Marylee Worley @MLPharm

@AshleyGWinter Chocolate is what I’m looking to due to pregnancy. So much anxiety!

A vaccine ban would kill and disable millions of Americans and collapse the economy. It is stunning that actual Americans on the edge of power would consider this idea, let alone advocate it. theguardian.com/us-news/2024/n…

🚨 BREAKING: Wow. This heart-rending ad, when tested, moves swing-state men 2.5 points away from Trump. Massive. Please share everywhere. Women are dying NOW in states with extreme bans. If Republicans win, a national abortion ban is next. Don't look away. #MAGAAbortionBan

@AshleyGWinter @InfectiousDz Yup. Same here, avoiding so many foods now, even frozen waffles! Hard to explain how risky it is to loved ones who are non medical, they just say, oh I’m sure a little won’t hurt you, have this boars head lunch meat sandwich.

@BoesingLoretta @ExpressRxHelp @Accredo PBMs are evil

‼️SHAME ON EXPRESS SCRIPTS Sharing with permission of the mother who wrote this letter to her senator. @ExpressRxHelp @Accredo "I am at such a loss for how to proceed. I am desperate for assistance regarding my son's health and medication. He has a rare genetic disorder called tuberous sclerosis complex, along with epilepsy and autism. One of his meds can only be obtained through specialty pharmacies via mail order and our PBM, Express Scripts by Evernorth requires us to use Accredo, the specialty pharmacy they own. I have battled Accredo for my son's Sabril since 2013. Nothing has ever improved. Brief periods of peace, always come to a screaming end with my son being put at risk month after month. Even when assigned a point person within the Express Scripts to assist us (due to my complaints on social media) she struggled to correct issues within her own company, and it has had no lasting effect. She no longer returns our calls. The reasons given for the delays filling his meds vary: prior authorizations needed, the prescription not written correctly, more than one account with his name on it creating technical difficulties, or "system issues" that are unexplained. Some of those issues would seemingly be resolved once the pharmacy gets on the phone with the doctor's office, but I can assure you that's not the case. Every time the nurses are told it's resolved, I call back to learn it's not. It is impossible to speak with someone who has any true authority to fix this. Those who answer the phone have very limited information and history. Escalating means getting someone from the social media team involved. They also cannot fix it or see the long term picture to resolve this once and for all. I have been trying to fill my son's medication since Wednesday. Accredo assigned members of the social media team to fix it. 5 days later the matter is unresolved and they don't know what the issue is. And of course they took the weekend off from working on it. Express Scripts says it's a PA issue. My son is now out of his medication and at risk of increased seizure activity, status seizures, hospitalizations and even death. We thought we could resolve some of the issues by finally giving in and requesting generic instead of namebrand because we were running into PA hurdles every month. We didn't make that decision because we thought it was in our child's best interest. We did it because being threatened with getting nothing each month was worse. Well, we can't get that shipped either. I will settle for someone getting on the phone with me and breaking down exactly what I need to do to make this work every month. It's taking a massive toll on my family's mental health. If I can get someone from ES/Accredo who understands what is happening within their own company, I need them to break it down for me--which should I ask for, generic or namebrand? Exactly how should the prescription be written? Why do the people I speak with never know anything about the calls from the doctor? Why do they always tell me they haven't received a response from the doctor office? While much of this occurs by phone, I have quite a bit of documentation via MyChart and in email with Accredo to show the reality behind these problems. This email is an incredibly condensed version. Most importantly, I am so far from alone in this nightmare. So many families suffer like we do. Please help us." @linakhanFTC Contact your legislator and ask them To cosponsor HR 9096 to stop these abusive practices and give patients choice of pharmacy. WHAT ARE YOU DOING ABOUT IT? @SenateGOP @SenateDems @JasonSmithMO @HouseGOP @HouseDemocrats @neeratanden @SecBecerra @HHSGov @TheJusticeDept @FTC

.@HIVMA Board member Elizabeth Sherman, PharmD, explains what ending the HIV epidemic means to her. Members of Congress need to hear from you. Join the Member Advocacy Program (MAP) and advocate on issues impacting the ID and HIV landscape: idsociety.org/map

BREAKING: The Lancet backs UNAIDS call on Gilead to drop the price & share the tech for the new HIV prevention medicine that only needs two injections a year. Their Editorial demands “the price will need to be a lot lower” and warns “the world is watching to see how Gilead acts.”

@AshleyGWinter Yeah there is usually also an antimicrobial stewardship conference always on Mother’s Day weekend as well. Never understood the timing of that too. They changed it for this year!

@Angry_Staffer They probably fired (laid off) all the US software developers and rely on some overseas help that probably isn’t trained adequately and is paid shit. That appears to be the new strategy for many tech companies in the US.

