SabiaHealthnc

Your employer picked your health plan and might be the reason your costs keep going up. 💼

Most employers don’t actually know what they’re paying for. They hand it off to a broker, sign whatever the carrier puts in front of them, and never see what’s happening underneath — the rebates, the markups, the secret contracts.

But some employers are skipping all of that. It’s called direct contracting — negotiating straight with doctors and surgical centers, cutting out the middleman entirely.
One company doing this, Hero Health Plans, contracts directly with top-rated doctors and surgical centers and gives members zero out-of-pocket cost when they use them. All the drug rebates go back to the plan instead of getting pocketed by a carrier. Employers using this model are seeing members spend 10 to 30% less.

This is happening across the industry — employers building plans around a single trusted health system instead of a giant opaque network, and seeing real savings for it.

If you run a business: ask your broker if direct contracting is even on the table. A lot of them won’t bring it up — because it cuts them out too.

Last one in this series: what you, the patient, can actually do about all of this. 🦉

Your doctor’s office got bought by a hospital system. Your care didn’t change. Your bill did. 🏥

It’s called a facility fee. The second a hospital buys a physician practice, they can start charging you extra — just for walking in the door. Same doctor, same visit, same exam room. New charge.

This isn’t small. The same procedure can cost several times more — in some cases over ten times more — at a hospital-owned outpatient center than at an independent office. Same procedure. Same skill. Completely different price depending on who owns the building.

People have been billed over $500 for a routine pediatrician visit. Over $6,000 for a minor dermatology procedure. Not because the care was different — because the ownership was.

And here’s the part that should bother you: most states don’t even require hospitals to report this. Only a handful require them to say where the care actually happened on your bill. You can be charged a facility fee and never know that’s what happened.

Before you book a procedure: ask if the facility is hospital-owned. Ask if there’s a facility fee. And ask if there’s an independent option nearby — sometimes there is, and it can save you hundreds.

Next up: what employers can actually do about all of this. 🦉

Why do your prescriptions cost so much? A lot of it comes down to a middleman you’ve probably never heard of. 💊

PBMs — pharmacy benefit managers — sit between your insurance and your pharmacy. They decide what you pay at the counter, and that number isn’t always the real cost of the drug.

It’s called spread pricing: the PBM pays the pharmacy one price, bills your insurance a higher price, and keeps the difference. You’re the one covering that markup — often before you’ve even hit your deductible.

For years, pharmacists were legally barred from telling you cash was cheaper unless you asked first. Most states have banned that now, but you still usually have to ask.

Here’s the good news: Mark Cuban’s Cost Plus Drugs sells drugs at 15% over cost, no matter what — some cancer medications go for under $100 that would cost thousands through a PBM-managed plan. And because they publish their prices, they’ve put real pressure on the rest of the industry to be more transparent too.

Before you pay what your insurance tells you to: check your local independent pharmacy, check Cost Plus, and ask.

Two physicians just went to bat for us at the FDA yesterday. Let’s keep the pressure on. 💪

Your pharmacy says it’s out. The FDA says there’s no shortage. Both of those things are somehow true — and it’s costing women access to a medication that changed their lives.

Huge respect to Kelly Casperson, MD➖Urologist and Rachel S. Rubin MD, who went before the FDA to advocate for a formal patch shortage declaration. This is exactly the kind of physician advocacy that moves the needle — thank you for using your voice for all of us. 🙌

Here’s the disconnect they’re fighting: the FDA’s shortage list runs on manufacturer self-reporting, and all six manufacturers report full capacity. ASHP’s list — the one pharmacists actually use — already has 14 estrogen patch products on backorder or allocation.

Estrogen patch prescriptions are up 184% since 2018, because more of us finally know hormone therapy is safe. Demand outpaced supply, and the agency tracking it still won’t call it what it is.

Your voice matters too:
🔗 Sign the petition (link in bio)
📋 File a MedWatch report every time a pharmacy can’t fill your patch (link in bio)
🗣️ Tell your prescriber when you get turned away
📢 Make noise — local news, your congressman, wherever you have a platform

Women’s health has a long history of being an afterthought. Physicians like Dr. Casperson and Dr. Rubin, and patients like you, are pushing back on that — together.

GenX is not going to go quietly!