Time to reflect on where we have been and where we are going

It seems like over the last few months several supporters and or support groups for the chronic pain community have been going through a metamorphosis.  There also seem to be a lot fewer chronic painers that are even “active” within the community.  There seems to be less unity and interest in going in one direction toward a solution. Everyone has their own ideas and heads off in their own directions.

I started this blog about 12-13 yrs ago. The other day, I was searching for a blog post that I had recently made, in searching for the blog posts Word Press came up with numerous posts and I realized that the subject I was looking for, the search brought up not only a recent post but multiple blog posts where I had written a post on the same subject every 1-2 yrs going back to the beginning of my blog.

All of a sudden, I got the impression that I had been traveling in a virtual circle. Either my advice was useless/ineffective and/or the pt lacked the Chutzpah to try and advocate for themselves.

The community may have passed the point of no return. The effects of the agreement with the 41 state AGs, the three largest drug wholesalers, and the three largest chain pharmacies have yet to reach full traction.  President Biden’s for lower Rx prices, the segment of the industry he overlooks is the Insurance/PBM industry which is probably the biggest reason for high Rx prices. Of course, since the Insurance/PBM industry has one of the largest pots of money to lobby Congress.  But the PBM industry seems to be prepared for “taking a financial hit”.  It seems that they have changed their reimbursement rates to especially independent pharmacies. I shared this post a few days ago Cash crunch pushes independents to the brink, data shows PBMs the cause

In a recent survey of independents, 30% expect to close their doors this year, that could be as many as 5,000 independent pharmacies no longer around.  Rite Aid is in bankruptcy and closed some 600 stores and what is going to happen to the remaining 1500 is up in the air. Both Walgreens and CVS are planning on closing 200-300 stores each for the next few years. These chains are closing stores – NOT BECAUSE they are NOT PROFITABLE, but because they are not making ENOUGH PROFIT. Many of these stores are in rural areas and as they run the independents out of business and decide to close their stores because they are not making as much profit as they would like, many pts will find themselves in a “pharmacy desert”. The closest pharmacy could be 25-30 miles away.

Please follow this FB page https://www.facebook.com/groups/2117694318443765/user/100042730215813 Loretta Boesing is fighting against mail-order pharmacies and their lack of concern about mailing meds without much concern for keeping the meds within the recommended storage temperature per the FDA, USP and NF. This is the path that the Insurance/PBM industry is leading us down. As “pharmacy deserts” evolve pts in those areas will start getting mass communications from their PBM encouraging them to get their Rxs filled “conveniently ” via THEIR MAIL ORDER PHARMACY.

I am no longer going to share hyperlinks to other FB pages that are not mine.  Anyone who wishes to share my blog posts on other FB pages there are links at the bottom of this post. I am a little tired of others telling me that some of post are POLITICAL and then listen to them tell people to contact their representative in Congress. Then listen to them bitch because they didn’t get a response or the response they got had nothing to do with what they can contacted their member of Congress about.

 

 

 

If you repeat a lie often enough

Do we really want the Feds to dictate what companies should charge for their products?

At the bottom of this post is a graphic that outlines where the dollars you pay for your medications go. The entities that get the largest chunk of the money, are the ones that have no R&D costs, no inventory costs, and no delivery/distribution costs. They pay the pharmacy $10 for an Rx, then demand a discount/rebate/kickback from the pharma so that their meds are on the PBM’s approved formulary and do not require prior authorization.  Then charge the insurance many times what they paid the pharmacy for the medication.  If you notice in this article, the PBM industry is not part of the cost-savings. Of course, the 5 major PBM’s are owned by major insurance companies.  Back in the day, when there were no PBMs, there were virtually no generics, there was no shortage of medications, there were no prior authorizations, and the average Rx’s price was $4 -$5 each. If nothing had changed, maybe the average Rx price would be $40-$50 each, but with the percentage of generics we now use, maybe the average Rx price would be in the $20-$30 range. If this administration does not see price savings from the PBM industry, collectively we may experience fewer new/improved medications coming to market. No one else does Research and Development (R&D) for new meds, and no one else markets these new meds to doctors.  Maybe that is what the Feds want, lowering the life expectancy so that fewer dollars will be paid out by SS and Medicare.  When SS was first started > 50% of people did not live to 65 y/o and when Medicare was started in 1965, was just as the Baby Boomers were graduating from high school, and I suspect that the federal bureaucrats looked at the then largest population was going into the workforce and the youngest Baby Boomer was just being born in 1964

