@NYS_AM what is going on with A5882c? 121/150 members have signed on as cosponsors, it deserves a vote!
Don’t let PCMA stop you from protecting patient access to pharmacy care in communities across New York.
#FixRx
It's one thing for the PBM lobby to announce a 7-figure ad campaign to repair their reputation as harmful middlemen who drive up the cost of prescription drugs. But now they claim to be "the most transparent part of the drug supply chain.” 🤯
"[PBMs] wield enormous power and influence over patients’ access to drugs and the prices they pay. This can have dire consequences for Americans, with nearly three in ten surveyed Americans reporting rationing or even skipping doses of their prescribed medicines due to high costs." - Excerpt from FTC report
Just discovered one of the most egregious pharmacy Medicare Part D claims to date…
pregabalin 50mg 180 capsules (90 day supply)
@WellcarePlans sets the reimbursement for Walmart at $104.40.
Walmart is a standard, in-network pharmacy.
Our independent pharmacy is also a standard, in-network pharmacy.
So, what do they set the price at for my independent pharmacy for the same prescription?
$14.40
This type of shit should be illegal and prosecuted.
The unsuspecting patient would pay a price 7.25x higher just by walking into Walmart instead of a locally owned pharmacy.
I thought Walmart prides itself on having the lowest prices?
Guess that ideology doesn’t apply toward prescription drugs.
Big shoutout to @ExpressScripts for making this possible.
Rot in eternal hell.
Humana is deliberately destroying my home health agency, which delivers high-quality care to patients.
They are my direct competitors, with over a dozen Humana-owned home health agencies in the same area. They refuse to allow us in-network at fair rates, even though our CMS star ratings are higher than those of 95% of the agencies listed on their provider list—which is 88% inaccurate.
This includes many 1- and 2-star rated agencies that do not accept Humana, as well as numerous ghost listings (agencies that do not exist). Several of their own agencies are listed with different addresses but ring to one central location, where the receptionist has confirmed that the listed addresses have been closed for years.
Humana is not about quality. Instead, they focus on eliminating competition and depriving patients of choice and access to quality care through unfair practices and abuse of power.
Current policies leave us without protection—both as honest, hard-working independent healthcare providers serving our communities and as patients who do not realize their choice and access to quality care have been taken from them until it is too late. By then, patients are trapped in the Humana ecosystem.
Their business model is to deny, delay, and destroy quality care offered by providers in order to increase profits for shareholders, funded by Medicare, Medicaid, and taxpayer dollars.
Vertical integration has never been about delivering better care or saving taxpayers' money. It is about a loophole to circumvent the MLR rules and protect profits at all costs—at the expense of patients’ health and thousands of jobs, by destroying quality care providers who stand in the way of ensuring their stocks grow each quarter.
@Humana, give us a contract with the same rates you pay your own agencies, and let us care for the patients who choose us for their recovery. We actually save you money by simply caring and putting patients first—keeping them out of the hospital, preventing infections, providing manual therapy, and more.
Fair competition should not even be something we have to ask for and beg for. Reimbursing us the same rates you pay your own agencies next door—with zero extra to offer—is not only unfair and un-American, but it also harms patients, destroys jobs, and wipes out small and mid-size businesses. This is done by blatantly violating anticompetitive laws in ways that are mind-blowing to know are allowed in America.
@DrOzCMS@VP@AFergusonFTC@KenPaxtonTX@POTUS Why are you continuing to allow this? I am a local business with 100+ dedicated employees who are passionate about care. We have a spotless record in both compliance and quality care, and we have served the community for over a decade. Why are you allowing Humana, UHC, and other insurance companies to destroy us and thousands of others in the same position—from pharmacies to clinics and more?
It has been proven to lower quality, cost far more, and harm millions.
If the goal is to destroy us all and help these few giant for-profit, careless corporations make a few more billions for stockholders while gaining full control over our health, then just be honest with us. (Which I want to believe is not the case, and prayed that this madness will end with the new administration.)
If not, then immediately change it, save the providers who remain, and give patients real choice.
Thousands of jobs that actually care about people and are committed to the highest quality care can still survive.
Let patients have a choice—please do it now. We cannot survive this much longer. They are rapidly eliminating us and stealing our patients.
I don't like to demand, so I ask. As a business, I am not blocked from serving the customers who choose my services—especially not by my direct competitors. How is that even possible in our great country?
What’s next? We can’t buy our groceries where we want from whom we want? We can’t get our hair cut where we want by whom we want? We can’t get an attorney we choose to represent us—it will have to be the one owned by the company that is suing us? We can’t get the car we want to buy from whom we want to buy it from?
