Death Certificate Project Accuses 64 Calif. Doctors

https://www.medpagetoday.com/painmanagement/opioids/81954

The so-called Death Certificate Project initiated by the Medical Board of California that began in 2015 has now resulted in formal accusals of wrongdoing filed against 64 physicians related to their drug prescribing, primarily involving opioids, newly updated records show.

Five of the 64 have surrendered their licenses; six others were put on probation, and eight received public reprimands.

These are out of a total of 469 physicians investigated for excessive prescribing because of patients’ overdose deaths in 2012 or 2013.

Two of the 64 accusations were withdrawn, according to statistics released by the board last week.

The remaining 43 physicans of the 64 accused still await final decisions; half of these have been hanging more than 7 months and five for nearly a year.

Beyond the 64 doctors against whom an accusation had been filed, another 11 of the 469 are still under investigation. It remains to be seen whether a round orange gavel signifying a disciplinary action will mark any of their profile pages.

The agency’s investigators continue to prowl the state Department of Justice’s prescription drug database to identify doctors who prescribed opioids to a patient who, according to a death certificate, fatally overdosed in 2012 or 2013, even as long as three years after that doctor wrote that script, and not necessarily from the same drug the doctor prescribed.

Separate investigations were conducted of 72 nurse practitioners, physician assistants, and osteopathic physicians — who are governed by different state boards — but the results of those were not immediately available.

In the next leg of the investigation, the medical board, which licenses some 140,000 physicians, will scrutinize practices of doctors whose patients fatally overdosed in 2016 and 2017, when presumably far more conservative opioid prescribing had replaced more liberal practices and as the extent of addiction potential and lethality of these drugs was better understood.

‘Witch-hunt’

The project is intended to stop overdoses and save lives. But it has been harshly lambasted by some doctors as a “witch hunt.” It also has disrupted practices by many physicians who — prior to 2014 — were abiding by the now outdated mantra that patients’ pain complaints should be aggressively treated with whatever it takes.

Many representatives of organized physician groups said the project is now hurting patients in pain trying to get relief. Pain specialists’ waiting lists have backed up and increasing numbers of primary care providers refuse to prescribe opioids in fear that years later, a patient death — even by suicide — may put their licenses under public scrutiny as well.

But Kimberly Kirchmeyer, the medical board’s executive director, defended the project. In an e-mailed statement, she said it “is helping the board meet its mission of consumer protection in a proactive way.” She added that her agency “will continue to find ways to improve this process.”

In remarks to the board during its January meeting, Kirchmeyer gave more detail. She said expert reviewers looked for high-dose opioid prescribing patterns that included morphine equivalencies greater than 90 mg, opioids in combination with sedating drugs like benzodiazepines, Soma, sleeping pills, and other unsafe combinations of medications. Additionally, the reviewers zeroed in on doctors who prescribed dangerous drugs frequently, “and other red flags.”

A welcome change?

Perhaps not surprisingly, consumer advocates have applauded the Death Certificate Project for calling out doctors with reckless prescribing habits.

Carmen Balber, executive director of Consumer Watchdog, spoke from “the injured patient’s perspective,” saying, “Doctors in this state are accustomed to weak or non-existent regulatory oversight. For patient safety, it’s about time that the medical board started acting to proactively investigate the opioid crisis.”

In many accusations she’s read, dangerous prescribing practices are obvious. “Patients are not getting medical exams. Doctors are not confirming the injuries the patients came forward with. Doctors are prescribing wildly excessive doses of medications. Even to a lay person it seems blatantly obvious that action should have been taken,” Balber said.

Patient safety activist Eric Andrist of Los Angeles, who started the newer Patient Safety League which posts stories about medical harm and patient experiences, travels around the state to every medical board meeting to complain that the agency is too soft, allowing hundreds of dangerous doctors to get off with no more than a slap on the wrist. He said he’s pleasantly surprised the board tackled the opioid issue in the first place.

“They’ve always said that they don’t and won’t look for cases themselves … and only act on complaints brought to them,” he said. Without this initiative, these doctors would never have been punished or called out. He also praised the yield of 19 accusations resulting in disciplinary action to date — even with 43 more to go — because by his count the agency’s average is much lower.

Five licenses surrendered

Among the most egregious cases, those that prompted five physicians to surrender their licenses, departure from the standard of care was especially well documented.

In the longest accusation, a 63-page petition to revoke the license of Frank D. Gilman, MD, of San Diego, the board listed hundreds of prescriptions written for four patients. He prescribed 370 prescriptions for one of them, and of those more than 200 were for oxycodone. Two of his patients died from overdoses. Gilman was accused of gross negligence, repeated negligent acts, incompetence, repeated acts of clearly excessive prescribing, and failure to maintain adequate and accurate medical records.

John Winthrop Pierce, MD, of San Francisco, surrendered his license after one of his patients died of an overdose of hydrocodone. The board’s 28-page accusation said that he had prescribed a long-acting combination of fentanyl and morphine for another patient who had exhibited suicide ideation, and overall prescribing behavior that constituted gross negligence and repeated negligent acts.

