PBM
Psyence Biomedical Ltd. Common Shares
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Keep an eye on PBM. Keeps getting halted but worth a peep 👀
PBM another one of these run, halt, run halt that is impossible to get into
Their visor tech was used in the Venezuela raid. They're partly embedded in the US military which is why Congress won't target them as a monopoly. Microsoft and Nvidia are safe from antitrust regulation, because our leaders are afraid that splitting them up or hindering them in any meaningful way will allow China to leap ahead of us technologically, with their own corporations. The only "monopoly" we've split in years was CVS and Aetna. But Id argue they weren't really a monopoly to begin with: buying Aetna, the largest PBM, was just a strategy to shield them from Walmart and Amazon's expansion into pharmaceuticals. They also paid too much for the PBM and have been reeling from the cost
They have been ripping off people in health plans and employer groups for years and closing independent pharmacies with their underwater payments for services rendered for their PBM . They are about to have that rug yanked , you will see more insiders from the government dumping this trash companies stock.
In the case of UNH, your comment is not accurate at all. Over the past decade or so they have been aggressively both vertically and horizontally integrating to keep all the money for themselves. Even Congress has called them out for it, specifically buying out other insurance companies and expanding into the PBM business yet their prices have only increased.
True, but Buffet usually bets on durability over decades, not smooth quarters and PBM reform is a real earnings headwind in the sort to medium term.
Oh, health dropped due to PBM investigation for CVS and UNH(they own optumrx)
$PBM cancelled RS announcement today. $PFSA has a RS proposal on the vote for 1/27. Maybe some of these - low float stocks sorted by lowest RSI ;) https://preview.redd.it/u68jnhvyzreg1.png?width=1743&format=png&auto=webp&s=2436535e2d8e01b06e38acb199a4dbf760c36005
ACRV was a PBM level bull trap
I have completed a structural and probabilistic audit of Geron Corporation (GERN). I’M GOING ALL IN AND STARTING A SQUEEZE. The entity has transitioned from a clinical-stage narrative to a commercial execution engine following the FDA approval of Rytelo (imetelstat) in mid-2024. Phase 1: The Archetype • ECONOMIC DNA: DISRUPTOR (Commercial-Stage). Geron is moving from a "Capital Sink" to a "Revenue Engine." The core driver is Imetelstat’s first-in-class telomerase inhibitor status for Low-Risk MDS. • VALUATION BRIDGE: Market sentiment is currently depressed (trailing ~12% decline month-over-month) due to a Q3 2025 revenue miss ($47.2M vs $54M expected). The Valuation Delta is wide: the market is pricing in a "linear growth" failure, while structural reality shows a 150-account expansion (1,150 total) and a 97% gross margin. • CAPITAL VELOCITY: Currently a reinvestor. The entity is aggressively burning cash for the EU launch (2026) and the IMpactMF Phase 3 trial. Phase 2: Stability Scan • PRICING RESILIENCE: PRICE MAKER. In the orphan/specialty heme-onc space, Rytelo holds significant pricing power, though it faces competition from Bristol Myers Squibb’s Reblozyl. • CAPITAL STRUCTURE AUDIT: LEAN/STABLE. Cash and equivalents sit at $420M (as of Sept 30, 2025). With a revised downward OpEx guidance ($250M-$260M), the runway extends into 2026/27, reducing immediate dilution risk. • SYSTEMIC RISK: High sensitivity to Medicare/PBM drug pricing negotiations and the "adoption lag" in community oncology centers. Phase 3: Analytic Deep-Dive • MARKET PLUMBING: • Implied Volatility (IV): 76.0 (63rd percentile). Options are pricing in higher-than-average movement. • Put-Call Ratio (PCR): 0.06. Extreme bullish skew in open interest; the market is heavily bet on a "call-side" recovery. • Gamma Walls: High concentration at the $2.00 and $3.00 strikes. Price is currently pinned in a "liquidity vacuum" below $1.50, lacking the delta-buying pressure to trigger a squeeze. • SIGNAL AUDIT: Smart money remains anchored. RA Capital and BlackRock hold significant positions (>16% combined). Recent 1/3 workforce reduction (Dec 