I am a proud American who loves this country with all my heart, but I feel like I am living the stories my grandparents told me about living in Europe under communism—some of which I fear we are heading toward rapidly in healthcare and as a business owner.
If this spreads to other industries, the story of having only two types of cars to choose from and a 16-year waiting list may end up being the story of my children or grandchildren, too, as it was for my grandparents.
Please stop it now. I am not asking for charity or a handout. I am asking you to stop allowing my life’s work and my future to be stolen from me any more than they already have been, so I can rebuild before I am wiped out like dust on the Humana and UHC jets they fly to their cocktail parties.
P.S.: It is an additional slap in the face that they are doing this with taxpayers’ dollars. In Humana’s case, it is 100% Medicare, Medicaid, and its subsidiaries. I have been forced by my own government to pay for my own destruction.
Starting in July, I won’t even be able to afford health insurance for my own family (36K/yr), while being forced to pay over $250,000 for employee coverage — which many of them still choose to keep, even though it takes a huge portion of their paycheck, mostly because they have to.
The health insurance companies can steal billions of our tax dollars, raise forced health insurance premiums by 25%–30% every year, and pay providers little or nothing in return. How is this okay?
I have never been an angry person — actually the opposite — and I am grateful for everything in life. But I am angry now. I am trapped in a helpless situation that I have zero control over and zero protection against — a situation that I did not create for myself, my staff, or my patients.
It feels like my government has released the Hunger Games on independent healthcare businesses with no time limit — allowing the big insurance companies to attack, break in, destroy everything, and eventually finish us off with no consequences. And instead of protection, they have taken away every tool we could use to defend ourselves.
Dramatic? Yes, it is dramatic — because it is really happening. I want someone to hear me and stop it. We need a hero @elonmusk@mcuban or someone with whom they speak; people listen. I do appreciate all the fight against fraud, but please, at the same time, don't let the honest, hard-working providers be destroyed.
Special thanks to @nickshirleyy, fighting fraud, he may have to be the one who actually exposes this biggest fraud ever, and a legalized mafia (thanks to our politicians) that cost us trillions of dollars, our businesses, and in many cases, lives. ENOUGH!
The drug is Prednisone.The PBM is Express Scripts.The plan is @TRICARE. The drug costs pharmacy $0.95. The reimbursement is zero from Tricare, with a $0.73 copay 4 patient. Pharmacy lost $0.22 just on medication costs.This does not factor cost of dispensing. A stamp costs $0.78
During today’s Texas Senate Health and Human Services Committee hearing, Senator @MollyforTexas, a nurse, said it is part of her workflow to ask her patients what #pharmacy they use. “When it’s an independent pharmacy, 100% of the time they love it. They will gush about their pharmacy,” Cook said. “It’s a really top priority to me to keep independent pharmacies across the state open, and I hope it is for the committee as well.” #txlege
Question for our government @AFergusonFTC@MeadorFTC@DrOzCMS@SecKennedy@SecVetAffairs@RepDougCollins
Question for pharmacy benefit managers @OptumRx owned by $UNH and @TRICARE@ExpressScripts owned by $CI
Why does a senior citizen Veteran with @MedicareGov and @TRICARE still have a $2.56 copay for their reflux prescription that costs $7.44?
Why are neither PBMs paying anything on claim?
How much are the PBMs billing the government???????
Did you know this is the ExpressScripts take or leave contract offered to independents in markets with several pharmacies? Could the PBM mailorder accept this reimbursement?
"Importantly, #pharmacies are not closing because PBMs found a cheaper option elsewhere. In many cases, the PBM-owned option is actually more expensive overall," TPA member and independent #pharmacy owner Crystal McEntire explained to Chair @LoisKolkhorst and the Texas Senate Health & Human Services Committee today. "Pharmacies are closing because the PBM pays itself more and the independent pharmacy less, making the average appear fair on paper." #PBMReform #txlege
🚨ANNOUNCEMENT🚨
.@EarlyVoteAction is setting up shop in South Dakota.
In addition to the staff we have on the ground — right now — in Pennsylvania,
we’ll also be hiring in South Dakota.
After Senator Cassidy’s loss in Louisiana & Senator Cornyn’s loss in Texas, Leader Thune still has the opportunity to pass the SAVE America Act.
I’ll be attending the South Dakota Republican State Convention in June.
My goal is to meet with as many donors & business owners as possible to start this statewide operation in preparation for 2028.
Another goal is to begin interviewing prospective field staff.
👉I can make one promise: If the SAVE America Act does not go into effect BEFORE November 2026,
Leader Thune will have a Texas-sized primary on his hands — peacefully👈
If you live in South Dakota, please reach out to me.
Game on.