Get Rid of the Middlemen!

Ever wonder why medications and medical supplies are so expensive? Ever wonder why some critical medications are in such short supply?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Get Rid of the Middlemen!

  1. Steven Zeitzew
    April 2, 2019 at 2:34 pm

    I understand that in some states Physicians are permitted to directly purchase wholesale generic drugs and then dispense and sell them to patients either at cost or with small mark-up. There was an article at the Kevin MD blog…

  2. Kurt
    March 27, 2019 at 2:00 pm

    Yeah and I really like the $5.00 a pill tetracycline when it used to be 2 cents.

  3. Janis Chester
    March 27, 2019 at 11:25 am

    If you would like to submit comments to the administration to get rid of the parasitic middlemen, please use this format (you can cut and paste or edit) generated by the Association for American Physicians and Surgeons.

    Step 1: Copy these template comments:
    Dear Secretary Azar,

    I am writing in support of the HHS proposal that rebates on prescription drugs covered by Medicare Part D and Medicaid be passed through to patients at the point of sale.

    Currently rebates are too often pocketed by middlemen in exchange for covering a certain drug while excluding others. Drug choices should be based on which drug is the best fit for an individual patient, not on which manufacturer pays the biggest bribe to the Pharmacy Benefits Manager (PBM).

    However, while the proposed change will lower costs for some patients, it is not a panacea for drugs that are too expensive.

    Until the root problem of widespread third-party payment for non-catastrophic needs is addressed, prices will remain bloated. To see prices drop, it is imperative to put patients in charge of their own spending and care decisions, especially for everyday medical care and medications.

    HHS need look no further than the success of Direct Primary Care practices in dramatically lowering drug costs for their patients by offering them medications at near wholesale prices:

    In Pennsylvania, a DPC physician saved a Medicare patient nearly $300 per month for the 4 to 5 months per year she was in the Part D coverage gap. A physician caring for underserved patients in Detroit was able to offer a patient $1012 per month savings on the patient’s eight medications. A Wichita cancer patient was quoted $2200 per month for a needed medication, but his DPC physician was able to purchase it for $6.70 and pass that price along to the patient.

    To put it simply, the more entities in between patients and the care they need, and the more third-party dollars are used to pay for the care, the more expensive it will be. Congress, in tandem with HHS and other federal agencies, too often enact policies that increase third party interference and payment. It’s time to move in another direction toward excising the middlemen and encouraging competition by empowering patients to obtain high-quality, low-cost care, directly from the medical professionals of their choice.

    Step 2: Visit the comment submission form, paste in the comments, modify them to your satisfaction, and submit.

    The comment submission form is located at:

  4. Jennifer Hollywood
    March 27, 2019 at 8:21 am

    The video doesn’t point out that now many of the PBMs and insurance companies are owned by the same parent company. Therefore the patient’s own insurance company is actually increasing the cost of health care by simply putting the money in a different pocket (the PBMs) and then claiming that their (the insurers) costs have gone up. Then the insurer charges the patients more money for insurance. All the while the insurers are blaming increasing costs on the physicians and harassing physicians with PCMH’s (PROFIT centered medical homes) in an effort to make it look like the insurer is trying to save everyone money while providing good care. It’s like a magic show- lots of redirection.

  5. George Voigtlander
    March 27, 2019 at 8:21 am

    Good expose of these parasites. When someone dies due to self rationing of life saving meds do they become saprophytic?

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