W.Va. AG leads push for DEA to better account for illicit use of opioids

https://www.journal-news.net/w-va-ag-leads-push-for-dea-to-better-account/article_363661f4-24a7-5b49-b3b0-8fb3a7e25277.html

HUNTINGTON — A group of attorneys general led by West Virginia Attorney General Patrick Morrisey are pushing federal regulators to better track illicit use of opioid painkillers, an effort to capitalize on sweeping reforms achieved by Morrisey’s prior lawsuit against the U.S. Drug Enforcement Administration.

The coalition of six states, in comments on a proposed rule, identified 16 specific ways the DEA can better account for diversion when setting the number of pills that can be manufactured each year. The suggestions come in response to agency concerns that it is unable to accurately track pills diverted for non-medical use.

“The opioid crisis is a never-ending battle,” Morrisey said in a release. “Responsible, research-backed quotas are an essential tool in our continued fight. We will never have a full and accurate picture of the legitimate medical, scientific and industrial need without the DEA improving its methodology. We have to do all we can to stop senseless death.”

The coalition’s 16 suggestions include ways to better use six national databases that track the scope and magnitude of opioid abuse. That includes two systems already housed within the DEA, along with the National Survey on Drug Use and Health, a database that tracks the treatment of drug abuse episodes and two others that track poisonings.

The coalition further suggests the DEA consult nine similar state databases and, separately, take into greater account information from its Drug Take Back Day as evidence of overprescribing.

The coalition acknowledges that no database is perfect or all-inclusive, but its members contend there is still plenty of material that when reviewed from different angles can help the agency better account for diversion and thereby gain a more accurate picture of the nation’s medical, scientific and industrial need.

In October, a U.S. Department of Justice inspector general report found the DEA was slow to respond to the opioid crisis. The report said between 2013 and 2017, the DEA significantly reduced using one of its key enforcement tools — the ability to suspend manufacturers, distributors and other registrants to keep drugs from being diverted.

Following Morrisey’s lawsuit in late 2017, the DEA enacted sweeping reforms to its drug quota system that embraced the attorney general’s call for greater input and consideration of diversion in determining how many opioid pills can be manufactured each year.

The DEA previously relied on the amount of pills pharmaceutical manufacturers expected to sell within a year. The broken approach did not account for the number of pills diverted for abuse, Morrisey said.

The DEA’s proposed limits for 2020 slash hydrocodone manufacturing by 19% and oxycodone by 8.8% in one year.

West Virginia filed the comments with support from attorneys general in Arkansas, Florida, Kentucky, Missouri and Nebraska.

DEA proposes to reduce the amount of five opioids manufactured in 2020, marijuana quota for research increases by almost a third

https://www.dea.gov/press-releases/2019/09/11/dea-proposes-reduce-amount-five-opioids-manufactured-2020-marijuana-quota

WASHINGTON – The U.S. Drug Enforcement Administration is proposing to reduce the amount of five Schedule II opioid controlled substances that can be manufactured in the United States next year compared with 2019, per the Notice of Proposed Rulemaking being published in the Federal Register tomorrow and available for public inspection here today. 

 

DEA proposes to reduce the amount of fentanyl produced by 31 percent, hydrocodone by 19 percent, hydromorphone by 25 percent, oxycodone by nine percent and oxymorphone by 55 percent. Combined with morphine, the proposed quota would be a 53 percent decrease in the amount of allowable production of these opioids since 2016.

 

DEA proposes to increase the amount of marijuana that can be produced for research by almost a third over 2019’s level, from 2,450 kilograms to 3,200 kilograms, which is almost triple what it was in 2018. This will meet the need created by the increase in the amount of approved research involving marijuana. Over the last two years, the total number of individuals registered by DEA to conduct research with marijuana, marijuana extracts, derivatives and delta-9-tetrahydrocannabinol (THC) has increased by more than 40 percent, from 384 in January 2017 to 542 in January 2019.

 

“The aggregate production quota set by DEA each calendar year ensures that patients have the medicines they need while also reducing excess production of controlled prescription drugs that can be diverted and misused,” said Acting Administrator Uttam Dhillon. “DEA takes seriously its obligations to both protect the public from illicit drug trafficking and ensure adequate supplies to meet the legitimate needs of patients and researchers for these substances.”

 

The Proposed Aggregate Production Quotas and Assessment of Annual Needs being published in the Federal Register addresses more than 250 Schedule I and II controlled substances and three List I chemicals, which include ephedrine, pseudoephedrine, and phenylpropanolamine. This reflects the total amount of substances needed to meet the country’s legitimate medical, scientific, research, industrial and export needs for the year and for the maintenance of reserve stocks. DEA endeavors to set production limits at a level required to meet these needs, without resulting in an excessive amount of these potentially harmful substances.

