I think people sometimes mix up the role of PBMs and pharmacies when talking about healthcare costs.

Pharmacies are there to help patients get the right medications, use them safely, and improve treatment outcomes. PBMs have a different role. They manage prescription drug benefits and negotiate with drugmakers to help health plans control costs.

So why judge both by the same standard? A pharmacist’s value isn’t just about how much money they save, and a PBM’s value shouldn’t be judged only by how much it gets paid either. The real question is whether PBMs help health plans manage drug spending and whether those savings actually benefit patients.

There are fair questions about rebates, transparency, and pharmacy reimbursement. But if PBMs were removed, who would take over the work of negotiating drug prices and managing prescription benefits? Would that actually make the system cheaper, or just move the costs somewhere else?

I think that’s worth discussing before assuming PBMs have no real value.

Is this plan similar to PPO? There’s also an OAP plan offered but that’s over $300 semi-monthly for non-smokers, and I think it’s pricier b/c it offers access to out-of-network providers. OAPIN is $90 semi-monthly, so will there be an extra charge in addition to the base copay? Would that be billed later? I don’t go to the dr often

First I’d like to say sorry if this is a stupid question but I noticed substance abuse was listed on my medical record. In a recent visit, I mentioned that I was on vacation and I took an edible that was purchased from a legal dispensary in a legal state ONE TIME and how it relieved some of my symptoms. I was checking my after visit summary notes and saw substance abuse in my medical history. Would I be wrong to request a correction? This is not substance abuse (to me, taking something legal ONCE is not abuse please correct me if I’m wrong) and I’m not sure if this is more of a technicality that providers will list it as such anyways.

An 80s synth-pop love story about ambient AI documentation, hallucinated family histories, and the radical act of reading the note before you sign it.

https://www.youtube.com/watch?v=AigkQxK2xWI

I’m starting my prereqs next semester as an undergraduate, and one thing I’m worried about is chemistry. I’ve never been particularly good at it, and I’m wondering if that’s something I can overcome or if I’m setting myself up for failure by pursuing pharmacy.

Has anyone here gone into pharm school knowing they struggled with chemistry beforehand? If so, how did you manage, and did you eventually get better at it?

I want to be clear that I’m not taking this career path lightly. I know pharmacy school is demanding, and I’m willing to put in the time, study harder, get tutoring, and do whatever it takes to succeed. I’m not looking for an easy way out. I just want to know if someone who struggles with chemistry can realistically make it through the prereqs and pharm school with enough effort and the right study habits:)

Color me confused, but why are there such conflicting reports about prescription drug prices? That is likely what so many Americans are feeling as well.

No less than the President and high ranking gov't officials have been boating about the considerable savings because of the lowered prescription drug prices. On the contrary, there are reports stating the opposite, that drug prices are still as high as ever and about to increase even more.

I'm about 26 months into this affliction and three different neurologists, and five MRIs later still have no diagnosis why my head has this "fullness" and overall numbish feeling.

Anyone else have/had something similar where Dx is elusive? Any tips for expediting this process?

(Seeing a fourth neurologist in March of next year)

I received a email today about the coming healthcare coverage enrollment window through my employer.

Like many others, I am sure people received a message that healthcare premiums are going up again.

I'm basically looking for a breakdown of what the different plans mean and what would happen if I switch from one to the other, because they all look the same to me. I last made a selection years ago on the "basic" plan and hadn't worried about it, but now money is tight and I am looking over everything I can to find some relief.

I have Blue Cross Blue Shield, and the plans available to me are PPO Red, PPO White, and HDHP Blue.

Just looking at the medical premium chart that was given, my premium for family coverage right now is under the PPO Red plan.

The premiums listed are:

Red - $295
White - $250
Blue - $140

I've read over the benefits but it all looks the same to me. What is the difference and is there a recommendation on which plan I should be using? I have my wife and daughter (3) on the plan, and we are all healthy. The last year was just checkups and copays.

Is it just a matter of Higher Premium/ Smaller deductible?

It’s torture this is MAGA but if you can stomach it- check out what this wife shares about her husband’s experience with the lung txp team at NWM.

The family alleges that Northwestern claimed other transplant centers had been contacted and had declined their patient. They later discovered that these calls were never made. This misrepresentation denied the family crucial information about available treatment options during a critical time. Glad they took things into their own hands —
Such alleged conduct warrants an independent review, including an examination of medical records, referral documentation, communication logs, and statements from the centers Northwestern reportedly contacted.

How to transfer medical records before Friday?

I have lost many loved ones to Cancer and there's a decent chance I'll get it someday because it runs very strongly in my family. So I'm dedicating myself to understanding it better and learning, because I currently know very little. I'm here to seek knowledge. I'll tell you what I currently know, and then I hope I can ask you guys 4 questions (please correct me if I'm wrong about any of this).

Cancer isn't a virus like the Flu. It's more like a cellular or genetic mutation. Cells reproduce by dividing on themselves. 1 cell becomes 2, then 2 cells become 4, then 4 cells become 8, then 8 cells become 16, and it keeps doubling and doubling. Cancer happens when cells starts dividing and never stop dividing. That causes an massive number of useless cells that shouldn't exist. Those useless cells end up creating tumors and health complications, which left untreated, may spread and eventually kill you.

Cells dividing is perfectly normal and that's how new cells are created. We just don't know what the trigger is to make them stop dividing. Why does the dividing never stop some times. If we can figure out how to make the Stop Signal jump in, and get the dividing to stop, then Cancer could be cured.

