This appears to another “bench trial – no jury “, in a FEDERAL COURT – where historically anyone taken to a federal court – 90+% are found guilty. It is also odd that they claim that Walgreens “shipped” 1 out of every 5 Oxycodone & Hydrocodone doses nationally and yet Walgreen has/had about 10,000 community pharmacies out of a total of abt 50,000 community pharmacies.  None of the filled opiate Rxs were illegal prescriptions.

I find it strange that they are going after Walgreen and does not appear to be going after even the FIRST PHARMACIST for filling any of these opiate Rxs. With 10,000 pharmacies, Walgreen could have some 30,000 pharmacists working for them.  Legally, it is the Pharmacist that has the final say if a Rx is legit and should – or should not – be filled.  I guess that it was going to be a very expensive going after all/some of those 30,000 Pharmacists for filling these opiate Rxs… with little financial rewards to the bureaucrats… So they went after the single entity with the deepest pockets.  They state in the article that Walgreen paid a 80 million dollar fine to the DEA almost 10 yrs ago…  So that didn’t cause any real visible financial harm to Walgreen with that large fine… so it would seem like the bureaucrats and our legal system appear to be treating the corporations involved in opiate manufacturing and distribution like ATM machines that they can come and “withdrawal” money every decade or so.  They don’t want to run them out of business, too many people would be harmed from employees of these corporations to pts that are be taken care of by these corporations and there is not enough reserve capacity available to absorb and take care of all the people who would basically be tossed to the curb.  Besides, that could possibly mean that is one last corporation they come after every decade or so .. to extract money from.

Walgreens ‘Helped Fuel’ Opioid Crisis in San Francisco, Says Judge

https://reason.com/2022/08/11/walgreens-helped-fuel-opioid-crisis-in-san-francisco-says-judge/

Is Walgreens an illicit drug dealer? That’s essentially what a federal court has ruled, suggesting the pharmacy should have stopped “suspicious orders” for opioids from being filled. In failing to do so, the retailer “substantially contributed” to the opioid epidemic in San Francisco, Judge Charles Breyer of the U.S. District Court for the Northern District of California ruled.

Walgreens was “responsible for shipping nearly 1 out of every 5 oxycodone and hydrocodone pills distributed nationwide during the height of the opioid crisis,” reports The Washington Post. And “more than 100 million prescription opioid pills were dispensed by Walgreens in [San Francisco] between 2006 and 2020,” notes the Los Angeles Times.

Walgreens isn’t accused of filling fake prescriptions; the opioid orders it filled were written by licensed doctors. But some of these doctors had “suspect prescribing patterns,” noted Breyer. And other orders were written by doctors who would go on to have their licenses revoked or face criminal punishment. The judge agreed with the city and county of San Francisco, which brought the suit, that Walgreens pharmacists were negligent in not realizing something was afoot and therefore illegally contributed to a public nuisance. A trial will be held to determine damages owed.

“The effects of the opioid epidemic on San Francisco have been catastrophic. The city has fought hard and continues to do so, but the opioid epidemic, which Walgreens helped fuel, continues to substantially interfere with public rights in San Francisco,” Breyer wrote.

This seems, frankly, insane. Walgreens fills prescriptions. It is not in the business of drug enforcement. If some of the prescriptions filled by Walgreens were written by dirty doctors or went to people who abused them, it is not on individual pharmacists to figure that out.

Expecting pharmacists to be drug cops, too, ensures that more pharmacies will be hesitant to fill legitimate prescriptions, leaving patients in the lurch. It also threatens to worsen America’s pharmacist shortage.

In a number of recent cases, pharmacies and pharmacists have been sued for not filling prescriptions. including opioid prescriptions. It seems we’ve put them in a classic damned if you do, damned if you don’t situation.

This isn’t the first time Walgreens has been found guilty of opioid crimes. Last fall, a federal court in Ohio found CVS, Walgreens, and Walmart guilty of ignoring “red flags” about opioid prescriptions and thereby contributing to a “public nuisance.”