2025) suggests a pivot toward "Efficiency over Expansion." • TIMESTAMP: Data retrieved as of Dec 30, 2025, 21:28 EST. Phase 4: Probabilistic Synthesis (Bayesian Update) • THE PRIOR: Biotech commercial transitions succeed in scaling to profitability only ~15% of the time within 24 months. • THE UPDATES: • Tier A (1.0): FDA/EMA Approval secured; Rytelo 97% gross margins (High Quality). • Tier B (0.6): Q3 2025 revenue miss; demand down 3% QoQ; workforce reduction (Mixed Quality). • Tier C (0.3): Bullish analyst price targets ($3.00+); high short interest ratio (10+ days to cover). • THE POSTERIOR: Calculated probability of outperforming the XBI (Biotech Index) over 18 months: 58%. The workforce reduction and EU launch prep act as the primary "Update" to the success probability. Final Synthesis & Output Confluence/Divergence: DIVERGENCE. The Chart/Price Action is bearish (near 52-week lows), but the Options Chain (PCR 0.06) and Institutional Holding (RA Capital) are aggressively bullish. This signals a "Value Trap" for short-term traders but a "Generational Entry" for long-term Bayesian players. 3. CONVICTION SCORE: TIER 2 (Strategic Opportunity) • The "Product" works and the "Moat" is legal/regulatory. The "Risk" is purely execution-speed. 4. DATA INTEGRITY SCORE: 9/10 • Recent Q3 filings and Dec 2025 restructuring news provide high-freshness data.
Haven’t seen too much about PBM on Reddit, maybe I need to dig deeper. Any of you all have thoughts about what happened on Friday, was it quad witching? Fin-tel shows 2.5M dark pool shorts applied on Friday and they went from good news, $2.06/share down to under a dollar. I jumped in around the dollar mark with a few thousand shares, I’ve swung this a few times this year, but trying to figure out are we going to probably be held down for a longer time period, or are we going to probably bust from a squeeze with their next exciting update? Seems like someone is trying to kill this stock and company…
ASTI…what a recovery bought at 2.39, hit a 52 week low twice lol then hit a 52 week high 3 weeks later…did it again on PBM, and again on CMBM. I don’t like talking about it lol
Can PBM capture the same lightning as Bright minds? Buying some shares gonna test it out...its gotta pop right?
PBM has some potential also.
In terms of plan providers, I know a lot of people talk about UNH, MOH, CNC, ELV but Cigna seems like a name never talked about. They have little to no medicare or medicaid exposure (which I would prefer to avoid) as they primarily serve employer plans. The one caveat is they are a large PBM, so not really a loved industry at the moment. They took a large haircut this past earnings due to expected margin pressures as they are revamping the PBM business from rebate to fixed rate to align with political pressures. Not an exciting name to be honest, but a bit low beta if you are looking for that. Trades very cheap (forward P/E of 8) as the margin pressures are fairly well discounted now. Management did state they except modest growth despite these headwinds. CEO bought a large number of shares on the sell-off post earnings (near the 240 level).
Wellgistics Health (NASDAQ:WGRX) and TheracosBio Partner to Expand Nationwide, PBM-Free Access to Brenzavvy(R), an FDA-Approved Diabetes Therapy, Through 6,500+ Pharmacies
PBM - holy cow! The news this morning was a nothingburger, but I'm not seeing why it resulted in a 22% drop to below its 52-week low.
PBM working on a rebound
PBM positive news. Currently dipping hard from some volatile action. Volume increasing fast. https://preview.redd.it/yjljysusme2g1.png?width=1458&format=png&auto=webp&s=517c5e3870b764b2eaa1c15deaaf3ff8956aed5e
sounds like how PBM operates, oh wait, they also got themselves into the prescription business, go figure
It's not "no news". I believe the catalyst for the recent stock price collapse was coming from CI earnings, where they said they are basically giving up on a lot of PBM margins to avoid political scrutiny. CVS and UNH tanked too given that have PBMs. Further, earnings were confirmed to be shitty too. Decreases in margins, unclear outlook for 2026, etc. Management said that EPS growth might not resume double digit growth un 2027. I gave up and walked away with a 10% gain.
