DISMISSED!!!!! Montana Board of Medical Examiners’ Dr. Ibsen “Screening Panel”

 

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I remember when Pres Johnson created his “Great Society” in 1965, which brought us Medicare & Medicaid. I was in  the second class of Baby Boomers to graduate High School in 1965. The last baby boomer was born in 1964 and so the bureaucrats had a stream of new 76 million new tax payers over the next 18 yrs.

Those born in 1900 By age 65, only about 2% of males and 2.3% of females from the original 1900 birth cohort were still alive

Those born in 1910  47.6% of Males and 34.7% females died before 65 y/o

Those born between 1946 and 1964 (Baby Boomers)

Approximately 25–30% of baby boomers in the United States died before reaching age 65

Approximately 70%-75% will live until 65 y/o

Medicaid plus CHIP: 23% of the population, (78.6 Million) which includes 41% of all U.S. children and 15% of adults

In 2025, about 40% of U.S. households—approximately 76 million “tax units”—will pay no federal individual income tax

roughly 65 million people in 2025 (based on a U.S. population near 330 million) who are not contributing to Social Security or Medicare through payroll taxes

The problem with socialism is that you eventually run out of other peoples’ money.

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I see a mass exodus of primary care physicians and most office practices will be “stacked” with mid-levels. PA, NP, APRN, and maybe some PharmD. Currently services provided by mid-levels is reimbursed by insurance at 85% of what a MD would get reimbursed, but mid-levels don’t get paid 85% of MD get paid. We may even seen a fair amount of self-care using a AI systems.

Our healthcare system seems to be on the brink of a major transformation – to what – I am not really sure

 

Five Ways Trump’s ‘Big Beautiful Bill’ Impacts Doctorshttps://www.medpagetoday.com/washington-watch/washington-watch/116518After President Trump signed the “One Big Beautiful Bill” into law on July 4, the question remained: How would it impact doctors?With more than $1 trillion in cuts to Medicaid and the Affordable Care Act over a decade, the mega-bill “represent[s] the biggest rollback in federal support for health coverage ever” according to Larry Levitt, executive vice president for health policy at KFF, an organization that researches issues in healthcare. Here are five ways physicians will be impacted by the law.Swamped Emergency DepartmentsBetween a decrease in the Medicaid rolls — largely due to the law’s imposition of a federal work requirement — and the expected expiration of the Affordable Care Act’s enhanced premium tax credits, an estimated 17 million people will lose their health insurance between now and 2034, according to KFF. And for emergency departments (EDs), fewer insured patients equals more uncompensated care.Joanne Conroy, MD, president and CEO of Dartmouth Health, which provides primary and specialty care throughout New Hampshire and Vermont, said about 10% of New Hampshire residents and one-third of Vermonters are on Medicaid. When patients lose insurance such as Medicaid, they don’t see a doctor and don’t get their medications. “Their healthcare kind of goes sideways, and they end up in our emergency rooms with healthcare conditions that are much more serious than if they’ve been addressed ahead of time,” Conroy said.Alison Haddock, MD, president of the American College of Emergency Physicians, agreed, telling MedPage Today that the health system isn’t functional if the ED is the only place patients receive care, because patients come to the department potentially much sicker.Looming Hospital Closures, LayoffsOver the last decade, a “huge swath” of small hospitals in central New Hampshire have closed their obstetrics departments, Conroy said, and now, with Medicaid cuts looming, some others are beginning to restrict services and lay off physicians. And if patients don’t have care they can walk to or care they can access with a short ride, they don’t get care, she added.UC San Diego Health recently cut 230 positions, blaming, in part, “federal impacts to healthcare” and “regulatory uncertainty.”A Medicare Payment Bump — But It’s InadequateAmerican Medical Association (AMA) president Bobby Mukkamala, MD, said changes the AMA sought that would have tied Medicare physician payment to the rate of inflation disappeared from the final bill. The law does include a 2.5% 1-year increase in the Medicare Physician Fee Schedule beginning in January, but both Mukkamala and Haddock said that was insufficient.For emergency physicians, seeing more patients with poor or no coverage — and trying to serve them with fewer staff and resources — has consequences. “When you’re trying to do more with less, constantly … It leads to that moral injury, that burnout, that has people saying … ‘This is not a sustainable job,'” Haddock said.Mukkamala, an otolaryngologist in Flint, Michigan, agreed. While he can diagnose a patient’s throat cancer, “Then what?” he asked. “Where are they going to get chemotherapy? Where are they going to get radiation therapy?” Without health insurance, the patient likely can’t get follow-up treatment and their cancer will grow exponentially, he said, adding that continued stress from these types of situations can lead physicians to early retirement.A Shrinking Physician Pipeline Those early retirements are compounded by a provision of the bill that caps unsubsidized federal loans for professional degrees at $200,000 over a lifetime.Medical student debt is on average a quarter of a million dollars, Mukkamala said. Even for those whose passion was to become a physician and help people, “the math” just may not allow them to pursue what they love. That could really hurt subspecialty care, especially in rural areas, according to Manan Trivedi, MD, MPP, a hospitalist in Washington who participated in a webinar hosted by the nonprofit Protect Our Care.“In the middle of the country, there could be two orthopedic surgeons in all of rural Nebraska, and now there might not be any because of this bill,” Trivedi said. “And so the sum of these sorts of hidden things in this bill, like the loan caps, are really going to have a significant impact.”Growing Maternity Care DesertsOne provision of the law — a provision which was temporarily blocked by a federal judge on July 7 — bars Medicaid funding for Planned Parenthood for 1 year. This provision is especially concerning to ob/gyns because Planned Parenthood provides a range of reproductive health services, including preventive care. Many of the clinics expected to close as a result of the provision are located in areas where services were already sparse, according to Sarah Bogdan, director of federal affairs for the American College of Obstetricians and Gynecologists.“Care deserts are likely to grow,” she said in an email to MedPage Today. Since ob/gyns practicing in care deserts are already struggling with large patient volumes, clinic closures will only add to their patient load, said Bogdan.