In 2013, Walgreens had to pay $80 million in civil penalties after the Drug Enforcement Administration (DEA) said it was negligent in filling narcotic prescriptions.

Under the Controlled Substances Act, pharmacies are required to have systems in place to monitor for suspicious orders. And Walgreens did. But the DEA—and now Breyer—say Walgreens’ policies weren’t sufficient.

The case showcases yet another bananas aspect of America’s war on drugs.

To sum it up: Walgreens filled prescriptions for a legal substance, but because some people went on to distribute or use the drugs in ways the government has forbidden, the company has to pay the government huge sums of money. Meanwhile, the inability of people to get prescription painkillers has given way to reliance on much more dangerous substances, like fentanyl, from which many more people are dying of overdoses. People keep taking opioids, and the government keeps making it harder for them to do so safely.

“These cases, along with thousands of other lawsuits by state and local governments that blame legal drug suppliers for opioid-related addiction and deaths, ask courts to focus on one link in a long causal chain,” noted Reason’s Jacob Sullum last November. “That chain includes decisions by state and federal regulators as well as actions by manufacturers, distributors, doctors, pharmacists, patients, black-market dealers who sell diverted pills, and nonmedical users who consume them.”

“We never manufactured or marketed opioids, nor did we distribute them to the ‘pill mills’ and internet pharmacies that fueled this crisis,” said Walgreens spokesman Fraser Engerman in a statement yesterday. “The plaintiff’s attempt to resolve the opioid crisis with an unprecedented expansion of public nuisance law is misguided and unsustainable. We look forward to the opportunity to address these issues on appeal.”

Filed under: General Problems | 2 Comments »

CVS/Aetna’s $9 billion in profits paid for a lavish party and stock buybacks. Not patients’ medical claims.

https://wendellpotter.substack.com/p/cvsaetnas-9-billion-in-profits-paid
CVS/Aetna’s spending included trips to Disney and a John Legend concert for employees.

A few days after executives of CVS/Aetna won a resounding thumbs up from Wall Street last week, they headed south (many undoubtedly on private jets) to Disney World for a lavish “leadership” party they threw themselves.

Thanks to videos posted on social media by some of the partiers, we know the company hired John Legend to entertain them.

John Legend doesn’t come cheap. Back in 2015, he reportedly was paid $300,000 to sing two songs at a Beverly Hills wedding. Luxury wedding planner Scarlet tells clients it will now cost them $1 million (plus travel and production costs) to snag Legend for their big events. We don’t know what his corporate rate is, but I doubt he would charge the country’s fourth largest corporation anything less than that.

Meanwhile, a few miles southwest of Orlando, friends of cancer patient Jasen Garrity are trying to raise $10,000 on GoFundMe to cover the out-of-pockets Aetna made Garrity pay before his treatment could begin. As the fundraiser’s organizer wrote:

Jay currently requires an insertion of a tracheotomy to allow him increased ability to breathe. It is difficult for him to sleep. Robin (his wife) is awake most nights worrying over Jay. To get the trach inserted Jay will need to be admitted to the hospital for 6 days and the hospital requires $2600.00 to even schedule the surgery because Aetna’s family deductible has reset.

Garrity’s story is by no means unique. While CVS CEO Karen Lynch and other executives were swag surfin’ in Florida, thousands of American patients have had to turn to GoFundMe because they can’t afford the deductibles, copays, and other out-of-pockets insurers demand they pay. In fact, 100 million Americans–most of them insured by Aetna and other big insurers–are mired in medical debt. As Kaiser Health News reported in June:

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills…A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to pay it off…The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy.

While Jasen Garrity and millions of other insured Americans with serious health issues were begging for money to stay alive last year, Lynch hauled in more than $20 million, 458 times the average pay of other CVS employees. Also know that Aetna is spending considerably less paying patients’ medical claims as a percentage of revenues this year than last year, despite the fact that CVS collected billions more from its customers during the first six months of this year than in the same period in 2021 ($157.5 billion and $141.7 billion respectively).

