Chad Gibbons

[Anthony Reznik @AnthonyReznik]

If a corporation argues that its pharmacy cannot survive unless its owned by the same entity that sets the reimbursement rate, then we’re not talking about a free market. We’re talking about control - State Sen. Harshbarger @NJAssemblyGOP @NJSenateGOP https://t.co/laxOI1HXXA

[Chad Gibbons @wcgibbo]

@kpharmd12 Damn, I thought for a minute we might be on the same route. We’ve had multiple drivers the last few weeks. Order could be 10am or 3pm, you never know. Only consistent driver is the one constantly on the phone we have to sign, and fucking up her convo to sign is a problem for her

[KP, Pharm.D. @kpharmd12]

I swear, nobody in Washington DC gives two fucks about independent pharmacies, do they?

[KP, Pharm.D. @kpharmd12]

ONE HUNDRED EIGHTY-FIVE YEARS.

All thanks to super corporate greed by none other than @CVSHealth @UHC @ExpressScripts @Humana et al.

I firmly believe that every store closure is 100% due to PBM under cost reimbursement issues.

These businesses are the heart and soul of their communities. Take them out one-by-one and you soon have a dying Main Street.

[Forest Park Pharmacy @ForestParkPharm]

Welcome back to Two Tiered Justice, the show where the same crime gets two very different endings depending on how big you are.

This week, two Florida men pleaded guilty to conspiracy to pay and receive illegal healthcare kickbacks. It is the old classic. Laurent Cassagnol, an employee of the VA Community Care Program, got paid to steer veterans to a clinic called Family Integrative Medicine of Orlando. The clinic's CEO, Heriberto Rivera, then billed the VA for the visits. Rivera paid Cassagnol about $175,000 in kickbacks, which generated more than $14 million in claims to the VA, and the VA paid out nearly $12 million before it fell apart.

It is the same recipe every single time. Find something the government wildly overpays for, then bribe somebody on the inside to approve it. I will admit, though, I had never seen it run for acupuncture before. That is a first for me.

And it is instantly obvious why this is illegal. You are rigging who gets patients so you can bill taxpayers for overpriced care. Clearly a crime. Clearly harmful. Illegal for everyone.

Well. Everyone except the insurance company.

Because here is the same scheme, running out in the open, at a scale that would make those two Florida guys dizzy. Express Scripts runs the pharmacy program for TRICARE, the military's health plan. They get to set the reimbursement price. They steer patients to pharmacies they own. And then they pay that price to themselves, all billed to the government. Set the price, steer the patient, pay yourself. Sound familiar?

Look at one drug. Fingolimod, an MS medication, costs about $100 at my pharmacy with no insurance. Express Scripts pays itself $33,314 for it. Same molecule. That is not a typo. A hundred dollars versus thirty-three thousand.

So when a United States Senator pressed the Department of Defense about this obvious self-dealing, what was the response? They said Express Scripts is "operating within the parameters of the contract."

And there it is. Two men are headed to prison for the small version of this. The industrial-scale version, the one costing taxpayers exponentially more, is not a crime. It is just, the contract.

I am not defending the Florida guys. They earned their sentencing date on November 5. But if steering patients and billing the government for inflated prices is a felony, it should be a felony at thirty-three thousand dollars too, not just at a hundred and seventy-five.

While we wait for justice for all, there is a pharmacy with no middleman, no steering, and no invented price. Just the real cost of your medication and a fair markup.

Head to https://t.co/PWTHuNrAlM, check our price checker, and transfer today to save.

See ya.

Sources: U.S. DOJ, Middle District of Florida (U.S. v. Cassagnol and Rivera); U.S. Senate hearing record on Express Scripts and TRICARE.

[Ginny Crisp, PharmD @ginny_crisp]

Five questions about spread pricing went up this morning. The one your PBM hopes you skip: show me what you billed the plan and what you paid the pharmacy, side by side, for the same claim. If they can't, the gap is the answer.

