Prior auth is the scam that keeps on paying. In this week’s Doctor’s Lounge, we talk surgical emergencies delayed by bureaucracy, Ai algorithms denying care, and why 66% of employers could kill prior auth, but don’t. We also ask the uncomfortable question: Did the previous

💯💯⬇️⬇️

Disintermediating PBM middlemen would save Americans $100b a year says USC research. They nailed it academic.oup.com/healthaffairss…

85% of patients agree that the bond physicians form with their patients is central to health care. Physicians choose medicine because they want to treat patients, understand their health care needs, and provide the care they need to get better. #YourCareisatOurCore

TJ Parker⚡️ Concerned PharmD 🇺🇸 For brands , hopefully , there would be no rebates. And if we have to use rebates. The cost we use is the cost after rebates. We have done the math. Employers have no clue what they pay, net, on a claim for a brand. It's mostly done by therapeutic class. If the wac on

Crazy? The pharmacy has to buy the bagel for $400 from a big wholesaler, then get rebates to try to get their cost down to the $7. Which they can only do if they buy 90 plus percent of their generic bagels from their big primary wholesaler. If they buy generic bagels elsewhere,

🚨 Court Upholds Arkansas Rule 128 A federal court ruled that Arkansas’s pharmacy reimbursement Rule 128 is not pre-empted by ERISA, reinforcing states’ ability to regulate PBM practices. This decision could inspire more states to pursue “fair reimbursement” laws, creating

Mark Cuban (Mark Cuban) testifies on Pharmacy Benefit Managers (PBMs) before the Senate Full video here: c-span.org/event/senate-c…

Congressional diabetes caucus leaders object to proposed CMS pymt changes for diabetes tech. Journos: Follow the data. Rental of devices isn't about access to new tech. It's about the ownership & marketing of pt data generated by devices. medtechdive.com/news/legislato… via MedTech Dive

🌟 Celebrating 5 Years Since PCMA v. Rutledge: A Turning Point for PBM Accountability Five years ago, the U.S. Supreme Court issued a unanimous ruling in PCMA v. Rutledge (2020)—a landmark decision that reshaped the landscape of PBM regulation across the country.

Even our colleagues across the country can see #HB2211 striker is a bad bill. #AZLeg Arizona House Republicans Arizona House Democrats AzHHA HSAAZ Arizona Medical Association (ArMA) Arizona Nurses Assoc

Brian Blase is exactly right. Medicare prices are set by politics, not markets, which means hospitals win, insurers win, and physicians lose. And that distortion is driving the healthcare cost crisis, not solving it. Since 2000, the physician conversion factor has gone from

Marion E Mass, M.D. #patientsfirst #scrubsnotsuits Patients have legal & regulatory weight behind requesting their complete health records. But they currently lack the means to receive, organize, or meaningfully share them. They’re on the wrong end of the digital power imbalance. Patients should be able to function as sovereign

Registration is now open for the National Health Council's 2026 Science of Patient Engagement Summit: Turning Evidence into Impact! Join us May 11-12 as we explore how meaningful patient engagement leads to better health care. Register today: bit.ly/4baxmac

Did that already in AZ in 2024, good sir!

Actually, Mark Cuban Cost Plus Drug Company would sell every brand and specialty drug we could. But there are brands and specialty manufacturers that won’t sell to us because your buddies at the PBMs tell them they will diminish them on their formularies. That could cost them billions in some

8 alarming health care developments 1. Looming and increasingly daunting shortages of specialists and sub specialists. And the overload on physicians across many key areas of care. 2. Washington on the left and right seems broken for solving health care problems. 3. Fixation

BIO5 member Deepta Bhattacharya is part of a University of Arizona team developing gene-edited stem cells that may avoid immune rejection, opening the door to Type 1 diabetes therapies without lifelong anti-rejection drugs. Read more: bit.ly/3MOsT3T