Thread by @BethWaldron

CVS Health reported $2.3 billion in profit for the first quarter, which exceeded Wall Street's expectations.
I've read $CVS Q1 report & frankly, it's sickening to me as a patient who was denied access to my life-saving medication for purely profit-motivated reasons the same Q.🧵

https://twitter.com/brucejapsen/status/1521811018141159425

2/ First the $CVS financials:
Total Q1 revenues ⬆️to $76.8 billion,⬆️11.2% compared to prior year
In PBM Caremark segment, total revenues⬆️8.6% to $39.4 billion
Q dividend ⬆️10%, $722 million shareholder return, first corp stock buy back since 2017.
Earnings forecast ⬆️
☀️💵

3/What drove $CVS PBM Caremark's revenue growth?
👉"improved purchasing economics"
What does this mean for patients?
Non-medical switching. Patients are forced to change drugs not based on their doctor's medical advice but ONLY because another drug provides higher profit.

4/ Here's the proof. Anticoagulants Eliquis & Xarelto retail for the same price. No clinical reason to drop Eliquis. None. In fact clinical data shows it is preferable in some patients. Yet the kickback on Xarelto to PBMs is higher than the one for Eliquis. So what does CVS do?

5/CVS Caremark who manages the prescription benefit for 1 in 3 Americans dropped Eliquis from their commercial formulary 1/1. They did NOT grandfather ~150,000 at-risk cardio patients already stable on it,forcing them to switch to warfarin or Xarelto. I was one of those patients.

6/ Eliquis is a top cardiovascular therapeutic. 3 million Americans take it. Even @POTUS takes it! This move was seen as so dangerously disruptive for patients at risk for stroke & DVT/PE that 16 (!!!!) nonprofits asked $CVS Caremark to reverse their decision.

7/ Here's what the American Society of Hematology
@ASH_hematology told CVS PBM Caremark
"gravely concerned"
"serious impact" on patients
"ASH urges CVS to reconsider"
They cite data showing increased bleed risks & poor outcomes.

8/ Here's what @advcardiohealth co-signed by 14 (!!) additional non-profits told $CVS PBM Caremark
"this abrupt change will be dangerously disruptive for patients"
"unquestionably exacerbate health equity concerns that exist in cardiovascular care"
static1.squarespace.com/static/56e6efd…

9/ CVS even ignored the expert clinicians w/ the guideline creating American College of Cardiology @ACCinTouch & American Society of Hematology @ASH_hematology who met twice w/ Caremark medical leaders to try to reverse the dangerous formulary decision.
acc.org/Latest-in-Card…

10/ Now unsurprisingly the predicted adverse events--thromboembolic stroke & clinically significant bleed-- due to CVS's profit motivated non-medical switching are now occurring. I have documented events in 5 states, one in a 26 year old! fox13memphis.com/news/local/doc…

11/ So I truly feel sick when I see CVS posting 2 BILLION PROFIT in the very quarter they benefited from kicking previously stable patients at-risk for DVT & STROKE off their medication to squeeze out even more profit. Yet CEO @KarenSLynch says they are improving care ACCESS? 🤯

12/ To add insult to injury, yesterday CVS promoted its Caremark Chief Medical Officer who participated in this shameful care disruption to be the CMO over of all of CVS Health. Unbelievable reward. forbes.com/sites/brucejap…

13/ I initially felt the Eliquis drop was a mistake easily corrected. I once worked in insurance. Surely no one informed would take a heart patient at high risk for stroke doing well on a drug for YEARS & create sudden treatment instability over the objection of their physician?

14/ Yet once I understood Caremark leadership did fully understand the patient safety risks & THEY DID IT ANYWAYS & still even now won't reverse, I keep asking WHY? Putting patients thru hell & their health at risk merely for a few percentage points more rebate??
#StopTheSwitch

15/ Seriously for what reason? When HUNDREDS of clinicians literally beg a company to put a drug back on formulary for their patients--one they had on it for YEARS & the answer is no. What is the rationale? Not listening to doctors isn't quality care. It's greed. #MedTwitter

16/ This illustrates painfully clearly that patients need strong protections from PBM practices such as non-medical switching! PLEASE HELP US! It's time we all work together. @linakhanFTC @SenBlumenthal @SenFinance @FTCPhillips @RKSlaughterFTC @CSWilsonFTC @RonWyden @MikeCrapo

17/ To be clear, I have covered access again to the medication I had been stable on for 8 years when my plan @NCTreasurer overrode Caremark's formulary change on 2/9. I'm VERY grateful. I now want all patients to have the care decisions they make with their doctor respected.

18/ Other NC patients like me are not as fortunate. Protections from such non-medical switching practices by far off corporations is needed. Prescribing decisions should be between a patient & their doctor. @NCHouseSpeaker @SenatorBerger @JoshStein_ @NC_Governor @NCInsuranceDept

19/ To learn more about the patient impact of non-medical switching, please see onlinelibrary.wiley.com/doi/full/10.10…