Audrey Stevenson ❌👑 @oddss

My wife and I own a pharmacy. Last month we spent days trying to pry one prescription loose from a company that did everything it could to hold onto it. The drug was everolimus. A generic. It treats cancer and protects transplant patients from rejecting their new organ. Not exotic. Not rare. A pill. The patient wanted it filled with us because we're cash-pay and cost-plus. No insurance. No PBM. No secret markups, no games. Our price was $318. That's not cheap by our standards — most of what we fill runs under $20 — but it was honest. Here's what that same prescription looked like on the other side of the counter. In 2023, Medicare was paying about $6,645 for it. That's roughly 21 times our price for the identical medication. Medicare spent around $240 million on everolimus alone that year. If they'd paid our price, they'd have saved roughly $230 million. On one generic drug. So how does an insurance company profit off a drug that expensive? Don't they pay for it? No. You pay for it. In your premiums. Their job isn't to spend less — it's to keep your healthcare dollars circulating inside their own companies. And the tool they use is called spread pricing. Spread pricing works like this: the middleman bills the health plan one price, pays the pharmacy a lower one, and keeps the difference. You never see it. On TRICARE, they pay an independent pharmacy like mine about $311 to fill everolimus. That barely covers our cost of the drug. Meanwhile the plan gets billed thousands. That gap — north of $6,000 on a single fill — is pure margin the middleman pockets. Now here's the part they'd rather you not think about. The pharmacy we were fighting was Accredo. Accredo is owned by Express Scripts. Express Scripts is the pharmacy benefit manager owned by Cigna. Same company, three masks. That nesting-doll structure isn't an accident — it's the whole design. When the pharmacy, the PBM, and the insurer are all one entity, they can shuffle money between their own pockets and call it whatever they want. The confusion is the product. And this isn't a story about one weird drug. It's the business model. The FTC has been digging into exactly this. In its January 2025 report on the three biggest PBMs — CVS Caremark, Express Scripts, and OptumRx — staff found those companies marked up specialty generic drugs by hundreds and thousands of percent when dispensing through their own affiliated pharmacies. Just those markups generated more than $7.3 billion above what the drugs actually cost to acquire, from 2017 to 2022. One in five of the specialty generics they studied was marked up over 1,000%. Some cancer generics: over 3,000%. On top of that, the FTC pegged spread pricing on those same drugs at another $1.4 billion. One example straight from the FTC's files: dimethyl fumarate, a multiple sclerosis drug. Costs about $177 to acquire. The PBMs paid their own pharmacies close to $4,000 for a 30-day supply. Same trick. Different drug. And they steer the profitable ones to themselves on purpose. Pharmacies affiliated with the big three took in 68% of specialty dispensing revenue in 2023 — up from 54% in 2016. The prescriptions marked up more than $1,000 disproportionately end up at their own pharmacies, not independents like mine. So when we called to transfer this patient's everolimus to be filled without insurance, it landed like we were asking them to set $6,000 on fire. Of course they stonewalled us. That's why we fired them. No insurance means no invisible $6,000 charge buried in a premium you can't itemize. It means the price you see is the price. Ours was $318. Theirs was thousands. Same pill.

The sitting president of the United States had to pay $5 million to a woman he raped and defamed, and not one person in his entire cult of a party is calling for his resignation. Not one.

I just wanted to update my resume. Instead, I accidentally proved how a multi-billion-dollar AI tool hallucinates a glass ceiling for women. I changed a single variable: My name. Here is what happened when "Jennifer" became "Jeff."

On this 82nd anniversary of D-Day, remember: The way we wonder why Germans didn’t stop Hitler is exactly how the rest of the world views Americans and Trump today.

My hot take is US Senators should be paid whatever their states minimum wage is. That’s how you represent your constituents, you live like them.

I woke up to a message from New Hampshire. A bill had made it to the state Senate — one that Representative Julie Miles championed after watching me do peer-to-peer calls with insurance reviewers who weren't qualified to be making decisions about my patients. I'm a surgeon in Texas. I had no idea this had traveled that far. Between cases at Redbud today, I fired off emails to NH Senate members, logged into a YouTube Live, and watched HB 1554 pass. Here's what it does: ✅ Requires peer reviewers to be actual peers — credentialed, named, with their NPI number and specialty certification on the line ✅ Allows physicians to communicate with that peer reviewer at any point in the prior auth process — not just after a denial or on appeal This is a patient-centered, common-sense reform. And it happened because someone posted something. Told the truth. Did the right thing. Thank you, Representative Julie Miles and Senator Tim McGough. New Hampshire just set a standard. I hope other states are paying attention. Get involved. Speak up. You never know what good it might do.

Had a 45-minute conversation with my 15-year-old son tonight about abortion. He came in hot with “there should be restrictions.” So I went hard. Not to bully him — to build him. We talked about bias. About whose body we’re actually discussing. About what it means to hold an opinion on something that will never, ever affect your body. I asked him to look up the stats. Read the actual data. Then come back and finish this sentence: “I’m a man, and I should have the final say over a woman’s body because…” He couldn’t finish it. That’s the point. He’s 15. He’s allowed to be wrong. What matters is that he’s willing to think — really think — not just echo what he’s heard. Raising boys who become men who understand bodily autonomy isn’t optional. It’s the whole job and now I’m tired because he gets these opinions from kids in school. Gawd.

@KurtSupeCPA 70% of stress in modern times is trying to figure everything out because it’s all so intentionally complicated. Plus, you’re trying not to be scammed by literally everyone. I want the 80s back.

Donald says we would have won the Vietnam War if he'd been president. Maybe he should have just served.

A day in life without inventions by women

Men: won’t wear condoms, won’t get vasectomies, won’t raise kids. Still want women punished for abortion. That’s misogyny, not morality.

The same people who say the Pope should stay out of politics want to force prayer and the Ten Commandments in public schools

Trump says his life was better before he became president. Dude, everyone's lives were better before you became president!

The man who spent a year literally begging for a Nobel peace prize is attacking the pope for advocating for…peace.

OVERHEARD: For context on how big today is: Viktor Orbán has been the blueprint. The proof that leaders can slowly dismantle democracy from the inside and stay in power forever. His model spread across Europe and the USA. Orbán’s playbook was the literal blueprint for Project 2025. The Heritage Foundation worked directly with Orbán’s allies in Hungary. CPAC held conferences in Budapest three times Tonight that blueprint lost. In a landslide.

If the 14th amendment was only meant to protect the “babies of slaves” then the 2nd Amendment is only meant to protect the right to own a musket.