THE CURE HEIST

The middleman is optional. There are doors around him. Four of them.

Use them in this order. The first one wins most of the time.

First move on any prescription: check Cost Plus. Then Costco cash. Then manufacturer direct if it applies. Then GoodRx to compare.

Ten minutes. Phone in hand. Do all three.

1. Open costplusdrugs.com. Type in every medication you take. Compare to what you pay now.
2. Download GoodRx. Run the same medications through your local pharmacies.
3. If you take insulin or a GLP-1, open lillydirect.lilly.com or novocare.com. The manufacturer is selling direct because even they know the middleman is broken.

If any of those prices beat what you’re paying now, you have a target for tomorrow.

Three parent companies own roughly 80% of US prescriptions.

• CVS Health owns Caremark (the PBM) AND Aetna (the insurer).
• UnitedHealth Group owns OptumRx (the PBM) AND UnitedHealthcare (the insurer).
• Cigna Group owns Express Scripts (the PBM) AND Cigna (the insurer).

Same parent. Three name tags. The referee, the scorekeeper, and the team owner are the same person.

The pharmacist at the counter is not the villain. They run your card, watch the computer say denied, and shrug. They want to help. They are not allowed to help.

Health sector lobbying in 2024: $751 million. Number one lobbying sector in America, ten years running. Both parties cashed the check.

In 1923, Frederick Banting and his colleagues sold the insulin patent to the University of Toronto for one dollar. Each. They did it on purpose. They patented it to prevent someone else from patenting it and locking it behind a paywall.

The story goes, Banting said insulin belongs to the world.

He died in 1941. Plane crash. Age 49.

A hundred years later, three companies control approximately 90% of the global insulin supply. Cost to manufacture: $3 to $6 per vial. List price: up to $275 per vial. The molecule has not changed since 1923. The price has risen approximately 1,200% since 1999.

Alec Smith, 26, died June 27, 2017. He timed out of his mother’s insurance. He cut his dosage to save money. He died of diabetic ketoacidosis.

He gave it away for a dollar. They took it back at three hundred bucks a vial.

Thirty minutes. Spread across the week.

1. For any medication that’s cheaper outside insurance, call your prescriber. Ask them to send the prescription to the cheaper pharmacy.
2. Pull your plan’s formulary (drug list). Check which of your medications are on the preferred tier and which are not.
3. Open your most recent EOB (Explanation of Benefits). Check for denials and wrong “patient responsibility” amounts. Appeal anything that looks wrong. The appeal success rate is roughly 50%. The system is counting on you not asking.

If you have a 401k with a total market index fund, you own UnitedHealth, CVS, Cigna, and AbbVie. Probably without ever clicking a button.

Joey got denied the $1,900 blood test. His 401k probably went up the same week. Somebody bought UnitedHealth at 4am on a Friday using an algorithm. He was asleep.

We are not buying the stock. We are the product funding the spreadsheet that supports the stock that pays our retirement.

You did not choose this. The fund chose it for you. But knowing should change something about how angry you are.

Your body isn’t a market segment.

The system isn’t broken. It’s working exactly as designed. To make money when you’re sick, and to make even more money when you’re too sick to fight back.

The middleman is optional. Four doors, open now.

You do not have to win every fight. You do have the right to walk around the building.