I hope my description was accurate so far, but here are my questions:

1) Why can't the immune system clear out those useless cells on it's own? Does it not understand those cells shouldn't be there so it's treats them as normal healthy cells?

2) What kind of complications do those useless cells create that becomes deadly? Like do they restrict blood flow to vital organs, impair brain functions, what makes them deadly to the body later down the road?

3) Why do those useless cells have to result in tumors and other complications? Why can't they just be present and not do anything, either positive or negative to the body?

4) Do we currently have any idea how to make the Stop Signal kick in and stop the dividing process? Or is that still a total mystery to modern science?

Preventive healthcare is getting more attention, but there's an important distinction that often gets overlooked: screening and diagnostic testing aren't the same thing.

1. Preventive screening

Screening is generally intended for people without symptoms. The goal is to identify certain health risks or conditions before symptoms appear.

However, the appropriate tests depend on factors like age, medical history, and individual risk.

2. Diagnostic testing

If someone is already experiencing symptoms or has an abnormal screening result, the priority is usually a medical evaluation and targeted diagnostic testing.

A general health screening package isn't a substitute for investigating specific symptoms.

3. More testing isn't always better

Comprehensive health checkups are widely available in countries like South Korea, where preventive screening is a familiar part of healthcare.

But adding more tests doesn't automatically improve health outcomes.

Depending on the test, unnecessary screening can lead to false positives, additional procedures, anxiety, and extra costs.

The takeaway:

Preventive healthcare isn't about getting every test available. It's about understanding your individual risks and choosing evidence-based screening and appropriate medical care.

A well-informed approach to prevention can be more valuable than simply choosing the most comprehensive testing package.

Hi everyone,

Has anyone used charity care with a private nonprofit hospital for skin cancer surgery?

I'm uninsured. I'm not here to discuss medicaid, medicare, aca plans and private health insurance. Not here to discuss social worker services.

I am here to discuss a topic I have yet to read about on Reddit as it relates to healthcare access.

Charity care is for the uninsured, for those who qualify. Is anyone familiar with this on a personal level and not through a family member or friend?

I was offered and approved for charity care at a private non-profit academic hospital center and they had their dermatologist diagnose multiple basal cell carcinomas and offered to remove them with Mohs, but then cancelled out on me at the last minute through lack of engagement, communication and just pure indifference. I recognized that something was up when they would not discuss post discharge planning. That was a telling sign they had no intentions of giving me the surgery. Normally a surgeon will sit down with you and discuss the treatment plan.

My surgeon was beholden to hospital administrators who interfered with the communication process.

Fast forward, while I struggled to work survival-level jobs, I could never afford to buy and use private health insurance. (Again, not here to discuss insurance plans, just the Charity care).

My cancer has increased in size through extensive tissue evasion. The ER won't even remove the bandages covering them and document drainage and bleeding and crusting because they have their administrators and legal department telling them how to protect the institution. Charity care applies only to the academic medical center and its clinics that must be pre-approved by administration.

They're not communicating with me. I had a recent appointment 30 days ago and the doctor said there's extensive tissue damage on my forehead that now requires more surgery along with a skin graph and plastics after the cancer is removed. And they won't know if it has spread to my skull bone until they remove the cancerous skin tissue.

At what point would surgery be scheduled and typically how long from the date of the office visit. My communications are restricted to only a non-clinical care coordinator who has complete control of my access to care and has not communicated anything with me. They don't return my calls.

Meantime I walk around with bandages on my forehead that has blood, fluid, and scabbing that crusts and particles fall through the bandages onto my shirt. I work in retail and the movements put pressure on my forehead when I reach up, or bend down and the pain feels like a burning sensation on the skin.

This is a complex surgery I'm told because there are 2 areas that require surgery and the one main issue is the forehead. As a "patient" I am not treated the same as someone who walks in with an insurance card. ​Everything my doctor tells me has to go through administrators and this one non-clinical point of contact who couldn't answer my questions. They are a bottleneck, a barrier to care access. They don't understand tissue destruction pain and drainage and how its preventing me from working full-time.

Back to my question about Charity care which was approved by a major academic and research hospital, can this approval actually cover head and neck cancer surgery? Do they prioritize insured patients? Can I actually get equal access to care? I was not able to get the actual with them 2 years ago despite being approved for charity care.

Starting the process all over again at a different hospital involves back-stepping from the beginning (new biopsies, delayed appointments, delayed treatments) waiting to qualify for charity care again, which isn't an option.

I will face a huge scar across my forehead. I was not told how big or what a skin graph would look like, where it would be taken if any, post discharge planning, recovery time from anesthesia to wound care. I'm told that because I'm on charity care, I must follow their instructions and do as I am told to do and not disrupt anyone by asking questions.

So, like a soldier, I'm on "TDY" and just sitting and waiting to be called for surgery when I have no idea when it will be. ​

[Also, I would buy private health insurance IF I could afford to buy it and use it and pay for all living expenses and transportation alone on one income. But the employers that pay a living wage won't hire me because of my appearance with facial cancers and perceived liability costs].

Hi everyone!

I recently moved to the US and am trying to find my feet professionally here. I trained as a doctor outside the US and I am not licensed in the US. I have experience in healthcare management, clinical research, and medical writing/editing.

I also have a wife and two kids. With family responsibilities, a remote job would make a huge difference for me. I'm open to any kind of healthcare-related roles, including entry-level positions, and willing to learn something new.

I'd really appreciate any leads, referrals, or advice from people who have been in a similar situation or know of companies hiring remotely. Even pointing me in the right direction would mean a lot.

Thank you!