I have been nominated to be part of the Trump administration in regards to healthcare and MAHA

@everyone

https://discourse.nomineesforthepeople.com/t/steve-ariens/36342

 

Your support and votes are appreciated – see link above

Here is a video of a Federal attorney that elaborates how they use normally “innocent statements” from prescribers and pharmacist and daisy chain various otherwise “innocent activities” into violations of the Controlled Substance Act and the number of charges against the healthcare professionals start to stack up. US Attorney Admits that He was Directed to Target Doctors Who had NO criminal intent ( » US Attorney Admits that He was Directed to Target Doctors Who had NO criminal intent )
Here is an article from FIVE SENATORS Elizabeth Warren Advocates to Formalize Barriers for Pain Patients » Elizabeth Warren Advocates to Formalize Barriers for Pain Patients calling for the DEA to increase the DENIAL of pain medications to chronic pain patients. Here is a video on how the PBM industry now operates https://youtu.be/jp1_6SDfxlE?si=GCegamZsrAjGSmOV
Here is Senator Eliz Warren’s interaction with the CEO of United Health and all the control that they have over our healthcare system and all the profits they are taking out of our healthcare budgets, that should be devoted to pt care. If this group is hoping to improve pt’s QOL while controlling medical costs. It is going to need someone that understands where are the $$ are being sucked out of the system and to the bottom lines of many medical middlemen. I may be one of but a few people who can related to all those involved from the medical practitioner perspective and the pt’s perspective. I am retired and have no allegiance to any corporation and I have a wife that has been a intractable chronic pain pt for 3+ decades.

Image

Should we share the hell out of this?

I know that many of you are not happy in how the election turned out, but if you want to continue to put your personal political opinions over what is the best for the chronic pain community. You can stop reading right here ! Just go ahead and shoot yourself in the foot or HEAD!

There is a new sheriff in town and he is bringing along a lot of deputies that are claiming that they are making a change to how things are done.

Trump has admitted that some of the people recommended to him in his first term were not the appropriate people for the tasks they were given.  Perhaps many were covert members of “the swamp” that he was trying to drain.

I don’t think that Elon Musk,  Robert F. Kennedy Jr and whoever the new Attorney General will be of the previous SWAMP!

Musk claims he is going to focus on cutting costs – maybe he should look at all those 100 of millions of dollars being spent on Epidural Spinal Injection. That are not recommended by the FDA and the pharma that makes the corticosteroid most often used in ESIs. In reality those ESIs at best provide the pt some minor/temporary pain relief, but in the long run will cause more deterioration in the spine.

Those pain docs that are telling pts that they must be subjected to ESI to get some oral opioids, may be violating a federal law that is part of the Sherman Antitrust Act calling Tying Commerce https://en.wikipedia.org/wiki/Tying_(commerce) and providing those ESIs that are not really medically necessity, some consider it insurance fraud and if Medicare/Medicaid are involved then it could be considered federal fraud.

I read where – on average – TWO DOZEN – veterans commit SUICIDE EVERY DAY, because the VA system is refusing to treat those veteran who have come home with painful “broken bodies” and the VA system is just electing to ignore their pain.

Kennedy is suppose to be focusing on improving our health.  Could working with our new Attorney General to get the DEA to focus on getting much of the ILLEGAL FENTANYL off our streets and causing all those poisoning/ODs.

IMO, the only thing that may stand in the way of the community making some progress is to DO NOTHING! That will guarantee that the community will GET NOTHING! There is nearly 11,000 post on my blogs and I have pulled some that I consider very appropriate to work with the new administration.

https://www.pharmaciststeve.com/wp-content/uploads/2017/06/harmfrompain.jpg

 

Breaking: Supreme Court Rules ‘Red Flag’ Gun Laws Unconstitutional – should RED FLAGS used by DEA be UNCONSTITUTIONAL ?

US Attorney Admits that He was Directed to Target Doctors Who had NO criminal intent

Another reaction to the SCOTUS overturning the Chevron Doctrine

Is how the DEA enforces the CSA… in violation of this federal law ?

https://www.pharmaciststeve.com/wp-content/uploads/2023/11/kaiser.pdf

Could this be why no one can get a law firm to sue medical care deniers

Pain Refugees: Collateral Damage of the War on Drugs

SCOTUS Petition Takes Aim at Ambiguous Federal Opioid RX Laws Aug 5 Written By Ronald Chapman II Lubetsky v. United States

How opioid prescriptions are tracked and monitored by law enforcement and health care providers

 

 

Relax: Nothing is under control

Pin en El animal

Lauren Conrad Quote: “Sometimes, you just have to take a step back and ...

I have been writing/sharing on my blog for 13-14 yrs. I have seen many people who would come into the community the with attitude that they can “get ‘er done”.  They stay/hang around for a few months, maybe even a few years, and then they realize that the task is something that they can’t tackle, and they are GONE!

