Ambulatory Care Pharmacist here! Yes!!! Get rid of PBMS so that your community pharmacist can KNOW YOU and help you improve your health and reduce your medication burden. We know so much and want to help.
I ♥️Pharmacists! When I was a new NP-C & was still learning the ropes beyond allergies- like copays & several other $ issues, the Pharmacists walked me through the steps. Several also told me I was welcome to call them even if it wasn’t their facility as long as it was a calc issue, we were colleagues! Nobody died! Funny how now I live next door to my favorite Pharmacist in my decade+ of being an NP! Initially, I thought he may have been doing drugs. NOPE! IDDM, not particularly stable. These days, I just happen to live next door to him. Am not standing around w/ binoculars but if his car doesn’t move for > a couple days, I ask his ex-in-laws who live on the other side of us if he’s OK (after I once told them that I knew him as a Pharmacist) & they give me a skinny. All three know am available, day or night. Grateful to be able to have his back in retirement as he had mine when I was a new NP.
I write about PBMs in my book, Healthcare from the Trenches. I hope that physicians could better collaborate to bring this type of information to the public eye. Thus far, it has not happened.
I would happily watch this entire video twice just for the part about complex financial products being scams. I have been trying to tell my friends for years: Remember back in our 20's, when you'd go out for drinks and dinner with 6 or more people, you're trying to split the check and there's always one person who takes everyone's cash and then distributes everyone's change? The "math" was always insanely complicated and, if anyone feels they didn't get the right amount of cash back the answer is always: "Oh no, that's right, you just aren't getting the math ... don't worry it's fine!" That was, of course, complete bullshit - and so are super complicated financial products and PBMs and any other obvious shell game financial schemes.
I can speak to the primary care situation. Just recently I lost my PC of 25 years to being overworked, she carried a load of 1,800 patients and never saw her family. She has switched over to concierge medicine now with a load around 300 patients. Trying to find a PC with an appointment that isn't 6 months out is impossible, we are in desperate need. Thank you for this video today very insightful.
TRUTH. I work ER as a PA. The ER is often utilized for primary care by people. I'm really not trained for that, don't enjoy it, and don't do a good job of it. The system desperately needs to change.
@@robertfox4524 I just sat in ER for 6 hours waiting for my Mother to be seen, we were seated by check-in and I was so angry over the crap that came to ER 60% of the people could have gone to Urgent care, made and appt with a Dr or taken a damn Tylenol! Sometimes PCP's are guilty because they send people there just for tests and scans too. Change needs to happen without taking away patient care.
The US has an incredible distribution system (local independent pharmacies) that provide healthcare across the country, down to small towns that the big box chain pharmacies would never open in, and the PBMs are crushing them, putting them out of business. It is way past time for this madness to stop, before these “pharmacy deserts” become the norm, and the average person had very limited access to the healthcare they deserve.
"It's amazing how much of life is just what your elementary school teachers tell you." That one little line fro you guest had me in tears. I'm doing my best to advocate for my kids with their teachers, especially my 9 year old right now. See them as individuals, for the love of God. I'm so glad I was homeschooled. I wish I could offer that to my kids. But at least I can be in their corner.
Two questions: (1) why pharmaceutical companies don't sell direct? and (2) why insurance companies don't try to lock pharmaceutical companies into selling at RRP?
Just found this video. Thank you for what you guys are trying to do. I'm a Superficial Siderosis sufferer with medication that costs $9k per month in U.S. Something needs to be done.
Retired anesthesiologist here..The pharmacist in hospital told my husband and I that his chemotherapy would be $10,000 each dosage every 6 weeks but with our insurance , it is $20! My response to him was that it is really sad for the uninsured who have to die early. He agreed.
Or an uninsured patient may qualify for charity care and get the treatment for free. Another option is paying a reduced cash price, though this could bankrupt a middle-class family.
Thank you both! Ill soon be searching for every med I don’t have to get from PBM’s! I spent so many years and $$$ for meds that make my life with fibromyalgia bearable. My disdain for PBM’s began 11 years ago when my rheumatologist’s PA wrote the Rx for lyrica in the wrong format & they charged me $400 for a month supply rather than the 90 days I normally received.
