When healthcare providers end up really being healthcare deniers

I got the email below on Jan 1, 2024.  This pt’s story is not a unique issue. Another example of bureaucrats and politicians attempting to “solve” our fabricated opioid crisis by creating a “one size fits all” on pain management.

After having this blog for 12-13 yrs, I have developed a fairly sizeable network of chronic pain pts, chronic pain advocates, and numerous healthcare practitioners.  I shared this woman’s email with a couple of select people that I believed might be able to STEP UP. And one did:

When a pt’s long term medical records mean nothing when seeing a new practitioner

When everything seemed to start to fall into place for this young lady. This young lady’s pharmacist and the mid-level practitioner who was forcing her to reduce her pain meds had to step in to make sure that things were not going to change the way that this mid-level practitioner wanted things to happen. Here is a video this young lady sent that she personally explains what has happened.

Hi Steve,

I have sent you my story before. I am a single disabled palliative care sick patient in Maine. In September of 2021, my doctor and I were targeted by the assistant attorney general, Michael Miller. We think it was for 2 reasons-he was very effective at getting patients disability, testings, procedures, equipment, etc and because I require a high dose of opiates to physically and mentally function. Dr. Lommler believes Michael Miller made a deal with the insurance companies and profited somehow for taking him out. Michael Miller used at least 2 agencies to target, harass, and destroy us. They suspended Dr. Lommler’s license for going over the 100 MME limit on my prescription. However, Maine has a palliative care exemption that allows people (like me) to have access to opiates for pain control and disease treatment options. It also allows us to go over the 100 MME limit. They refused to lift the suspension unless he transferred to a “board approved” facility. He chose to retire because he wanted to stay at his independent office with his 200 complicated and unique patients. They gave neither one of us any due-process! They used backdoor methods and I believe they were illegal! There was a covering LNP seeing me for a year. We tried to find a doctor everywhere in Maine to see me but because of the Opiate Task Force and doctors getting red-flagged for going over the 100 MME limit and being dragged in front of the board, no one would see me. I was forced to transition to the hospital where all of my specialists are. You see, Maine and New Hampshire were the 2 states prescribing the most Opiates so they created a New England Opiate Task Force and sent them to work with the Governor Mill’s administration to red-flag doctors prescribing over the 100 MME limit and drag them in front of the board of medicine! They have forced independent providers to either retire or transfer to a “board approved” facility. These “board approved” facilities all have anti-opiate one-size-fits-all policies. The hospital that I am at has an anti-opiate provider masquerading as a “pain specialist.” She believes Opiates are life threatening and dangerous to everyone. She is force tapering me off all my pain medication! I am complicated and unique-I have multiple health conditions. I had an original medical nightmare that left me with life altering physical deformities and severe debilitating pain. I have Crohn’s disease, vitamin and bone deficiencies, and neuropathy-all of these cause malabsorption so I have to take double doses of all of my medication! I cannot have the conventional pain management treatments because I am allergic to everything and sensitive to anything and I have a prosthetic heart valve. I have Scoliosis and severe Osteoporosis with dangerously low Scores. I am 46 in an 86 year old’s body.
They are stereotyping anyone on opiates as addicts and forcing them off pain medication. The only option they give you is Suboxone-I cannot take this because the side effects would be catastrophic to my body. I had nothing but recovery and progress with my 8 1/2 year stable pain regimen. I was able to semi function independently with a decent quality of life. Since this provider has been force tapering me, I can no longer function independently at all and I have zero quality of life! According to Maine’s own definition and standards, what this facility and provider are doing to me is disability abuse! I tried to contact patient services for an advocate but was told there wasn’t one. The woman I spoke with for 2 minutes, asked me what my concerns were. I explained to her what was happening to me. 2 days later I received a letter stating my concerns were forwarded to the Medical Director and Operations Manager and they agree with the provider force tapering me. They also said there was no medical justification for my pain medication. I filed a public accommodation discrimination complaint with the Maine’s Human Rights Commission but haven’t heard a word since intake months ago! The letter gave an 800 number to call if you disagreed with their decision. It was the board of licensure telling you to submit a complaint. I already filed a complaint with the board of medicine and nurses months ago. So, you have to go to the same people that are red-flagging and harassing doctors going over the 100 MME limit. I won’t hold my breath! These are the same people that asked Dr. Lommler how he didn’t know that I was taking half of my pain medication and selling the other half! Dr. Lommler provided them with 7 1/2 years worth of passed urine screens and passed frequent random pill counts! I wasn’t even allowed to attend or participate into the investigation into my opiate use-I could’ve answered that question myself-I have never misused my pain medication! In fact, I did everything that I was supposed to do! How in the world can I trust they will help me!