 

In setting the APQ, DEA considers data from many sources, including estimates of the legitimate medical need from the Food and Drug Administration; estimates of retail consumption based on prescriptions dispensed; manufacturers’ disposition history and forecasts; data from DEA’s internal system for tracking controlled substance transactions; and past quota histories. As a result of new laws and regulations that took effect in 2018, the number of factors that DEA considers in setting the APQ has increased. Information on these factors and how they were assessed appears in the Notice.

 

The five opioid substances were subject to special scrutiny following the enactment last year of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, known as the SUPPORT Act, which requires DEA to “estimate the amount of diversion of the covered substance that occurs in the United States” and “make appropriate quota reductions. DEA’s estimates of the amount of diversion that took place for each of these five opioid substances and how those estimates were calculated appear in the Notice.

 

Interested parties may submit public comments on the proposed APQ until 11:59 p.m. on October 10, following the instructions in the Notice. After taking the comments into account, DEA will publish another notice later in the year informing the public of the established APQ. After that, DEA allocates individual manufacturing and procurement quotas to those manufacturers that apply for them. DEA may revise a company’s quota at any time during the year if change is warranted due to increased sales or exports, new manufacturers entering the market, new product development, or product recalls. 

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Nearly 150K in Pa. will be forced to change medications beginning Jan. 1. Here’s why

https://www.pennlive.com/news/2019/12/nearly-150k-in-pa-will-be-forced-to-change-medications-beginning-jan-1-heres-why.html

Nearly 150,000 Medicaid recipients in Pennsylvania will be forced to change their prescription medications in the new year, the result of new regulations the state says will cut down on healthcare costs, but that many physicians are concerned could harm patient care.

Beginning Jan. 1, the Department of Human Services will require the eight companies that manage pharmacy benefits under Medicaid in the state to use the same preferred prescription drug list — essentially, drugs that will be automatically covered — instead of their own individual lists.

As a result, some drugs currently provided will no longer be available without a special exception. That will force an estimated 150,000 of the state’s 2.8 million Medicaid recipients to switch to new medications, state officials said. Among that group, approximately 40,000 will have to switch multiple medications.

The change is widely seen as beneficial in the long term, simplifying care and decreasing healthcare costs. The preferred list prioritizes cheaper options and makes them automatically available, while requiring doctors to seek special approval for coverage of more expensive drugs.

The Department of Human Services estimates the new approach will save the state $85 million a year. While there is some disagreement over that figure, physicians say the real concern is that the quick rollout of the new list could delay access to critical medications.

Some of those affected may find a drug similar to their current medication on the new list, but not everyone will find an appropriate replacement, said Mary Stock Keister, president of the Pennsylvania Academy of Family Physicians and a practicing doctor at a family health center in Allentown.

“I worry there will be gaps in care,” Keister said. “We always have to balance cost savings with the danger to patients of changing medications. I hope this doesn’t change what I do in seeing patients and deciding on the best option for them.”

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For instance, Keister said, the new list is missing certain concentrations of long-acting insulin that she recommends to many of her diabetic patients, and it only has one class of oral osteoporosis medication.

Ed Balaban, a licensed physician and a consultant for the Penn State Cancer Institute, said the new list doesn’t include intravenous immunotherapy drugs that are commonly used for cancer patients. While there are oral cancer drugs on the list, those work differently, he said, and in some cases, the two are more effective when combined.

More choices also allow patients to find a medication with the fewest side effects, he said. And in a field like oncology, where new drugs roll out every few months, the fact that the drug list will only be updated once a year means the latest treatments will be missing.

“The unfortunate reality in medical care is a lot of decisions are economically based rather than therapeutically based,” Balaban said.

The new drug list — compiled by a committee of doctors, pharmacists and consumer representatives — doesn’t prevent patients from accessing other drugs, but it makes it harder. To get an off-list, or “non-preferred,” drug, a doctor has to submit a request to the company that handles pharmacy benefits, justifying the need for that medication, and the company needs to approve it.

Many physicians worry their requests will be denied since the state, under the new regulations, is requiring the companies to adhere to the preferred drug list 95% of the time. If they fall below that rate, the companies could face fines starting at $1,000 a day.

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“In order to get the highest number of people on the preferred drug list, I worry there will be a tightening of what will be approved for off-list use,” Stock Keister said.

Sally Kozak, deputy secretary for Pennsylvania’s Office of Medical Assistance Programs, said the state’s goal is not to penalize companies. They won’t start monitoring for compliance until July 2020, she said, and if off-list medications are approved for true medical necessity, it won’t count against the companies.

