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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

@mass_marion

Dec 21

I am happy that the out of pocket costs for this person ( @Crimsontider ) are low.
But what is Medicare paying for these prescriptions?
If Medicare is paying far too much ( they are) the system is unsustainable for our kids and grandkids.
So to ONLY worry about your copay is to ignore the plight you are leaving behind for kids and grandkids.
A thread 1/? 🧵

Let’s use a real life example. This coverage statement was shared by the caretaker of a special-needs person with seizures who is on a Medicare plan. Let’s call the patient ‘Elle’. Caretaker was shocked at how much money Medicare ‘covered’ for Elle’s Fintelpa. She’s a smart cookie this caretaker and knows that Fintelpa is half of the old diet drug FenFen so it’s years and years old. Should be cheap
Even though Elle paid nothing in co-pay, her caretaker was shocked to see that for a months worth of a decades old drug, Medicare paid $12,000. 2/5 🧵

From our example, our special needs patient Elle tried and failed on seizure med Fintepla, which should be inexpensive, but Medicare paid $12,000 in one month for. They were required to use a specialty pharmacy.

From Elle’s caretaker:
“We don’t have trouble accessing meds and we don’t pay much in copays. I am just appalled at the cost to taxpayers. I think everyone making money see our Elle as a cash cow.”

How sad that industry is profiting off the sick at the expense of taxpayers. 3/5🧵

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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

@mass_marion

Dec 19

https://twitter.com/sdixitmd/status/1869713216936526067

Guess who makes a pile of money 💰 marketing United’s Medicare advantage plans?
AARP
1/4🧵

https://twitter.com/sdixitmd/status/1869713216936526067

The millions in conflict of interest the AARP has with United healthcare makes it very problematic that AARP has time and again supported PBM kickbacks.
Here is whole article in @GoErie 2/4🧵 goerie.com/story/opinion/…

@GoErie These non profits like AARP, often have many people profiting handsomely. 3/4 🧵

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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

@mass_marion

Dec 16

There is nothing free-market about the BIG #PBM
-They are consolidated both horizontally and vertically with the big insurers like United/Aetna/Cigna, and with big box pharmacies.
-Because they collect #kickbacks (legally per our government) they create monopolies or near monopolies of many medications, including insulin, and they make more 💰 when they choose a more expensive med for the formulary. ⬆️cost for 🇺🇸
-Because PBM control $$ flow to pharmacies, they have been shortchanging mom and pop pharmacies, while functionally helping themselves to $ from Medicaid, and putting Indie pharmacies outta business, in a practice called 'the spread'
NOT passing PBM reform is a windfall for BIG insurance, BIG PBM and harm for patients that I and every other physician pharmacist and nurse faces.
@nataliegwinters I ask you to read this thread and learn what I have learned over 8 years in advocating for PBM reform 1/5 🧵

2/5🧵From a 2021 piece in #BucksCounty @CourierTimes
I grew up here in bucks and served for 7 years on the editorial board of this paper.
I learned a LOT about the media while writing and on the board , that I'd love to tell you, @nataliegwinters ! Would make a super podcast about modern journalism.
phillyburbs.com/story/opinion/…

3/5🧵Here is a pictorial demonstrating that #PBM are responsible for 80% of the increased cost of insulin. The bottom line is the net price, what pharma is making from insulin, the top line, the list price is what pharma makes, PLUS what PBM get in kickbacks and other 'price concessions'.
This happens for MANY drugs. Ask rheumatologists, pulmonologists and others
The root of the problem is kickbacks which should be repealed. Why would we allow any company the right to collect kickbacks?
But it is how we are getting monopolies of medications, why 3 big pharma companies made most of the insulin instead of having competition.
Let the PBM unchecked and they will keep minting 💰 at the expense of Americans. Pic is from this presentation I did for LA health commission In 2022 .
I came in from a shift, pulled a jacket over my scrubs at 11 pm and had at it. hat fun! youtube.com/watch?v=WfVV1p…

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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

@mass_marion

Dec 15

Pull up a seat for another multipart thread, this one is regarding #PBM pharma middlemen
as Congress is poised for PBM reform...

But, PCMA, the PBM lobby group is teaming up with the Competitive Enterprise Instutite and former Senator Toomey to tell us that PBM are 'market based".....in fact....

1/5🧵

We are all busy shopping and visiting and cooking up fab (hopefully healthy) meals, so I will make this shorter than last week's @voxdotcom thread

It's tough for me to see PCMA, CEI and Sen Toomey calling PBM 'market based', when they help themselves to medicaid money, through something called the 'spread', collect kickbacks (also non transparent) which creates a monospony ... a series of monopoies among pharmaceutical products, and cause the shutdown of independent pharmacies.
Last time I checked in the Bible of free market capitalism, monopolies, kickbacks and anticompetitive behavior were not Included 2/5 🧵
Here is article in #BucksCounty Courier Times where pic is from phillyburbs.com/story/opinion/…

I know about PCMA, the lobby group for PBM, but I did not know about The Competitive Enterprise Institute (CEI), who are also defending PBM as 'free market' so I did some looking. They are a non profit who has lobbied with $2million over the last several years and collects $10 million in revenue each year, from what I could find 100% is from contributors.
Who contributes? 3/5🧵.....
cei.org/wp-content/upl…

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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

@mass_marion

Dec 7

Pull up for a long thread about this @voxdotcom article with the subtitle "What the fight between @AnthemBCBS and anesthesiologists was really about." 1/12 🧵 @anesthesianews vox.com/policy/390031/…

I'm a pediatrician. For 15 years I did hospitalist work. That meant I went to difficult deliveries where mom and baby were sick, I saw sick patients in the ER that needed to be intubated, some had critical airways or hard to get IVs.
In these and many more cases, the patient NEEDED the anesthesiologists... the physicians that slept in the hospital to make sure the patient had an airway or IV access. They are the docs that the surgeons rely on to keep their patients alive while they cut into bodies to save lives. 2/12 🧵

Here is a slide from the study that the vox article referenced that indicates what anesthesiologists find hard about their job.
Besides the long hours and endless glut of regulations, it is 💯 true that despite a fair surprise medical billing law, anesthesiologists and other docs have to fight tooth and nail to get paid for work done because @HHSGov favored the insurers in the implementation of the law . They are fighting the 3rd party payers who were ALREADY paid by the patients.
It's not the docs who are abrogating their duty to patients, it's the 3rd party payers who are, including our government . 3/12🧵

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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

@mass_marion

Nov 8

Years ago, I went to a meeting in Philadelphia. The after lunch lecture was all about quality measures. They were all the CMS people up on stage yapping about what the quality measures were doing. I honestly don’t even know what they were saying. When they were done, they asked for questions.…1/3

@EdGainesIII …. So, CMS experts, I get it, you want to make sure you’re getting value from physicians so you have this MIPS. How much did it cost to plan launch and implement MIPS, and is there any data that it’s saving America 🇺🇸 money 💰?
The CMS experts all looked at each other… 2/4 🧵

And one of the CMS experts said “ma’am, I don’t know how much we spent. It might be on our website and we’re hoping we’ll have some data in a couple of years that shows we’re making savings.”

( incidentally if you meet me in person, please everyone call me ‘Miss’ so I can feel a little bit younger. Haha 3/4 🧵

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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

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