Marilyn Heine Profile picture
May 27, 2022 6 tweets 4 min read Read on X
🔥A must-read: ⁦@oncologyCOA⁩ report on #PBMs

Some takeaways:

“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.”
2/ “PBMs have done this by overwhelmingly abusing their responsibility to protect Americans from this country’s drug pricing crisis, instead exploiting the opacity throughout the nation’s drug supply chain to enrich themselves.”
3/ “[The report] explores how the recent levels of consolidation among PBMs and health insurers is adversely impacting #cancer care, fueling drug costs, all while allowing for massive profits for #PBMs and health insurance companies.”
4/ “Examining the most pervasive and abusive #PBM tactics, each section highlights the adverse impact of PBMs on #patients, health care payers (including #Medicare, #Medicaid, employers, and taxpayers), and providers, while also detailing potential solutions.”
5/ “[Solutions] include legislative efforts at both the state and federal levels…regulators (both state and federal) have tremendous tools available to them, that up until this point, have not been widely utilized.”
6/ To read the @oncologyCOA report, “Pharmacy Benefit Manager Exposé: How PBMs Adversely Impact Cancer Care While Profiting at the Expense of Patients, Providers, Employers, and Taxpayers.” please see:
communityoncology.org/wp-content/upl…

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More from @MarilynHeineMD

Dec 2, 2025
🎇⁦@AmerMedicalAssn⁩ wrote to ⁦@CMSGov⁩ Administrator Oz to urge safeguards to avert administrative barriers that will lead to eligible individuals losing health coverage, which could block or disrupt their access to care.

👉

🧵 tinyurl.com/5fejb6xmImage
2/ AMA wrote:

“We appreciate that robust processes are needed to ensure Medicaid program integrity. However, we are deeply concerned that, without adequate safeguards, doubling the frequency of redeterminations will create administrative barriers…”
3/ AMA concern:

“…[administrative barriers] that will lead to eligible individuals losing health coverage, which could block or disrupt their access to care.”

“Access to stable, comprehensive health coverage is essential for patients across the country to access medical care.”
Read 6 tweets
Oct 1, 2025
🎇Government Shutdown: What Physicians Need to Know

Please read the attached memo ⤵️ for details provided by the ⁦@AmerMedicalAssn⁩.

Links and additional information are included in the comments below. 🧵 Image
2/ Links:

CMS contingency plan: tinyurl.com/5yn4cacr

For physicians in MSSP ACOs: tinyurl.com/ymwy27w7

Latest info, check your MAC’s website and tinyurl.com/hky3752h

Medical practice w/Medicare payment delays d/t ⬇️ agency staffing, inform ama.advocacy@ama-assn.org
3/ Medicare Advantage plans aren’t subject to the same restrictions. Physicians should contact their plan for guidance to know whether the insurer provides #telehealth benefits as part of #Medicare-funded “basic benefits.”
Read 6 tweets
Sep 29, 2025
🌠Big win for truth in advertising: Big win for patients!

A California U.S. District Court upheld as constitutional CA’s longstanding law that limits use of the term “doctor” and prefix “Dr.” to a person who is a California-licensed allopathic or osteopathic physician. 🧵 Image
2/ From @AmerMedicalAssn: The case, Palmer v. Bonta, was filed by three nurse practitioners who held a Doctor of Nursing Practice (DNP) degree and asserted that California’s law reserving the title doctor to licensed physicians violated their First Amendment right to free speech.
@AmerMedicalAssn 3/ In cross motions for summary judgment, the court ruled in favor of the defendants, thereby upholding the law as constitutional.

The court agreed w/ the defendants that CA law does not violate the plaintiffs’ freedom of speech & is a legitimate regulation of commercial speech.
Read 9 tweets
Sep 17, 2025
🌠New AMA resources on the massive budget reconciliation package “One Big Beautiful Bill Act” (OBBBA) of 2025 focus on impacts forthcoming funding cuts and policy changes to Medicaid and the ACA marketplaces will have on patients, physicians, hospitals and health care coverage.🧵 Image
2/ As OBBBA was debated, AMA advocated against provisions that will severely cut funding for federal health programs & restrict access to health care coverage.

OBBBA does not include per capita caps, FMAP reductions, or elimination of the Medicaid expansion eligibility pathway.
3/ AMA advocacy Included coalition coordination, targeted Hill engagement, grassroots mobilization, and strategic communications formally and on social media.

Letters were sent:

May 13: tinyurl.com/mtzmbt68

May 20: tinyurl.com/mubxfze6

June 20: tinyurl.com/4dzvdvrx
Read 14 tweets
Aug 26, 2025
🧵”The AMA strongly supports the Department of Health and Human Services’ ⁦@HHSGov⁩ recent decision to upgrade #Medicare Plan Finder so patients can choose plans that actually include their trusted physicians and hospitals.” Image
2/ “This…mirrors AMA’s January 2025 advocacy calling for HHS to integrate plan network data into Plan Finder. Once this is complete, patients no longer will be forced to click through multiple websites just to confirm if their physicians are in-network.

tinyurl.com/5869nja2Image
3/ Patients can compare plans:

Medicare Advantage (Part C)
Medicare Prescription Drug (Part D)
Medigap plans at :

After entering zip code, meds, preferred pharmacies, the tool generates a list of plans available in the area, along with estimated costs.medicare.gov
Read 6 tweets
Aug 6, 2025
🚨As AMA’s representative to the HL7 Da Vinci Project Clinical Advisory Council (CAC), I ask that you please take urgent action.

Your participation could be the difference between meaningful improvements to prior authorization (PA) and little change.

Details in🧵

#FixPriorAuth Image
2/ **ISSUE OF CONCERN:

🔥On the PA and burden reduction use-case calls, some payers and EHR vendors are advocating that PA users should be back-office staff only, not clinicians based on their understanding and experiences.
3/

❗️Reliance on back-office is not the original intent of Da Vinci PA use-case design.

The goal was to have a clinician-oriented process that renders real time coverage information at the time of clinical decision and ordering to inform more timely and efficient PA workflows.
Read 8 tweets

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