Even if the state finds improper approval of off-list medications, she said, the first step will be to have a conversation rather than simply issue a fine. Still, at a Senate committee hearing in October on the new preferred drug list, physicians said the 95% threshold was a significant concern.

In written testimony, Johanna Kelly from Reading Pediatrics Inc. said that medicines used for children with autism or mental illness almost always require special approval.

“We will exceed our 5% allowed very quickly,” she wrote, “and if this population of children do not remain on their medicine or can’t get medicine they need, we will have a disaster on our hands.”

Even if requests for off-list medications are approved, Balaban said, waiting for the approval creates a delay. In surveys by national and local physician groups, doctors say the approval process delays necessary care about 90% of the time.

“Cancer patients may not have that kind of time frame to wait and see,” Balaban said.

The Department of Human Services said it has tried to account for these concerns by grandfathering in some medications, meaning people who were already using certain drugs that are no longer on the list will be allowed to continue without special approval.

That significantly reduced the worries for many pediatricians, said Deborah Moss, president of the Pennsylvania Chapter of the American Academy of Pediatrics. Still, other physicians say they’d prefer the compliance rate be lowered to 80%.

Patients affected by the change were notified by mail this fall and given a list of any medications that will need to be changed. And if patients run into issues come Jan. 1, there are laws in place to protect them, said Laval Miller-Wilson of the Pennsylvania Health Law Project, which provides free legal counsel to Medicaid recipients.

Patients can request a 15-day emergency supply of their old medication while figuring out how to move forward with their doctor, he said.

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The parking lot suicides

https://www.washingtonpost.com/news/national/wp/2019/02/07/feature/the-parking-lot-suicides/

Alissa Harrington took an audible breath as she slid open a closet door deep in her home office. This is where she displays what’s too painful, too raw to keep out in the open.

Framed photos of her younger brother, Justin Miller, a 33-year-old Marine Corps trumpet player and Iraq veteran. Blood-spattered safety glasses recovered from the snow-covered Nissan Frontier truck where his body was found. A phone filled with the last text messages from his father: “We love you. We miss you. Come home.”

Miller was suffering from post-traumatic stress disorder and suicidal thoughts when he checked into the Minneapolis Department of Veterans Affairs hospital in February 2018. After spending four days in the mental-health unit, Miller walked to his truck in VA’s parking lot and shot himself in the very place he went to find help.

“The fact that my brother, Justin, never left the VA parking lot — it’s infuriating,” said Harrington, 37. “He did the right thing; he went in for help. I just can’t get my head around it.”

A federal investigation into Miller’s death found that the Minneapolis VA made multiple errors: not scheduling a follow-up appointment, failing to communicate with his family about the treatment plan and inadequately assessing his access to firearms. Several days after his death, Miller’s parents received a package from the Department of Veterans Affairs — bottles of antidepressants and sleep aids prescribed to Miller.

His death is among 19 suicides that occurred on VA campuses from October 2017 to November 2018, seven of them in parking lots, according to the Department of Veterans Affairs. While studies show that every suicide is highly complex — influenced by genetics, financial uncertainty, relationship loss and other factors — mental-health experts worry that veterans taking their lives on VA property has become a desperate form of protest against a system that some veterans feel hasn’t helped them.

The most recent parking lot suicide occurred weeks before Christmas in St. Petersburg, Fla. Marine Col. Jim Turner, 55, dressed in his uniform blues and medals, sat on top of his military and VA records and killed himself with a rifle outside the Bay Pines Department of Veterans Affairs.

“I bet if you look at the 22 suicides a day you will see VA screwed up in 90%,” Turner wrote in a note investigators found near his body.

VA declined to comment on individual cases, citing privacy concerns. But relatives say Turner had told them that he was infuriated that he wasn’t able to get a mental-health appointment that he wanted.

Veterans are 1.5 times as likely as civilians to die by suicide, after adjusting for age and gender. In 2016, the veteran suicide rate was 26.1 per 100,000, compared with 17.4 per 100,000 for non-veteran adults, according to a recent federal report. Before 2017, VA did not separately track on-campus suicides, said spokesman Curt Cashour.

The Trump administration has said that preventing suicide is its top clinical priority for veterans. In January 2018, President Trump signed an executive order to allow all veterans — including those otherwise ineligible for VA care — to receive mental-health services during the first year after military service, a period marked by a high risk for suicide, VA officials say. And VA points out that it stopped 233 suicide attempts between October 2017 and November 2018, when staff intervened to help veterans harming themselves on hospital grounds.

Sixty-two percent of veterans, or 9 million people, depend on VA’s vast hospital system, but accessing it can require navigating a frustrating bureaucracy. Veterans sometimes must prove that their injuries are connected to their service, which can require a lot of paperwork and appeals.