CI or BMY? CI just warned of margin compression over the next two years due to PBM contract renegotiations and not providing guidance. They tend to operate conservatively so the sell-off is a bit of an overreaction but warranted. Definitely at least a $300 stock if you use the $29.60 EPS and throw a 10 multiple on it. Doesn't seem right to give it any lower of a multiple. BMY is likely a sell the news on the report. Pipeline needs to deliver and it doesn't seem to be doing it.
Pharmacy is about to take a brutal hit from negotiated Medicare pricing and the PBM and insurer worlds are struggling right now too. Feels like forward guidance might be shaky. Still no extension of ACA subsides.
Medicaid is a small part of their business. They have a large Medicare Advantage business and they also own the largest PBM. They should crush the EPS estimate of $2.81 but the key is the MCR and how much they hype their AI pivot.
I posted about SLS forever ago. (Not a penny) but also archer at $9. Posted about HIT at $0.80. Posted about MDAI still moving up. Just actually read the dd and do your own. There are still people posting about real growth potential companies. Someone posted about NUAI @ $0.48 I biught $1000 and sold because I got weak hands but just got to did through the trash and you’ll find the gold. Posted about PFSA before they had a 150% move the day before and got downvoted into oblivion. PBM and CGEN are still sleeper companies.
PBM, BIAF,IMMP, RVPH, SENS after RS will have a look.
$PBM tiny float been trying to go today. 4$ tonight will be 10 soon
PBM - there’s rumors they’ll get breakthrough status. Take that as you will.
You son of a bitch, I'm in. This play is going to print and the DD doesn't fully factor in vibes. The Optum Rx cybersecurity outage was catastrophic for pharmacies. Their PBM wing is on an apology tour "increasing payments to pharmacies" right now, presumably trying to mend fences for their colossal fuckup straining businesses and people to the breaking point before contracts come up for renewal. That client retention groveling will drag profits over the next few quarters, if it even works on everyone. Lastly, open enrollment is finally nigh and I am predicting a decrease in sign ups. Everyone hates UNH. We saw what happened when the CEO got demoted to compost last December, no one gave a fuck. Everyone was already locked in to plans for the year, but they're about to choose again. Some will have options. Some will think of Luigi and say "fuck UNH I'll pay $10/mo more to go with HealthNet." No one is out here saying "I can't wait to sign up for UNH, they're so well known for not fucking over patients!" Situation gets worse for UNH if the ACA subsidies aren't extended and premium cost spikes. Many reasonably healthy people will simply roll the dice on nothing bad happening this year and not sign up for any coverage, leaving only sicker patients who need more care signed up. Lastly, a wild card - Taco dropped a 100% tariff on imported prescription meds. No fucking clue how that is going to play out. Will it be savings due to meds not given? Or losses due to missed meds causing bigger, more expensive problems?
Family member works for an independent pharmacy, this may put them out of business. Pharmacies operate on a very thin margin, and reimbursement rates are set by the PBM. They already lose money on many meds because PBMs set reimbursement rates lower than the medication cost. You can't refuse to fill them or you can get dropped from the contract. Im not convinced the PBMs will change the reimbursement rate enough to cover the cost difference. Basically the cost is now doubling and there is no ability to change how much they get paid. I bought puts on CVS, we will see what happens.
Any of you fine regards have any info on the PBM premarket chaos?
I agree that the PBM threat is understated by bulls. >To me it just seems like the whole US health insurance business is a sinking ship. Lots of people want lower premiums and a public option. If your time horizon is 10+ years, I agree. But the federal government has been pushing seniors more towards Medicare Advantage than the regular Medicare these days because of cost control reasons. I don't see health insurance reform being a thing over the next few years because of how ossified our politics have gotten. PBM legislation is only moving forward because it hasn't been vilified like Medicare for All has been.
I'm bearish. I think it's objectively the worst health insurer in the country and I don't get why anyone would want one of their policies unless they had no other option. Add to that the anti-PBM legislation being proposed, I don't think enough UNH people are considering the threats to their PBM business. All of that is before the DOJ stuff. All we have to get at this point is more reps in office to push for US healthcare reform, which we will since the GOP is torpedoing their chances at every turn, then that will cut into insurer profits. To me it just seems like the whole US health insurance business is a sinking ship. Lots of people want lower premiums and a public option. There are way, way better and lower risk investments than UNH. I don't get the appeal of it.