[Forest Park Pharmacy @ForestParkPharm]

Sen. Warren laid it out plainly: Express Scripts reportedly billed the DoD ~$484 MORE per generic drug when it filled the script at its own pharmacy.

The DoD official's response? "I'm not aware of the cost."

Asked why 13,000 pharmacies have walked away from TRICARE? "The contractor is meeting its contractual requirements."

Let that sink in. Here's one drug — Droxidopa, 90-day supply:

💵 Cash, no insurance: $180🏪 TRICARE pays an independent: $131🏬 TRICARE pays a big chain: $2,400🏴‍☠️ Express Scripts pays ITSELF: $9,700

Same pills. Same bottle. The only thing that changes is who's pocketing the spread — and it's the middleman, every time.

And they don't stop at gouging pharmacies. They gouge patients too. That same drug at an Express Scripts pharmacy? $13 copay. At your local independent? $48 — even though the independent option saves the plan over $9,000.

You read that right. They charge YOU more to steer you toward the option that costs the PLAN more. Because the friction is the point. Every closed pharmacy, every inflated price, every "I'm not aware" — it all feeds the same machine.

This is why we fired Express Scripts and the PBM middlemen who profit by making your healthcare worse.

No PBMs. No hidden fees. Just transparent cash pricing.

[Forest Park Pharmacy @ForestParkPharm]

Tennessee just did what Congress can't.

They passed a law to break up the health insurance giants.

Specifically, they made it illegal for pharmacy benefit managers — the companies in charge of pharmacy insurance — and pharmacies to be owned by the same company.

That makes perfect sense.

For example: CVS Caremark is the PBM, and CVS is the pharmacy. So if you have Aetna insurance, you have CVS Caremark as your PBM, and they're going to do everything they can to make sure you use CVS as your pharmacy. Aetna, Caremark, CVS — all the same company.

That causes all kinds of incredibly obvious problems that this law hopes to fix.

If your insurance company is in charge of approving your medication, deciding how much to pay for it, AND deciding who gets that money — while also being the pharmacy that gets paid at the end — guess what happens to prices?

They go up.

Governor Lee signed the law last week. CVS immediately filed a federal lawsuit because they said it will force them to close all 136 stores they have in Tennessee.

Let that sink in.

I'm not sure most people realize what that says about CVS and health insurance in general. They had to choose between owning the middleman (the PBM) or the healthcare provider (the pharmacy).

Without hesitation, they chose the middleman.

The biggest pharmacy chain in the country — with a store on every corner — would drop all 136 of their Tennessee locations in a second if it means keeping their middleman business.

It is more profitable for them to be a health insurance middleman getting between you and your healthcare than it is to actually provide the healthcare.

That is the problem with healthcare in America.

We have made the middleman so powerful that they've taken complete control of the entire system. Three PBMs — Caremark, Express Scripts, and OptumRx — handle around 80% of all prescriptions in this country.

How on earth can we expect healthcare to work well and remain affordable if that's where the money is?

We all auto-pay our insurance straight out of our paycheck before we even see the money. And not surprisingly, they're keeping a ton of it.

That's why we fired them.

And they can't file a lawsuit to stop us.

That lets us offer fair, transparent prices. No PBMs. No insurance games. No hidden markups. You see the cost, you pay the cost.

[Mark Cuban @mcuban]

Capitalism is the solution in healthcare. But, there is a reason we have anti-trust laws. There are reasons why we have the @FTC

We are at a point in time where the big vertically integrated carriers and providers are abusing their market positions. Neither agency has done shit to stop them over the past decade

There is a bill, the Break Up Big Medicine Bill from @HawleyMO and @SenWarren. I have talked to democratic senators who have said they will support it if more republican senators do. They want to match 1 dem to 1 rep. Totally dumb shit. So they say nothing.