I have seen a lot of in-fighting within the multitude of “support groups’, even seen some support groups disband and then some of the fragments of those groups create another group or two and the cycle keep repeating.

I complained to Barb once many months ago, about all the infighting,  I married a very wise woman… she told me that I would never understand… because I never a girl/female in Jr/Sr High School.

Reading what those two attorney posted on the web over the last few weeks, it is posted below. I don’t think that the community will ever fine enough money to hire an attorney/law firm that has enough balls to address the problems with practitioners being able to  treat chronic pain and other subjective diseases, with the appropriate controlled medications.

Barb just had an appt with our PCP, who we have been seeing since last 1969 – early 1970. He is like a “Dr Marcus Welby” – if you don’t know the reference – do a web search. He is pulling back on his office hrs. He lost a adult kid to COVID-19 during the epidemic and he recently had some health issues where he was out of the office for a few weeks.

Years ago, he told the that  -God willing- he was going to be practice till he was 75 y/o.  But now he is about 70 y/o. I have an appt with him the first week of Feb, 2025. I will find out what his plans are.

We may be looking for a new PCP soon, but I know a number of the local prescribers and being a decent advocate, I think that we can hopefully transition over  to a new practitioner without missing a beat. Only time will tell.

IMO, the community has fragmented itself into many pieces or “tribes”, each with at least one Face Book page. Last week, I was not feeling very well one day and I just turned my phone off and shut my computer down.  The next morning, I found over 100 emails and I can’t count the number of FB posts – many of them repeats of people re-posting them in hopes that someone would read them. Then there was all the texts.

I have made nearly 11,000 posts on my blog over the years and it is approaching THREE MILLION PAGE VIEWS. I am approaching the end of my EIGHTH DECADE ON THIS PLANT.

Barb and I tend on aging in place, but I have not been able to find a “handyman” to do much of the maintenance around the house. I have the experience and the tools to do most all of the work, but my energy and endurance isn’t what it use to be.

Within the next few weeks, I will be pulling back from reading any of the Face Book pages and responding on those pages. I am still going to be around, and I can be reached via the links listed below. Chronic pain pts are still going to continue to get their pain meds taken away and they are still going to have to take a stand to get some of them back.

The path that the community may be on, may take longer than the number of years that I have left to try to change directions.  It looks like I may have other personal battles that I may have to deal with, and family comes first.

 

https://www.facebook.com/pharmaciststeve/

https://x.com/Pharmaciststeve

 

 

 

 

 

 

 

 


“Red Flag” Prosecutions against physicians continue. In United States v. Campbell, the Government used its unenumerated list of “red flags” to support a smoke-fire prosecution absent actual evidence. Tune into my 6th Circuit Oral Argument this Wednesday.


Could this be why no one can get a law firm to sue medical care deniers


Could this be the CANARY IN THE COAL MINE moment?

When Dr Bockoff’s office was raided by the DEA and shut down and first, there was the double suicide—Danny Elliott and wife Gretchen from Georgia who took their lives one week after the physician’s office was raided. The above hyperlink is another article on how our judicial system left those two no options but to commit DOUBLE SUICIDE.

A couple of weeks later another patient 42-year-old Jessica Fujimaki, died Dec. 10 at her home near Phoenix. Click the hyperlink above to read a story about Jessia. Autopsy results are pending, but her husband told VICE News he believes the cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. She left behind two daughters, ages 13 and 11.

Those of us involved with the chronic pain community, often hear about chronic pain pts that die after the DEA raids a prescriber’s office. Either commit suicide because they are left in a torturous level of pain after the DEA/DOJ raided their prescriber’s office and/or they suffer a premature death from the complications of under/untreated pain. Here is a chart that outlines all of those complications. https://www.pharmaciststeve.com/wp-content/uploads/2017/06/harmofpain.jpg

The DOJ/DEA has done this so often to so many prescriber’s offices, they know what is going to happen as a result of their actions… PATIENTS WILL DIE… directly or indirectly because their actions.

