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Marion E Mass, M.D. #patientsfirst #scrubsnotsuits Profile picture
Marion E Mass, M.D. #patientsfirst #scrubsnotsuits
@mass_marion
Wife mom pediatrician gardener writer, speaker. Quality accessible sustainable medical care 4 less? YES WE CAN! #sunshine4all co-founder @PPA_USA
Jan 15 • 5 tweets • 3 min read
USA needs to 👀 at the 340B program.
Here's a ⭐️ piece in @nytimes
-Cancer patient gets a drug from a non-profit 340B hospital. List price for drug is $2700
-Hospital bills insurance $22K for drug, insurance pays $10K
-Hospital bills cancer patient $2500, and sends her to collections when she won't pay
-Pt moves to free-standing Oncology who billed much less, pt charged nothing.
-Reporter discovers a little-known middleman named Apexus has been cashing in working behind the scenes to supercharge the #340B program

Let's learn more about Apexus.
You can learn the most about 340B from @DrDiGiorgio
He's an uber expert. 1/ 5🧵
nytimes.com/2025/01/15/us/… @nytimes @Free2care wrote about 340B in our last paper
👀 here, start on p 19, it's brief
2/5 🧵 free2care.org/files/report.p…Image
Dec 21, 2024 • 5 tweets • 2 min read
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/? 🧵Image 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 🧵Image
Dec 19, 2024 • 4 tweets • 2 min read
Guess who makes a pile of money 💰 marketing United’s Medicare advantage plans?
AARP
1/4🧵 Image 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/…Image
Dec 16, 2024 • 4 tweets • 3 min read
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 🧵Image 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/…Image
Dec 15, 2024 • 5 tweets • 3 min read
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 threadImage 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/…Image
Dec 7, 2024 • 12 tweets • 6 min read
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 🧵
Nov 8, 2024 • 4 tweets • 1 min read
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 🧵
May 28, 2024 • 6 tweets • 4 min read
.@ChrisMurphyCT, we can't help Denise ( and many other patients) with unaffordable meds without #PBM reform. PBM are at the center of drug finances...Pic from Millman
a 🧵 milliman.com/en/insight/pri…

Image Some of those 'rebates' in the pic above are really kickbacks that were legalized by our government. First for middlemen #GPO ( GPO in first pic on this thread) and then later for PBM
Great read here in @econliberties
Pic shows short letter to @WSJ 2 🧵economicliberties.us/press-release/…Image
May 10, 2023 • 5 tweets • 9 min read
a 🧵 In prep 4 today's 1pm @SenateHELP hearing on making #insulin affordable.
On graph: list price is roughly = net price (what pharma collects) + "rebates"/fees collected by Pharmacy Benefit Managers (#PBM) .

