Archive for the ‘Uncategorized’ Category

More Plan Sponsors Eye The Canadian Connection

Saturday, July 2nd, 2022

“What! I thought It was The French Connection!”

county government in New York has been accessing Canadian prescription drugs through their self-funded health plan since 2004 with savings in the millions of dollars. Now we see more employers considering the same by moving away from traditional Predatory Business Models (PBM’s) as drug prices reach unaffordable levels in this country.

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Searching For The Perfect TPA

Saturday, July 2nd, 2022

We are looking for the perfect TPA. Some of the qualifications are memorialized here: Selecting a Third Party Administrator.

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Predatory Business Model (PBM) – The Case of The Missing 40%

Saturday, July 2nd, 2022

Holms & Watson Remain Stumped

SOURCE: Vitori Health

report by the PBM Accountability Project reveals the details of PBMs’ “evolving business models and revenue.” Despite the available financial data, the authors could not identify “the source of nearly 40% of PBMs’ total gross profit.”

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Which Drug Would You Buy?

Friday, July 1st, 2022

DRUG A – This One Costs $683

 

 

 

 

 

 

 

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The Tale of Two Underwriters

Friday, July 1st, 2022

By Bill Rusteberg

“What color is that orange?” asks the first underwriter. “It’s yellow!” says the second underwriter. “It can’t be! It’s an orange!” responds the first.

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AAA – Solution To High Cost Ambulance Service?

Thursday, June 30th, 2022

How many more renewal increases, deductible adjustments, or narrow network offerings till you decide enough is enough⁉️

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Canadian Prescription Drugs Provide Savings For Health Plans

Wednesday, June 29th, 2022

ATTENTION EMPLOYERS: Do you have anyone in your health plan who is costing big dollars due to high-cost prescription drugs? The same drug may be significantly less expensive in Canada.

MEDSAVE MANAGEMENT LLC assists self-funded plan sponsors towards obtaining Canadian prescription drugs for plan members.

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American Hospital Association Issues Fact Sheet on Reference Based Pricing

Wednesday, June 29th, 2022

Some employers are moving away from offering traditional coverage with a provider network and instead are using reference-based pricing for some or all of services they cover.

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States Move Ahead With Canadian Drug Importation

Wednesday, June 29th, 2022

What did the cat say when the train ran over it’s tail?”

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Boiled Alive

Tuesday, June 28th, 2022

Article Referred By Brent Evans

There was once a frog who had been captured by his country and put in a cage. As he was a very scared and naive frog, he believed it when told it was for his own good.

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Canadian Prescription Drug Importation Program

Tuesday, June 28th, 2022

How it Works

  1. We select a Canadian pharmaceutical manufacturer and negotiate with the manufacturer and the seller.
  2. Rx is imported to the United States where we test and relabel the product, transport it to a warehouse, and store it securely.
  3. Your state agency orders the Rx from us, and we prepare, ship, and deliver the order.

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Employers May Have To Pay More in 2022

Tuesday, June 28th, 2022

Employers may have to pay more in 2022. but here’s a solution………

For plan years beginning in 2022, coverage is considered affordable if an employee’s required contribution for self-only coverage does not exceed 9.61% of the employee’s household income.

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Blue Cross: You Can Check Out Anytime You Like But You Can Never Leave

Tuesday, June 28th, 2022

The Bottom Line: Brokers earn bonuses, vacations to keep companies from switching from Blue Cross

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Lawyers Have Field Day With Dobbs vs Jackson

Tuesday, June 28th, 2022

Put two lawyers in a room and they will come out with three different opinions………….

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Does Your Rx Plan Cover RU-486?

Monday, June 27th, 2022

RU-48 was developed in 1980 and came into use in France in 1987. It became available in the United States in 2000. It is on the World Health Organization’s List of Essential Medicines.

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TRS ActiveCare Touts “FREE” Specialty Drug Benefit

Monday, June 27th, 2022

Feel-good email brings great news for plan members but threatens plan finances…..

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New York State Set To Enter Medical Tourism Business

Sunday, June 26th, 2022

New York Announces Special Medical Tourism Package Designed For Pregnant People…………

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Buying Down An Aggregate Corridor

Sunday, June 26th, 2022

Realizing the decision to purchase will be based on worst case scenario, a broker can deliver the lowest bid every time if he knows how.

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Send This Man To Rehab! Will Insurance Cover It?

Friday, June 24th, 2022

We need to know if he’s high. Has he been doing bong hits, blasting rails, chasing the dragon, and/or dropping acid? Is he hopped up on goofballs?

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Former Insurance Worker Becomes A Mermaid

Friday, June 24th, 2022

“The former insurance company worker described the experience of gliding under water, half-human and half-fish, as “meditation in motion.”