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The HALT Fentanyl Act

1. https://www.congress.gov/bill/119th-congress/senate-bill/331
2. https://www.congress.gov/bill/119th-congress/house-bill/27
3. https://www.aapmr.org/members-publications/newsroom/member-news/2023/06/01/u.s.-house-of-representatives-passes-halt-fentanyl-act
4. https://energycommerce.house.gov/haltfentanyl
5. https://www.attorneygeneral.gov/taking-action/ag-sunday-urges-u-s-senate-to-pass-halt-fentanyl-act-that-closes-the-copycat-fentanyl-loophole-and-saves-lives/
6. https://www.sciencedirect.com/science/article/abs/pii/S2468748022000066
7. https://www.sentencingproject.org/press-releases/house-of-representatives-embraces-failed-unjust-and-dangerous-drug-policies-by-passing-halt-fentanyl-bill/
8. https://www.ussc.gov/sites/default/files/pdf/amendment-process/public-comment/20171113/Synthcon.pdf
9. https://www.judiciary.senate.gov/press/rep/releases/support-grows-for-swift-passage-of-halt-fentanyl-act
10. https://www.cbo.gov/publication/61243
11. https://www.pnnl.gov/explainer-articles/fentanyl-analogs
12. https://www.booker.senate.gov/news/press/booker-statement-on-vote-against-halt-fentanyl-act
13. https://www.fda.gov/media/126835/download
14. http://rules.house.gov/bill/118/hr-467
15. https://civilrights.org/resource/the-leadership-conference-opposes-h-r-27-the-halt-fentanyl-act/
16. https://apm.amegroups.org/article/view/37307/html
17. https://morgangriffith.house.gov/news/documentsingle.aspx?DocumentID=404393
18. https://www.fda.gov/news-events/fda-voices/update-fdas-overdose-prevention-framework-addressing-critical-areas-need
19. https://www.congress.gov/crs-product/LSB10404
20. https://nida.nih.gov/research-topics/fentanyl

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The US District of Columbia Department of Health, HealthHIV.com and DCEngage.com have invited, funded, and published the following 1.5-hour course in Continuing Medical Education:

https://reduceharmdc.org/training/cdc-clinical-practice-guidelines-for-prescribing-opioids/