 

I Am Torn: Grappling With the Killing of UnitedHealthcare’s CEO

— I detest everything Thompson stood for, yet I am troubled by thoughts of hate

https://www.medpagetoday.com/opinion/second-opinions/113318

 

The Canary In The Coal Mine Died - by Ken Bodnar

The DEA Shut Down a Pain Doctor. Now 3 People Are Dead.

https://www.vice.com/en/article/dea-beverly-hills-doctor-shut-down-opioids/

 

 

Here is what http://www.perplexity.ai has to say about pts who have been patients of a physician’s office that has been raided and shutdown by the DEA/DOJ. Should “we” look into the how the “average Joe” is treated when they do something that they knew could or would end up harming or killing someone and how is members of our DOJ/DEA is treated when they raid prescribers’ offices when they know or should have known that some patients of those prescribers will end up dying (suicide or premature death) or left in a torturous level of pain because of their decisions and actions?

what does the DEA do to help chronic pain patients of physicians’ practices that they raid and shut down and the patients have no physicians who will accept and treat these patients

The Drug Enforcement Administration (DEA) does not appear to have specific programs or measures in place to directly help chronic pain patients whose physicians’ practices have been raided or shut down. The DEA’s actions have had significant unintended consequences for chronic pain patients, often leaving them without access to necessary pain medications and struggling to find new healthcare providers willing to treat them.

## Impact on Chronic Pain Patients

When the DEA raids and shuts down a physician’s practice, chronic pain patients often face severe challenges:

1. Loss of access to pain medications: Patients suddenly lose access to their prescribed opioids, which can lead to withdrawal symptoms and increased pain[1].

2. Difficulty finding new providers: Many physicians have become reluctant to prescribe opioids due to fear of DEA scrutiny, making it extremely challenging for patients to find new healthcare providers willing to treat their chronic pain[2].

3. Increased suffering: The sudden loss of pain management can result in increased pain, reduced functionality, and a lower quality of life for patients[1].

4. Mental health consequences: Some patients report experiencing suicidal thoughts when unable to access their prescribed medications[6].

## DEA’s Approach and Consequences

The DEA’s primary focus appears to be on enforcement rather than addressing the needs of chronic pain patients affected by their actions:

1. Targeting high-dose prescribers: The DEA has been known to target physicians who prescribe high doses of opioids, even when these prescriptions may be medically necessary for certain patients[1].

2. Creating a chilling effect: The DEA’s actions have led many physicians to stop prescribing opioids altogether, further limiting options for chronic pain patients[2].

3. Lack of direct support: There is no evidence of the DEA providing direct assistance or alternative care options for patients affected by their enforcement actions[1][2].

## Unintended Consequences

The DEA’s approach to combating opioid abuse has had several unintended consequences:

1. Increased suffering for legitimate patients: Many chronic pain patients who rely on opioids for pain management have been left without adequate care[1].

2. Reduced access to pain management: The fear of DEA scrutiny has led to a decrease in the number of physicians willing to prescribe opioids, even for legitimate medical purposes[2].

3. Potential increase in illegal drug use: Some patients, left without access to prescribed medications, may turn to illegal sources to manage their pain[1].

While the DEA’s intentions may be to address the opioid crisis, their actions have often resulted in significant hardships for chronic pain patients. The lack of specific programs or measures to assist affected patients highlights a gap in the current approach to balancing drug enforcement with the needs of legitimate pain patients.

Citations:
[1] https://www.vice.com/en/article/dea-raided-chronic-pain-doctor-forest-tennant/
[2] https://simonfengmd.com/the-deas-role-in-depriving-patients-of-pain-medications/
[3] https://wa-provider.kaiserpermanente.org/static/pdf/provider/resources/pain-toolkit.pdf
[4] https://www.mhs.net/patients-and-visitors/pain-management
[5] https://painconnection.org/support-groups/national-support-groups-for-chronic-pain/
[6] https://lynnwebstermd.com/2015/04/06/dea-inflicts-harm-on-chronic-pain-patients/

How do patients find new doctors after their previous ones are shut down by the DEA

Finding new doctors after a previous physician’s practice has been shut down by the DEA can be a challenging and frustrating process for chronic pain patients. While the search results don’t directly address this specific situation, we can infer some strategies that patients might use to find new care providers:

## Strategies for Finding New Doctors

1. Contact insurance providers: Patients can reach out to their insurance companies to obtain a list of in-network pain management specialists or primary care physicians who may be willing to take on chronic pain patients[1].

2. Utilize patient advocacy organizations: Organizations like the U.S. Pain Foundation and The Pain Community offer resources and support for people living with chronic pain. These groups may be able to provide guidance on finding new healthcare providers[2].

3. Seek referrals from other healthcare professionals: Patients can ask their other healthcare providers (e.g., physical therapists, psychologists, or specialists in other areas) for recommendations or referrals to pain management doctors.

4. Join support groups: Pain Connection offers national support groups for chronic pain patients via videoconference. These groups can be valuable sources of information and peer recommendations for finding new doctors[3].

5. Use online resources: Websites of organizations like the American Chronic Pain Association may provide directories or resources to help patients locate pain management specialists in their area[5].

## Challenges in Finding New Care

It’s important to note that chronic pain patients often face significant obstacles when seeking new care providers after their previous doctor’s practice has been shut down:

1. Reluctance to prescribe opioids: Many physicians have become hesitant to prescribe opioids due to increased scrutiny, making it difficult for patients to find doctors willing to continue their pain management regimens.

