Congressman Fed Bitter Pill After Online Complaint About Drug Coverage Denial

Representative Greg Murphy, a physician-turned-lawmaker with an estimated net worth of $18 million, took to X this week to complain that his insurance company and its pharmacy benefit manager, CVS, had blocked a medication he has taken for over five years. The complaint was received about as well as would be expected.Sounding very much like thousands of his constituents, the North Carolina Republican, who serves on the House Ways and Means Committee Health Subcommittee, bemoaned that he had been forced to wait weeks by an unnamed insurance provider and CVS.“So once again my wonderful insurance company, and its PBM partner, @CVS is blocking a medicine I have been taking for over 5 years. Instead of just renewing it, pre-authorization has held it up for over 3 weeks in the hope I will just pay for it out of pocket,” the congressman wrote on X.The post sparked immediate backlash — no small amount of it noting the irony. “Maybe call one of your PBM lobbyist friends. I’m sure they can hook you up,” wrote health plan architect Christine Price.Others were less restrained. “No offense, but good! What you guys are doing to the medical field is absolutely criminal,” wrote a Tampa-based eye surgeon, Kyle Linsey, referencing the federal health insurance program for elderly, disabled, and lower income Americans. “You keep cutting CMS reimbursements and expect us to have sympathy for you because you can’t get your drugs.”Dr. Murphy has long positioned himself as a health care reformer. On his congressional website, he writes that “greedy practices that put profits over patients have been a driving force that have caused healthcare costs to soar.” He has introduced multiple pieces of legislation through the years, including this congressional session, aimed at bringing daylight to billing charges and profit structures by hospitals, insurers, and pharmacies. In January Dr. Murphy grilled the CEOs of UnitedHealth, CVS, Cigna, and Elevance at a committee hearing. “You have put profits above patients,” Mr. Murphy told them. “You have squarely abused your position of authority to deliver healthcare to patients in this country.”However, little has come of the congressman’s efforts or any health care reform for that matter, in no small part because of cross-party disagreements over the federal government’s obligation or ability to help pay for personal coverage. Several X users were quick to point out the gap between Dr. Murphy’s financial circumstances and those of his constituents. “And yet, you still have better insurance than the vast majority of your constituents, guaranteed for life,” wrote a self-described nurse and mom, GlassyLady. User @ADHDMom5 offered a terse few words: “Physician, heal thyself.”Dr. Murphy is not alone in his criticism of insurance companies. The prior authorization system drew fire from physicians who described the insurers’ delays and denials as a daily reality. “Happens every January in my practice. It sometimes happens every time we change the dose of a med we already got approved last month,” wrote an internal medicine physician, Ric Montemayor.“This is every single day in America, over and over and over. Patients and physicians getting tortured & crushed. Deny or delay, that is their MO,” wrote an orthopedic surgeon and former member of President George W. Bush’s Council on Physical Fitness and Sports, Nicholas DiNubile. “And those Insurance Companies, who are posting record quarterly profits, are fully insulated and protected, with no consequence for the medical decisions (deny/delay) they are making. Where is Congress on all this? Crickets.”Others questioned the implications of insurance companies owning pharmacies. “What can you expect from AMERICA’S WORST CORPORATE CITIZEN!! @CVSHealth must be SEPARATED FROM CAREMARK. I beg that you subpoena ALL third party billing records, including state and federal employees. Share discrepancies in payment to independent pharmacies an CVS, and billed amt,” wrote a compounding pharmacist, William Beckham.The frustration comes at a precarious moment for American health care. The Trump administration recently announced it will end a Biden-era subsidy program that helped keep Medicare Part D drug premiums stable for roughly 23 million seniors. The head of the Centers of Medicare and Medicaid Services, Mehmet Oz, defended the move on social media, claiming premiums would rise by less than $10 for most enrollees — a figure disputed by health care advocacy groups, who warn the impact on fixed-income seniors will be far more significant.

Congressman Fed Bitter Pill After Online Complaint About Drug Coverage Denial

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