In Canada the Pharma companies aren’t allowed to advertise on tv or magazines & newspapers so people aren’t persuaded to like one med or another. They don’t want people going to their doctors and demanding a med because they’ve seen more adds of a particular medicine.
Would you guys consider talking with members of Congress about this? It is a bipartisan issue and should be topic #1 in our elections; it involves our own healthcare as well as our national economics. Congressman Khana from California and Congressman Gaetz from Florida are both very reasonable people from opposite sides of the aisle known for responding to those with good ideas that would be potential resources for federal advocacy. We need to change this, it is unacceptable.
Please tell me they are reaching out to state governments and their self-insured health plans. There's nothing sexier to voters than state governments saving a shit-ton of taxpayer money while still attracting and retaining quality government workers by offering good health benefits. I know, I'm one of those government workers with past work experience in health insurance.
Depending on which province in Canada you like in we pay way less. Where I am people over 60 never pay more than $21 a month, kids from 0-25 pay $0 and everyone else pays up to $94.00 a month deductible and that’s it. All Cancer meds are free I get the bill but the total to pay is $0 but each injection is $4740.70 but I pay zero. Why can all other countries figure this out except the USA? Every other country has universal or socialized healthcare. No one here has to ration their insulin or skip days.
@@yvonnemiller418 Greed has destroyed the Country …. Brand Name Pharmaceutical Companies , with their huge profit reserves , have gotten what they wanted from Congress, to the detriment of the public, since the 80’s. So don’t expect a bribed Congress to do anything in this Oligarchy.
*53:00** i wonder what the actual price point is in m4a single payer systems* , i mean it is still betr for pts. but i bet the "negotiated price is still some bs. _JC
My pharmacology teacher in nursing school half-owns a small pharmacy. (This is irrelevant but interesting.) My 3yo granddaughter got a UTI. (Supposedly) the bacteria was only susceptible to ONE ABx. We called every pharmacy in town and they did not have it. We drove out of town, to Ty's pharmacy, to get liquid cefdinir. I told him when I got there, "I'm kind of in a hurry because we have to get back to pick up my older granddaughter from kindergarten." I had that antibiotic QUICKLY. Some people care.
You mentioned labs. There is a doctor in my area who does not accept medical insurance. He draws his own blood and charges like*almost nothing* for labs. Some people CARE.
Great conversation. I work for a rural community health insurance company (read small, non-profit) and the cost of these genetic treatments and could literally bankrupt us and the other prices are already breaking everyone's back. Something must change. Disclaimer: my opinions are my own and I am not speaking in behalf of my employer. Also: pay attention algorithm.
Every year I go to war to get Lantus pens. I have MS si hands tremor. The pens are key. Also basal glar does not control my sugars, like iver 209 fasting. But every year I do get it!
You guys are cute. I am non-stop trying to fill patient's meds. I have frustration levels you would not believe. Haha. I once wound up crying in the HR office with my DON like, "I'm just trying to get my patients their meds!"
I had a prescription for Tetracycline in my 20's and remember it being less than $10, fast forward 25 years and my son's prescription was around $300 (at CVS). I couldn't understand how it could have gotten so much more expensive. This answers my question, thank you.
Tetracycline is a bad example. It went completely off market for a while. When it came back, it was much more expensive. Doxycycline and minocycline are much less expensive.
average taxpayers are beyond fed up with broken systems and even worse the lack of political will do change them because the companies own the politicians
*always an important topic to hamr.* but i wonder how many direct pharmacies can open before "suicides" start hapng in rooms locked from the outside. _JC
How about the price of biologics!!!! $14K a dose. People need these to stop their autoimmune diseases in their tracks. It is so incredibly sad to hear these people's stories.
this should be broadcast on every tv station. i want older folks who take 10 different medications to watch this. It' amazing that no cable news station will touch this. hope i'm wrong. do one on medical devices. it's the wild west.
If congress would get rid of pharmacy benefit managers , they wouldn’t need his company because your local independent pharmacy can take care of all of your pharmaceutical needs but their hands are often tied beyond their control. Example - getting paid by insurance company $40-50 below cost so that the PBM can make billions on rebates on brand names when there are generic drugs available
@@rohypnotist6263 yep. look at 60 minutes a few weeks ago. they did a segment on wegovy. A drug, i believe, for diabetes and now used for weight loss. the cost i think was 26k a year or more. ozempic is the same drug just dosed differently. zero pushback from leslie stahl.