• Incidence of treatment-related substance use disorder or overdose is less than one patient per thousand patients who are treated with prescription opioid analgesics in the context of an ongoing patient-doctor relationship.
• In rare cases where a drug overdose, suicide attempt, or successful suicide occurs in patients who have been treated with prescription opioids, factors in mental health history are from six to twenty-four times more significant as predictors of short-term risk, compared to prescription of opioid pain relievers as such.
• Contradicting assertions of the US Centers for Disease Control and the Veterans Administration, 40 years of data published by both Agencies demonstrates beyond any reasonable doubt that there is no significant relationship between rates of opioid prescribing and either accidental drug overdose deaths or hospital admissions for overdose treatment.
• Over-prescribing of opioid pain relievers to chronic pain patients is not now and has not been for 40 years, a dominating cause of accidental drug overdose.  That distinction belongs to illegal drugs circulating in street markets — presently illegal fentanyl and stimulants like cocaine or methamphetamine, often compounded by alcohol.  Such markets are almost totally unknown to patients with regular health insurance who are treated adequately for pain by a doctor.   

 

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The chart below is the possible adverse effects to the human body if a pt’s pain is under/untreated.

I have listed below 5 different chronic health issues and the consequences to the pt if they are not properly treated. I have put in RED three of the chronic health issues that Medicare Part D & Medicare-C monitor how compliance the pt is in taking their medications for those chronic health issues.  They monitor to such a degree that if all the prescriber’s or pharmacy’s pts are determine to be out of compliance – I think that it is – on average – the pts are not taking 85% of their prescribed medications. That puts the STAR RATING of the prescriber & pharmacy at risk and that means that the reimbursement for caring for those pts will get “dinged”, and those practitioners will be getting “warning letters” from Medicare. So, the fact that Medicare is encouraging all practitioners to limit, reduce or eliminate adequate opioid therapy on chronic pain pts, is apparently counter productive in their “bean counting” if pts are taking their prescribed medications regularly and as prescribed. Since 1935 there has been a law that prohibits any Federal employee interfering with the practicing of medicine. A lawsuit against the 3 largest drug wholesalers by the vast majority of state AGs. Where they agreed to sell less controlled meds to community pharmacies. https://www.pharmaciststeve.com/pharma-prescribed-opioids-to-pts-with-valid-medical-necessity-0-022-pts-odd/kaiser/

The DEA, on a annual basis reduces the controlled med production quotas https://www.pharmaciststeve.com/proposed-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances/

Is it just me or is the DEA/DOJ doing their best efforts to prohibit chronic painers from getting their pain management therapy prescribed and/or pharmacies can’t get  pain medication(s) from their wholesaler and all of this direct/indirect denial of care could be impacting the pt’s co-morbidity issues that CMS is following how/if the pt’s co-morbidity issues are being properly managed. 

All of this push-pull with the DEA/DOJ & CMS involving how/if pts get appropriate care, could possible cause the pt to be falsely labeled as a PHARMACY SHOPPER and get more push back from practitioners and pharmacies because of the pt’s high Narxcare score, which they do not deserve, but could get punished all the same.

Below I outlined the adverse effects that pts may experience due to under/untreated pain, with other critical chronic health issues the pt is already dealing with or cause the pt to develop some other chronic health issues because of their under/untreated pain?

42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

 

 

 

 

 

 

 

 

 

 

 

 

 

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If a patient’s high blood pressure (hypertension) is not properly controlled, it can lead to a wide range of serious and potentially life-threatening complications affecting multiple organ systems:

• Cardiovascular system: Uncontrolled hypertension damages blood vessels, leading to heart attack, stroke, heart failure, angina, atherosclerosis (hardening and narrowing of the arteries), and aneurysms (which can rupture and be fatal)

• Kidneys: High blood pressure can cause the blood vessels in the kidneys to narrow, weaken, or harden, leading to chronic kidney disease and potentially kidney failure

• Brain: Hypertension increases the risk of stroke and can cause vascular dementia or other cognitive impairments due to reduced blood flow to the brain

• Eyes: Damage to the small blood vessels in the eyes can result in retinopathy, leading to vision loss or even blindness

• Sexual function: High blood pressure can cause erectile dysfunction in men and reduced libido or arousal issues in women

• Metabolic syndrome: Uncontrolled hypertension can contribute to a cluster of conditions including increased waist size, high triglycerides, low HDL cholesterol, and high blood sugar, which increase the risk for diabetes, heart disease, and stroke

• Other complications: These can include memory loss, fluid in the lungs, and, in severe cases, aortic dissection (a tear in the wall of the aorta)

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Harms of Untreated Blood Sugar Abnormalities

When blood sugar is not properly managed—whether too high (hyperglycemia) or too low (hypoglycemia)—it can lead to serious, sometimes life-threatening complications. Below are the key risks associated with untreated blood sugar problems:

Untreated High Blood Sugar (Hyperglycemia)

Short-Term Complications:

• Diabetic Ketoacidosis (DKA): A dangerous buildup of acids (ketones) in the blood, which can cause coma or death if not treated promptly.