Veterans who take their own lives on VA grounds often intend to send a message, said Eric Caine, director of the Injury Control Research Center for Suicide Prevention at the University of Rochester.

“These suicides are sentinel events,” Caine said. “It’s very important for the VA to recognize that the place of a suicide can have great meaning. There is a real moral imperative and invitation here to take a close inspection of the quality of services at the facility level.”

Keita Franklin, who became VA’s executive director for suicide prevention in April, said the agency now trains parking lot attendants and patrols on suicide intervention. The agency also has launched a pilot program that expands its suicide prevention efforts, including peer mentoring, to civilian workplaces and state governments.

“We’re shifting from a model that says, ‘Let’s sit in our hospitals and wait for people to come to us,’ and take it to them,” she said during a congressional staff briefing in January.

For some veterans, the problem is not only interventions but also the care and conditions inside some VA mental-health programs.

John Toombs, a 32-year-old former Army sergeant and Afghanistan veteran, hanged himself on the grounds of the Alvin C. York VA Medical Center in Murfreesboro, Tenn., the morning before Thanksgiving 2016.

[Trump’s VA vowed to stop veteran suicide. Its leaders failed to spend millions set aside to reach those at risk.]

He had enrolled in an inpatient treatment program for PTSD, substance abuse, depression and anxiety, said his father, David Toombs.

“John went in pledging that this is where I change my life; this is where I get better,” he said. But he was kicked out of the program for not following instructions, including being late to collect his medications, according to medical records.

A few hours before he took his life, Toombs wrote in a Facebook post from the Murfreesboro VA that he was “feeling empty,” with a distressed emoji.

“I dared to dream again. Then you showed me the door faster than last night’s garbage,” he wrote. “To the streets, homeless, right before the holidays.”

‘They didn’t serve him well’

Miller was recruited as a high school trumpet player into the prestigious 2nd Marine Aircraft Wing Band based in Cherry Point, N.C. In Iraq, he was posted at the final checkpoint before U.S. troops entered the safe zone at al-Asad Air Base.

Hour after hour, day after day, his gun was aimed at each driver’s head. He carefully watched the bomb-sniffing dogs for signs that they had found something nefarious.

After he came home, Miller’s family noticed right away that he was different: in­cred­ibly tense, easily agitated and overreacting to criticism. He eventually told his sister that he suffered from severe PTSD after being ordered to shoot dead a man who was approaching the base and was believed to have a bomb.

Miller called the Veterans Crisis Line last February to report suicidal thoughts, according to the VA inspector general’s investigation.
The responder told him to arrange for someone to keep his guns and to go to the VA emergency department. Miller stayed at the hospital for four days.

In the discharge note, a nurse wrote that Miller asked to be released and that the “patient does not currently meet dangerousness criteria for a 72-hour hold.” He was designated as “intermediate/moderate risk” for suicide.

Although Miller had told the crisis hotline responder that he had access to firearms, several clinicians recorded that he did not have guns or that it was unknown whether he had guns. There was no documentation of clinicians discussing with Miller or his family how to secure weapons, according to the inspector general’s report, a fact that baffles his father.

“My son served his country well,” said Greg Miller, his voice breaking. “But they didn’t serve him well. He had a gun in his truck the whole time.”

Franklin, head of VA’s suicide prevention program, called the suicide rate “beyond frustrating and heartbreaking,” adding that it’s essential that “local facilities develop a good relationship with the veteran, ask to bring their families into the fold — during the process and discharge — and make sure we know if they have access to firearms.”

She said VA is looking at ways to create a buddy system during the discharge process, pairing veterans who can support each other’s recoveries.

During the week of Miller’s birthday in December, his family joined his high school band leader to donate Miller’s trumpet to a local low-income high school.

“He was a blue-chip, solid kid,” said Richard Hahn, his high school band leader. “He does this honorable thing and goes into the Marines. Then we have this tragic ending.”

He sat with Miller’s mother, Drinda, as she closed her eyes in grief, rocking gently. Hahn and Harrington recalled their memories of Justin, playing the trumpet at Harrington’s wedding and taps at his grandfather’s funeral.

After the investigation into Miller’s suicide, VA’s mistakes were the subject of a September hearing in front of the House Veterans’ Affairs Committee, but it was overshadowed by Brett M. Kavanaugh’s testimony during his Supreme Court confirmation hearing.

Listening to the conversation about her son, Drinda broke down and left the room. She sat in the lobby, shaky and crying. Her daughter knelt down to hold her mother’s hand.