@shannonrwatts Had the worst p fasc prior to covid, then when I went from professional dress to scrubs/tennis shoes and stopped wearing any dress shoes (flats or heels) for many months, it disappeared. Have been in tennis shoes ever since (even w dress pants at work)

The PBM hired by TriCare, is out there trying to kill independent pharmacies by asking them to do a deal that pays them less than cost and ZERO for the work to actually fill the prescription. The Indy pharmacies are in a catch 22. They want to support all the service members in their communities, that put it on the line for our country. But the PBM doesn’t care about those local pharmacies. Here is an example. Eliquis -      Pharmacy cost: $576.57 PBM payment to Phamracy= $543.16 Pharmacy Net Loss = $33.41 It’s the same for ALL BRAND MEDs If you want to see your local pharmacy able to support our service members and their families, without going out of business, please call your Senator and ask them to do something to change the PBM that the DOD works with. Use a Pass Through PBM and save taxpayers billions and keep alive thousands of pharmacies If you have examples of PBM greed killing Indy pharmacies and /or costing taxpayers money, tag me and I’ll repost it

@IDstewardship So sorry 😞

@mcuban have you ever made a contact with a hospital buyer for cost plus drugs? Hospital I work with looking into pyrimethamine specifically. (Im in S FL so we need it more than other places).

@MrsPA_C I think I’m keeping my toddler caged until he can just do a twin bed on the floor and until we need the crib again. No free range toddlers!

"People are expected to ignore the threat of infection, continue working if they get sick, and face down stigma and ridicule, and a total lack of social support if they become disabled as a result." Ed Yong for @U2Fight_World youtu.be/8Ch828HnCTo?si…

@TPP_MD Wish this was an option, after my epidural I had the worst HA for 2 wks, couldn’t sit up. I even went back to the hospital to ask for the anesthesia team to do a blood patch and they looked at me like I had 5 heads, they didn’t know what I was talking about

How CVS Health is gaming PrEP medication claims and fueling the spread of HIV: CVS Health is tricking pharmacies into not filling pre-exposure prophylaxis (PrEP) medication for HIV prevention through drastic, deceptive up front underpayments. Generic Truvada has an acquisition cost (what it costs the pharmacy to buy) of $24.49 and an average wholesale price (AWP) of $2,100. CVS Health has contracts with plan sponsors such as employers, Medicare, and medicaid in which they charge those sponsors based on the inflated AWP while paying pharmacies based on entirely different rates. This is called spread pricing. Sounds like a scam right? It is. But it also gets much worse. In this particular example, Caremark is reimbursing the pharmacy based on maximum allowable cost (MAC), a secretive list of medications and their reimbursement rate that is protected as a "trade secret". The MAC pricing for generic truvada is $9.18 for 30 tablets, leaving the pharmacy losing $15.31 while Caremark bills for the inflated AWP. A lot of pharmacies will have to tell the patient to go elsewhere because they cannot afford to take the losses, but this is a mistake. There is also a generic effective rate (GER) at which pharmacy payments in aggregate are determined. And by "in aggregate" I mean all pharmacies across the network. A GER set at 20% of AWP would yield a final return of $420 for this medication even though it looks as if there is a drastic underpayment up front. This will trick many pharmacies into refusing to fill the medication, lowering overall payments for all pharmacies in the network. Drugs like this with a big AWP/acquisition spread are important to pharmacies because they are some of the only medications you make money on. But if the money owed for these drugs is thrown into a giant aggregate in which many pharmacies are not willing to take the loss up front, all pharmacies, including the smart ones, are hurt. When patients call to complain about this, they are then directed toward a CVS brick and mortar or CVS owned mail order pharmacy. It is easy to conclude that: 1. CVS Health wants these patients forced to one of their own pharmacies so that they can charge employers, state plans, and Medicare a fortune while keeping all profits in house. 2. They under pay up front because the effective rate contracts state that they will owe the pharmacies more in the future. 3. CVS Health is tricking pharmacies into not filling these prescriptions so that they can either take the patient or skip out on money they owe the pharmacies. 4. Even if a pharmacy is aware of the GER games, they are dependent on all other pharmacies being dependent on it as well. 5. PrEP patients, especially those with limited pharmacy access in urban and rural areas, will go without their medications, fueling the spread of HIV. 6. CVS Health makes or saves money no matter what while everyone else loses. This is what vertical integration and misaligned incentives have gotten us. PrEP patients and pharmacies deserve better than that. #Pharmacy #TwitteRx #PBM #PrEP

I made a video. Please keep sharing. I need this to go viral for our case to the @US_FDA

Ashley Winter MD || Urologist @AshleyGWinter

2 years ago

CALL TO ACTION: I need all of your help. There is a black box warning on low dose vaginal estrogen (VE) products. See below. It states, "warning: endometrial cancer, cardiovascular disorders, probable dementia." Low dose VE has NEVER been show to cause any of the above.

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@drtimothyli @GermHunterMD @DrNeilStone @FungalDoc Have seen it with C auris… didn’t end well, (pt then developed fungemia ) Wonder what should have been used for C auris from urine? Susceptibility results takes over a week so by then it’s usually too late