2. Limited availability: The number of pain management specialists may be limited in certain areas, leading to long wait times for appointments.

3. Lack of continuity of care: Patients may struggle to obtain their medical records from closed practices, making it challenging to provide new doctors with a complete medical history[1].

4. Stigma: Chronic pain patients may face stigma or skepticism from new healthcare providers, especially if they were previously treated by a practice that was shut down by the DEA.

While finding a new doctor can be daunting, patients are encouraged to persist in their search, utilize available resources, and consider exploring comprehensive integrative pain management approaches that may include both pharmacological and non-pharmacological treatments[2].

Citations:
[1] https://www.ama-assn.org/system/files/2021-02/Patient-access-obtaining-medical-records-from-closed-practices.pdf
[2] https://painmanagementalliance.org/resources/resources-for-people-with-pain/
[3] https://painconnection.org/support-groups/national-support-groups-for-chronic-pain/
[4] https://uspainfoundation.org
[5] https://www.acpanow.com

 

Imagine as you are being prepped for surgery and you are told we are a NO ANESTHESIA HOSPITAL!

I remember – as a kid – watching on TV the “old cowboy shows” when one of them got SHOT and the old country doctor was going to dig out the bullet and they would give the patient some WHISKEY and a small tree branch to “chew on” while the doctor begins to DIG THE BULLET OUT!

Back in the mid-1800s in the USA the average life expectancy was ~ 40 y/o. When the USA started our social security program and the first check was issued to Ida May Fuller in Feb 1940 for the magnificent amount of $22.54. However, > 50% of workers would not live to the ripe old age of 65 y/o to collect their first social security check.

Here is a quote from https://www.elevancehealth.com/

Elevance Health brings together the concepts of elevate and advance, exemplified by our bold purpose of improving the health of humanity. We are a health company dedicated to making real progress toward improving the health of the people and communities we serve.

Anthem BCBS drops controversial new plan to cap anesthesia coverage after backlash

https://www.usatoday.com/story/news/health/2024/12/05/anesthesia-policy-anthem-bcbs/76796002007/

After receiving intense backlash, a health insurance provider has rolled back its plan to implement a new policy that would have limited its coverage for anesthesia used during procedures.

Elevance Health, which recently rebranded from Anthem Blue Cross Blue Shield, first shared information about the proposed change for Connecticut, New York and Missouri via news releases posted Nov. 1, though the news only just started gaining traction this week. In some instances, provider notices were sent to specific states as recently as Dec. 1, which may have contributed to the delayed reaction.

Delayed or not, the public backlash has been fierce and swift. According to a description of the policy on Anthem’s website, billing guidelines would change in some states beginning in February 2025 to cap the amount of anesthesia care the company would cover based on time limits pre-set by the insurer.

This would mean that if a patient’s procedure ran long, the insurer would not pay for the care, the American Society of Anesthesiologists (ASA) said in a statement posted last month calling for the move to be reversed.

The proposition concerned not only members of the public, who began making tongue-in-cheek comments online about being woken up mid-surgery to swipe a credit card, but professional organizations, doctors and lawmakers alike.

Late Thursday afternoon, Anthem shared a statement with USA TODAY announcing the decision not to move forward with the change.

“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change,” the statement said. “To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”

Maybe this is why they are now calling it Medicare-C – there is little ADVANTAGE!

CMS proposes additional prior auth reforms for Medicare Advantage plans

https://www.cmadocs.org/newsroom/news/view/ArticleId/50770/CMS-proposes-additional-prior-auth-reforms-for-Medicare-Advantage-plans

CMS has proposed new regulations aimed at reducing the inappropriate use of prior authorization in Medicare Advantage programs.

The Centers for Medicare & Medicaid Services (CMS) recently proposed regulations that would establish additional guardrails on Medicare Advantage plans’ prior authorization practices — including the use of artificial intelligence (AI).

Amid rising concerns that algorithms are being used to improperly delay or deny care, the proposed regulations would remove unnecessary barriers to care resulting from the inappropriate use of prior authorization and internal coverage criteria. 

According to CMS, data reported by Medicare Advantage plans indicate that when appealed, plans overturn 80% of their decisions to deny claims. These data also show that a low percentage of denied claims are appealed, meaning many more would likely be overturned if they were appealed.

A U.S. Senate report released in October 2024 also found the Medicare Advantage insurers deny prior authorization requests for post-acute care following hospital stays at far higher rates than other types of care.

Published by the Senate Homeland Security Committee’s investigative subcommittee, the report looked at the nation’s largest Medicare Advantage insurers — UnitedHealthcare, Humana and CVS —  and investigated their practice of “intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities.”  