• Hyperosmolar Hyperglycemic State (HHS): Severe dehydration and very high blood sugar, leading to confusion, seizures, and coma

Long-Term Complications:

• Heart and Blood Vessel Disease: Increased risk of heart attack, stroke, and poor circulation

• Nerve Damage (Neuropathy): Tingling, pain, numbness, and loss of sensation, especially in the feet, which can lead to ulcers and amputations

• Kidney Damage (Nephropathy): Can progress to kidney failure, requiring dialysis or transplantation

• Eye Damage (Retinopathy): Can cause vision loss or blindness

• Poor Wound Healing and Infections: Increased risk of skin, urinary tract, and other infections due to impaired immune function and circulation

• Gum Disease and Tooth Loss: Higher risk of dental problems

• Cognitive Impairment: Increased risk of memory loss and dementia

Long-Term Risks:

• Brain Damage: Repeated or severe episodes can cause lasting cognitive impairment, especially in older adults

• Increased Risk of Heart Disease: Episodes of severe hypoglycemia are linked to higher rates of cardiovascular events and mortality

• Hypoglycemia Unawareness: Over time, the body may stop producing warning symptoms, increasing the risk of severe, unnoticed low blood sugar

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If high cholesterol goes untreated, it can have significant and potentially life-threatening consequences for patients. The main risks stem from the gradual buildup of cholesterol-rich plaque in the arteries, a process known as atherosclerosis. This buildup narrows and hardens the arteries, restricting blood flow and increasing the risk of several serious conditions:

• Coronary artery disease (CAD): Plaque accumulation in the arteries supplying the heart can lead to chest pain (angina), heart attacks, and heart failure. CAD is the leading cause of death in the U.S., and many people do not realize they have it until they experience symptoms or a cardiac event

• Stroke: If plaque builds up in the arteries that supply the brain (such as the carotid arteries), it can reduce or block blood flow. A ruptured plaque can also trigger a blood clot, which may travel to the brain and cause a stroke. Strokes can lead to long-term disability or death

• Peripheral artery disease (PAD): High cholesterol can cause narrowing of arteries in the limbs, particularly the legs, leading to pain, numbness, and, in severe cases, tissue damage or loss. PAD increases the risk of infections and poor wound healing

• High blood pressure: Plaque buildup makes arteries less flexible and narrower, forcing the heart to work harder to pump blood, which can contribute to or worsen hypertension

• Chronic kidney disease: Studies indicate that abnormal cholesterol levels double the risk of reduced kidney function over time. This can progress to chronic kidney disease, requiring dialysis or transplantation if not managed

• Other complications: High cholesterol is often associated with diabetes, which further increases cardiovascular risk. It can also interact with other conditions (like thyroid disease or chronic inflammation) to worsen overall health outcomes

High cholesterol is typically asymptomatic—most people do not feel any different until a major event (like a heart attack or stroke) occurs

. This “silent” nature underscores the importance of regular screening and proactive management, especially since the risk increases with age and other factors such as genetics, diet, and lifestyle

In summary: Untreated high cholesterol significantly raises the risk of heart attack, stroke, peripheral artery disease, kidney disease, and death from cardiovascular causes. Early detection and treatment—through lifestyle changes and, if needed, medications—are essential to reduce these risks and improve long-term health outcomes

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Low thyroid (T4) blood levels indicate hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone. This deficiency slows down many of the body’s metabolic processes and can cause a wide range of physical problems

The main physical problems associated with low T4 levels include:

• Fatigue and weakness: People often feel unusually tired and lack energy, even after adequate rest

• Weight gain: Metabolism slows, leading to unintentional weight gain despite no change or even a decrease in appetite

• Cold intolerance: Increased sensitivity to cold temperatures is common due to reduced heat production

• Dry skin and hair: Skin may become dry, rough, and pale; hair can become dry, brittle, and thin