Momentum and trend support is your main focus. Short terms catalysts are very important as well, they more often than not lead to excessive hype, lot of buys, and might dump before or on the expected catalyst news, aka sell the news. Some notable stocks: Open(being mentioned in reddit million times a day, already up a lot from $0.5), HCTI after RS, PBM a month and half after RS, ICU during sep october 2023, ALZN, CING, MNPR(all those three i picked during may june 2024 and the catalyst ran hard afterward). Forgot to mention, that picking a stock after RS could be a good thing, as the float is tiny(careful from dilution) and the stock moves fast on both ways, that's assuming there is some hyped news on the way...
Fun fact: About a decade ago UNH bought Optum for their prescription solutions PBM. Which ran and as far as I know still runs on Cobol. We were hired as consultants to try and fix it for them. They paid a shit tonne of money and decided Cobol was superior, when the newer .NET solution could only fulfill a few million scripts a day versus the Cobol one who just did unlimited somehow. Whole place runs on the equivalent of Atari's.
Did some major profit on it last year, when it rose from 0.50 to $14. Missed this run, but i'll wait for re-entry. Currently watching SXTP and ALZN and looking for re entry at PBM(did a huge move couple of months after RS due to positive news).
As others have said this one has already did its thing. When you look at CTB ideally you want to see it increase by at least 100%. This type of increase can likely mean an incoming event. SLRX does have a high CTB but it’s trending down from 900 something percent. Also it’s pretty when it’s stable like it this I believe it’s priced into the investment. I’ve seen tickers with very high CTB sit for years…(where my BTCM holders at?) https://preview.redd.it/kxqby904j9hf1.jpeg?width=1179&format=pjpg&auto=webp&s=ecb210d792cec80736f7f6bb65b4188a06e7c5ee For example, PBM has a nice trend up from 137 to 233 over a few days. Sometimes it’s more drastic than that.
GORO for 1. Vanguard and BlackRock increased right before earnings. Almost like institutes know it'll be $1.50 by year end. Yes I'm a shareholder. PBM for 2. 46% institutional ownership. Ibogaine research. If you don't know what Ibogaine is then I most definitely recommend you research it. Get ready to have the most drugged, pill-popping, country on earth all of a sudden have zero desire to use a drug any more, including alcohol. It's not just for addiction, there's positive news for people with brain injuries and PTSD. I'm a shareholder as well.
Thats true but there3 are 2 spots where you could have made 30-40%. I don't gamble on buying in and hoping there is a catalyst $PBM topped at 135%, BTAI, $VERB went to 115 04 15% roughly if you got in pre-market and $BTAI went as high as 70%. All decent gains. I don't claim to have a magic 8ball, ITs 50% skill 50% luck. However i get lucky alot.
$PBM just like the drones were far out and now they’re closing in, this is next. With Joe Rogan, pushing the narrative and Trump loving the approval of the GenX, I’m sure it’s bound to be federally legalized very soon.
You gotta call that the night before , Friday 8/1 .. PBM all the gains took place at market open
Anyone have any news on PBM?
Anyone into PBM? Whats happening with it?
Whats the deal with PBM? Any massive news or something?
As soon as it opens, the PBM is gaining strength
Trump is gonna stick it in and break it off on these crooks. I say that's not enough, PBM system and healthcare systems, taken over by insurance companies needs to be eliminated completely along with the ACA. Eliminate all taxpayer funded insurance carriers. Go to the system we all deserve, expand Medicare to all citizens and not this democrat run money laundering scheme we have now,
$PBM is a low float Psychedelic treatment play that's super cheap, meaning low market cap and stock price.. It's been heavily shorted, yet it's pumping after hours at the moment. I could see the price going down to $2 just as well as it could triple to $12+. Phase 2 trial news is impending, but probably coming out later this year.
Even if it does work, congrats, you will pay less for medication. Guess what will go up as a result? Your insurance premiums. Anyone who believes this BS is an idiot who has never heard 'PBM'. PBMs are the biggest contributing factor to absurd prices. They are why corporate pharmacies have all the power and there's basically no legitimate 'mom and pop shop' pharmacy. UNLESS said pharmacy is operating at a loss or unsustainable profit margins. This is why almost ANYWHERE you see a small pharmacy, you will often see them selling all types or other products, or said pharmacy is also involved in research and development and has created its own product.