That enabled the company to report making $9.3 billion in profits during the first half of 2022, $200 million more than during the first half of 2021. This year is off to such a good start for CVS that Lynch and her fellow executives told investors last Wednesday that they believe profits will be higher this year than they previously had expected.

Wall Street loved that news. By the time the New York Stock Exchange closed Wednesday afternoon, investors had bid the company’s stock up 6%, according to CNBC. 

CVS execs gave no indication they’ll use any of the extra billions to help customers like Jasen Garrity stay out of bankruptcy. They did say a few months ago, however, that they will spend up to $10 billion this year buying back shares of CVS stock, a gimmick that will increase the value of the millions of shares of CVS stock that Lynch and other company executives own.

By the way, most of the company’s revenues are now coming from the pharmacy benefit manager (PBM) it owns, not from its health plans and retail stores. During the first half of 2022, its PBM revenues totaled $82.3 billion, far more than the $45.9 billion from Aetna’s health plans and the $51.7 billion from CVS stores.

As patient advocate Beth Joyner Waldron tweeted about the company’s leadership bash in Orlando:

Beth Joyner Waldron @BethWaldron

How ironic CVS threw this party using patient profits the very weekend Congress passed a drug bill which excluded addressing the PBM industry & kickbacks they receive from pharma. We will NEVER get to the root of drug price inflation until we also address PBMs & formularies.

Beth Joyner Waldron @BethWaldron

It’s time for patients & clinicians to speak up LOUDLY against corporate practices which reduce our access to needed care while they reap record profits & party on completely deaf to our needs. Greater government protections for patients are needed ASAP to ensure patient safety.

I encourage you to read Waldron’s thread, which along with the pics and videos she found of CVS’ partying leaders, went viral. (If you have time, you might also consider reading a piece I wrote several years ago about the lavish parties insurers throw every year–using customers’ money–to reward their top sales executives. And take a look at the thread I wrote in March about the role Karen Lynch and Cigna CEO David Cordani played in creating America’s growing out-of-pocket debt crisis.)

I also encourage John Legend to donate whatever CVS paid him to help cover the outrageously high out-of-pocket expenses millions of insured Americans are desperately trying to cover.

I doubt he knew the enormous pain and suffering Aetna’s high out-of-pocket requirements are causing for so many. And based on this Twitter thread from 2020, I believe his heart is in the right place:

John Legend @johnlegend

It’s a trap for progressives to try to talk about healthcare as some sort of free market like they’re talking about tvs or cell phones. Healthcare is a necessity and there’s very little choice when you’re actually sick. You need treatment and you need it to not bankrupt you

He went on to say:

John Legend @johnlegend

And the so-called “market” for healthcare is so opaque, there are few if any perfectly informed consumers. And no one can predict what healthcare they’ll need in the future.

John Legend, the work I do now is an attempt to make amends for the years I helped big insurers make Wall Street happy and for all the leadership junkets I attended. I call on you to make amends for your ill-advised private CVS concert by supporting the important work of the Lower Out of Pockets NOW Coalition. We won’t rest until we make Aetna and the rest of Big Insurance change so their customers can stay out of bankruptcy and away from GoFundMe.  You can make an enormous difference if you’ll join us.

Filed under: General Problems | Leave a Comment »

CDC: Few Insured Patients With Hepatitis C Get Timely Treatment

— Not even one-third received curative drugs within a year of diagnosis

https://www.medpagetoday.com/infectiousdisease/hepatitis/100158

Although hepatitis C infection is a highly curable disease, few insured patients diagnosed received direct-acting antiviral (DAA) treatment during 2019-2020, while disparities contributed to treatment delays, according to new CDC data appearing in an early edition of the Morbidity and Mortality Weekly Report.

Adjusted multivariable regression analysis showed Medicaid recipients were least likely to initiate DAA treatment within 360 days of testing positive for hepatitis C infection (23%). Medicare recipients fared somewhat better (28%), as did individuals with private insurance (35%).