Since this provider has been forcing me off my pain medication, I have had sky high blood pressures-202/129, severe bloody noses, I have been discharged from aquatic therapy-which I needed to get into my Crow Walker boot, I am completely dependent on my sons, I have had to quit tutoring for supplemental income, I can no longer walk on my crutches so I am trapped in my wheelchair, and I cannot mentally or physically function! My counselor and former providers have tried talking with this provider but she refuses to listen because she knows best. I had to spend my Christmas in the ER and I am now watching my right leg and foot do exactly what my left leg and foot did in my original medical nightmare. When my body is in severe stress, my multiple conditions play off of one another and wreak havoc on my body. Last time, the severe stress was an allergic reaction to hardware (we didn’t know why at the time, it took years to figure it out). This time, it is force tapering my pain medication! This time, it’s the providers choice to force taper me because of her personal feelings about a medication! Medical providers are supposed to do what is in the best interest of the patient, not what is in the best interest of their personal feelings! I have cellulitis in my right leg and foot with ulcers everywhere! I maintain my left leg and foot with Cuban for compression. I tried to wrap my right leg and foot but it’s not used to being wrapped, and I get continuous Charley Horses. They are intolerable with all of my pain medication being taken away! I have severe PTSD and zero trust in doctors from my original medical nightmare! I never ever wanted to go back to that sick person trapped in a wheelchair, I thought I left it behind for ever! This time, I don’t have a heart valve to lose! I am petrified and profoundly devastated because I worked so hard for 8 1/2 years to recover and progress and now that has been destroyed! I see people helping doctors that have been arrested but what about people, like me, who have been targeted, harassed, discriminated against, and literally going through disability abuse-who tells our story and helps us?
My counselor gave me a brochure for adult protective services and she told me to call because what they are doing to me is discrimination and disability abuse. I called and the lady said there is no process for this situation. She told me that it does qualify but the only thing I can do is file a complaint with the board of medicine and nurses because they are the only entities that have authority and jurisdiction over medical providers. I told her that I already filed complaints but it will take months because they only meet one day a month! I told her my body won’t make it that long and I asked her, “what if I die in the meantime?” She said, “let’s hope it doesn’t come to that but good luck!” WHAT? It’s like a nightmare that I cannot wake up from! I have contacted every politician in Maine and asked for their help. Crickets…I requested assistance from Governor Mills but she doesn’t even think she has to answer to her constituents. I have reached out to every volunteer lawyer’s projects and disability rights groups but they all claim no to have the resources to help me. I have documented, taken pictures, recorded videos, screenshot messages from my portal between her and I, audio recorded my video appointments exposing her discrimination and disability abuse! I cannot find an attorney in Maine to help me. This provider only saw me one time in person! She never looked at any areas causing my pain, she’s not monitoring my vitals or everything that is happening to me, she doesn’t even have the correct MRI’s-she’s going by a 2008 one when I was a normal person and could walk on my own, and she’s retaliating against me for filing a complaint! I need help and I don’t know where or who to go to! I even have an appointment with cancer care, January 23rd. I have MGUS and the blood work markers and symptoms all point to it turning into Multiple Myeloma. I asked her to please pause the force taper until I can get into my appointment. She said, “Oxycodone will not cure Multiple Myeloma so the force taper will continue!” How cruel is that!
I was hoping that you may have some direction or advice to help me. If I knew how to file a civil lawsuit against the hospital and provider, I would do it myself. Since September of 2021, I have had to be my own advocate, case manager, and attorney!
I already missed about 6 years of my sons’ lives because of my original medical nightmare! I can do no physical activity without my pain medication! I really don’t think my body will make it through this force taper! Opiates are literally life saving for me! They knew that I wouldn’t be able to find another doctor to see me and Michael Miller and the board of medicine took 2 doctors from me! The provider force tapering me filed a complaint against the LNP that saw me for a year. In it, she said that she felt compelled because Kaye endangered my life by prescribing these life threatening and dangerous medications. She also accused me of bribing Kaye in her complaint. That is ludicrous-I have never bribed anyone! Kaye made it very clear in her response that no one forced or bribed her. She also made it clear that I was the only patient she ever prescribed narcotics for in her entire medical career! I have been accused of selling half of my pain medication and bribing doctors! I am a law abiding Mainer and American just trying to live my life!
Thank you for taking your time to read my email. You can reach me any time at xxx.xxx.xxxx

most societies/communities have 1 or more agitators, disruptors, false prophets, scammers, traitors, saboteurs and cult leaders

Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War..  Our society has voluntarily divided itself in – for lack of a better description – TRIBES.