When I was born, my life expectancy was 65 y/o, now that I have passed that age, my life expectancy is in the low to mid-80s. How much did the pharma industry contribute to that fact?

All drugmakers send in counteroffers in Medicare price negotiations

https://thehill.com/policy/healthcare/4506575-all-drugmakers-send-in-counteroffers-in-medicare-price-negotiations/

All of the manufacturers whose drugs were chosen for the federal government’s Medicare price negotiation program have sent back counteroffers for what they consider to be a maximum fair price, the White House said Monday.

President Biden confirmed in a statement Monday that all companies are continuing to engage in the negotiation process, despite the host of legal battles to block the program.

On Feb. 1, the Centers for Medicare and Medicaid Services (CMS) sent out initial offers of a maximum fair price for the first 10 drugs chosen for Medicare negotiations. These include medications of Eliquis, Jardiance, Xarelto, Januvia and Farxiga. Drugmakers had until March 2 to send back counteroffers.

“Today, my Administration is announcing that manufacturers for all ten selected drugs will continue to participate in drug price negotiations, as all manufacturers have submitted counteroffers,” Biden said Monday. “This is an important milestone in our fight to give seniors the best possible deal on their prescription drugs and in lowering health care costs for all families.”

“And it comes in the face of attacks from Big Pharma in the courts and from Republicans in Congress who continue to try to repeal the Inflation Reduction Act which would keep seniors on Medicare from benefitting from these lower-cost drugs,” he added.

Biden indicated he would have more to say on this issue in his State of the Union address Thursday.

Talks are expected to go through Aug. 1, when negotiations officially end, per CMS guidance. The maximum fair prices are scheduled to be published Sept. 1 and are set to go into effect at the start of 2026.

The pharmaceutical industry is engaged in a legal battle with the federal government to block the Medicare negotiation; drugmakers and trade groups have filed numerous lawsuits alleging the program violates federal law and is unconstitutional.

Since the start of the year, two of those lawsuits have gone in favor of the federal government, with one suit filed by the trade group PhRMA being dismissed last month and a federal judge issuing summary judgment last week in favor of Medicare negotiation in a case brought by AstraZeneca.

What should you vote for

Should “we” vote for a candidate on a single issue that the politician’s position agrees with your personal opinion

Should “we” believe what a politician claims they will do or not do?

Let’s face it, we have two political parties, and it appears that those two political parties have “rigged” the system so that it is nearly impossible for a new political party to get their “foot in the door”

Should “we” start by looking at the “planks” in each party’s political platforms?

I will focus this post on looking at those in the chronic pain community.

Over the last decade, decisions by politicians and certain state/federal agencies have had adverse effects on the QOL and even life itself of many within the community.

What is their position on treating chronic pain?  Strong support for some MME/day limit? Strong support for treatment only using BUPE or NSAIDs or Acetaminophen?  Do they have someone in the family or friend that has addiction problems or has OD’d?

There are ten states with “death with dignity” laws on the books and several other states are considering such laws

What is their position on treating addicts, putting them in jail, decriminalizing all drugs, or putting them on Bupe or Methadone with no limits

What is their position in dealing with drug dealers? Just leave them alone or charge them with murder for people dying from the illegal substances they are selling

What is their position on the execution (capital punishment) of people convicted of murder?