According 2 a 2021 @SenFinance "rebates" alone accounted for… twitter.com/i/web/status/1… Image @SenateHELP @SenFinance @BernieSanders @SenBillCassidy @BoesingLoretta @NSmithholt12 @Free2CareHC @MsPattiPatti @nickjonas @tomhanks @VWOfficial @alldiabetesnews 2. With #PBM making most of the $ In the Insulin market (and for other meds) it's wild that there is little #transparency for PBM.
All of the red ovals show places where we cant see the $
Pic from our @Free2CareHC report: free2care.org/files/report.p… Image
Jun 6, 2022 • 4 tweets • 4 min read
"the kind of misinformation that leads to more school closings as well as burdensome mask and quarantine mandates." Thank you, @DrJBhattacharya 1/4 🧵
wsj.com/articles/the-w… @DrJBhattacharya The kind of misinformation that is fomenting fear, is wreaking havoc with young people's lives.
On college campuses, kids worrying about covid have more mental health problems: @DartmouthHitch @washingtonpost @MartyMakary 2/4 washingtonpost.com/education/2022…
May 13, 2022 • 8 tweets • 9 min read
🧵Re baby formula #shortages:
@PressSec us pediatricians cannot conjure up baby formula.
We will do whatever we can to help our patients but you and @POTUS need to own the colossal supply chain mess that now threatens babies. @PressSec @POTUS @RogerMarshallMD @RepKimSchrier @MartyMakary @Rosemary100 @ab_peds @MedscapePeds 🧵While hospitals have been better at purchasing and distributing less formula, in an effort to encourage #breastfeeding , they still distribute a LOT of formula . Love to know how much @ahahospitals
May 13, 2022 • 5 tweets • 3 min read
Breastfeeding a 🧵
I am concerned we could have lower rates of breastfeeding now than pre-pandemic…@CDCgov do we have any data? cdc.gov/breastfeeding/… 🧵As a mom who breast fed all 3 for a year each, I can tell you that both establishing nursing and sustaining it is NOT easy. That first week was HARDER THAN INTERNSHIP.
We must give grace to those who cannot breastfeed, yet try to encourage it…
Apr 15, 2022 • 6 tweets • 6 min read
Mr. Scott of @pcmanet, the lobby group for #PBM has been called one of The Hill newspaper’s “Top Association Lobbyists” each year from 2015 to 2020.
Yesterday he spoke at the @FTC hearing on how mergers are affecting healthcare. Let's dissect what this lobbyist said 🧵1/6.... Scott of @pcmanet told @FTC that there were over 70 #PBM.
True, but from DrugChannels, we can see that SIX PBM control 95% of the prescription drug claims in the US
THAT is one WAAAAAY conslidated market! 🧵2/6
Apr 5, 2022 • 7 tweets • 13 min read
@thedailybeast The Affordable Insulin Now Act “ does not lower the price of insulin by one penny,” said @LloydDoggettTX
He's right.
It's a cap on the copay only.
Americans, including the uninsured will STILL pay 800% more than they should for insulin and many other drugs.
🧵1/6 @thedailybeast @LloydDoggettTX 🧵2/6 👀who the profiteers are in the Insulin Cartel
Net price is approx what the big 3 manufacturers pull in.
List price= net price + 💵 #PBM make
PBM are responsible for lion's share of cost of insulin, which will not ⬇️ with this bill.
Uninsured will still pay 800% ⬆️ BOO!
Feb 16, 2022 • 11 tweets • 7 min read
Another way to look at the 🇺🇸 HC spend:
70% of physicians owned by a hospital or corporation
Hospital systems own many clinics
This makes hospital costs really important to examine. Image It's REALLY important to know hospital prices! Image
Aug 11, 2021 • 4 tweets • 4 min read
1. In today's op ed in @CourierTimes , The head of TRG healthcare tells us that #PBM provide better access at a lower price.
When you are done laughing, 🤣
read all his unsubstantiated claims here: theintell.com/story/opinion/… 2. I am so glad to learn more about TRG healthcare
They help to create Mergers and consolidations
with places like @BeaumontHealth
Read more here: trghealthcare.com/services/align…
Aug 10, 2021 • 5 tweets • 4 min read
My recent Op Ed got the attention of @AARP HQ in Washington DC.

Here in rebuttal they state I am fueled by Big Pharma.

Let me be clear
I take no 💰 to advocate.
I am fueled by the need to create an affordable sustainable medical landscape. 👀 when disgruntled members sued the AARP for not acting in their interest, AARP lawyers said there is no requirement for the AARP to “act with the interests of [members] in mind.”
Why act for members when United healthcare pays you? commitmenttoseniors.org/aarp-says-its-…
Aug 9, 2021 • 5 tweets • 3 min read
Yep. And…
patients would receive better care.

Whose idea was it to exclusively ban one group from ownership in hospitals? healthaffairs.org/doi/10.1377/hb… @RepGonzalez @michaelcburgess Oh, I see…
“The American Hospital Association (AHA) joined the Federation of American Hospitals in 2019 to lobby against proposed legislation that would have repealed the POH ban.” armoneyandpolitics.com/ten-years-gone…
May 31, 2021 • 10 tweets • 6 min read
1. Here is something to know about physicians, Mr O'Neill:
Despite your maligning our millennia old profession,
you could show up in the ER with an appy, MVA, or your sick child and we would treat you + loved ones.
No questions asked.
We would keep your information private. 2. I have questions, @dp_oneill
Hope you don't mind being transparent, because your extensive work in the healthcare IT field is affecting billions of Americans. dponeill.com
May 22, 2021 • 17 tweets • 19 min read
1. Check out another way #PBM are making bank:
Insurer owns PBM who owns specialty pharmacy
Specialty pharmacy= pharmacy dispensing 💊💉stored under temp + special conditions: Chronic disease patients really need good specialty pharmacies. But....
beckershospitalreview.com/payer-issues/h… 2. Insurer can force patient to use their in-house specialty pharmacy... thus...Aetna makes pts use CVS, BCBS+Cigna makes pts use accredo, etc
Besides the whopping conflict of interest....
Apr 10, 2021 • 8 tweets • 7 min read
AHA!!! We all know that BCBS Is the biggest individual Health Care Insurance donor to congress over the past 20 years, right? opensecrets.org/federal-lobbyi… 2. How did BCBS get so rich? They were originals.
@BCBSAssociation the insurance co with the LONGEST In house owned #PBM: Prime theraputics
PBM are the insurers cash cows. 💵🐄
@Cigna revenues tripled when they bought Express Scripps. 60% of @CVSHealth revenues from PBM