Opinion Voices | Contributor: Focus on the real causes of the shortage in hormone treatments by Jennifer Weiss-Wolf and Suzanne Gilberg

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The article explains that the nationwide shortage of estradiol hormone patches for menopausal women is not due to a surge in demand but stems from structural problems in the U.S. pharmacy benefit manager (PBM) system, where a few vertically integrated insurance‑pharmacy conglomerates (CVS Caremark, Express Scripts, OptumRx) control most drug coverage and logistics, giving little incentive to keep low‑margin generic products like estradiol patches consistently stocked and instead favoring higher‑priced alternatives; the piece also notes that prescription rates for hormone therapy have actually remained low, debunks media narratives blaming women, and offers practical short‑term coping strategies (alternative formulations, online or compounding pharmacies, calling ahead) while urging systemic reforms to break the PBM-driven supply constraints.

Read more: https://www.latimes.com/opinion/story/2026-04-20/estradiol-patch-shortage-drug-supply

#FDA #CVSCaremark #ExpressScripts #OptumRx #CVSHealth #Cigna #UnitedHealthGroup #FTC #

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#SMDH
Hey #OptumRx , I wanted to send a secure message from your Member Services site to OptumRx about a pharmacy order, but the URL points to the adobeaemcloud domain! 🤦‍♂️

How is this for incompetent IT?

New problem from OptumRx (UHC): If dose of medication is changing, acquiring the new dose is considered a refill. I must use at least 80% of the prior dose before I can request the new one.

This medication (Mounjaro) is 4 single use autoinjection pens. This policy means I must use all 4 pens before I can request the new dose.

Orders can take over a week for this medication. I have to run out before I can request more, and risk being late on the next dose.

#USHealth #Insurance #UHC #OptumRx

Looks like OptumRx has told my pharmacy they don't want to cover the one triptan I found that they are supposed to cover.

OptumRx is owned by United Healthcare.

I'm so sick of this.

#USHealthcare #UHC #UnitedHealthcare #UnitedHealth #OptumRx

I found one generic triptan covered, in the form of a nasal spray: zolmitriptan. I'm a little concerned about the potential side effects, but I haven't had any issues with sumatriptan, so maybe it'll be fine.

This is such a stupid problem to be having.

#USHealthcare #OptumRx #UHC #UnitedHealthCare #UnitedHealth #Migraine

Forgot one drug in my drug coverage research: sumatriptan. If you suffer migraines, either episodic or chronic, you know what this is.

Coverage denied.

So researching...I can't find any triptans covered.

I guess fuck people with migraines? Just take high strength pain killers?

No wonder we have an opioid crisis.

Need to do more research. I refuse to fall back to rescue medications.

#USHealthcare #OptumRx #UHC #UnitedHealthCare #UnitedHealth #Migraine

Health insurance companies are notorious for exploiting prior authorization schemes to avoid paying for care and have denied claims at alarming rates in recent years.

However, corporate consolidation of industry “middlemen” that experts say are partially to blame for the prescription drug affordability crisis has received less scrutiny from the general public,
despite efforts by lawmakers and the Federal Trade Commission (FTC) to shine light on the notoriously opaque and confusing corporate bureaucracy that determines the cost of medicine.

We often hear about Big Pharma selling drugs at high prices
and insurance companies dragging their feet when it comes time to pay the bill,
but the prices patients pay out of pocket for pharmaceuticals is largely shaped by the connective tissue between insurers and drug manufacturers: #pharmacy #benefit #managers, or PBMs.

PBMs have been around for decades, but the largest PBMs have merged with major insurance companies to form conglomerates,
including UnitedHealth Group’s #OptumRx.

In theory, PBMs negotiate discounts and rebates paid by drug makers that are passed onto insurance companies and their patients,
but the lack of transparency in that process has long frustrated lawmakers and regulators attempting to contain the skyrocketing cost of medicine.

The PBMs say their secret negotiations with drug companies make prescriptions more affordable for consumers,
but this system has not shown to protect patients from sticker shock at the pharmacy counter.

Nearly 30 percent of Americans say they haven’t taken prescribed medication due to cost,
and an estimated 1.1 million Medicare patients alone could die over the next decade because they cannot afford the drugs prescribed by their doctors,
according to the American Hospital Association.

The FTC reports that in 2023, the U.S. spent more than $722 billion on prescription drugs,
💥nearly as much as the rest of the world combined.

Clearly the system is not working for patients or public health,
and policy makers in both parties have increasingly focused on the PBMs
and their recent mergers with major insurance companies.

According to a two-year FTC investigation on health care conglomerates released in July,
PBMs are “powerful middlemen inflating drug costs and squeezing Main Street pharmacies.”

“We’ve heard accounts of how the business practices of PBMs may deprive patients of access to the most affordable medicines
and how doctors find themselves having to subordinate their independent medical judgment to PBMs’ decision-making at the expense of patient health,”
FTC Chair Lina Khan said in a statement at the time.
https://truthout.org/articles/its-not-just-denied-claims-insurance-firms-are-hiring-middlemen-to-deny-meds/

A reminder that OptumRx is a UnitedHealthCare company and is very good at preventing patients from getting medication prescribed by their physicians. Also very good at preventing patients from getting their covered meds at local pharmacies.

#OptumRx #UnitedHealthCare