The chronic pain community is not all that different from our country of as a whole.

Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy.  All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts.  I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.

There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen.  One can only imagine the deprived mental status of those who have been involved in this.

Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information  and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back.  Some chronic painers have told me that I should charge for my advice.  My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.

After this issue with these end of life pediatric pts,  Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support.  Maybe in some small way, my advice can help more than just one person/family. 

 

https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues

https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects

https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and  helps provide housing for families with kids in the hospital

https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families

 

 

Encourage patients to submit complaints to Medicare

Encourage patients to submit complaints to Medicare

https://ncpa.org/newsroom/qam/2024/03/27/encourage-patients-submit-complaints-medicare

Patients across the country are facing issues filling prescriptions due to patient steering and PBM network issues. Encourage your patients to reach out to Medicare directly through their online complaint form or call Medicare directly. We’ve added that contact information into a printer-friendly document that you can hand your patient at the pharmacy counter when they experience pharmacy access issues.

Healthcare is nothing more… nothing less than a FOR PROFIT BUSINESS

I have read stories, that these insurance/pbm companies hire retired physicians to review the prior authorization process. Those articles also stated that those physicians are paid a BONUS based on the percentage of what the insurance/pbm saves from denial of coverage of a specific product or service. These physicians are paid their BONUS weekly.

The physician reviewing a prior authorization may not be credentialed in the specific disease they are reviewing to decide to approve or deny coverage.

https://www.cmadocs.org/newsroom/news/view/ArticleId/50483/New-York-Times-video-on-prior-authorization-spotlights-CMA-physicians-and-california-patients-160

SB 516, authored by Senator Nancy Skinner and sponsored by the California Medical Association (CMA) will reform the prior authorization process in California to ensure patients get the treatment they need when they need it. 

The New York Times published an opinion video today, titled “What’s my life worth? The Big Business of Denying Medical Care” that clearly demonstrates how insurance companies use prior authorization to protect profits, putting patients at risk.

To produce the video, the New York Times interviewed more than 50 physicians and patients who have dealt with prior authorization delays firsthand, including Irvine-based pediatrician and CMA member, Eric Ball, M.D., who spoke about how the “peer-to-peer” process for appealing a prior authorization denial can involve speaking with a physician who does not have a relevant specialty.

“I’m a pediatrician and sometimes I’ll end up talking to a neurologist,” Dr. Ball said. “Often times it’s not even a physician.”

Also interviewed were California patients Vivian Gonzales and Ocean McIntryre, both of whom were harmed by prior authorization delays and had courageously shared their stories with the California Legislature last summer when prior authorization legislation was heard in the Assembly Health Committee.

Gonzales, a public health nurse, dealt with multiple denials while trying to obtain care for her father, whom she eventually lost to cancer. “I spent so much time on the phone, writing letters, faxing, that I didn’t get to spend that time with my father,” Gonzales said in the video.

And McIntyre, a space science communicator, lost her eyesight as the care she needed was delayed for months due to prior authorization. “I finally got the authorization to see the neuro-ophthalmologist after 12 weeks, and he said, ‘We’re going to do this surgery, but it’s only to preserve the vision you have left. If we had seen you earlier, that would have been a different story,’” McIntyre said in the video. “Maybe I’d be able to see now. Maybe I’d have a different life.”

This year, CMA is sponsoring SB 516 to reform the prior authorization system and ensure patients get treatments they urgently need without unnecessary delays. Over the course of this legislative session, be on the lookout for updates and further communications regarding SB 516.

Share Your Story

CMA physicians have staunchly advocated for prior authorization reform by sharing personal stories and stories from patients about harmful care delays and denials; speaking to local media about the need for prior authorization reform; and submitting video testimonies about the impact of prior authorization. Patient witnesses also shared harrowing testimony in legislative hearings and through media outlets about the devastating impacts prior authorization delays have had on their lives and their loved ones.

CMA urges physicians to continue to share stories about the harms of prior authorization delays – both from your own experiences and practices, as well as from your patients. Together, we can win this fight and create a better system that prioritizes patients over profits.

How Reporters Caught Payers Using Algorithms

How Reporters Caught Payers Using Algorithms

https://www.daily-remedy.com/how-reporters-caught-payers-using-algorithms/

In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.­

“The level of anger and discontent was a real signal here,” says Ross, STAT’s national technology correspondent. “The other part of it was a total lack of transparency” on how the algorithm worked.