Adjusted odds ratios relative to private insurance for receiving DAA therapy were:

• Medicaid: 0.54, 95% CI 0.51–0.57
• Medicare: 0.62, 95% CI 0.56–0.68

And among those treated at some point, more with private insurance received it within 180 days of initial diagnosis (84%) compared with those on Medicaid (75%) or Medicare (77%), reported Carolyn Wester, MD, MPH, director of the Division of Viral Hepatitis at the CDC, and colleagues.

Medicaid is the least likely insurer to cover DAA treatment, so it was no surprise that residents of states with Medicaid treatment restrictions were less likely to initiate treatment, versus those in states without them (aOR 0.77, 95% CI 0.74–0.81).

Hepatitis C viral infection impacts over 2 million Americans with incidence on the rise — especially among young individuals with injection drug use — and leads to 14,000 annual deaths nationally. Eight to 12 weeks of DAA treatment is recommended to effectively cure 95% or more hepatitis C cases. Despite this, only about 1.2 million individuals initiated DAA treatment from 2014 to 2020, which remains far below the national elimination goal as fewer seek treatment.

“Everyone with hepatitis C should have access to lifesaving treatment, regardless of race, ethnicity, age or insurance status,” said CDC Acting Principal Deputy Director Debra Houry, MD, MPH, in a press release. “What these data tell us is that at best, only one in three people are treated within a year of being diagnosed and we must reduce the barriers and get more people treated for hepatitis C in our country. This is critical to stop preventable deaths and prevent new infections.”

For this report, CDC researchers retrospectively examined Health Verity data on over 2 million patients with hepatitis C across all 50 states and the District of Columbia from Jan. 30, 2019, to Oct. 31, 2020. Those included were adults ages 18-69, who were continuously insured for at least 60 days before and at least 360 days after their diagnosis. The analysis adjusted for demographics, insurance payor, and Medicaid restrictions.

Younger people – ages 18-39 – on Medicaid or private insurance had the lowest rates of treatment initiation, versus those ages 50-59. Across all insurance plans, men had consistently lower odds of initiating treatment than did women.

Among Medicaid recipients, odds of treatment initiation were lower for Black individuals (aOR, 0.93, 95% CI 0.88–0.99) or those coded as “other” for race (aOR 0.73, 95% CI 0.62–0.88), versus whites.

To increase treatment access, researchers suggested removing eligibility restrictions/preauthorization requirements, providing treatment where patients already receive services in as few visits as possible, and expanding primary care providers who can treat hepatitis C.

“People shouldn’t have to jump over hurdles to access lifesaving, cost-effective treatment,” said Wester in the CDC’s press release. “Removing barriers to treatment is a critical step, as is increasing screening for hepatitis C. We estimate about 40% of people with hepatitis C in the U.S. are unaware of their infection — testing is the first step to accessing curative treatment.”

Wester and colleagues acknowledged that the findings may not be generalizable to all hepatitis C patients, since those incarcerated or uninsured were excluded. Treatment initiation rates could have been overestimated, while data on ethnicity were missing for 61% of people included in the analysis.

Filed under: General Problems | Leave a Comment »

https://www.eventbrite.com/e/advancing-syringe-services-in-the-us-the-untapped-role-of-the-ada-tickets-339958243257

Filed under: General Problems | Leave a Comment »

Here’s who Democrats’ drug pricing bill will actually help

https://www.statnews.com/2022/08/09/democrats-drug-pricing-bill-will-help-medicare-patients/

WASHINGTON — Millions of patients in the Medicare program could eventually see lower prescription drug costs if Democrats pass their latest drug pricing plan into law.

The plan, which cleared a major hurdle Sunday when the Senate very narrowly approved it, has four major policies — it would allow Medicare to negotiate prices for some costly drugs, penalize drugmakers for hiking prices faster than inflation, redesign Medicare’s prescription drug benefit and cap annual costs at $2,000, and cap Medicare patients’ insulin costs at $35 per month.

Those changes won’t take effect right away. Most wouldn’t take effect until 2024; negotiated drug prices won’t be in place till 2026. The cap on insulin costs comes a little sooner, in 2023. And drugmakers that hike their prices would face penalties starting in October.