Other than Josh, not a single republican senator I have talked to has the guts to stand up for it. Period. They won’t give a reason. They just won’t do it.

If you want less government in healthcare, it can’t happen until these conglomerates are broken up

If you want single payer or M4A , it can’t happen until these conglomerates are broken up

Quit bitching and call your senator and tell them to grow a spine and support this bill

[Three Year Letterman @3YearLetterman]

A trip to Williams-Brice stadium in September for a noon kickoff would be literal death for a Europoor

[Mark Cuban @mcuban]

https://t.co/ZOf0wjM4Sb

[KP, Pharm.D. @kpharmd12]

I need to spend less time as a pharmacist worrying about why insurance companies won’t cover my cost of dispensing prescription drugs.

That alone takes a huge mental and physical toll to overcome.

Shouldn’t have to even worry about if I can break even dispensing a life saving medication for a patient, but we do it multiple times a day.

This extra time could be spent actually taking care of the patient and counseling them on their therapies.

Instead, I’m turning away patients because I simply cannot afford to fill for them.

Meanwhile, they head down the road to a large chain pharmacy who is paid sometimes 5-10x than what we are paid for the same medications.

Ohio pharmacists, and in every other state, need help drastically.

[Forest Park Pharmacy @ForestParkPharm]

The desperation is officially setting in. PBMs are now paying Tennessee influencers $13,000 for a single Instagram Reel and a few stories to "authentically" share the "real-life impact of reliable pharmacy access."

It is a hilariously transparent attempt to buy back public favor as their monopoly in Tennessee begins to crumble.

For those who don’t know, Pharmacy Benefit Managers (PBMs) are the massive middlemen—like CVS Caremark and Express Scripts—that sit between your insurance and the pharmacy. Most people don’t even know they exist, but they are the reason your drug prices are high and your local independent pharmacy is closing.

The timing of this "influencer" campaign isn't a coincidence. Tennessee is currently a primary battleground for PBM reform:

The FAIR Rx Act (SB2040/HB1959): This landmark legislation moving through the General Assembly would bar PBMs from owning the very pharmacies they manage. It targets "vertical integration"—where a company like CVS owns the PBM, the insurance provider (Aetna), and the retail pharmacy.

The Audit Bombshell: A recent Tennessee Department of Commerce and Insurance audit found that CVS Caremark was reimbursing its own pharmacies at rates up to 16,510% higher than independent competitors for the same drugs.

Text Message Scandal: Attorney General Jonathan Skrmetti is currently investigating CVS for using private patient pharmacy data to send political text messages to customers, trying to scare them into opposing these reforms.

They are terrified because Tennessee is finally pulling back the curtain. When a PBM-owned pharmacy gets paid hundreds of dollars for a generic pill while an independent shop down the street is reimbursed below cost, the "reliable access" they’re hiring influencers to talk about is actually just a forced monopoly.

If you see a creator suddenly talking about how much they love their "pharmacy access" or why PBMs are "essential" for "coordinated care," check for that #ad.

I already fired the PBMs at Forest Park Pharmacy. We don't need a $13,000 check to tell you the truth: transparency lowers prices. Middlemen raise them.

[Forest Park Pharmacy @ForestParkPharm]

🚨 Is CVS Caremark Hiding Money in Shell Companies? 🚨

The "choir boys" of pharmacy are back in the spotlight, and not for a good reason. CVS Caremark is being sued by a roofers union for allegedly using a shell company to hide millions in rebates that were supposed to be passed back to the union.

💊 The "Kickback" Game

If you’ve ever wondered why your insurance premiums are sky-high yet you’re still pushed toward the most expensive brand-name drugs, meet the Pharmacy Benefit Manager (PBM).

How it works:
PBMs like CVS Caremark negotiate "rebates" (essentially government-approved kickbacks) from drug manufacturers.

The Incentive:
The more expensive the drug, the bigger the rebate the PBM gets to pocket.