It's in the same industry as the rest of the health insurers. Sure it might not rely on government support as much but sell commercial health insurance is far less lucrative and the PBM model might be under attack.
This is pretty surprising. Caremark (the biggest PBM) took Zepbound off their formulary and made Wegovy their preferred GLP-1. Figured it would go the other way.
my brother in autism. they have a profit margin hovering around 1% for the past 15 years. they’re caught with their pants down after losing their PBM. they function primarily in medicaid and to a lesser degree medicare, with everything else being the smallest slice of their pie. Only an absolute moron buys in now.
Eh... PBM should float them for a while
PBM is the best low float primed and ready to fly 🍄🍄🍄
Why is PBM up by 35%? Is this momentum? News incoming? Low float FOMO?
Because I don’t see the health care industry changing anytime soon in the US. These companies are vital to that industry operating no matter how many people dislike them and they will be around for the long haul. If you believe that, like OP of this comment said, it would be a good time to invest in these companies. If you’re worried about government backed programs in the long run, Cigna completely got out of them to focus on commercial/PBM so they could be a safer play (CI has not dropped as much as ELV and UNH though) but I think in the long run the government backed programs will be ok too outside of a little bumpy road in the short term.
I personally have avoided UNH as I believe there will be significant PBM regulations coming. It may be good for trading intermediate term but long term I would be cautious.
they’re in deep, DEEP trouble. they’ve been in mortal peril since they lost their bespoke PBM over medicaid fraud. Conveniently, the CEO who ordered this “monetization” (his words) died riiiight as he could’ve been held accountable.
Genuine question, do you have insurance? You said "main formulary" which makes me think you do, but these copays.... Something isn't right here. Inhalers are typically covered by most plans. I bill dozens of albuterols/ventolins for $0 copay. The Budesonide/Symbicort thing is/has been a thing for a while now. Like you pointed out, could be a formulary thing where the INS just prefers brand (likely due to rebates the PBM negotiated).
Two weeks and two weeks. PBM reform? Also two weeks.
I just read some quick notes on Centene pulling guidance and I honestly have to say, what in the actual f. Do the all these investors think every PBM utilize the same actuaries or population models? Why is there a sector wide sell off?
RiteAid just filed for bankruptcy again after acquiring hundreds of local pharmacies. Walgreens is near bankruptcy and being acquired by private equity to break it into pieces and extract value. Local pharmacies barely exist after massive consolidation. Finally… CVS is not just a pharmacy. It’s the largest pharmacy benefits manager (the only pharmacy with a PBM), and one of the largest health insurers - Aetna. Yes CVS owns Aetna (the only pharmacy with a health insurer). Now, tell me why this is so hard for YOU to understand?
Some specialty pharmacies make $2B in a week or two. That's the dispensing pharmacy. Not the manufacturer. Not the PBM. Not the health plan. Your comment is pants on head stupidity.
Had at $1.1 sold at $2.3 before it backtracked. SVRE gave a very nice benefit too. Waiting for UPC and PBM for a similar move soon.
I would watch it as volume picked and it pumped, but I think it will trace back to at least support level before it might squeeze. PBM, UPC worth looking into, low float and known runners in the past(UPC and PBM ran 30% two days ago already and traced back).
Already moved, what's your PT? SBET did MOASS, SGN did nicely. Waiting for PBM now
I do FP&A for a PBM. Everybody was pricing in GLP-1s being insane blockbusters. They haven’t been. Utilization is much less than expected. For Novo, it doesn’t have a stranglehold on the niche, like Humira in anti inflams did for awhile.