‘He was making real progress’

A Rand Corp. study published in April showed that, while VA mental-health care is generally as good or better than care delivered by private health plans, there is high variation across facilities.

“There are some VAs that are out of date. They are depressing,” said Craig J. Bryan, a former Air Force psychologist and a University of Utah professor who studies veteran suicides, referring to problems with short staffing and resources. “Others are stunning and new, and if you walk into one that’s awe-inspiring, it gives you hope.”

The Murfreesboro VA hospital, where Toombs took his life, was ranked among the worst in the nation for mental health, according to the agency’s 2016 internal ratings. It has since improved to two out of a possible five stars.

The program, “while nurturing in some ways, also has strict rules for picking up medications on time and attending group therapy,” said Rosalinde Burch, a nurse who worked closely with Toombs in the VA program. She believes she was transferred and later fired from the program for being outspoken that “his death was totally preventable.”

He had been late several times to pick up his medications, and occasionally left group sessions early because he was suffering from anxiety, Burch said.

“But those shouldn’t have been reasons for kicking him out,” she said. “He was making real progress.”

Toombs’s substance abuse screenings were clear, and he was starting to counsel other veterans, she said. Burch wrote an email to the hospital’s program director, saying, “We all have the blood of this veteran on our hands.”

Since Toombs’s death, the program has a new leadership team, including a new program chief and nurse manager, the hospital spokeswoman said. Burch has filed a complaint with the Office of Special Counsel, an independent federal agency that investigates whistleblower claims, to get her job back.

For Miller’s family, their son’s death has motivated them to speak out about how VA can improve.

“The VA didn’t cause his suicide,” Harrington said. “But they could have done more to prevent that, and that’s just so maddening.”

On the snowy burial grounds behind St. Joseph of the Lakes Catholic Church in a quiet suburb of the Twin Cities, she huddled with her parents around his grave. Nearby stood the special in-ground trumpet stand that his father designed.

The family sipped from a tiny bottle of Grand Marnier, a drink that Miller liked. His mother shook her head in despair as she recalled the sounds of her son’s music.

“Justin used to play his trumpet for all of the funerals,” his father said. “But he wasn’t here to play for his own.”

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VA study uncovers critical link between pain intensity and suicide attempts

https://www.blogs.va.gov/VAntage/67708/va-study-uncovers-link-pain-intensity-suicide-attempts/

Many factors are associated with suicide risk. These factors range from PTSD, depression and anxiety disorder to financial and interpersonal concerns to access to opioids and other lethal means, like firearms. Even when we take these risk factors into consideration, moderate to severe pain intensity is associated with suicide risk.

Veterans are a particularly vulnerable group. The suicide rate among Veterans is 1.5 times that of the general population. Also, Veterans develop chronic pain conditions at higher rates and report greater pain severity than members of the general population.

VA’s Behavioral Health Autopsy Program: Executive Summary reports pain is the most common factor Veterans experience before they die by suicide. The VISN 2 Center of Excellence (CoE) for Suicide Prevention studied the link between reported pain intensity and suicide attempts. The results may uncover how effective pain treatment can be a critical suicide prevention tactic.

Managing pain in daily life

Veterans have several treatment options through VA to cope with pain and reduce pain intensity. Nonmedication interventions are considered first-line treatments. They include physical therapy, cognitive behavioral therapy for chronic pain and chiropractic care. Medication-based treatments include nonsteroidal anti-inflammatory medications and injections. Examples are cortisone for low back pain and botulinum toxin for migraines. Opioids may be used under close monitoring when they are taken appropriately and the benefits outweigh the risks.

Strategies

Strategies that improve psychological well-being can also help Veterans cope with pain in everyday life. Veterans can discuss the following tactics with care providers to see which may work best:

• Be honest about the pain you’re experiencing. An important step in managing chronic pain is accepting that it is part of your life. Accepting the presence of pain can help you move on and engage in enjoyable and everyday activities despite that pain.
• Pace your activities. Although you may not be able to do everything you did before the pain began, try to find ways to reintroduce some activities in a moderated way and create more balance in the activities you’re doing. For example, if you plan to go for a long walk in the morning, consider taking a break mid-day to give your body time to recover and to prevent a pain flare-up. Even if you start to feel better over time, avoid overdoing it to avoid a relapse or further injury.
• Explore mindfulness. Increasing awareness of the present moment can help relieve emotional and mental tension that can intensify physical pain. Meditation and other mindfulness practices help you become more comfortable in feeling the way you feel without judgement, helping to prevent pain from taking over your thoughts and acting on autopilot.

To learn more about pain management treatment provided by VA, explore VA’s pain management webpage for Veterans.