Democrats’ drug pricing reforms also won’t help as many people as they had originally hoped, as two major provisions that would have affected people who get insurance through their jobs ran afoul of Senate rules.

That means most of the patients who will directly benefit from the policy are adults 65 and older who are in the Medicare program. STAT has compiled a list of the categories of patients who are most likely to see benefits at the pharmacy counter.

There’s one big variable to keep in mind — insurance premiums. At least for a little while, as Medicare’s benefits get more generous and more patients can afford drugs, spending may go up.

“The premium effect is really difficult to predict, almost more difficult than the effect on drug prices,” said Juliette Cubanski, the deputy director of Medicare at the Kaiser Family Foundation.

The legislation would cap premium increases at 6% per year through 2029 to help decrease the impact, but it’s possible in the short-term that some beneficiaries could pay more for premiums than they would save.

None of the policies in Democrats’ package would directly affect people who get insurance through their jobs, or through Affordable Care Act marketplaces. There’s a raging debate over whether the pharmaceutical industry will charge these patients more to make up for lost money, or whether cost controls in Medicare could set a precedent for other insurers to demand lower prices, as well.

It seems counterintuitive, but Medicaid programs could actually have higher costs too if drugmakers raise their prices more slowly, according to congressional budget analysts. If that trend continues, it will cause states to have to make choices to work around the financial hit.

Medicare patients who pay a lot for drugs

The most obvious benefit is in the part of Medicare that covers drugs sold in pharmacies, Part D, where the reform package would cap patients’ annual out-of-pocket costs at $2,000 and spread them throughout the year, starting in 2024.

There are differing estimates of how many people could benefit from the cap.

Kaiser Family Foundation analysts found that 1.4 million people with traditional Medicare benefits spent $2,000 or more in 2020. An estimate co-authored by Sean Dickson, director of health policy at the West Health Policy Center, found that if a $2,000 out-of-pocket cap had been instituted in 2021, at least 3.1 million patients would have seen savings.

While many older adults may not spend more than $2,000 per year on their drugs right now, the new annual cost protections ensure financial protections for the future, said Vanderbilt University associate professor of health policy Stacie Dusetzina.

“People should be really excited. Medicare Part D has been an incredibly beneficial program for older adults, [and it] does not work for people who need expensive drugs,” Dusetzina said.

It’s unclear whether patients who take drugs that Medicare ultimately negotiates starting in 2026 will save money simply because of the negotiation.

They’re likely to be expensive, so it’s possible folks will still hit that $2,000 cap anyway. But if not, patients would likely end up paying a percentage of the lower price, which could save them money on each prescription fill.

Low-income patients on Medicare

The package also includes a change to Medicare’s low-income benefits for pharmacy drugs — a provision that has flown a bit under the radar.

Right now, Medicare enrollees who make between 135% and 150% of the federal poverty level get some help from the federal government for their drug costs, but they still have to pay 15% of the prices of their drugs. For 2022, 150% of the federal poverty level is $20,385 for a single person.

Starting in 2024, Democrats’ plan would allow people making up to 150% of the federal poverty level to get full benefits. That means they would have a set, low cost for each prescription instead of paying a percentage of the full price.

Around 400,000 people fell into that category in 2020, per a Kaiser Family Foundation analysis, but Dusetzina said there may be more patients out there who are eligible, but not enrolled.

“This is a really big deal because by definition, these patients are near poor but still have high cost-sharing,” Dusetzina said.

Medicare patients who use insulin

Democrats’ drug pricing plan would also force all plans in Medicare to offer insulin at a maximum of $35 per month for patients starting next year.

Medicare beneficiaries already have options to buy a plan that caps insulin costs at $35 per month, but about a quarter of Medicare patients still paid more than that in 2021, per data compiled by the the life science analytics firm IQVIA.

It’s a quick turnaround, as plans have already submitted their premium estimates for next year, but insurers have factored in that this policy could become law, West Health’s Dickson said.

Medicare patients taking drugs on the market now

It wouldn’t necessarily lower drug prices, but Democrats’ proposal to penalize drugmakers that hike prices faster than inflation would provide more predictable prices for Medicare patients.