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Governor Says “Who, Me?”

Friday, June 24th, 2022

Who, Me? Nope I Didn’t Do It!

New Jersey Governor says he didn’t intervene in insurer dispute

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Cash Pay Health Plans Make Sense

Thursday, June 23rd, 2022

Cash Pay Level Funded Plan Make Sense

Combining level-funded plans with locked-in cash-pay rates for medical procedures purchased prior to treatment creates an innovative cost containment network strategy for employers.

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Amarillo Drug Dealer Makes It Big

Thursday, June 23rd, 2022

Amarillo Drug Dealer Earns Billions

Little did anyone imagine a drug dealer in West Texas (you can’t get there from here) would turn into a billion dollar business. It all started with a $21,000 loan from a loving mother.

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Watch This Case Study Webinar

Wednesday, June 22nd, 2022

“Please take the time to watch this compelling case study webinar that showcases what is possible when an employer takes a truly proactive approach to controlling the cost of healthcare claims” – Dan Meylan

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Texas Based Study On NSA Arbitration Cases Raises Questions

Wednesday, June 22nd, 2022

Texas-based study raises questions about impact of using additional criteria in No Surprises Act arbitration cases

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Weird Insurance Company Names Cropping Up Everywhere!

Wednesday, June 22nd, 2022

First there was Goose Insurance, then we learn about Lemonade Insurance and Good Friday Health Plan. Now we hear about Pie Insurance!

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Gun Bill Includes Extension Allowing Kickbacks to Insurer’s PBMs

Wednesday, June 22nd, 2022

SOURCE: Howard A Green, MD – Linkedin

Can’t make this shit up. US Congress sneaks into the current gun bill an extension allowing continued kickbacks to insurers pharmaceutical benefit managers screwing patients and their physicians.

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Lawyers Get Sued Too

Wednesday, June 22nd, 2022

Lawyers Professional Liability Insurance

Zurich’s Lawyers Professional Liability Insurance Program offers Professional Liability/Errors and Omissions coverage to the following segments of attorneys: Law firms with attorney count of up to 100 attorneys; solo attorneys; part time attorneys and moonlighting attorneys.

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Davita Stock Price Plummets – 10k Report Reveals Fears

Wednesday, June 22nd, 2022

Davita Locations  

Certain payors have been attempting to design and implement plans by limiting the number of in-network providers, setting arbitrary provider reimbursement rates,……….

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Dialysis Limited Benefits Doesn’t Violate Medicare Secondary Payer Statute

Tuesday, June 21st, 2022

“The question in this case is whether a group health plan that provides limited benefits for outpatient dialysis — but does so uniformly for all plan participants — violates the Medicare Secondary Payer statute. We agree with petitioner Marietta and the United States as amicus curiae that the answer is no.

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Bankrupt Status-Quo Health Plan Eyes Cost-Shifting Remedies

Monday, June 20th, 2022

“There is no excuse for this! Poor risk management, old style remedies and believing in magic is a recipe for disaster!” – Don Pedro

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Cassie Brown

Monday, June 20th, 2022

Insurance Commissioner Cassie Brown

Cassie Brown was appointed to serve as Texas insurance commissioner by Governor Greg Abbott in September 2021. She is the chief executive of the Texas Department of Insurance (TDI), overseeing the regulation of the third largest insurance market in the nation and the eighth largest in the world. The agency regulates approximately 2,800 companies and more than 700,000 agents and adjusters.

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100 Million People in U.S. Saddled With Health Care Debt

Monday, June 20th, 2022

6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.

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PBMs Could Be Driving Up Plan Sponsors’ Drug Costs

Monday, June 20th, 2022

In  June 2016, only two months after the contract term began, an individual’s claim for an erectile  dysfunction compound medication totaled $405,325.43 over three months (more…)

Proposal to Import Drugs Creates Unusual Alliance in the Senate

Monday, June 20th, 2022

By Victoria Knight

Harmony is not often found between two of the most boisterous senators on Capitol Hill, Bernie Sanders (I-Vt.) and Rand… Read More

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Bill Smart

Sunday, June 19th, 2022

William Jackson Smart was a twice-married, twice-widowed Civil War veteran and father of 14 children……….

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Summer Session 2022

Sunday, June 19th, 2022

A Public  Purchasing Seminar – June 22, 23, 24, 2022 – Designed for Public Purchasing Professionals with special emphasis on the latest developments that are essential in public purchasing.

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Free Hospital Care For The Uninsured!