The reporters’ monthslong investigation would result in a four-part series revealing that health insurance companies, including UnitedHealth Group, the nation’s largest health insurer, used a flawed computer algorithm and secret internal rules to improperly deny or limit rehab care for seriously ill older and disabled patients, overriding the advice of their own doctors. The investigation also showed that the federal government had failed to rein in those artificial-intelligence-fueled practices.

The STAT stories had a far-reaching impact:

  • The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
  • Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
  • In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
  • Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm.
  • Amid scrutiny, UnitedHealth renamed NaviHealth.

The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.

Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.

1. Search public comments on proposed federal rules to find sources.

Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.

There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.

Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.

The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.

“These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.

“The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”

The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.

2. Harness the power of the reader submission box.

At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.

The floodgates opened. Hundreds of submissions arrived.

By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.

The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.

The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”

3. Mine podcasts relevant to your story.

The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.

But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.

The reporters also used the podcast to get Scully on the phone for an interview.

“So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”

4. When covering AI initiatives, proceed with caution.

“A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”

AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”

He suggests several questions to ask about the data behind AI tools:

  • Where does the data come from?
  • Who does it represent?
  • How is this tool being applied?
  • Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
  • How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?

5. Localize the story.

More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.

“So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.

Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.

The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.

“It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.

There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.

Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.

6. Get familiar with Medicare’s appeals databases

Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.

“Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”

There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.

CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.

Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.

CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.

7. Give your editor regular updates.

“Sprinkle the breadcrumbs in front of your editors,” Ross says.

“If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.

8. Get that first story out.

“You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”

Read the stories

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care

UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients

This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

FROM NEW YORK TIMES: “THE D.E.A. NEEDS TO STAY OUT OF MEDICINE” BY DR. SHRAVANI DURBHAKULA, MD, A PAIN MEDICINE PHYSICIAN FROM NASHVILLE

Shravani Durbhakula, MD, MPH, MBA | Department of Anesthesiology

FROM NEW YORK TIMES: “THE D.E.A. NEEDS TO STAY OUT OF MEDICINE” BY DR. SHRAVANI DURBHAKULA, MD, A PAIN MEDICINE PHYSICIAN FROM NASHVILLE

Congress strips out PBM reform at final hour, teeters toward shutdown with funding deadline

Our Congress passed a 1000+ page continued resolution to continue the funding of our government through the end of our fiscal year (09/30/2024). With 1.2 Trillion dollar patch to our federal spending, members of Congress had < 24 hrs to those 1,000+ pages BEFORE THEY HAD TO VOTE ON THIS BILL. Congress is required by law to have a budget passed for the next fiscal year before the fiscal year begins on Oct 1st of each year. With about 85% of the members of Congress up for re-election in Nov. I wonder how many millions of dollars from the insurance/PBM industry flowed into re-election campaign funds of those members of Congress up for re-election?

Here is a recent blog post about 30% of independent Pharmacist expect to close their doors by the end of 2024. That you be from 4,000- 6,000 independent pharmacies, mostly in rural areas. https://www.pharmaciststeve.com/cash-crunch-pushes-independents-to-the-brink-data-shows-pbms-the-cause/

Here is another post from today https://www.pharmaciststeve.com/medicare-advantage-is-under-fire-what-it-means-for-your-health-and-wallet/    Another example of how the insurance/pbm industry is putting profits over patient care/safety

Congress strips out PBM reform at the final hour, teeters toward shutdown with a funding deadline

https://ncpa.org/newsroom/qam/2024/03/20/congress-strips-out-pbm-reform-final-hour-teeters-toward-shutdown-funding

This week, Congress agreed to fund the government for the rest of fiscal year 2024, mere days before a looming government shutdown, with votes looking to happen this weekend. This agreement would fund nearly 70 percent of the government including the Departments of Defense, Homeland Security, Labor, Health and Human Services, and Education. NCPA is sad to share that PBM reform is not included in the final funding agreement, having been stripped out at the last moment. It was instead decided that a “skinny” health care package would replace the robust legislative package that committees had agreed upon late last week, which included several major NCPA legislative priority policies. The committees had finalized their package after Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) held a press conference with pharmacy leaders, pharmacists and patients — including NCPA CEO Douglas Hoey, pharmacy owner and former NCPA president Michele Belcher, and pharmacy owner Jack Holt — to discuss the urgent need for Congress to finalize bipartisan pharmacy benefit manager (PBM) reforms. Later that day Sens. Wyden and Crapo issued a letter to Finance Committee members reaffirming their commitment to enacting meaningful PBM reforms during this Congress. Additionally, last Friday, 21 Senators and 51 Representatives sent letters to their respective leadership calling for immediate action on PBM reform. The calls, led by Sens. Jon Tester (D-Mont.) and James Lankford (R-Okla.) in the Senate and Reps. Buddy Carter (R-Ga.) and Debbi Dingell (D-Mich.) in the House, highlighted the bipartisan support PBM reform has received in both chambers and the urgent need to act to preserve patient access to medications and pharmacies.