This policy is the first scheduled to go into effect. The penalties would start in October for pharmacy drugs, and in January for drugs that are administered in doctors’ offices.

It’s hard to predict the future of which drugs would have seen dramatic price spikes, but similar to the annual cost protections, it allows more predictability for Medicare patients. However, half of drugs covered by Medicare took price hikes steeper than inflation in 2020, according to a Kaiser Family Foundation analysis.

Filed under: General Problems | Leave a Comment »

Disney Epcot. LOTS of Disney photos floating around social. Reddit says some CVS ‘leadership experience’ attendees were given spending money for Epcot because it was a ‘team building exercise’. 🤔 pic.twitter.com/R5Iev9RIAp

— Beth Joyner Waldron (@BethWaldron) August 8, 2022

The most recent quarter CVS reported abt a 3 BILLION net profit (pretax)… the above apparently is from a recent “upper echelon management” is REWARDED for helping CVS generate all those $$ in profits…

from the twitter post  ” The private John Legend concert CVS Health hosted (despite restrictive formularies, non-medical switching & denying patients medication access due to cost) was just the icing on the cake CVS leaders enjoyed this week in Orlando. Let’s take a peek at good times on patient dime…“

https://twitter.com/i/status/1556442291480436736

Filed under: General Problems | Leave a Comment »

Pain Management in Breast Cancer Outpatients

https://www.uspharmacist.com/article/pain-management-in-breast-cancer-outpatients

Pain is reported by 25% to 89% of breast cancer (BC) patients during the disease process. This pain, which may be due to disease progression, surgery, or drug treatment, can range from mild to severe and can be of short or long duration. Little is known about how this pain is managed in the outpatient setting.

A retrospective, administrative claims data study utilizing information from the National Ambulatory Medical Care Survey (NAMCS), which is a national probability cross-sectional sample survey of office-based medical care services, was conducted to examine pain management practices and the factors associated with the prescription of pain medications, especially opioids, in women with BC. The study analyzed NAMCS data obtained between 2011 to 2016.

Women aged 18 and older years were included in the study if—based on either International Classification of Disease-9 (ICD-9) or ICD-10 codes—BC was their primary diagnosis. The medications were classified using the American Hospital Formulary Service (AHFS) classification and included opioids, nonopioids (e.g., nonsteroidal anti-inflammatory agents, acetaminophen, salicylates), and combinations of both drug classes. Adjuvant analgesics included the anticonvulsants (e.g., barbiturates), antidepressants (e.g., selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants), and corticosteroids.

Between 2011 and 2016, 23.95 million office visits were made by women with a primary diagnosis of BC. Of this group, over one-half (50.81%) were aged 40 to 64 years. One-third (32.81%) of visits occurred in the Northeast region, with almost all (95.65%) occurring in metropolitan areas. The vast majority of patients (83.7%) were identified as White. Most of these patients (84.93%) were seen in general and family practice settings. Depression and diabetes were the most common comorbidities.

During these visits, over one-quarter (27.12%, or about 6.5 million women) received pain medications. Among the total study population, 15.16% received opioids, 17.13% were prescribed nonopioid analgesics, and 22.7% received adjuvant therapies. Over one-tenth (10.27%) of patients received combination analgesics. Tramadol and oxycodone were the most prescribed opioids (3.75% and 1.57%, respectively). Ibuprofen, followed by naproxen, were the most prescribed nonsteroidal anti-inflammatory agents (3.73% and 1.27%, respectively). Benzodiazepines, followed by glucocorticoids, were the frequently prescribed adjunctive therapies (7.61% and 6.98%, respectively).

Factors significantly associated with the decreased prescribing of analgesics included residing in the Northeast as opposed to the West (odds ratio [OR] = 0.31, 95% CI -0.10 to 0.99), being White as opposed to Black (OR = 0.5, 95% CI 0.3-0.85) and being seen by nonprimary care physicians rather than primary care physicians (OR = 0.37, 95% CI 0.15-0.94). Being on Medicaid or other state-based payment programs as opposed to having private insurance (OR = 2.38, 95% CI 1.15-4.93), being prescribed adjuvant medications versus not receiving these agents (OR = 4.74, 95% CI 3.10-7.24), and visiting general or family practice specialties compared with other specialties (OR = 3.18, 95% CI 1.22-8.29) were associated with increased prescribing of pain medications.