• Constipation: Slowed digestive processes can lead to persistent constipation

• Muscle and joint pain: Muscle aches, stiffness, cramps, and joint pain or swelling are frequent complaints

• Slow heart rate: The heart may beat more slowly, and in severe cases, hypothyroidism can contribute to heart failure or pericardial effusion (fluid around the heart)

• Elevated cholesterol: Hypothyroidism can increase total and LDL cholesterol, raising the risk of heart disease

• Menstrual and fertility issues: Women may experience heavier, irregular periods and fertility problems due to disrupted ovulation

• Peripheral neuropathy: Long-term untreated hypothyroidism can damage peripheral nerves, causing numbness, tingling, or pain in the limbs

• Mental health changes: Depression, slowed thinking, memory problems, and decreased interest in activities can occur

• Goiter: The thyroid gland may enlarge as it attempts to compensate for low hormone production, sometimes causing visible swelling in the neck and difficulty swallowing

• Myxedema: In severe, untreated cases, swelling of the skin and tissues (myxedema) can develop, and in extreme cases, lead to a life-threatening myxedema coma

In infants and children, untreated hypothyroidism can cause serious physical and mental developmental problems, but early diagnosis and treatment can prevent these outcomes

In summary: Low T4 levels slow down metabolism and can cause a range of symptoms affecting energy, weight, temperature regulation, skin, hair, heart, muscles, nerves, and reproductive health. If untreated, hypothyroidism can lead to significant complications, but it is generally treatable with hormone replacement therapy

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Consequences of Long-Term Untreated SaO₂ ≤ 85%

When a patient’s arterial oxygen saturation (SaO₂) remains at or below 85% for an extended period without intervention, it leads to chronic hypoxemia. This condition can have severe and potentially irreversible effects on multiple organ systems.

Immediate and Short-Term Effects

• Cognitive Impairment: Low oxygen levels can cause confusion, irritability, drowsiness, and visual changes. Severe hypoxemia can lead to loss of consciousness, seizures, or even coma.

• Cardiorespiratory Symptoms: Patients may experience shortness of breath, rapid breathing, increased heart rate, and abnormal heart rhythms

• Cyanosis: A bluish or grayish tint to the skin, especially when saturation drops below 75%, indicating dangerously low oxygen delivery to tissues

Long-Term Consequences

1. Neurological Damage

• Brain Injury: Prolonged hypoxemia can result in irreversible brain damage, cognitive decline, and increased risk of stroke. Brain cells are highly sensitive to low oxygen and may die within minutes to hours of severe hypoxia

2. Cardiovascular Complications

• Pulmonary Hypertension: Chronic low oxygen levels cause constriction of pulmonary arteries, leading to increased pressure (pulmonary hypertension)

• Right-Sided Heart Failure (Cor Pulmonale): The right ventricle works harder to pump blood through the lungs, eventually leading to right-sided heart failure

• Arrhythmias: Hypoxemia can trigger abnormal heart rhythms, increasing risk for sudden cardiac events

3. Hematological Changes

• Secondary Polycythemia: The body compensates for low oxygen by producing more red blood cells, which thickens the blood and increases the risk of clotting and stroke

4. Multi-Organ Dysfunction

• Organ Damage: Chronic hypoxia can irreversibly damage vital organs such as the brain, heart, kidneys, and liver, ultimately leading to organ failure

• Reduced Exercise Tolerance & Quality of Life: Muscle dysfunction, fatigue, and reduced stamina are common, limiting daily activities

5. Increased Mortality

• Higher Risk of Death: Studies show that persistently low oxygen saturation is independently associated with increased all-cause mortality, especially from pulmonary and cardiovascular diseases

Summary Table: Major Consequences

Heart & Lungs

Pulmonary hypertension, right heart failure, arrhythmias

Blood

Secondary polycythemia, increased clot risk

Organs (multi-system)

Irreversible organ damage, failure

General

Increased mortality, reduced quality of life

Key Points

• SaO₂ ≤ 85% is a medical emergency and requires prompt intervention.

• Untreated chronic hypoxemia leads to progressive, often irreversible, multi-organ damage and significantly shortens life expectancy

• Early recognition and treatment are critical to prevent these severe complications.