Sunday, June 19th, 2022

Attorney General Bonta Issues Consumer Alert Following Reports of Hospitals Failing to Inform Patients of Options for Free or Reduced-Price Medical Care

“Only dumb people pay for health insurance in California” – Molly Mulebriar

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5 Steps to Providing Better Employee Health Coverage: $0 Premium, $0 Copay, $0 Deductible

Sunday, June 19th, 2022

 “Great turnout at TASB Summer Leadership Institute in San Antonio! My presentation was standing room only and about 20 Board Members were listening from the hallway. I’m excited to see so many districts ready to join this movement. Thousands more school employees will have access to affordable health coverage next year.” – Ben Clinton

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Goose Insurance – Historic Change in Product Distribution

Saturday, June 18th, 2022

“Our current system of distribution through independent agents in their brick-and-mortar offices will be largely replaced with digital distribution channels like Goose and Lemonade Insurance startups. That’s the future and the future is now” – Bill Rusteberg

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Attention Plan Sponsors – Stake Your Claim To $485 Million Rx Settlement

Friday, June 17th, 2022

Ranbaxy exploited the FDA’s “abbreviated new drug applications” (ANDAs) in order to secure valuable first-to-file generic status and lucrative 180-day exclusivity that comes with the first-to-file status.

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New Sales Opportunity For California P&C Agents

Friday, June 17th, 2022

How many Californians have guns? Whatever that number is, a proposed government mandate requiring liability insurance will bring fast and easy bucks to aspiring P&C agents. “George, you own a gun?” is the opening line sales pitch……………”Then you have to buy this policy or go to jail!” is the closing line………………”Sign here!”

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AMPS Offers Solutions For Hospital Sponsored Health Plans

Thursday, June 16th, 2022

Advanced Medical Pricing Solutions (AMPS) offers the consultancy experience, external contacts and integrated solutions you need to make it possible…………..

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Texas Shuts Down Unlicensed Insurer – 65,000 Policyholders Affected

Thursday, June 16th, 2022

TDI orders unlicensed insurer, Salvasen Health, to wind down operations in Texas

The Texas Department of Insurance (TDI) issued a consent order (PDF) today requiring Houston-based operation Salvasen Health to stop selling unauthorized health insurance and begin an orderly shutdown.

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Does Free Cafeteria Plan Administration Constitute Rebating?

Wednesday, June 15th, 2022

Cafeteria Plan Administrators offering “Free” administration services in return for selling insurance products earn commissions on insurance policies sold to plan members.  Nothing wrong with that, sounds like a good deal. But are there any regulatory issues?

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Employers – It’s Time To Help Hospitals Achieve Their Charitable Mission!

Wednesday, June 15th, 2022

Give Me Your Poor, Your Tired, Your Huddled Employee Masses…………..You may be surprised by how many of your employees are eligible for free hospital care!

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Clueless City Struggles With Health Care Costs

Tuesday, June 14th, 2022

KEY TAKEAWAYS:

  • Top two rated insurance consultants replaced with the bottom two ranked consultants proving it pays to be last

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Texas MedClinic Acquired By Community Health Partners

Monday, June 13th, 2022

Dr. Bernard Swift, founder and CEO of Texas MedClinic

Texas MedClinic sold to larger private equity-backed network.  The company announced the sale of 20 urgent care clinics to national operator Community Care Partners.

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Go Farther Gasoline

Monday, June 13th, 2022

A tankful of Go Farther Gasoline would sure go a long way towards easing the pain at the pump these days…………………..

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Hospitals Fined The Equivalent of Two Hospital Admissions

Monday, June 13th, 2022

“Don’t worry, it’s only a scratch. We’ll make it up on the next one or two hospital admissions” 

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U.S. LawShield – Legal Defense Protection for Gun Owners

Monday, June 13th, 2022

Texas Man Wins Arms Salesman of The Year

There is no other arms salesman on the entire planet even close to what this Gun Salesman of The Year has achieved! He has sold more guns in less time than anyone else in history. His secret sauce? Reverse psychology selling – “Hell, yes, we’re going to take your AR-15, your AK-47…..”

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Tesla Insurance

Monday, June 13th, 2022

Will Tesla take the top insurer spot from State Farm?

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Community Care Partners

Sunday, June 12th, 2022

Community Care Partners is a physician owned and managed group of urgent care and primary care clinics serving patients across the United States under the brands Nova Health, SouthStar, Coastal and BestMed Urgent Care.

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Yottaflow Offers Instant Online Stop Loss Quotes

Sunday, June 12th, 2022

MyHealthGuide Source: Yottaflow, 6/7/2022

CLEVELAND — Yottaflow is excited to announce brokers and TPAs can now obtain illustrative stop loss quotes instantly from Yottaflow’s quoting partners.

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Aldeen’s Sunday Morning Bathroom Read

Sunday, June 12th, 2022

By Doug Aldeen, Attorney at Law

Lawyers are the fourth branch of government: If you cannot legislate or regulate it, litigate it.