With PBM reform on the way, this is really not a good bet
Only current valuation. The company generates give or take 24 billion free cash flow. This is nearly 9% yield against the current market cap of 265 bil market cap. Basically it means, theoretically, UNH can give out a 9% dividend. That is very high considering that the company with this size and likely secular growth with an aging population. Please note the following: 1. The company will very likely announce buyback due to shares being depressed so much. 2. DOJ is on the losing side in regards to its civil lawsuit against UNH for overbilling because the Special Master judge recommended dismissal of the case. The case may continue but even then DOJ most likely going to settle than go to years of trial. 3. The premiums are going to go up and the reimbursement fees are set to increase for Medicare Advantage in 2026. 4. Tariff proof stock. The scary parts however: 1. No guidance. I have no clue what their adjusted EPS going to be like. 2. PBM. I have no idea how states are going to regulate this in years to come. 3. CEO abrupt absence. I have no idea why there was no gradual transitioning. The relief I get however from these scary parts: 1. Massive stock buying from the insiders especially CEO. 2. CEO's much net worth is in UNH stock. Close to 375 million dollars now. His 60 million stock option likely at around 370. Stocks need to go up for him to get this money. 3. Insurance company can do whatever they like. They will increase the premium or ask the government for more money if people are using it more. They reprice each year. 4. Because of this repricing mechanism. UNH almost always went up from June to Decemeber. Given their new repricing starts the beginning of each year. My conclusion: I personally think everyone should set aside small percentage of their portfolio to health care (remember UNH stock actually went up during tariff fear/recession fear). I rarely recommended it due to valuation. But I do recommend now due to its valuation. And the number 1 health care stock I would recommend is UNH. It is like Exxon if you were picking oil stock. It is like Apple if you were picking tech stock.
lol… bad assumption. My source - go look at SEC filings/profit statements for the insurance industry, pharmaceutical industry, and look at non-profit filings for healthcare systems. You’ll see a common theme very quickly over the last 5 years since COVID…. Insurance, PBM, and pharma are doing either very well or at least decent… hospital systems are getting absolutely killed. The market I’m in, every single hospital system came back in the red in 2023 and all of them will likely report much worse in 2024 when their filings are made public. Budgets are continually getting worse with no changes in Medicare/medicaid reimbursement.
Those MLR requirements are true of their insurance business, but UNH is able to profit at a much higher rate on the provider side of things (Optum) and the PBM side of things (OptumRx). Furthermore, MLR is equal to claims as a % of premium, and ignores other expenses (admin, overhead, etc.) No health insurer profits 20% on their insurance business. I work in this space, that commonly spread chart about UHC’s denial rates is misleading at best. We do not see a reduction in claims or premium with UHC that is commensurate with a denial rate that high. The real way they were (allegedly) gaming the system is on their Medicare Advantage business. They were upcoding claims, forcing their population to appear riskier, and therefore letting them receive more in reimbursements from CMS than they would otherwise be entitled to.
Once upon a Monday, in the smoldering ruins of a red week, a brave Redditor named Mavs-ManiAAC saw the UNH chart bounce and declared: “Healthcare never dies. The pump is real. I’m going full port.” With the precision of a CPA and the recklessness of a YOLO warrior, he slammed every dollar into UnitedHealth. Jim Cramer was probably yelling “BUY” about an unrelated stock, but that didn’t matter. r/wallstreetbets said, “Be a BOL and BTFD” So he did. He was no ordinary investor — he was a Level 99 BOL, deep in the trenches, fueled by Taco Bell and suppressed trauma. ⸻ Wednesday: The Double Tap Bombshell #1: The Nursing Home Allegations The Guardian reports UNH allegedly paid nursing homes to keep patients out of hospitals. Whistleblowers. Congress. Secret deals. The whole nine yards. UNH: “Not true. DOJ passed on it.” Market: “We don’t care.” -5.8% intraday. Portfolio? Torched. Mavs-ManiAAC? Still BOL. Bombshell #2: HSBC drops the kitchen sink HSBC downgraded UNH from Hold to Reduce, slashing the price target from $490 to $270 like it owed them money. “MLR too high.” “PBM risk.” “Return on equity is going limp.” “CEO probably doing a kitchen sink reset.” “Oh and EPS might not recover till 2027, oops lol.” He read it twice. Then threw his phone into the void. ⸻ Thursday: Acceptance (and memes) Mavs-ManiAAC turned to Reddit for guidance. Someone posted a Pepe wearing hospital scrubs crying over a stethoscope. Another user wrote: “UNH is the new GME. Just needs a catalyst… like a miracle.” He DM’d his friend: “Bro I’m literally down 37% but I still think this goes to $600.” ⸻ Friday: The Calm The stock floats around $295. Downgrades continue raining down from Wolfe, TD Cowen, Truist, Bernstein, and Raymond James like Wall Street’s version of Thanos snapping your tendies away. And yet… Mavs-ManiAAC still holds. Because deep down he knows: True BOLs don’t fold. They meme through the pain. They DCA into the darkness. They believe in the comeback. ⸻ He remains… Bagholder. Warrior. Meme Knight of the Round Portfolio. Sir Mavs-ManiAAC, the Boldest of BOLs. “It’s not a loss until I sell. It’s not a loss until the court filings stop. And it’s not over… until UNH hits $600.”