What is their position on abortion?  Strongly pro-life with little/no exceptions for medically necessary abortion? Abortions within limited days into gestation? Strongly pro-abortion, even up to and including the day of delivery.

All these questions have to do with the politician’s view of the importance of life itself. If a politician has a family/friend who ODd from opioids and supports reducing the availability of Rx opioids to pts with a valid medical necessity, but has little/no concern about street dealers selling illegal drugs that is the primary cause of OD’s

“We” may find that the majority of politicians personally have very mixed ideas about the “value of life”

 

DEA: ORIGINS OF THE DEEP STATE ACCOUNTABLE TO NO ONE!!!! THIS WILL ROCK YOUR SOCKS

MOSCOW, RUSSIA – FEBRUARY 29: (RUSSIA OUT) Russian President Vladimir Putin speaks during his annual state of the nation address, on February 29, 2024, in Moscow, Russia. Just over two years since Moscow launched its full-scale invasion of Ukraine, Putin is expected to be re-elected in the 2024 Presidential Elections, scheduled for March. (Photo by Contributor/Getty Images) ACCOUNTABLE TO NO ONE

FOREST TENET, MD

CHIEF JUSTICE ROBERTS

DEA: ORIGINS OF “THE DEEP STATE,” UNELECTED, UNCHECKED, NO OVERSIGHT NO ACCOUNTABILITY TO THE US GOVERNMENT: PART-1

DOJ-DEA USES PUTIN’S PLAYBOOK AS A PERMISSION TO MASS LOOT AND STEAL FROM DOCTORS, PHARMACIST AND HEALTHCARE PROVIDERS, FORCING OUR VETERANS INTO MASS SUICIDE

HANDS UP-DON’T SHOOT

PUTIN’S PLAY-BOOK

PREDICTIVE POLICING: THE DEPARTMENT OF JUSTICE PRACTICING PUTIN’S PLAYBOOK, GRANTING PERMISSION TO OUTRIGHT STEAL (“MASS LOOTING”) FROM MEDICAL DOCTORS AND HEALTHCARE PROVIDERS, KILLING OUR VETERANS

Mark Cuban talks about the ELEPHANTS IN THE ROOM

THE LIBBY REPORT OF 2005: EXPOSED THE MOTHER OF ALL MEDICAL FRAUDS, DOJ-DEA’S DECEPTION, TARGETING, FALSE IMPRISONMENTS, NOW THRU THEIR INCOMPETENCE TENS OF THOUSANDS ARE DEAD

DEA DIRECTOR ANNE MILGRAM: The concept of “pre-crime,” once relegated to science fiction, has taken on a chilling reality in contemporary law enforcement practices. In a thought-provoking article titled “Pre-Crime” and the Danger of “Risk Assessments” authored by Paul J. Hetznecker, the issue of “pre-crime” and the utilization of “risk assessments” by law enforcement is brought to the forefront.

 

“THE OPIOID PANDEMIC,” THE GREAT AMERICAN HOAX: WHY AND HOW THE DEA WAS ABLE TO CREATE THE 25 YEARS OF OPIOID HYSTERIA: “FASCINATE THE FOOLS THEN MUZZLE THE INTELLIGENT”

Russian-linked cybercriminals ALPHV/BlackCat hacked Unitedhealth and demanding ransomware

UnitedHealth confirms ransomware gang behind Change Healthcare hack amid ongoing pharmacy outage

https://techcrunch.com/2024/02/29/unitedhealth-change-healthcare-ransomware-alphv-blackcat-pharmacy-outages/

Ransomware gang ALPHV/BlackCat claims huge breach of US patient records

American health insurance giant UnitedHealth Group has confirmed a ransomware attack on its health tech subsidiary Change Healthcare, which continues to disrupt hospitals and pharmacies across the United States.

“Change Healthcare can confirm we are experiencing a cyber security issue perpetrated by a cybercrime threat actor who has represented itself to us as ALPHV/Blackcat,” said Tyler Mason, vice president at UnitedHealth, in a statement to TechCrunch on Thursday.