Key elements of the latest CMS proposal would define the meaning of “internal coverage criteria” to clarify when plans can apply utilization management, ensure plan internal coverage policies are transparent and readily available to the public, ensure plans are making enrollees aware of their right to appeal and address after-the-fact overturns that can impact payment, including for rural hospitals.

Additionally, efforts are underway that will allow CMS to collect detailed information from initial coverage decisions and plan-level appeals to gain a better line of sight on utilization management and prior authorization practices.

The proposed rule would also ensure services are provided equitably, irrespective of delivery method or origin. It clarifies that if plans use AI or automated systems, they must provide equitable access to services and not discriminate based on any factor related to the patient’s health status. 

The proposed rule would also, among other things:

  • Provide greater oversight of health plan “medical loss ratios” (MLR) to limit  plan expenditures on profit and overhead, including a prohibition on including administrative costs associated with quality improvement in the MLR
  • Expand access to transformative anti-obesity medications under the Medicare Part D and Medicaid programs, helping to ensure more Americans have access to these medications.
  • Promote access to behavioral health care providers and improve the administration of supplemental benefits;
  • Strengthen existing regulations regarding coverage of and responsibility to provide all reasonable and necessary Medicare Part A and B benefits; and
  • Address marketing practices that are misleading to seniors and persons with disabilities.

While CMA is reviewing this lengthy new rule, we applaud the many reforms that protect patients and help physician practices. 

Pain Refugees: Collateral Damage of the War on Drugs

https://www.cato.org/events/pain-refugees-collateral-damage-war-drugs

For much of the 21st century, public health officials and policymakers have blamed doctors for overprescribing opioids and causing the overdose crisis. In response, the Centers for Disease Control and Prevention issued pain management guidelines aimed at reducing opioid prescriptions. Most states have codified them into law.

Federal and local drug task forces have arrested doctors whom they accuse of overprescribing opioids. This has led to a situation where many physicians either undertreat pain or choose to abandon their long-term pain patients. As a result, opioid prescribing has dropped below 1992 levels, while overdose deaths among nonmedical users have skyrocketed.

This crackdown has also created a population of “pain refugees”—chronic pain patients who have lost or were abandoned by their doctor and are left searching for a doctor willing to treat them. Many, out of desperation, turn to the black market for relief, while others resort to suicide.

Join us to discuss the pain refugee crisis, its causes, and potential solutions. Our panel includes a physician who treats and advocates for pain patients, an attorney who defends these doctors, a civil rights attorney who is also a patient advocate, and a pain refugee.

 

HEY BIDEN !!

Pharmacies sue GoodRx, accusing the company of conspiring with PBMs

Pharmacies sue GoodRx, accusing the company of conspiring with PBMs

https://www.healthcare-brew.com/stories/2024/11/19/pharmacies-sue-goodrx-accusing-company-conspiring-pbms

It’s not all good news for GoodRx.

The drug discount company is facing at least three separate class-action lawsuits from independent pharmacies accusing it of “conspiring” with pharmacy benefit managers (PBMs) to fix reimbursement rates in a way that boosts the PBMs’ profits. Also named in two of the three suits are four PBMs: Caremark, Express Scripts (owned by Cigna), Medimpact Healthcare Systems, and Navitus Health Solutions.

PBMs are companies that negotiate between drugmakers, insurers, and pharmacies to decide which drugs insurers cover and how much pharmacies are reimbursed for dispensing those drugs.

The lawsuits come as PBMs face increasing scrutiny, with the Federal Trade Commission bringing a lawsuit against the country’s top three PBMs in September for allegedly boosting profits by inflating the price of insulin.

What’s the issue?

The crux of the class-action lawsuits—filed in late October and early November—relates to a new line of business GoodRx started in 2023 called the “integrated savings program” that deals with generic drugs, which make up about 90% of drugs dispensed in pharmacies in the US.

Under the program, the independent pharmacies serving as plaintiffs allege that GoodRx has formed partnerships with certain PBMs in which the PBMs pay GoodRx to use its database of proprietary pricing data to lower the amount PBMs pay in reimbursement fees to dispensing pharmacies.

The program involves drug discount cards, which consumers can receive from PBMs to get cheaper prices on specific drugs at partner pharmacies. In 2021, discount cards made up 5.4% of all prescription drug transactions, according to data from the Association for Accessible Medicines.

As an example, let’s say Caremark, one of the top three PBMs in the US, gives a consumer a drug discount card for the diabetes drug metformin.

Without the GoodRx program, after a customer picks up their metformin prescription from the pharmacy, the pharmacy submits a claim for reimbursement to Caremark. Then Caremark reimburses the pharmacy a previously agreed-upon amount—say, $10—and the transaction is complete.