As an EU citizen I have been amazed whenever I heard or read about your American healthcare system and drug prices .It's hard to conceive for us that this is allowed to not only continue but worsen over the years .The New Zealanders have it figured out even better than we do , the Kiwi model should be applied worldwide .If politicians ever dare to destroy our system my country would see a national strike within a week .I live in Belgium btw
Many of us have been indoctrinated to believe that our system is better than yours because you have to wait months to see a doctor, you have death panels that refuse care to really sick people and your doctors and technology are far below our standard. Only recently am I starting to see the sad reality
The issue comes down to size and ability to get stuff done. If I’m not mistaken your nation/s are fairly United are they not? Unfortunately the US is about as far from united right now as can be without being in an active civil war. To make matter worse, we have such a huge area to cover and many conflicting cultures who disagree on what medicine should provide. To put it into perspective, Texas is more than twice the size of modern day Germany. There has also been a cultural issue of most Americans want a simple solution (usually a pill) to solve everything. I hope this helps as an explanation. Don’t fully take my word though as I’ve only just seen my 18th spring in a few weeks
PBM’s have created a whole job industry to get meds covered by pharmacy insurance now. Also, optum has different branches of pharmacy benefits + specialty pharmacy + they are venturing into diagnostics (like MRI’s). It is absolute madness.
It’s not exactly their field. Zdogg is a hospitalist ( Internal Medicine) and the other gentleman was a surgical resident. They are part of the solution, not the problem
Also, Mark Cuban’s model is what independent pharmacies always provided until the PBMs corrupted the system. They can still provide this service, just ask what the cash price is.
In Louisiana, we got legislation that says we can with no repercussions from the PBMs. I know, goes against common sense to think you can’t help the patient.
His model is unsustainable. He is not charging enough because he doesn't have a minimum dispensing fee to ensure you won't lose money. You can find pharmacies which use an acquisition plus method for cash prescriptions. You just need to make sure the price is above Medicare and medicaid reimbursement.
All meds used to be made in the US..., you couldn't even go to Canada to get the same stuff cheaper. Walmart started $4 Rx....made in India, Israel and so .....; the they all turned around and NOW you pay top dollar for all these crappy generics.....God forbid you want the Brand name..... $cam galore ......
Ambulatory Care Pharmacist here! Yes!!! Get rid of PBMS so that your community pharmacist can KNOW YOU and help you improve your health and reduce your medication burden. We know so much and want to help.
What is the name of your pharmacy?
Costplusdrugs?
I ♥️Pharmacists! When I was a new NP-C & was still learning the ropes beyond allergies- like copays & several other $ issues, the Pharmacists walked me through the steps. Several also told me I was welcome to call them even if it wasn’t their facility as long as it was a calc issue, we were colleagues! Nobody died!
Funny how now I live next door to my favorite Pharmacist in my decade+ of being an NP! Initially, I thought he may have been doing drugs. NOPE! IDDM, not particularly stable. These days, I just happen to live next door to him. Am not standing around w/ binoculars but if his car doesn’t move for > a couple days, I ask his ex-in-laws who live on the other side of us if he’s OK (after I once told them that I knew him as a Pharmacist) & they give me a skinny. All three know am available, day or night. Grateful to be able to have his back in retirement as he had mine when I was a new NP.
@@kathytrawick3554 find your local independent pharmacy and start talking with and learning from the pharmacists there.
I write about PBMs in my book, Healthcare from the Trenches. I hope that physicians could better collaborate to bring this type of information to the public eye. Thus far, it has not happened.
I would happily watch this entire video twice just for the part about complex financial products being scams. I have been trying to tell my friends for years:
Remember back in our 20's, when you'd go out for drinks and dinner with 6 or more people, you're trying to split the check and there's always one person who takes everyone's cash and then distributes everyone's change? The "math" was always insanely complicated and, if anyone feels they didn't get the right amount of cash back the answer is always: "Oh no, that's right, you just aren't getting the math ... don't worry it's fine!" That was, of course, complete bullshit - and so are super complicated financial products and PBMs and any other obvious shell game financial schemes.