The only two factors that were significantly associated with opioid prescribing were geography and medical specialty. Women living in the Northeast, Midwest, and South were 94-fold (OR = 0.06, 95% CI 0.01-0.29), 85-fold (OR = 0.15, 95% CI -0.04 to 0.62) and 76-fold (OR = 0.24, 95% CI 0.06-0.92) less likely to receive opioids than those residing in the West. General and family practice clinicians were significantly more likely to prescribe opioids compared with other disciplines (OR = 6.76, 95% CI 1.71-26.70).

This study provided a clear picture of pain medication usage among women with BC and can assist pharmacists in targeting deprescribing efforts geared at both patients and providers.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

Filed under: General Problems | Leave a Comment »

HHS, DOJ Issue Guidance to Eliminate Telehealth Discrimination

https://mhealthintelligence.com/news/hhs-doj-issue-guidance-to-eliminate-telehealth-discrimination

The federal agencies’ guidance provides examples of discrimination during telehealth visits and actions to ensure virtual care remains accessible to all.

 In honor of the Americans with Disabilities Act (ADA) anniversary, the US Department of Health and Human Services (HHS) worked with the US Department of Justice (DOJ) to publish new guidance that seeks to eliminate discrimination in the telehealth arena.

The COVID-19 pandemic has been accompanied by rapid expansions in healthcare access, particularly through the use of telehealth. Although telehealth is a valuable resource, discrimination does exist, leading to barriers to care. For example, research has shown that racial minorities, older age groups, and those living in rural areas use telehealth less frequently than their counterparts, and the digital divide further exacerbates disparities in virtual care access.

As 2022 marks 32 years since the introduction of the ADA, HHS and DOJ released guidance focused on federal nondiscrimination laws, including the ADA Section 504 of the Rehabilitation Act of 1973, Title VI of the Civil Rights Act of 1964, and Section 1557 of the Patient Protection and Affordable Care Act, and actions healthcare providers can take to ensure they are in compliance with these laws.

The guidance aims to ensure equitable care for those with disabilities, including people who are blind, deaf, or do not speak English proficiently. Blind people who seek out telehealth solutions may find that the modality does not contain screen reader software, and deaf people may have trouble engaging with an interpreter over telehealth. Those who are not fluent in English may struggle to seek and schedule an appointment. 

To curb discrimination, providers can take several actions, including making changes to their policies and practices to provide additional support for disabled people who wish to have a virtual visit, such as implementing sign language interpretation and language assistance services.

“It is critical to ensure that telehealth care is accessible to all, including patients with disabilities, those with limited English proficiency, and people of all races and national origins,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division, in a press release. “Federal civil rights laws protect patients from discrimination whether they receive health care online or at the doctor’s office. The Department of Justice will vigorously enforce the ADA and other civil rights laws to ensure that health care providers offering telehealth services are doing so free from discrimination.”

HHS and DOJ also said that people can file complaints if they feel they are a victim of telehealth discrimination.

Complaints related to ADA violations are common and can occur when treating various conditions.

In May, AIDS Alabama and CHLPI claimed that Alabama Medicaid did not provide hepatitis C treatment for those struggling with substance use disorders. While filing the complaint, the organizations defended their argument by pointing out that Alabama Medicaid is in violation of the ADA.

Filed under: General Problems | Leave a Comment »

7 healthcare takeaways from Senate Democrats’ newly passed $739B landmark bill

https://www.beckershospitalreview.com/finance/7-healthcare-takeaways-from-senate-democrats-newly-passed-739b-landmark-bill.html

With a 51-50 vote, Senate Democrats passed a sweeping $739 billion bill Aug. 7 that furthers some of the largest changes to healthcare in years.