But GoodRx’s integrated savings program allegedly introduced a new step to the process, Miranda Rochol, SVP of provider solutions at health tech company Prescryptive Health, told Healthcare Brew. Prescryptive operates in the pharmacy benefits space and advocates for increased transparency among PBMs.

But that’s not all, Rochol added. GoodRx also allegedly charges the pharmacy a transaction fee—which is usually between $5 and $10, according to the lawsuits—that it splits between the other PBMs it compared its prices with, further lowering the amount of money the pharmacy gets paid, Rochol said.

Navigate the healthcare industry

Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.

“These partnerships amount to price-fixing agreements that enable the PBMs to allocate discount card transactions amongst one another in real time, ensuring the PBMs pay the lowest possible reimbursement rates to pharmacies on every transaction,” according to one of the lawsuits filed by Old Baltimore Pike Apothecary and Smith’s Pharmacy in the US District Court for the District of Rhode Island on November 1. “By targeting generic drugs, [the] defendants are attacking a stream of revenue on which independent pharmacies depend for most of their survival.”

Another lawsuit, filed by Keaveny Drug, Inc. in the US District Court for the Central District Of California Western Division on October 30, claims that thanks to the GoodRx program, the PBMs listed in the suit could end up underpaying pharmacies about $35 million just in 2024. The third lawsuit was filed in the same California court on November 1 by Community Care Pharmacy.

All three lawsuits allege that the integrated savings program favors chain pharmacies that are affiliated with PBMs, such as CVS, which owns Caremark. They also allege the arrangement violates the Sherman Antitrust Act, a federal law that prohibits practices that stifle competition.

“The premise of these lawsuits is categorically false,” Express Scripts spokesperson Justine Sessions said in a statement sent to Healthcare Brew. “Our partnership with GoodRx helps promote lower prices for patients at the pharmacy counter by directly integrating discount card pricing with customers’ pharmacy benefits. This program is an important part of our work to protect people from high drug costs, particularly for those with high deductible plans.”

Caremark spokesperson Michael DeAngelis told Healthcare Brew that the PBM “generally reimburses independent pharmacies at higher levels than chain drugstores, including CVS pharmacies. Our Caremark Cost Saver program also helps lower out-of-pocket drug costs for our clients’ members. These lawsuits are entirely without merit, and we will vigorously defend against them.”

Neither GoodRx nor the other PBMs named in this story responded to Healthcare Brew’s requests for comment.

The bigger picture

Independent pharmacies are already struggling to keep their doors open.

The National Community Pharmacists Association (NCPA) said in March that nearly one-third of the country’s roughly 19,000 independent pharmacies are in danger of going out of business. And in 2023, about one independent pharmacy closed per day in the US, according to the NCPA.

Chronic Pain Is Rising, and It’s Not Clear Why

Chronic Pain Is Rising, and It’s Not Clear Why

More Americans are living with pain now, CDC data show

https://www.medpagetoday.com/neurology/painmanagement/113149

A new CDC report indicated that the percentage of Americans with chronic pain rose considerably in recent years, and it’s not clear why.

In 2023, 24.3% of U.S. adults had chronic pain lasting 3 months or longer. In 2016, that figure was 20.4% and in 2021, it was 20.9%

The numbers came from the National Health Interview Survey (NHIS), a cross-sectional poll conducted annually by the CDC’s National Center for Health Statistics. The NHIS methodology and questions have not changed, the CDC said.

“What is clear is we have an astounding and growing public health crisis of chronic pain,” observed Sean Mackey, MD, PhD, of Stanford School of Medicine in Palo Alto, California, who co-authored the CDC’s analysis of chronic pain prevalence in 2016.

“This crisis touches everyone and requires a broader public health approach to reverse this concerning trend,” he noted.

Aging and Other Risk Factors

Several reasons may account for rising chronic pain percentages, Mackey said. “Chronic pain prevalence increases with age,” he told MedPage Today. “The U.S. population has a growing proportion of older adults, which may contribute to higher rates of chronic pain overall.”

The COVID-19 pandemic may have played a role, he added. “The pandemic led to delays in healthcare access and surgeries, increased sedentary lifestyles, and heightened mental health challenges such as anxiety and depression, all of which are associated with chronic pain,” Mackey noted. “Even outside COVID, we appear to have a more highly stressed population.”

Economic disparities, reduced access to healthcare, and environmental factors in rural or non-metropolitan areas also may have exacerbated chronic pain rates, he said.

An overall decline in health in the U.S. could be another factor, suggested Beth Darnall, PhD, also of the Stanford School of Medicine. Type 2 diabetes rates are increasing and obesity is widespread, she indicated. “There is a clear connection between obesity and chronic pain, and it is multifactorial,” she told MedPage Today.

It’s not just diabetes and obesity, Darnall emphasized: many chronic disease rate are accelerating, and most of these diseases are associated with different types of chronic pain.