I can speak to the primary care situation. Just recently I lost my PC of 25 years to being overworked, she carried a load of 1,800 patients and never saw her family. She has switched over to concierge medicine now with a load around 300 patients. Trying to find a PC with an appointment that isn't 6 months out is impossible, we are in desperate need. Thank you for this video today very insightful.
TRUTH. I work ER as a PA. The ER is often utilized for primary care by people. I'm really not trained for that, don't enjoy it, and don't do a good job of it. The system desperately needs to change.
@@robertfox4524 I just sat in ER for 6 hours waiting for my Mother to be seen, we were seated by check-in and I was so angry over the crap that came to ER 60% of the people could have gone to Urgent care, made and appt with a Dr or taken a damn Tylenol! Sometimes PCP's are guilty because they send people there just for tests and scans too. Change needs to happen without taking away patient care.
I may never watch TV again! The world these smart well-informed people bring to me is fascinating.
The US has an incredible distribution system (local independent pharmacies) that provide healthcare across the country, down to small towns that the big box chain pharmacies would never open in, and the PBMs are crushing them, putting them out of business. It is way past time for this madness to stop, before these “pharmacy deserts” become the norm, and the average person had very limited access to the healthcare they deserve.
Just spent half my work day appealing denied PAs… I’ll just have the PCPs send the Rx here. Thank you 🙏🏼
ZDogg, this is amazing and amazingly depressing. Thanks for Bringing Dr. Alex to us.
"It's amazing how much of life is just what your elementary school teachers tell you." That one little line fro you guest had me in tears. I'm doing my best to advocate for my kids with their teachers, especially my 9 year old right now. See them as individuals, for the love of God. I'm so glad I was homeschooled. I wish I could offer that to my kids. But at least I can be in their corner.
Great overview and commentary as an American in Australia it provides insights to the systems here also
I just checked at work and sure enough it pops up as an option in EPIC
Great to see a follow up on this company. I believe that the last one came out just before the pandemic
Two questions: (1) why pharmaceutical companies don't sell direct? and (2) why insurance companies don't try to lock pharmaceutical companies into selling at RRP?
Thank you both! I will be sharing this with my lovely, local pharamacist!
I shared this immediately. Thank you. Just thank you. Zdogg, Alex and The big M.C. God bless you all
Don’t fight the old, create something new ✨
Thank you, thank you, thank you!
Just found this video. Thank you for what you guys are trying to do. I'm a Superficial Siderosis sufferer with medication that costs $9k per month in U.S. Something needs to be done.
Retired anesthesiologist here..The pharmacist in hospital told my husband and I that his chemotherapy would be $10,000 each dosage every 6 weeks but with our insurance , it is $20! My response to him was that it is really sad for the uninsured who have to die early. He agreed.
Or an uninsured patient may qualify for charity care and get the treatment for free. Another option is paying a reduced cash price, though this could bankrupt a middle-class family.
Thanks!
Thanks Robin!
This is so so so awesome!! Health 3.0! Let’s do it!
Shared with all my physician friends and internal network. Thank you!
Thank you both! Ill soon be searching for every med I don’t have to get from PBM’s! I spent so many years and $$$ for meds that make my life with fibromyalgia bearable. My disdain for PBM’s began 11 years ago when my rheumatologist’s PA wrote the Rx for lyrica in the wrong format & they charged me $400 for a month supply rather than the 90 days I normally received.
In Canada the Pharma companies aren’t allowed to advertise on tv or magazines & newspapers so people aren’t persuaded to like one med or another. They don’t want people going to their doctors and demanding a med because they’ve seen more adds of a particular medicine.
Only 2 countries allow DTC advertising …. US and New Zealand
@@richardcrocker8048 yep I usually write that too🤙🏻
Would you guys consider talking with members of Congress about this? It is a bipartisan issue and should be topic #1 in our elections; it involves our own healthcare as well as our national economics. Congressman Khana from California and Congressman Gaetz from Florida are both very reasonable people from opposite sides of the aisle known for responding to those with good ideas that would be potential resources for federal advocacy. We need to change this, it is unacceptable.
Please tell me they are reaching out to state governments and their self-insured health plans. There's nothing sexier to voters than state governments saving a shit-ton of taxpayer money while still attracting and retaining quality government workers by offering good health benefits. I know, I'm one of those government workers with past work experience in health insurance.