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Geico To Pay $5,000,000 For Car Sex?

Saturday, June 11th, 2022

Car insurer Geico may have to pay $5m after woman contracts STI in a vehicle………..

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Howden Acquires TigerRisk

Thursday, June 9th, 2022

Howden acquires TigerRisk, creating “much-needed” fourth global reinsurance broker

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Everything You Need To Know About Writing Professional Liability Insurance in 30 Minutes

Thursday, June 9th, 2022

Any business that gives advice needs professional liability coverage including insurance agents and consultants active in health care…………………..

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What Does The Future of Healthcare Look Like?

Wednesday, June 8th, 2022

The world of medicine is changing faster than ever, with new treatments and technologies being discovered all the time. The Medicine 2042 conference, taking place between June 8-9 in Tel Aviv envisions the future of medicine and science, and what that might look like in the year 2042 and beyond.

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Pay Your Hospital Bill with Salt Water

Tuesday, June 7th, 2022

“You have provided me with a surprise medical bill.  I am providing you a surprise medical payment …………..”

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Wholesale Brokerage Expands Texas Footprint

Tuesday, June 7th, 2022

 

 

The MGU unit acts as an underwriting manager for various insurance companies for which it primarily underwrites ICOA insurance, Texas Non-Subscriber and related insurance products.

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I Don’t Have Time To Choose The Right Vendor!

Tuesday, June 7th, 2022

Shortlister – An HR vendor selection community that helps empowered, data-driven technology buyers to find and choose the right vendor.

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Dostarlimab 

Monday, June 6th, 2022

18 rectal cancer patients were given dostarlimab every three weeks for six months and ended up cancer-free………………………….“I believe this is the first time this has happened in the history of cancer………”

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Another Virtual Healthcare Offering Hits Market

Sunday, June 5th, 2022

Benefits include unlimited virtual visits with $0 copay and $0 deductibles, capacity to treat over 1,500 conditions, the ability to prescribe medications and write orders for labs, x-rays and other diagnostic tests………………….Dedicated physician, $1 drugs………….

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Backstory On This Whole Rx Rebate Fandango

Saturday, June 4th, 2022

As Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean……………..

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Amber’s Homeowners Insurance Policy To The Rescue?

Saturday, June 4th, 2022

“While legal experts say using homeowner’s insurance policies is common in defamation cases, Virginia lawyer Jeremiah Denton told The Post that most policies have a clause that stipulates judgment costs will not be covered.”

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Obamacare Premiums Set to Spike By 53%

Saturday, June 4th, 2022

“What turned the Joker into Joker was losing his government-subsidized mental health care. His whole life went to shit because the government made him dependent and then pulled the rug out from under him.”

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Radion Health

Thursday, June 2nd, 2022

A 400 life case can be underwritten without claims experience or individual health questions?  That’s interesting………….Is experience rating becoming a thing of the past? (more…)

We Want Your Stop Loss Business

Thursday, June 2nd, 2022

Web based real time on-line final rates, immediate firm quotes, no participating requirements, quote down to 10 lives……………………level funding made easy

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State Farm Email Solicits Agents For “Unique Project”

Thursday, June 2nd, 2022

“On January 18, 2022, State Farm sent an email recruiting its agents for a “unique project”. Consumers’ Research obtained a copy of that email, and we knew we had a duty to alert the public.”

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The $1,000,000 Vitori Victory© Guarantee

Wednesday, June 1st, 2022

Meet the Vitori Victory© Guarantee, the first of its kind.  This health plan savings guarantee will reimburse you up to $1,000,000 if we don’t hit your savings target.*

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FDA: Pharmacists and Wholesalers Can Import Drugs From Canada

Tuesday, May 31st, 2022

“How Sweet It Is…………………….!

Pharmacists and wholesalers can import drugs from Canada but only as part of state programs ……………meanwhile, back at the ranch, everyday Americans are importing Canadian drugs for personal use often facilitated by plan sponsors under the personal use doctrine achieving significant savings. An 800 life  San Antonio employer ran 12 months of paid drug spend through CANARX and found they could have saved over $800,000………A county government employee health plan has saved millions by importing Canadian drugs for personal use of their plan members since 2004…………….

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 No Surprise – “Pure” RBP is Always Superior

Tuesday, May 31st, 2022

The most effective way to address the NSA legislation, particularly elements of the IDR process, is to adopt a “pure” RBP plan.

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Health Insurance Stocks Through The Roof!

Tuesday, May 31st, 2022

Health Insurance Carrier Stock Performance Has Been Amazing!

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Latuda

Monday, May 30th, 2022

The cost for Latuda oral tablet 40 mg is around $1,503 for a supply of 30 tablets according to drugs.com. That’s $50 per pill.

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