Study findings

A CoE study looked at Veterans’ average pain intensity scores in the year after they began receiving pain specialty services to determine whether pain intensity was associated with suicide attempts. Based on data from 2012–2014, moderate and severe pain over the course of a year increased the risk of a suicide attempt, even after considering other factors like a Veteran’s history of suicide attempts.

As the graph to the right shows, those with higher pain intensity had lower survival rates than those who had mild pain or no pain at all. This close correlation between pain intensity and suicide risk and death rates suggests that reducing pain, or the perception of that pain, can help prevent Veteran suicide.

Advice for Veterans’ family members and friends

Family members and friends are often the first to realize that a Veteran may be at risk for suicide. Warning signs include changes in mood or behaviors, outward comments about suicidal thoughts or increased interest in lethal means, such as firearms and opioids. If you see these signs in a Veteran in your life:

• Start the conversation. Topics of pain and suicide can be challenging to talk about. Still, don’t be afraid to begin the conversation with the Veteran you’re concerned about. Starting the conversation can help the Veteran realize the need to address pain. It also reassures the Veteran that you’re willing to help.
• #BeThere for the Veteran and engage in healthy activities. Invite your friend or loved one to a movie or dinner or for a walk around the neighborhood. Getting a Veteran out of the house can remind them of activities they can enjoy, despite their pain. Research suggests changing a Veteran’s mindset and engaging them in activities can improve overall wellness.

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Group backing private Medicare is funded by insurance giants

https://apnews.com/8f6960ea00424a868fa3ef2dfcee7a92

WASHINGTON (AP) — A group gaining influence in Washington as a champion for Medicare beneficiaries is bankrolled by major health insurance companies that are trying to cash in on private coverage offered through the federal health insurance program.

The Better Medicare Alliance claims a far-flung network of seniors, with a Facebook community of more than 380,000 and 110,000 signed up to receive email alerts. Its website displays profiles of “BMA Seniors” who describe private Medicare plans in glowing terms. The Associated Press found that one of the featured seniors, David Kievit, died in March at age 91.

The multimillion-dollar budget for the alliance isn’t supplied by seniors, but by UnitedHealthcare, Aetna and Humana, according to the group’s president and its federal tax returns. There are many prestigious law firms with lawyers helping clients with ERISA claims which would be able to help them to start a new life peacefully in their desired location inside the country. The three insurance giants together account for close to 50 percent of all enrollees in private “Medicare Advantage” plans and stand to benefit as that part of Medicare keeps growing.

The organization’s website and Facebook page don’t say where its money comes from, making it easy to miss the industry tie.

Since its establishment in December 2014, the alliance has built its profile. It lobbies Congress and the administration and sponsors research. It has reported spending $370,000 so far this year on lobbying Congress primarily, according to disclosure records. Among other issues, the alliance is seeking the repeal of a tax on health insurers imposed by the Obama-era health care law.

President and CEO Allyson Schwartz enjoys credibility among Democrats, having helped pass the Affordable Care Act as a Democratic congresswoman from Pennsylvania. And Republicans have long been fans of private Medicare plans, giving the alliance a foothold in both political parties.

David Lipschutz, a senior policy attorney for the Center for Medicare Advocacy, a nonprofit legal organization that represents Medicare beneficiaries, called the Better Medicare Alliance an “Astroturf group.” The term refers to an organization that casts itself as a grassroots movement to mask their corporate interests.

“They represent themselves as representing Medicare beneficiaries, but they really represent the interests of the insurance industry,” Lipschutz said.

Schwartz rejects any suggestion that the organization is a front for the insurance industry. She said during an interview with the AP that the alliance’s funding sources “are well known,” even though the names and addresses of donors were blacked out of copies of the alliance’s tax returns that it provided to AP.

Federal rules permit nonprofits like the Better Medicare Alliance to shield the identities of donors. Critics say that’s problematic because the public has no way of knowing whether the anonymous donors have a specific interest in a matter before the administration, Congress or the courts.

“I don’t know that this entity is representative of the people who receive this type of insurance, or is it representing the interests of the businesses that offer this type of insurance,” said Daniel Borochoff, the president of CharityWatch, a national watchdog group. He reviewed alliance tax documents for AP and said it appears to be “akin to a trade organization.”

The alliance has received $19.9 million in donations over the last three years, accounting for 99.9 percent of its total revenue during that period, according to the organization’s tax returns for 2015 through 2017. Schwartz said when asked that the money came from UnitedHealthcare, Aetna and Humana.

“You can ask any nonprofit organization about their funders and say, ‘Do they tell you what to do? Does that dictate what you do?’” Schwartz said. “You pay attention to your funders, but you ought to be making your own decisions. We do.”