Titled the Inflation Reduction Act, the bill touches energy, tax reform and healthcare. The House is expected to take it up Aug. 12, with Democrats aiming to approve it and send it to President Joe Biden’s desk.  

Here are seven healthcare takeaways from the 755-page bill: 

Drug pricing

1. For the first time, Medicare would be allowed to negotiate the price of prescription medicines with manufacturers. Negotiation powers will apply to the price of a limited number of drugs that incrementally increases over the next seven years. Ten drugs will be eligible for negotiations beginning in 2026; eligibility expands to 15 drugs in 2027 and 20 by 2029. 

2. The HHS secretary will provide manufacturers of selected drugs with a written initial offer that contains HHS’ proposal for the maximum fair price of the drug and reasoning used to calculate that offer. Manufacturers will have 30 days to either accept HHS’ offer or propose a counteroffer.  

3. Members of Medicare Part D prescription drug plan would see their out-of-pocket costs for prescription drugs capped at $2,000 per year, with the option to break that amount into monthly payments, beginning in 2025.

4. Democrats lost on a provision to place a $35 cap on insulin for Americans covered by private health plans. The provision to cap insulin at $35 dollars for Medicare enrollees passed by a of 57-43. 

5. Drug companies will be required to rebate back price differences to Medicare if they raise prices higher than the rate of inflation, coined an “inflation rebate.”

6. The legislation makes all vaccines covered under Medicare Part D free to beneficiaries with no deductibles, co-insurance or cost-sharing, starting in 2023. 

Tax subsidies 

7. The legislation extends the Affordable Care Act’s federal health insurance subsidies, now set to expire at the end of the year, through 2025. Democrats say the extension will prevent an estimated 3.4 million Americans from losing health coverage.

This can be a slippery slope to what Congress can control… Did they only mandate $35/month price limit ONLY ON INSULIN PAID FOR BY Medicare Part D and part  C, maybe because it would be a bad political move – and possibly unconstitutional – to tell private insurance companies and the three pharmas that produce insulin… in what they can charge for a product.

The PBM industry claims that they “negotiate” with pharmacies on what they will be paid to fill prescriptions and that industry controls about 90%+ of the FOUR BILLION Rxs that are filled in the USA.  Their action of  “negotiating ” with pharmacies is actually a “take it or leave it” contract. In the end the pharmacy is told to sign/take the contract offered or we will make sure that most of your pts will end up having their Rxs filled at one or more of your competitors.

The play a similar game with the Pharmas,  the pharmas are told if you want your brand name med on their approved formulary, you will pay the PBM a certain percent – claimed to be up to 75% of the AWP (Average Wholesale Price) otherwise the PBM will be require that to get their med paid for will require a PA (prior authorization) and everyone knows that the PBM will suggest to the prescriber a therapeutic alternative that doesn’t require a PA for the pt to get some medication for their health/medical needs.

This year, I ran into a problem with Humana Part D that they would only pay for a particular generic pharma med, even though on their website, they state that the generic is “covered”, HOWEVER, paying CASH for the med was $15.00 LESS than my copay would have been unless a particular pharma’s generic was dispensed.  Where was that extra $15.00 going ?… Probably into Humana’s bottom line, because the rebate/discount/kickback to Humana from the pharma was greater than the generic that my pharmacy stocked and wanted to fill and bill Humana.

If Congress can dictate what a manufacturer can charge for this particular product (Insulin) what will prevent Congress – other than a lot of lawsuits – from telling untold number of manufacturers, retailers and others are allowed to charge for their products and/or how much gross/net profit  a business could legally allowed to make.  Are we on a path for Congress to attempt to nationalize many large businesses…the next step towards socialism ?

Filed under: General Problems | Leave a Comment »

Minnesota is among the first states to address the unintended consequence of CDC opioid guidance from 2016

https://www.kare11.com/article/news/local/breaking-the-news/law-could-be-life-saving-for-chronic-pain-patients/89-b22f2aba-667d-42cb-877d-20c3eb70efd3

Filed under: General Problems | 1 Comment »