Depending on which province in Canada you like in we pay way less. Where I am people over 60 never pay more than $21 a month, kids from 0-25 pay $0 and everyone else pays up to $94.00 a month deductible and that’s it. All Cancer meds are free I get the bill but the total to pay is $0 but each injection is $4740.70 but I pay zero. Why can all other countries figure this out except the USA? Every other country has universal or socialized healthcare. No one here has to ration their insulin or skip days.
Oligarchy
greed
@@yvonnemiller418 Greed has destroyed the Country …. Brand Name Pharmaceutical Companies , with their huge profit reserves , have gotten what they wanted from Congress, to the detriment of the public, since the 80’s. So don’t expect a bribed Congress to
do anything in this Oligarchy.
This is my SOAP BOX as a graduate student provider in Mental Health my patients who can not get medications suffer terribly...
*53:00** i wonder what the actual price point is in m4a single payer systems* , i mean it is still betr for pts. but i bet the "negotiated price is still some bs. _JC
My pharmacology teacher in nursing school half-owns a small pharmacy. (This is irrelevant but interesting.) My 3yo granddaughter got a UTI. (Supposedly) the bacteria was only susceptible to ONE ABx. We called every pharmacy in town and they did not have it. We drove out of town, to Ty's pharmacy, to get liquid cefdinir. I told him when I got there, "I'm kind of in a hurry because we have to get back to pick up my older granddaughter from kindergarten." I had that antibiotic QUICKLY. Some people care.
You mentioned labs. There is a doctor in my area who does not accept medical insurance. He draws his own blood and charges like*almost nothing* for labs. Some people CARE.
I love you guys. You are saying what needs to be said.
Great conversation. I work for a rural community health insurance company (read small, non-profit) and the cost of these genetic treatments and could literally bankrupt us and the other prices are already breaking everyone's back. Something must change.
Disclaimer: my opinions are my own and I am not speaking in behalf of my employer.
Also: pay attention algorithm.
Great video, learned a lot. Thank you both!
Thank you! Thank you! So wonderful to see 2 physicians who are willing to tackle this greedy system.
great interview you both rock 👍
We need something like this for labwork. Even a holistic clinic I tried had a $50 draw fee.
Fantastic! I hope this flourishes and inspires additional much-needed reforms.
Every year I go to war to get Lantus pens. I have MS si hands tremor. The pens are key. Also basal glar does not control my sugars, like iver 209 fasting. But every year I do get it!
You guys are cute. I am non-stop trying to fill patient's meds. I have frustration levels you would not believe. Haha. I once wound up crying in the HR office with my DON like, "I'm just trying to get my patients their meds!"
Great job. Thanks again. M
I had a prescription for Tetracycline in my 20's and remember it being less than $10, fast forward 25 years and my son's prescription was around $300 (at CVS). I couldn't understand how it could have gotten so much more expensive. This answers my question, thank you.
Tetracycline is a bad example. It went completely off market for a while. When it came back, it was much more expensive. Doxycycline and minocycline are much less expensive.
Great information. Thank you!
astounding. thanks you guys.
average taxpayers are beyond fed up with broken systems and even worse the lack of political will do change them because the companies own the politicians
There can be problems with generic drugs and their bioavailability. Will any trade name drugs become available?
Thank you!
My dimensions go to 11!
"Life is not about finding yourself. Life is about creating yourself." --Lolly Daskal
🎉interesting podcast.
*always an important topic to hamr.* but i wonder how many direct pharmacies can open before "suicides" start hapng in rooms locked from the outside. _JC
definitely really cool!
Preach
How about the price of biologics!!!! $14K a dose. People need these to stop their autoimmune diseases in their tracks. It is so incredibly sad to hear these people's stories.
It’s been painfully obvious for many many years pts and their well being are not priority… it’s greed !!!
The US medical price model and "discounts" never made sense to someone who isn't raised in the US.
He is not suicidal! 😳😯 Truth!!!
Truly enjoyed learning this update; thank you. (catching up Tue 14-Feb)
So big pharma is not causing the high cost issue, it's the distribution?
Greed. Systemized and institutionalized
Goes beyond greed to Govt/Political corruption.
Thank you for all your hard work.
this should be broadcast on every tv station. i want older folks who take 10 different medications to watch this. It' amazing that no cable news station will touch this. hope i'm wrong. do one on medical devices. it's the wild west.