Changes in Pain Management

The U.S. opioid crisis also rose to the forefront between 2016 and 2023, and changes in pain management   guidelines followed.

“Efforts to reduce opioid prescriptions may have led to inadequate pain management for some individuals, potentially increasing reports of chronic and high-impact pain,” Mackey said. “We have been concerned about this unintended consequence for a long time.”

The new CDC numbers reflect the reality that many patients are facing, noted Charles Argoff, MD, of Albany Medical College in New York, who is president of the American Academy of Pain Medicine (AAPM), and Antje Barreveld, MD, of Newton-Wellesley Hospital in Newton, Massachusetts, who is AAPM’s president-elect.

“Those with the greatest need for chronic pain care too often do not have access to the type of pain management care that is most likely to help,” wrote Argoff and Barreveld in an email to MedPage Today.

“We need to leverage technology, including telemedicine and other approaches, to be able to offer team-based care to all those who can benefit from it,” they added.

“We will continue to see higher rates of chronic pain in our population unless we change how we deliver optimal care to all people. This will require a coordinated effort across not only all medical specialties, but also all payers,” Argoff and Barreveld continued. “Pain medicine specialists comprise less than 1% of the medical workforce so we need to truly work as a team with others if we are going to be able to address this chronic pain crisis effectively.”

Some providers feel unequipped to treat pain despite the availability of many effective treatments, they pointed out. “A fear of opioids and misconceptions about what else besides medications can help reduce pain also has led to many healthcare providers being afraid to treat chronic pain.”

Better Treatment Needed

“We need better comprehensive treatment for acute and chronic pain alike,” noted Darnall. “If we treat acute pain better, we will have fewer people transitioning to the chronic pain state.”

The new CDC data also showed that 8.5% of U.S. adults had high-impact chronic pain — pain severe enough to restrict daily activities.

“Currently, people with high-impact chronic pain are over-medicalized with costly and often risky treatments that offer limited benefit, while we undertreat with the lowest-risk behavioral treatments. The idea isn’t to prevent medical care, but to ensure access to low-risk evidence-based behavioral options for symptom management,” Darnall said.

“Encouragingly, we see a clear trend toward offering behavioral treatments as standard care — meaning everyone gets them, with no screening applied,” she added.

Argoff and Barreveld emphasized the importance of “appropriate care to all patients experiencing chronic pain, whoever they are and wherever they live.”

“We must work together to combat obstacles, like the fact that insurers are more likely to pay for a pill or invasive procedure than for comprehensive multidisciplinary team-based care, which is often more effective,” they said.

UnitedHealth Pays Its Own Physician Groups More Than Others

Warren Blasts United Health CEO for Monopolistic Practices that Harm Patients

Here is a 5 minute video of Senator Warren “ripping” the president of UHC over how they financially operate.

UnitedHealth Pays Its Own Physician Groups More Than Others

https://www.medpagetoday.com/special-reports/features/11314

UnitedHealth Group pays many of its physician practices “significantly more” than other groups “in the same markets for similar services,” a STAT investigation found

The “above-market payments” were discovered in an analysis conducted in partnership with health analytics company Tribunus Health. It looked at data that UnitedHealth reported to the federal government revealing what its commercial insurance unit pays 16 Optum-branded physician groups for common or expensive services.

Ultimately, the analysis found that insurance subsidiary UnitedHealthcare paid 13 of the Optum practices more on average for common services than market price, STAT reported. The finding varied from 3% to 111% above market price.

“The higher prices reward UnitedHealth at the expense of almost everyone else,” STAT wrote. “Patients end up paying more when they see their doctors and struggle to afford recommended follow-up care. Employers counting on the insurance giant to control ever-rising costs get little or no relief. And doctors trying to compete with UnitedHealth’s practices find themselves frozen out of the higher rates the company is paying its own providers, making it more difficult to remain independent and keep their doors open.”

STAT noted that its analysis had limitations and was not comprehensive. UnitedHealth’s data files were “imperfect” and did not include certain information, the outlet noted. And the analysis included just a subset of common services.

Prior to publication, STAT shared its analysis and a list of questions with UnitedHealth. Though the company declined to make a representative available for an interview, spokesperson Eric Hausman provided a statement to STAT that called the analysis “flawed.”

The company further told STAT that it ran its own analyses and asserted that, “UnitedHealthcare pays Optum Health consistent with other payers in the market.” It declined to share its analyses with the outlet.

C.O.L.A. Cost of living adjustment – what a joke for those on Social Security

The first SS check was issued in Jan 31, 1940 for a total sum of $22.54 and employees & employers each paid 1% of the first $3,000 a person earned.

By the time I graduated college (1970) SS taxes were 4.6% of the employee’s first $7,800 and of course the employer had to pay a equal amount.