The Conflict:
These rebates are often legally required to be shared with the plan sponsor (like a union or employer) to lower costs for everyone.

🐚 The Zinc Shell Game

According to the lawsuit, CVS Caremark didn't just keep the money—they allegedly hid it. By funneling funds through a shell company called Zinc, they were able to
obfuscate the true value of the rebates being collected,
retain a massive percentage of the cash that belonged to the union members and lie about the total amount of money being held back.

🛡️ Why This Matters

This isn't just a corporate spat; it’s a direct hit on the pockets of hardworking people. When PBMs prioritize their own "cut" over transparent pricing, the patient loses every single time.

Fortunately, the tide is turning. We’re seeing more lawsuits as these "hidden" tactics finally come to light.

At Forest Park Pharmacy, we’ve already fired the middleman. We offer fair, transparent prices without the shell games or the jacking up of costs just to line a PBM's pockets.

[Dutch Rojas @DutchRojas]

Calling this a “scandal” is like calling a casino a “charity that occasionally takes your money.”

The PBM model isn’t broken; it’s doing exactly what it was designed to do.

It creates opacity and extracts value.

The most expensive part of a prescription isn’t the drug; it’s the series of invisible hands it passes through….

[Super 70s Sports @Super70sSports]

The GOAT Super Bowl halftime performance and in absolutely zero danger of losing that title today.

[NACDS @NACDS]

📰 "As pharmacy closures accelerate, the cost of inaction becomes increasingly severe. When a pharmacy closes, patients lose access, communities lose a trusted healthcare provider, and small businesses disappear," says Brian Clark, CEO of @yourSCPhA.

"South Carolina can protect patient choice and stabilize access to care by advancing meaningful pharmacy benefit manager reform, starting with H.4791 and S.342. Delay is not an option."

We couldn’t agree more. PBM practices are driving pharmacy closures, limiting patient choice, and undermining access to care across South Carolina — particularly in rural and underserved communities.

Now is the moment for state leaders to act and deliver real PBM reform that protects patients, preserves local pharmacies, and strengthens the healthcare infrastructure communities rely on every day. #PBMReform

Check out the full column 👇
https://t.co/TLIuL0oGG3

[Mark Cuban @mcuban]

Why do the big drug distributors seem to get a pass when it comes to healthcare cost dysfunction ?

The fact that pharmaceutical wholesalers buy at what is effectively retail price is the foundation of pharmacy pricing dysfunction

The only industry I know that buys at retail price.

As a result
1. Indy pharmacies pay more cash out of pocket then pray they get reimbursed a fair amount.
2. Patients pay this price, full retail, during their deductible phase and a percentage of this inflated number for coinsurance
3. PBMs make a killing because they charge employers, manufacturers and patients fees and apply rebates as a percentage of WAC.
4. You don’t want to look at how this works for specialty drugs. It’s so profitable that these wholesalers are buying clinics to keep the business under their control.
5. This is the flu in the ointment in DTC. Pharm to table ? More like dollars to expensive middlemen charging a fortune that keeps the DTC prices higher than they need be. Fortunately some some manufacturers are realizing that consignment is a better supply chain model than what is currently happening

6. If brand manufacturers went completely to consignment for all brand and specialty drugs, the above might have to come to reality.

Or

If they went to all net pricing then:
Pharmacies would have more cash and less reimbursement risk.
Patients would pay far less during the deductible phase, and less in coinsurance and more
Spread pricing would be less of a problem
Etc.

Can someone explain to me why the big wholesalers get a pass when evaluating why healthcare costs are so horrific ?

[Chad Gibbons @wcgibbo]

@JoeCarloLaw @redlgb1969 Amen to that Joe! Couldn’t agree more.

[Chad Gibbons @wcgibbo]

@JoeCarloLaw @redlgb1969 I can’t pay my employees or feed my family with “reg compliance”