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DOJ Subpoenas Doctors Over Youth Gender Care

https://www.medpagetoday.com/washington-watch/washington-watch/116458

The U.S. Department of Justice (DOJ) announced that it had sent more than 20 subpoenas to doctors and clinics “involved in performing transgender medical procedures on children.”

Though additional details on the subpoenas and their recipients were not immediately available, the department said investigations include healthcare fraud and false statements.

“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,” Attorney General Pamela Bondi said in a statement.

The issue also came up in a Wednesday workshop held by the Federal Trade Commission (FTC) on “unfair or deceptive trade practices” in gender-affirming care for youth.

Speaking at the event, Chad Mizelle, chief of staff at the DOJ, noted that “there’s a basic principle of law, you cannot deceive consumers.”

“You cannot lie to them to get them to buy your products, use your services,” Mizelle said. “You cannot commit fraud. This is true in providing medical services, but also more generally. There’s no doubt in my mind, based not only on what we’ve heard here today, but just looking around with our own eyes, that the industry that is formed around providing gender-affirming care and transitioning services for children has perpetuated one of the greatest frauds on the American public.”

“One of the most important tasks of government is to prevent this fraud from continuing and to remedy the consequences of this fraud,” he added.

The subpoenas are just the latest in a string of actions taken by the Trump administration regarding gender-affirming care for youth.

In January, President Donald Trump issued an executive order entitled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.”

And in May, a 409-page report from HHS urged therapy for transgender youth rather than broader gender-affirming care, questioning standards of treatment issued by the World Professional Association for Transgender Health (WPATH). The Associated Press noted at the time that the report was likely to be used to support the federal government’s “abrupt shift in how to care for a subset of the population that has become a political lightning rod.” Medical experts sharply criticized the report as inaccurate.

Also in May, CMS announced that it had sent a letter to certain hospitals “performing pediatric sex trait modification procedures outlining urgent concerns with both the quality standards adherence and profits related to these harmful procedures.”

In June, the FBI issued a public plea on X: “As the Attorney General has made clear, we will protect our children and hold accountable those who mutilate them under the guise of gender-affirming care.” It then asked for reports of any hospitals, clinics, or practitioners performing these surgical procedures on children.

Additionally, the HHS Office for Civil Rights began an investigation into a major health system in Michigan regarding allegations that a healthcare provider there fired a medical professional for “exercising her federally protected rights of conscience” after requesting religious accommodation from certain employment practices. These included “requiring use of patient pronouns that do not align with the patient’s sex,” and “assisting in certain sex trait modification procedures.”

And earlier this month, the Wall Street Journal reported that the Trump administration was weighing whether to cut funding to hospitals that provide gender-affirming care for youth.

In a statement to MedPage Today, WPATH and its U.S. arm, USPATH, said the FTC workshop “sends a discouraging and unfortunate message – that the lives and very existence of transgender and gender-diverse youth are somehow up for debate. Let us be perfectly clear: they are not.”

“Transgender and gender diverse youth are human beings deserving of dignity, respect, and the freedom to access healthcare that can improve their lives and well-being in consultation with their parents and doctors,” the statement said. It continued that the workshop was a way for the federal government to “platform misinformation, further sow division, and weaponize patient-doctor relationships to pursue a purely political agenda.”

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Judge Orders CVS’ Omnicare Unit to Pay $949 Million Over Invalid Prescriptions

https://gvwire.com/2025/07/08/judge-orders-cvs-omnicare-unit-to-pay-949-million-over-invalid-prescriptions/

 

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The message below is going around the web and apparently Google has decided to let their AI program Gemini to have access to all the data on a Android cell phone, unless you do specific things to stop it from doing this. Remember your data is part of the next “gold rush” and worth a lot money to Goggle and whoever Google sells your data to

 

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Switch to Dry-Powder Inhaler Worsened COPD, Asthma Patient Outcomes

Veterans Affairs formulary change acted as a “natural experiment” for the study

https://www.medpagetoday.com/pulmonology/smokingcopd/116412

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I have always contended that the average Rx price went up in direct proportion of the percentage of the Rx market that the PBM’s controlled
Look at the chart below, as the percentage of generics increased, which should have showed the average Rx price would have been lower, but the percentage of the Rx market place that the PBM controlled. The average Rx price went up.

How Insurance/PBM industry use PAs to pad their bottom line

 

 

 

 

 

 

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