Beth Waldron

Proof retired seniors are not ‘choosing’ Medicare Advantage, rather they are being coerced by employers. This today from State of NC Health Plan:

Media needs to cover patient stories. Put a real face on life threatening cuts.

Brown University Surgeon and Professor Are Deported to Lebanon Despite a Judge’s Order Dr. Rasha Alawieh, a kidney transplant specialist and Brown University professor who had a valid visa, was expelled in apparent defiance of a court order.

A kidney transplant specialist and professor at Brown University’s medical school has been deported from the U.S., even though she had a valid visa and a court order temporarily blocking her expulsion, according to her lawyer and court papers.

Medicare benefits are already being cut. Telehealth coverage ends April 1.

Alarming.
“It’s a six-month production cycle...So one can only assume that we’re not picking flu strains this year.”

They also said Medicare would not be touched, but quietly last week eliminated a popular benefit..telehealth visits (phone & video) will no longer be covered effective April 1.

A direct result of PBMs. Consumer protections are needed.

Let's make care more difficult for the elderly and disabled?

‘It’s a death sentence’: US health insurance system is failing, say doctors Firms including United Healthcare have denied basic scans and taken months to reconsider, physicians say

Health insurance giants, including United Healthcare, have denied basic scans and taken months to reconsider, physicians say

It was not pharma who suddenly stopped covering my lifesaving medication I’d taken for 8 years…it was the PBM & not for clinical reasons but simply because they got a higher profit kickback on one drug over another.

I & many other patients with blood clots…especially those with cancer associated clots & pregnant women.…have taken enoxaparin. The generic is still wildly expensive of this life saving blood thinner. Now from the FTC, we learn PBMs profited from dramatic mark ups ranging 100-1000%.

Yep. There is nothing special about them except the profit margin they can impose!

Anyone surprised? The question is: when will Congress act on such knowledge to protect patients.

FTC to discuss new findings from PBM study. Talk is good, but patients can’t keep waiting for action—from Congress or the FTC. The facts are already abundant & clear. Nontransparent PBM profit maxing practices put patient lives at risk. As premium paying consumers, we deserve robust protections.

One of my 4 year old patients was just charged $145 for an inhaler that was removed from her PBM’s formulary, and all 3 of those inhalers are “E” for excluded. She can’t use the dry powder, breath-actuated alternatives on the PBM list. Neither can the other millions of kids with #asthma. 4/

@mcuban.bsky.social - kids with #asthma and the families and doctors who love them could use your help.
Inhalers that kids can use to prevent asthma attacks - HFA inhalers that attach to a spacer - are so expensive that families literally can’t afford to help their kids breathe. 1/

‘Uncomfortable things’ necessary to fix NC Health Plan, new treasurer says In a break with previous administration, new NC Treasurer Brad Briner says higher premiums, not legislative fixes, needed for NC Health Plan.

Higher premiums, less coverage. Hate to say l told you thusly, but its the classic Aetna/CVS Caremark playbook. www.wunc.org/health/2025-...

Twitter was an effective platform for me, other patients & health care professionals to advocate for care. With the evolution of X, no longer the case.

I'd love to build a health care advocacy network on Bluesky addressing insurance & PBM barriers to care. Follow please if interested. #MedSky

And days after annual enrollment ended, leaving Medicare patients without access to their doctors. If consumers can only make insurance changes once a year why are insurers able to make changes year round?

A pilot raced through the airport to surprise an old friend: the woman who saved his life | CNN When Allie Reimold boarded Flight 2223 in Houston a week ago, she didn’t expect to see the pilot whose life she had saved.

Eight years ago, a budding scientist gave a commercial airline pilot a gift that would link the two for life.

Since then, they'd met in person and linked up on social media. But when she boarded a flight a week ago, she didn't expect to see him.

Then an announcement came over the PA system.

Premium paying patients need consumer protections. Allowing PBMs to take opaque financial considerations (legalized kickbacks) to prefer one product over another = patients are not getting access to the clinically best therapies, nor cheapest, but the ones with highest profit margin for the PBM.

Why does one unelected billionaire have the power to essentially govern? The CR includes needed PBM reform, which is bipartisan. Patients can’t continue to wait for reform.

Tell me more

Drugmakers Paid PBMs Not to Restrict Opioid Prescriptions Drugmakers including Purdue Pharma paid pharmacy benefit managers not to restrict painkiller prescriptions, a New York Times investigation found.

Drugs on formulary reflect not necessarily what’s clinically best, but what’s most profitable for the PBM, earning the highest rebate. This is further evidence. www.nytimes.com/2024/12/17/b...

Opinion | Ways to Fix the Health Insurance Debacle (Gift Article) Responses to an essay by Andrew Witty, the C.E.O. of UnitedHealth Group. Also: Threats to democracy, in Hungary and America; a check on Trump; avoiding taxes.

Read my response in the New York Times to United Healthcare's CEO recent oped (second letter down in link) It's time for ALL of us to speak up, share our personal experiences & for advocates to network together to improve care. #medsky #RxSky #cardiosky #pharmsky www.nytimes.com/2024/12/16/o...

Do You Have Insights Into Dental and Health Insurance Denials? Help Us Report on the System. Insurers deny tens of millions of claims every year. ProPublica is investigating why claims are denied, what the consequences are for patients and how the appeal process really works.

We're investigating health insurance denials. If you want to share your insights, here's how:

A health care deal BROADER on PBM (pharmacy benefit manager) reform you say? 🤔 After years of inaction despite wide bipartisan support, that would truly be a Festivus miracle.

Health insurer stocks fall as WSJ says lawmakers set to break up pharmacy-benefit managers Shares of health insurers such as UnitedHealth and CVS Health fell on Wednesday after a Wall Street Journal report said a bipartisan group of lawmakers was set to introduce legislation to break up pharmacy-benefit managers.

PBMs should not be able to steer patients to the pharmacies they own. This reform needed to protect patients. www.reuters.com/business/hea...

Patients ultimately shoulder risk, yet often have no idea what their final care costs will be until long after services are rendered & the bills arrive. 90% of Americans are insured, yet 41% carry medical debt. Simple cost transparency & equitable pricing would reduce everyone’s risk.

If only 3 mega PBMs control 80% of prescription benefits yet there are 3,553 different prices for the same medication, maybe PBMs are not truly negotiating the lowest price for premium paying consumers as they say. 🤔