only raises the cost of them. Middlemen are expensive!

[Dutch Rojas @DutchRojas]

The British Empire didn't conquer India with an army. It conquered India with a trading company that gradually assumed governmental functions while its investors collected dividends.

American healthcare has done the same thing to the American employer.

What started as a fringe benefit has become a mandatory cost center consuming 20% or more of total compensation. The employer didn't choose this system. The system chose the employer.

And just like the East India Company's investors, the intermediaries collecting tolls on this arrangement have no incentive to simplify it. Complexity is the product.

The employer who understands this will do what the British Parliament eventually did: revoke the charter and start over.

[Dutch Rojas @DutchRojas]

We price oil to the penny in real time across 195 countries. But nobody on earth can tell you what a knee replacement costs before you get one. That’s not complexity. That’s a cartel.

[Pharmassists @Pharmassists]

Patient's copay for 10 levaquin at Walmart with Humana insurance= $32
Patient's copay at my pharmacy= $3.90
But the government needs until 2028 to fix this? 🤣.

[Valerie Anne Smith @ValerieAnne1970]

A 20-year study found women who regularly cleaned their homes lost lung function equivalent to smoking 20 cigarettes a day.

Yes — 20 cigarettes a day worth of damage & only in women. Men did not show the same damage. Why the huge gender gap?

Women use far more cleaning sprays, disinfectants, air fresheners, scented detergents, candles & fragrance-loaded products — all containing volatile organic compounds (VOCs) and irritants that aerosolize & get inhaled deeply into the lungs.

~The study "Cleaning at Home & at Work in Relation to Lung Function Decline", (based on the long-running European Community Respiratory Health Survey) tracked lung function over 20 years in 1000s of participants. Women who cleaned regularly (weekly or more) had accelerated lung function decline comparable to ~20 pack-years of smoking. No similar effect was seen in men, due to lower exposure to household cleaning chemicals.

The fix is cheap & simple: Switch to non-toxic alternatives — vinegar + water, baking soda, castile soap, hydrogen peroxide.

Throw out the scented sprays, "synthetic fragrance" plug-ins & harsh volatile chemical cleaners.

Your lungs don’t regenerate like your liver. Damage accumulates for life.

You wouldn’t smoke a pack a day. Why clean like you do?

What are you cleaning with these days???

[Pharmassists @Pharmassists]

Two more pharmacies in the county lost their ability to get narcotics. The reason? Too many cash claims. I think it's better just to not fill narcotics than to lose money billing insurance. But for many pharmacies this is a death sentence.

[KP, Pharm.D. @kpharmd12]

Just filled a long list of meds for a patient recently diagnosed with (most likely) terminal cancer.

Among their med list were:

#180 Oxycodone 5mg
#15 methadone 5mg
#30 dronabinol 5mg

All highly controlled drugs, all paid less than my wholesale cost to acquire them.

Patient has also met all out of pocket expenses for the year, so their copays are now $0 across the board for all medications.

Do you know how difficult it is to have a conversation about being paid under cost for medications (that this patient needs to have a decent quality of life) for everything they are going through?

PBM’s don’t care.

They aren’t the ones having to look these patients in the eye to tell them the truth.

All they do is lie to keep their corrupt gravy train rolling down the tracks.