“Our experts are working to address the matter and we are working closely with law enforcement and leading third-party consultants, Mandiant and Palo Alto Network[s], on this attack against Change Healthcare’s systems. We are actively working to understand the impact to members, patients and customers,” the spokesperson said.

“Based on our ongoing investigation, there’s no indication that except for the Change Healthcare systems, Optum, UnitedHealthcare and UnitedHealth Group systems have been affected by this issue.”

In a post on its dark web leak site on Wednesday, ALPHV/BlackCat took credit for the cyberattack at Change Healthcare. The Russia-based ransomware and extortion gang claimed to have stolen millions of Americans’ sensitive health and patient information. Ransomware gangs typically publish the names of their victims to their dark web leak sites often as a way to extort the victims into paying a ransom demand.

ALPHV/BlackCat’s claims could not be immediately verified. ALPHV took down the post claiming responsibility, sometimes an indication that the victim is negotiating with the hackers. UHG spokesperson Mason did not respond to a comment asking if the company paid a ransom or is in negotiations with the hackers.

TechCrunch confirmed on Monday that the ongoing cyberattack was linked to ransomware. Reuters first reported the news.

UHG-owned subsidiary Change Healthcare is a health tech giant and one of the country’s largest processors of prescription medications, handling billing for more than 67,000 pharmacies across the U.S. healthcare system. The healthcare tech giant’s website says it handles 15 billion healthcare transactions annually — or about one-in-three U.S. patient records.

Change Healthcare merged with U.S. healthcare provider Optum in 2022 as part of a $7.8 billion deal under UnitedHealth Group, the largest health insurance provider in the United States. The merger allowed Optum broad access to patient records handled by Change Healthcare.

UnitedHealth Group collectively provides over 53 million U.S. customers with benefit plans and another five million outside of the United States, according to its latest full-year earnings report. Optum serves about 103 million U.S. customers.

Pharmacy outages stall prescriptions

The cyberattack began on February 21 early on the U.S. East Coast, causing widespread outages at pharmacies and healthcare facilities. Change Healthcare said it took much of its systems offline to expel the hackers from its systems.

Change Healthcare’s incident tracker page shows most of its customer-facing systems remain offline.

Hospitals, healthcare providers and pharmacies across the United States have reported that they are unable to fulfill or process prescriptions through patients’ insurance.

Nebraska television outlet KLKN-TV reports that the majority of Nebraska hospitals are unable to verify patient insurance for inpatient stays, provide precise cost estimates, or process patient billing as a result of the ongoing cyberattack at Change Healthcare.

U.S. military health insurance provider Tricare said in a statement this week that the cyberattack at Change Healthcare is “impacting all military pharmacies worldwide and some retail pharmacies nationally.”

UnitedHealth previously attributed the cyberattack to an unspecified nation-state actor. Researchers have yet to determine a link between the ALPHV/BlackCat group and a government.

“The ransomware problem has been getting worse for years. If governments don’t get it under control quickly, critical services will continue to be disrupted, with potentially catastrophic consequences,” said Brett Callow, a ransomware expert and threat analyst at Emsisoft, told TechCrunch.

It’s not yet clear how the hackers gained access to Change Healthcare’s systems. In an interview with TechCrunch on Thursday, ConnectWise chief information security officer Patrick Beggs ruled out a recent vulnerability in his company’s products as the cause of the cyberattack at Change Healthcare.

“With all the subsidiaries including United all the way down to Change Healthcare, we have no record or no indication of any [managed service provider supporting them, or them themselves having ScreenConnect installed on their infrastructure,” Beggs told TechCrunch.

UnitedHealth made $22 billion in profit during 2023, according to its full-year earnings filed in January. According to the company’s most recent report on executive pay, UnitedHealth’s chief executive Andrew Witty received close to $21 million in total compensation during the previous fiscal year.

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just because you have health insurance doesn’t mean you will GET HEALTHCARE