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The insurance business is tough—health insurance, even more so. It’s no surprise that after all these years, Warren Buffett remains a fan of the industry. Just look at the challenges Amazon, Berkshire Hathaway, and JPMorgan Chase faced with their joint venture, Haven (ABC company). They eventually exited the health insurance experiment altogether. UnitedHealth Group ($UNH) stands apart. It’s not just a health insurance company; it’s a comprehensive healthcare giant, unmatched in scale and scope. While the ongoing Medicare investigations and scrutiny of the PBM (Pharmacy Benefit Management) business are not new, these challenges have persisted for years. The recent CEO departure might seem concerning, but it could be a positive development. The company’s strategic architect, Stephen Hemsley, remains on the board, guiding the organization’s trajectory. Under his leadership, UnitedHealth achieved explosive growth. The company’s accountant-led management team is known for its focus on disciplined, sustained growth. The next year may be challenging, especially with limited guidance provided, but UnitedHealth has weathered many storms before. It’s worth remembering how the 2012 Michael Moore documentary cast health insurance companies in a negative light, despite the fact that their profit margins hover around 6%. For instance, UnitedHealth’s $22 billion in net profit on $400 billion in revenue highlights the slim margins in an industry where the true issue lies in the soaring cost of care in America. On Friday, Hemsley bought $25 million worth of UnitedHealth shares at a market price of $288. For context, a million-dollar investment might not raise eyebrows, but $25 million is a significant commitment—even for a healthcare CEO, representing roughly a year’s worth of salary. I’ve decided to go all-in with leaps, confident in the company’s resilience and long-term potential. ⸻ Not a financial advice and opinions are my own. Do your own DD.
Trump and RFK are crushing Pharmacy Benefit Managers (PBMs) per their May 13 press conference. UNH gets 52% of their profit from its in house PBM, Optum. Luigi says it’s going down further.
CVS. Health insurance is under attack. Even the dividend doesn't make it safe if the entire PBM business may become obsolete.
Pass. Insurance is a dogshit business where any pool of capital competes against another pool of capital with limited barriers to entry and a race to the bottom on rates. The customers can’t tell the difference between insurance companies because there isn’t one. The only good thing the company has is the PBM. Everything else is a dogshit competitive business the company bought to hide pbm profits.
Yeah and 30% of their revenue comes from Optum, which is just a PBM middleman. They’re fucked the second that HHS direct to consumer purchase plan is rolled out in less than a month
The EO did not drop UNH, actually that day is was only down a small percentage because their PBM is such a small part of the business
Humira was developed in the UK and Germany. Abbvie Pharmaceutical bought the patent to the drug, they have since been sued multiple times for price gouging and illegally preventing other manufacturers from marketing cheaper identical biosimilars. Not to mention that nations with universal healthcare do not have PBMs making bank of if pricing negotiation. And if we banned prescription drug advertising on TV and other media perhaps they could put those millions of dollars towards research. I have worked on the pharmacy end. Generic drugs that cost literally pennies are charged out to insurers for hundreds of dollars. My husband's metformin wholesales for about $80 for a 90 day supply. Charge to insurance is $750. Who gets a kickback on that, the PBM. Not the pharmacy. It's greed. Just greed.
I think they gonna break UNH up and make them sell off their medical care units and all other non insurance related units including PBM's. Might be a $50 stock in a years time.
We don't care about that article, we're coming for the PBM business.
Usually, what one PBM does, the others do, too. For future reference.