If congress would get rid of pharmacy benefit managers , they wouldn’t need his company because your local independent pharmacy can take care of all of your pharmaceutical needs but their hands are often tied beyond their control. Example - getting paid by insurance company $40-50 below cost so that the PBM can make billions on rebates on brand names when there are generic drugs available
Pharma is a major ,if not the major sponsor of cable tv ...
@@rohypnotist6263 yep. look at 60 minutes a few weeks ago. they did a segment on wegovy. A drug, i believe, for diabetes and now used for weight loss. the cost i think was 26k a year or more. ozempic is the same drug just dosed differently. zero pushback from leslie stahl.
Agreed!!! Great information and video.
Can we get cards or pamphlets of some kind to give patients about this? email me.
As an EU citizen I have been amazed whenever I heard or read about your American healthcare system and drug prices .It's hard to conceive for us that this is allowed to not only continue but worsen over the years .The New Zealanders have it figured out even better than we do , the Kiwi model should be applied worldwide .If politicians ever dare to destroy our system my country would see a national strike within a week .I live in Belgium btw
It's embarrassing
Many of us have been indoctrinated to believe that our system is better than yours because you have to wait months to see a doctor, you have death panels that refuse care to really sick people and your doctors and technology are far below our standard. Only recently am I starting to see the sad reality
The issue comes down to size and ability to get stuff done. If I’m not mistaken your nation/s are fairly United are they not? Unfortunately the US is about as far from united right now as can be without being in an active civil war. To make matter worse, we have such a huge area to cover and many conflicting cultures who disagree on what medicine should provide. To put it into perspective, Texas is more than twice the size of modern day Germany. There has also been a cultural issue of most Americans want a simple solution (usually a pill) to solve everything. I hope this helps as an explanation. Don’t fully take my word though as I’ve only just seen my 18th spring in a few weeks
What about pet meds?
Get insulin and use a returnable cooler box.
Have any name brand manufacturers expressed interest in joining your system?
Someone get this man on Joe Rogan.
Acquiring Taylor Swift tickets is a lot like acquiring medicine.
Except nobody really needs Taylor Swift
But don’t say that when you are outnumbered by women ages 15-21! Lol
The PBMs simply exist to extract money
PBM’s have created a whole job industry to get meds covered by pharmacy insurance now. Also, optum has different branches of pharmacy benefits + specialty pharmacy + they are venturing into diagnostics (like MRI’s). It is absolute madness.
Love these 2 guys exposing their own corrupt field.
It’s not exactly their field. Zdogg is a hospitalist ( Internal Medicine) and the other gentleman was a surgical resident.
They are part of the solution, not the problem
@@karenkaren3189 sorry, but for me, they are part of the cozy relationship with big pharma. And actually c19 revealed a LOT about this cartel.
Yes, this is evil incarnate.
Also, Mark Cuban’s model is what independent pharmacies always provided until the PBMs corrupted the system. They can still provide this service, just ask what the cash price is.
Actually, they cannot legally tell you the cash price once you have established you have insurance
Messed up, but true
In Louisiana, we got legislation that says we can with no repercussions from the PBMs. I know, goes against common sense to think you can’t help the patient.
@@patmonahan6844 you’re absolutely correct! I always advise people to call pharmacies and ask for the cash price first.
His model is unsustainable. He is not charging enough because he doesn't have a minimum dispensing fee to ensure you won't lose money. You can find pharmacies which use an acquisition plus method for cash prescriptions. You just need to make sure the price is above Medicare and medicaid reimbursement.
Why not start shaming these company,s. Put names on the scam.
All meds used to be made in the US..., you couldn't even go to Canada to get the same stuff cheaper. Walmart started $4 Rx....made in India, Israel and so .....; the they all turned around and NOW you pay top dollar for all these crappy generics.....God forbid you want the Brand name..... $cam galore ......
I try spreading the word about Cost Plus Drugs to everyone!
Jesus get to the subject lol
Can't believe I was only "Like" 29. Great Podcast
YESssss ❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤
It is VILE what is going on with healthcare costs.
The sweetest sound in the world is hearing the phrase "free healthcare."
Sounds a bit like blink drug.
Thx for the video.
Please stop throwing personal anecdotes and jokes between topics. It’s hard to concentrate😁