She said BMA has 125 “allies” that include the insurance companies, local agencies that serve seniors, patient advocacy groups, and nurse and doctor associations that all back Medicare Advantage. They include the American Medical Group Association and Meals on Wheels America.

“Our job is to find the common ground,” Schwartz said.

Medicare Advantage is a growing business for insurers. About 22 million Medicare beneficiaries, or close to 2 in 5, are expected to be covered by a Medicare Advantage plan next year. The private plans promise coordinated care and generally offer lower out-of-pocket costs. They limit choice of doctors and hospitals and employ other restrictions such as prior authorization for services.

UnitedHealthcare has 25 percent of the Medicare Advantage enrollees, Humana has 17 percent and Aetna has 8 percent, according to an analysis of government data by the nonpartisan Kaiser Family Foundation.

Schwartz earned just over $600,000 last year in base salary, bonus pay and other compensation, an increase of $52,000 from 2016. The alliance’s board of directors determined her salary following a compensation survey of comparable nonprofits, according to the tax returns, but she makes more than the top executives who run other Medicare-related organizations.

Max Richtman, president of the National Committee to Preserve Social Security and Medicare, earned $391,185 in 2017, according to the organization’s latest tax return. The group advocates against cuts to retirement security programs.

James Firman, president of the National Council on the Aging, was paid $343,558, according to the organization’s tax return that covers the year between July 1, 2016 and June 30, 2017, the latest available. The council is a decades-old advocacy group.

Among the senior profiles on the Better Medicare Alliance’s website is one of Kievet, a World War II veteran who died in March. There’s a photo of him wearing his veteran’s cap, along with a brief first-person article.

His family was startled to see his photo there, said his son, John Kievit, who lives near Houston.

“I’d like to see the article updated, at least,” he said.

Here is a recent post concerning Medicare Advantage insurance is really only good IF YOU ARE NOT SICK 

Medicare Advantage :you get what you pay for – OR – end up paying for what you get ?

All Medicare Part D, Medicare Advantage and Medicaid HMO programs are PRIVATE INSURANCE and what the Democratic candidates are describing is MEDICAID FOR ALL because they are claiming that no one will have any premiums, deductibles, co-pays.

Congress will go down this path for two reasons:

1. The feds will get to pay a FIXED monthly premium for each person

2. The insurance industry has one of the best funded “pot of money” to fund lobbyists.

It is claimed that lobbyists spend 9+ million/day to get Congress to pass bills in a certain way.  They claim that you can’t buy a member of Congress, but many seem to be on very Long TERM LEASES.

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We NEED everyone in New York to contact the Governor’s office TODAY, December 23rd, and request that he sign S6531.

It is CRITICAL that you emphasize the importance of the provisions of the bill that 1) license and regulate PBMs, 2) prevent PBMs from imposing onerous accreditation requirements above and beyond those of the state board of pharmacy, 3) provide all New Yorkers the same protections as patients in the Medicaid program by banning harmful spread pricing practices in commercial insurance plans, and 4) prohibit PBMs from substituting patients prescriptions without authorization from their prescribers.

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Falsely accused of shoplifting, Tracy couple sues CVS after ordeal sends woman to ER

https://www.recordnet.com/news/20191222/falsely-accused-of-shoplifting-tracy-couple-sues-cvs-after-ordeal-sends-woman-to-er

STOCKTON — A Tracy couple has filed suit against a national pharmacy chain, claiming employees at one of its stores in Tracy falsely accused the husband of shoplifting, then refused to fill the wife’s prescriptions for pneumonia and asthma medications. Later that same day, the wife — unable to breathe — was rushed to a hospital emergency room.

Lorina Fermaint, 34, a nurse raising four children with husband Vincent Mares, went to her doctor the morning of June 10 after suffering from a high fever for several days. Upon reviewing her X-rays, Fermaint’s doctor told her she had pneumonia. Combined with her asthma, she was having serious trouble breathing.

The doctor gave her prescriptions for medicines to treat both the pneumonia and the asthma, so Fermaint, being driven by her husband, went to the CVS pharmacy on West 11th Street in Tracy where she has been filling prescriptions since she was 15 years old.

She dropped off the prescriptions at the pharmacy counter and was told it would be about a 45-minute wait. Too weak to wait inside the store, she told her husband: “I don’t have the energy, so let’s just go wait in the car. As soon as we got into the car, I got a phone call from CVS. They told me the man I was with stole something from the store and they would not fill my prescriptions.”

Unsure what to do next, Fermaint surprised Mares by asking him if he had taken anything from the store. Perplexed by the question, Mares — who works as a plumber — said “of course not.”

So the couple went back into the CVS where they were met by a cashier who called two managers to the front of the store.