UNH has an annual dividend of $8.40/share. They did not yank their dividend. Most U.S. companies offer UNH as their health plan, and changes to employer-provided health plans typically occur at the end of the year. The WSJ article is weak; if the company is being investigated for Medicaid fraud, the claim is absurd and extremely difficult to prove. Each Medicaid claim goes through multiple channels to prevent fraud. For such fraud to occur, it would have to involve the patient/doctor, UNH, drug companies or third-party data providers, and Medicaid. UNH has been investing heavily in AI, and its business model, particularly through Optum's PBM operation-stands to benefit tremendously, as these services are primarily driven by relational data management and brokerage. I own UNH and find this hit on my investment as stupid.
Oh grants. Thanks for the enlightenment. That means “free money“. U have absolutely no clue. PBM’s are propaganda? Do yourself a favor and google how much PBM’s increase the cost of drugs.
Pharma worker here (scientist): Because it’s a) unenforceable and b) pharmas don’t “set” prices. What you pay is an agreement between your insurance, a PBM, and the pharma. PBMs have much more of an influence over what you end up paying than pharmas do. Rather than having a centralized government agency that negotiates coverage and deals for how much insurers will cover the drug and at what price, it’s outsourced to PBMs.
FYI 35% of UNH's revenue comes from it's PBM (OptumRx), 3rd biggest in US
If you’re playing it safe, wait for a verdict on PBM. If you’re willing to risk it, now.
1.) They literally said their revenue will shit the bed because of unexpected dynamics in the field and they cannot give guidance. Sure they have historically had a nice chunk of cash on hand, but last years revenue will not equate to this years. That is also excluding all the suits going on with the company. That is why their price dropped. There is no guidance to factor in pricing. 2.) See above. 3.) Maybe. But also need to factor in a huge part of their business recently was targeted with an EO a few weeks ago (Optum) surrounding transparency of PBM’s. How that technically plays out is up in the air. But even at a state level there is a lot of legislative pressure to keep them at bay. That will absolutely not help out their company if you are looking at it from a profitability standpoint. Ethically that is a whole different argument in which some of the most conservative states are not even siding with UNH on. 4.) While UNH has a global footprint, the systems pulling in the most money are not modeled after the US model of care. I don’t see this as bullish in anyway. 5.) I see it as more likely to lead to efficiencies and access, the latter of which UNH has publicly stated is causing their revenue to decline. This comment also tells me you don’t understand the main drivers of what makes their main market unhealthy (US). AI is not going to magically fix that.
The real issue is PBMs A PBM is like a mafia don who: Controls the docks, ships, and warehouses (they own pharmacies, insurers, even clinics/ health systems) Riggs the auctions (they steer you toward their own drugs and pharmacies) Takes secret kickbacks (rebates from drugmakers they don’t pass on) Tolls every shipment (opaque spread-pricing skims the difference between what they bill and what they pay) Silences competition (excludes lower-cost pharmacies or drugs) What those tricks mean in plain terms Secret kickbacks (rebates): Drug companies give PBMs discounts they never share with you, so your out-of-pocket stays high. List-price inflation: They let manufacturers jack up sticker prices so their “discounts” look big—even though you still pay more overall. Opaque spread-pricing: They tell your insurer, “We paid $100 for this drug,” tell the pharmacy, “We’ll pay you $80,” and pocket the $20 gap—without ever showing you the math. Network lock-in: They push you into their own or favored pharmacies, shutting out cheaper options. You end up paying more at every turn, while the PBM pockets the extra.
I have a completely different take. The US pays the entire load of the R&D costs for drugs and the rest of the World does not. The drug cos completely deserve to recoup their R&D costs, but not to be paid for by one Country. This administration will end PBM's (huge expense) and it is not unreasonable to have stabilized prices throughout the World and give more affordable access to people they may not have insurance.
It’s still another 30% overvalued if PBM become illegal.
UNH PBM accounts for 50% of profits. Even if the PBM side gets completely eliminated the stock is already halved in price.
It does when you realize Aetna is owned by a PBM (CVS caremark) that gets rebates (kickbacks) from drug companies for putting their thing on the formulary over a competitor. And sets their own reimbursement rate to profit more vs the reimbursement rate for other pharmacies forcing a loss.