Prior to 1984, Social Security benefits were entirely exempt from federal income taxes

The new tax policy established that beneficiaries with total income exceeding certain thresholds would be required to pay federal income tax on a portion of their benefit income

The initial thresholds set in 1983 were:

  • Single beneficiaries with modified adjusted gross income greater than $25,000
  • Married couples filing jointly with modified adjusted gross income greater than $32,000

For those above these thresholds, up to 50% of their Social Security benefits became subject to federal income tax

In 1993, additional legislation extended the taxation of benefits:

  • It increased the taxable portion from 50% to 85% for higher-income beneficiaries
  • New thresholds were introduced: $34,000 for single filers and $44,000 for joint filers

It’s worth noting that these income thresholds have not been indexed for inflation since their introduction, which has resulted in an increasing proportion of beneficiaries becoming subject to this tax over time

Today that $32,000 trigger in 1984 to require the person to pay taxes on 50% of their SS income, would be ~ $98,000 in 2024

Today that $44,000 trigger in 1993 to require the person to pay taxes on 85% of their SS income, would be ~ $96,000 in 2024

The average couple receiving social security would get ~ $46,000/yr. in 2023, and the average couple back in 1993 would get ~$15,300/yr.

BTW, a fellow by the name of Joe Biden was in our Senate and voted for both of these increase in taxes, and voted not to index the income dollars at which SS income would be considered taxable.

After getting the notice that those on SS would get a 2.5% increase as of the first of Jan 2025. So I put all the $$ figures into a spread sheet.  All that I could compare is Medicare Part B premiums, deductible and our supplement premium and deductible and off course our Part D premium and deductible.

I won’t bother you with the RAW DOLLARS, but collectively all those fixed costs, will be ~ 2.5 times in 2025 than they were in 2024! So, what is suppose to be a COST OF LIVING INCREASE… will not cover the increase in our basic healthcare costs.

In regards to our medication, our Part D deductibles and premiums will be close to $2,000 for 2025, before we get the first PENNY in coverage for our medications.

 

DOJ suspends DEA searches at airports over civil rights concerns

DOJ suspends DEA searches at airports over civil rights concerns

https://nypost.com/2024/11/23/us-news/doj-suspends-dea-searches-at-airports-over-civil-rights-concerns/

(The Center Square) – The U.S. Department of Justice told the Drug Enforcement Administration to suspend consensual searches at airports and other mass transit facilities after hearing about potential civil rights violations.

Department of Justice Inspector General Michael Horowitz announced the suspension after hearing concerns about in the DEA’s transportation interdiction efforts, which include conducting consensual searches.

During such searches, the DEA Task Force Groups approach people at airports, ask for consent to speak with the person and, if the Special Agents or Task Force Officers think it warranted, ask for consent to search the individual’s belongings.

The practice has raised civil rights concerns after video of one search went public.

Horowitz said the DEA wasn’t following its own policies on those searches, which often included seizing cash. Such seizures put the onus on the traveler to prove the money wasn’t from drug trafficking to get it back. 

Horowitz said the DEA wasn’t complying with its own policy to document each consensual encounter despite the agency having promised to do so in 2015.

The Office of Inspector General’s office also said the DEA had suspended its transportation interdiction training in 2023. Such training is required by DEA policy and has not restarted, according to the memo

The alert came after a search earlier this year involving a traveler who was approached for a consensual encounter by a DEA Task Force Officer while boarding a flight.

The practice has raised civil rights concerns after video of one search went public.

Horowitz said the DEA wasn’t following its own policies on those searches, which often included seizing cash. Such seizures put the onus on the traveler to prove the money wasn’t from drug trafficking to get it back.

Horowitz said the DEA wasn’t complying with its own policy to document each consensual encounter despite the agency having promised to do so in 2015.

The Office of Inspector General’s office also said the DEA had suspended its transportation interdiction training in 2023. Such training is required by DEA policy and has not restarted, according to the memo

The alert came after a search earlier this year involving a traveler who was approached for a consensual encounter by a DEA Task Force Officer while boarding a flight.

The OIG concluded that continuing such searches could “imperil the Department’s asset forfeiture and seizure activities.”

“Absence of critical controls, such as adequate policies, guidance, training, and data collection, the DEA is creating substantial risks that DEA Special Agents and Task Force Officers will conduct these activities improperly; impose unwarranted burdens on, and violate the legal rights of, innocent travelers; imperil the Department’s asset forfeiture and seizure activities; and waste law enforcement resources on ineffective interdiction actions.”

The Deputy Attorney General issued the directive to the DEA suspending all consensual encounters at mass transportation facilities “unless they are either connected to an ongoing, predicated investigation involving one or more identified targets or criminal networks or approved by the DEA Administrator based on exigent circumstances.”