While PBM reform has been stripped out this time,

it made it to final negotiations a promising outlook and even more reason to fight for final passage. NCPA will continue to work with policy leaders to get PBM reform passed this year.

Medicare Advantage Is Under Fire. What It Means for Your Health—and Wallet

Medicare Advantage Is Under Fire. What It Means for Your Health—and Wallet.

https://www.barrons.com/articles/medicare-advantage-medigap-choice-healthcare-retirement-3bb736e4

Insurers may cut back on benefits as their profits get squeezed. Why a Medicare/Medigap plan could be a better deal for consumers.

Marcia Mantell won’t be eligible for Medicare for a few years yet. But she’s sure of one thing: Pitchmen like William Shatner won’t be luring her into a Medicare Advantage plan.

“You are nickel-and-dimed to death,” says Mantell, 62, a retirement consultant in Plymouth, Mass. Out-of-pocket costs can add up quickly in the plans, she says. And once you’re in, it’s tough to go back to traditional Medicare. “It sounds on TV like you can switch whenever you want. You can’t. It’s a 30-year decision.”

No one has a crystal ball to see how their health will hold up through retirement. But concerns are mounting about Medicare Advantage, also known as Part C—the insurance plans that manage Medicare coverage for more than 30 million people. Some big players in Advantage —notably Humana —are reporting sharply higher costs and lower profits, causing their stocks to fall. If the trends continue, it could translate to ancillary benefit cuts and more denials of services.

Other pressures on Advantage are mounting. Some large hospital chains and medical providers have dropped Advantage plans, citing low payments and administrative hassles. The federal government is scrutinizing Advantage plans over insurance industry practices that are driving up costs. The Biden administration has also taken aim at Advantage marketing—featuring the likes of Shatner and football legend Joe Namath in TV ads—saying it may be misleading consumers.

DR. TIMOTHY E. KING, MD THE DOJ-DEA, DR. JOSEPH MENGELE, MD OF PAIN CARE INHUMANITY IN AMERICA AND HIS TRAVELING SHOW OF CORRUPTION, LIES AND DECEPTIONS NEEDING CONGRESSIONAL OVERSIGHT

 

 

Timothy E. King, MD “The Rat King Mother of All Fraud” Dr. King’s assertion that prescriptions of opioids should be deemed illegitimate if there is no objective evidence of functional improvement among patients. This premise, however, fails to account for the inherently subjective nature of pain – a critical factor in assessing the effectiveness of pain management.

JAIL!!! FOR DR. TIM E. KING, MD, DOJ-DEA’S DR. JOSEPH MENGELE, MD, THEIR TW0 CLONES OF INHUMANITY, JAIL !!! OVERSIGHT!!!! FOR THE KING RAT!!! JAIL!!!

 

Profits over pt’s safety – the new healthcare system

 

In America, covered medications on the list of covered drugs and drug prices are so deceptive that they we are losing so many beajtiful people. Another life is lost for the profits of a billion dollar industry. It’ll only get worse as too many remain silent.

 

When agendas can smother the FACTS regardless of who gets harmed

 

A recent study aiming to find factors that increase risk of opioid overdose in chronic pain patients instead found that overdose is vanishingly rare, despite the researcher’s best efforts to obscure the truth. This recent Systemic Review and meta-analysis of almost 24 million patients set out to find what risk factors lead to opioid overdose in chronic pain patients. The results were not what the authors expected, with the data showing that while there were factors that increased the risk of overdose, the ABSOLUTE risk of overdose in chronic pain patients was less than 1%. That’s right. Less than 1% We covered another recent study which showed that addiction is also vanishingly rare. So the question begs to be asked – WHY are chronic pain patients being force tapered off their safe and effective long-term opioid therapy? This is a ground-breaking study, but not for the reasons the researchers hoped. They cherry-picked the data and selectively reported to hide the facts – that overdose is incredibly rare in chronic pain patients. Here’s link to the study – Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies Take note of the authors, they include David N. Juurlink and Jason W. Busse. If you found this information valuable, please consider giving the video a thumbs up, subscribing for more content, and sharing it with your network. Your support helps us continue to bring you high-quality, evidence-based research and STOP the FORCED TAPERS and undertreatment of chronic pain.

Ground Hog version of the SOTU address