At that time, the managers explained that loss prevention staff had reviewed surveillance tapes and identified Mares as having taken merchandise from the store, Fermaint said.

Furthermore, the managers told Fermaint they wouldn’t release anything to her — not her medications even though she was plainly suffering, and not the prescriptions the doctor had written.

“They didn’t call the cops on us, which is really bizarre, especially if they have camera footage of it,” Fermaint said.

So Fermaint and Mares drove straight to the Tracy Police Department themselves. Fermaint said the officer they spoke with was confused by the pharmacy’s actions and said they can’t withhold medication.

The officer called the store, spoke to another manager who told him that Mares did not steal anything, but they now couldn’t release Fermaint’s medications until the next day because she had been “red tagged.”

That night at home without her medications, Fermaint suffered a severe asthma attack.

“It literally feels like you’re drowning and you can’t breathe at all,” she recalled. She spent hours in the hospital emergency room where she received stronger medications before being discharged with more prescriptions to fill at the same CVS pharmacy.

When she went in the next day, she said, “The lady behind the counter apologized to me. The managers told me about the red flag on my account, and another manager apologized saying (Mares) just fit the description of someone who shoplifted at another store. They tried to offer a $20 gift card to Target.”

The personal injury lawsuit, filed as in category of the statute of limitation accidents last Monday in San Joaquin County Superior Court by Tracy attorney Richard Hyppa on behalf of the couple against Rhode Island-based CVS Pharmacy Inc., seeks unspecified damages for personal injury and breach of duty and good faith.

“It’s a pretty unusual set of circumstances. These people did nothing wrong, yet the CVS employees took it upon themselves to determine that he had been shoplifting,” Hyppa said.

“It’s the kind of thing that shouldn’t happen to anybody,” he said.

A spokesman for CVS was not able to immediately address the situation or the lawsuit.

“We haven’t been served with this suit. Looks like it was just filed (last Monday). We will investigate the allegations therein,” Mike DeAngelis, senior director of corporate communications for CVS, responded by email to a request for comment.

Fermaint said she and her husband pursued a lawsuit for a variety of reasons. She described Mares as “a very hard worker and a family man who is of Latino descent and has tattoos on his body. To flat out lie about him really made me question their motives and what was behind that. Was he profiled?”

She expressed concern for others who might have experienced similar treatment. “If they can do this to me, they can do it to anybody. I know my rights and I know what they were doing is illegal and I wasn’t just going to let it go. They never apologized, they never said what they did was wrong. They just continued to justify their actions.”

“It humiliated us, in front of the store, in front of customers and other employees, and caused me to have severe anxiety and asthma because they refused to give me all of my breathing medications,” Fermaint said.

The first scheduled court hearing has been set for a case management conference at 8:30 a.m. June 18 before Judge Michael Mulvihill in Department 10C.

Contact reporter Joe Goldeen at (209) 546-8278 or jgoldeen@recordnet.com. Follow him on Twitter @JoeGoldeen.

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https://www.youtube.com/channel/UCl0gxZtNAGDoqlLHiLPzPCA

https://www.cchfreedom.org/

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folks who do not understand the industry. I know when I submit a bid to a PBM there is not an exorbitant profit built into the equation…in fact, after all of the rebates and discounts, the profit margin is unbelievably slim. I also hear how the gov. Does not negotiate prices, well here is what I do know, when I submit anything to the government I have to use a formula to get a GNUP and use that number. It is far from retail. Most of the drugs that are at issue are specialty drugs and can be more of a supply and demand play. I have actually had to accept a 64% rebate demand from a PBM, not to mention administration fees of 4.5% and an early pay discount of 2%. There was another fee as well ~3%.

For those keeping score at home, that is 73.5% off of AWP (average wholesale price)

I had always heard that the PBM’s demanded rebates/kickbacks/discounts from the pharmas of up to 50% to have one of their drugs on the PBM’s formulary and being approved without going thru a PA.

Now it is more apparent was to why insulin is now several hundred dollars for a 10 ml vial.

With a vial of insulin costing $50 a few years ago .. it is easy to see why it could now be $200 because of demands of the PBM’s to PAD THEIR POCKETS.

For every $1 that a pharma wants to raise their price to cover increased business expenses… they would have to raise the price $4 to cover the kickback money to the PBM’s.

This also explains why Canada and other countries with national health insurance… there is no for profit insurance and PBM middlemen… and thus their retail price could be 75% less expensive.

It has been stated that the Insurance/PBM industries have one of the largest pots of money to funding lobbying, so.. it is unlikely that Congress will pass any such price controls… with 435 members of the House and 33-34 members of Senate up for reelection is 10 months..

 

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