Joe

UC Berk. BA w/Honors, Retired Pipefitter, ex highend audio mfg,ex mcycle roadracer/scribe.Ex lover,husband & caretaker. Still lover,brother, father, & friend.

[Joe @jfmcrr]

Maybe one day I will be a querulous, resentful, hate filled, fearful old man, desperate to try to make a world that is leaving me behind become the world of the past as I imagined it to be.
Nah. NTFL (Not Too Likely)

[Joe @jfmcrr]

@Ritholtz Stop losses. Is the column you wrote for https://t.co/CibPKNQLhK under the title “Protect your assets” or under a couple of other titles, still where it can be accessed?

[Joe @jfmcrr]

@dougboneparth Too much whining and sniveling about rings on the carpet, and “Get it down the stairs yourself. It was your idea in the first place”

[Joe @jfmcrr]

@dougboneparth Not answer the door and not answer the phone. Too many people asking what I’m going to do with the $350 million.

[Joe @jfmcrr]

@DesertDweller93 Yee Hah! For the patients first. Then for the rest of us....

[Joe @jfmcrr]

@Scaramucci I'm setting up a presentation for next month w/ a teaser this evening @ the local Labor Council. A lifetime of educational work for an old retired geezer. Will you be at Stocktoberfest?

[Joe @jfmcrr]

@Biotech2k1 Nothing quite like a bloody nose and cleaning up after it to set you straight. You can get back in the ring and fight another day as long as you leave the ring on your feet the day before.

[Joe @jfmcrr]

There is no end to the Internet’s ability to inform and entertain. https://t.co/4usZJwUMFD

[Joe @jfmcrr]

https://t.co/nts54RRKW0

[Joe @jfmcrr]

https://t.co/nts54RRKW0

[Mark Cuban @mcuban]

Then I asked for a simplified version of the above :

Here it is in plain English. Denver hired UnitedHealthcare to run its employee health plan. Denver pays the actual medical and drug bills itself — United just processes them. That’s what “self-funded” means. The problem is that Denver can’t see what it’s actually paying for drugs.

1. United buys the drug for one price and charges Denver a different price. It keeps the difference. Say the pharmacy gets paid $40 for a prescription. United bills Denver $100. United keeps $60. Denver never sees the $40. The contract says this out loud in three different places — it’s not hidden, it’s just written in language nobody reads. There’s no cap on how big that gap can be.

2. Drug companies pay rebates. United keeps all of them and hands Denver a flat number instead. United collects rebate checks from drug manufacturers. Instead of passing those through, it promises Denver a fixed amount per brand prescription (about $740 in 2023). If the actual rebate was $1,500, United keeps the extra $760. The contract literally says any rebates above the fixed amount belong to United. Denver has no right to know what the real number was.

3. United decides which drugs are “specialty” — and specialty drugs are where the money is. The contract defines a specialty drug as, essentially, “whatever United’s own specialty pharmacy sells.” United also reserves the right to reclassify drugs whenever it wants. Once a drug is labeled specialty and filled at United’s own pharmacy, it drops out of the normal price guarantees entirely. So the most expensive drugs are the least protected.

4. The most expensive drugs of all — the ones given in a doctor’s office or infusion center — have no price guarantee at all. The contract flatly excludes them. Cancer drugs, infusions, injections administered by a provider. Zero pricing protection.

5. Denver can’t shop around, and it can’t leave without a penalty. Denver isn’t allowed to negotiate directly with any drug manufacturer. It must use United’s mail-order pharmacy exclusively. And if Denver hires an outside vendor that steers employees to cheaper drugs or cheaper pharmacies, United can cancel all the pricing guarantees. If Denver ends the drug program early, United keeps every rebate it owes.

6. Denver can’t audit its way out of this. Denver is allowed one audit a year, capped at 300 prescriptions, using a random sample United has to approve. No auditors paid on commission. No computer-based searches for errors. You cannot find a pricing problem across hundreds of thousands of claims by randomly checking 300 of them. The audit rules exist to make sure nothing gets found.

Is any of it illegal? Almost none of it. It’s a legal contract that Denver signed. The one thing that might cross a line: federal law since 2021 bans “gag clauses” — contract terms that stop an employer from seeing its own cost and claims data. This contract says United may let Denver see its pricing information, at United’s discretion. Federal regulators have said that “only if the vendor allows it” language is exactly what the gag-clause ban prohibits. And Denver has to certify to the government every year that it has no gag clauses in its contracts.

The one thing Denver could actually do about it: Colorado banned this drug markup practice, effective January 2025, and self-funded employers like Denver can opt in. It’s an election, not a lawsuit. Somebody should check whether Denver ever filed it.

The bottom line for an HR person: the drug program looks free. There’s no fee for it anywhere in the contract. That’s the tell. United isn’t working for free — it’s getting paid out of the drug prices, and the contract is built so Denver can’t measure how much.

[Joe @jfmcrr]

@edmayaguez @NormEisen @DDFund_ Or maybe Trotsky.

[Joe @jfmcrr]

@edmayaguez @NormEisen @DDFund_ Lenin.

[Joe @jfmcrr]

@marceelias I’ll buy you a drink the next time you’re in Colorado Springs.

[NYTPitchbot @DougJBalloon]

I can't breathe the air, I can't eat lettuce, I can't afford gas, and my kids have measles. But at least now our soldiers will have enough testosterone.

[Thomas Massie @RepThomasMassie]

Remember when Leavitt said Epstein was a hoax & DOJ had released everything— 30,000 pages?

Our EFTA forced them to release 3 million documents, but they’re withholding millions more, won’t help victims, & refuse to help New Mexico AG prosecute.

That’s why we introduced EFTA II.

[Joe @jfmcrr]

@billsweet Manly men chew. Still gonna need that open window....

[Joe @jfmcrr]

@dougboneparth That’s exactly what my wife did.

[Joe @jfmcrr]

@Dansfera If you told people what it would take to move prices back 5 years, they's pass out.

[Joe @jfmcrr]

@dougboneparth 1999 in SF was cash offers onna first day, bidding day was 30 bids between $390Kand $440K, 6 bids up to $520K and one at $539,500. Been there, done that, I'd rather sell a house like it's 1999.

[Joe @jfmcrr]

@princetongb Back in the day, I applied to UC Berkeley grad school for clinical psych. Three openings and 450+ applicants. I figured how many were 4.0's or 4.5's /exemplary letters of recommendation? Thank Gawd I didn't have to cipher any higher GPA's....