Robert M. Littman, MD, of San Diego, also surrendered his license after the board’s accusation said that his treatment of a patient, who was found dead at her home from “carisoprodol, lorazepam, oxycodone, zolpidem and trazodone toxicity” with traces of amphetamines and clonazepam, constituted “gross negligence.” The patient had received prescriptions from multiple doctors, and “doctor shopped,” but Littman had failed to conduct toxicology screenings and had not checked the prescription database to see what other prescriptions she had been getting.

Philipp Leo Bannwart, MD, of Zermatt, Switzerland, surrendered his license after the board found fault with his treatment of a patient in Concord, near San Francisco. She died of “acute methadone intoxication.” The board accusation says that Bannwart wrote combination prescriptions for her, including methadone, Percocet, Norco, and promethazine-codeine syrup, constituting what the board called “gross negligence, repeated negligent acts/incompetence/improper prescribing without an appropriate prior examination and medical indication.”

Daniel George Clark, MD, of Auburn, surrendered his license after the agency found that a patient died after Clark increased dosages of fentanyl, which it labeled “gross negligence.”

Probation and public reprimand

Six accused physicians were placed on probation for periods of 3-7 years: Ashmead Ali, MD, of California City; Jay Milton Beams, MD, of Susanville; Harold Budhram, MD, of Shasta Lake; William Lee Matzner, MD, of Simi Valley; Michelle Anne Orengo-McFarlane, MD, of Martinez; and Ilona Sylvester, MD, of Thousand Oaks.

Another eight physicians were formally reprimanded and ordered to take courses on prescribing practices and, in most cases, medical record-keeping: Alyn Gary Anderson, MD, of Huntington Beach; Michael S. Basch, MD, of Temecula; Jose Rosendo Cesena, MD, of El Cajon; Vorakiat Charuvastra, MD, of Los Angeles; Moshe Miller Lewis, MD, of San Francisco; Diana Maria Prince, MD, of Rohnert Park; Charles Yang, MD, of Huntington Beach; and Tahir Yaqub, MD, of Atwater.

Still-pending accusations against the remaining 43 physicians can be read here.

The California Medical Association did not respond to a request for comment about the current status of the Death Certificate Project. But in an interview late last year, David Aizuss, MD, CMA president and an ophthalmologist from Encino, criticized the board for going after doctors because of how they prescribed controlled substances before 2014. “I don’t think it’s appropriate to apply our current clinical guidelines to what was going on six or seven years ago,” he said then.

Asked why the investigations take so long, medical board spokesman Carlos Villatoro replied that for the latest fiscal year ending June 30, 2018, it took an average of 322 days after an accusation was filed for the case to conclude without compromising due process. He added that the process involves the Attorney General’s office and the office of administrative hearings, both of which are outside the board’s control, he said.

Other MedPage Today stories about the California Medical Board’s Death Certificate Project:

‘Death Certificate Project’ Terrifies California Doctors

Provider Groups Hit Back at California’s Death Certificate Project

Calif.’s ‘Death Certificate Project’ Nabs 11 More Physicians

Foundation Wants Revamp in Calif.’s Death Certificate Project

Methodology Fixes Coming for Calif. Death Certificate Project

Filed under: General Problems | 1 Comment »

 

For Immediate Release:

September 2, 2019

PainWarriorsUnite.com Announces its official website launch in observance of Pain Awareness Month.

At long last, we are extremely excited to announce the official launch of our “community”website which has been in development since April of 2018.

Patients, physicians, and professional advocates have made their presence known throughout the country since the release of the CDC’S controversial opioid prescribing guidelines.

Hundreds of pain groups who exist on social media & the web have focused on different strategies to garner attention from policy makers and media, and have made significant progress in fighting for our collective cause. However, we need to expand our numbers and reach the patients/advocates who are not tech savvy or do not have access to social media. 

Our website was created BY pain patients FOR pain patients and will serve as an invaluable tool to UNITE each and every group by providing a free page on the website for everyone who wishes to participate & use this resource to amplify their unique missions.

We hope that this website will help streamline the process of sharing information and actionable steps, and save enormous amounts of time by eliminating the repetitive posting of the same redundant information being dissected in different ways.

We’re all fighting for the same goal at the end of the day, so this solution will allow everyone to retain administrative control, yet it gives our community a singular platform to stand as ONE united front for media and lawmakers to see just how many of us are being affected by their misguided policies. This should encourage them to work with us to enact public policies that balance attempts to reduce addiction while protecting patients who depend on individual treatment plans that include pain medication to maintain their function and quality of life.

We’re hopeful that this community effort will help to dispel the STIGMA attached to the responsible use of prescription pain medications for legitimate medical purposes, and quickly reverse the government’s overarching approach which is interfering with individualized treatment, eroding the doctor patient relationship,  and hindering their ability to prescribe such medications as they see fit.

Respectfully submitted, 

Andrea Patti

Tamera Stewart

Co Founders, Pain Warriors Unite 

Website: PainWarriorsUnite.com

Phone (202) 792-5600

Email: info@painwarriorsunite.com

Twitter: @PainWarriorTeam

Facebook:  https://m.facebook.com/PainWarriorsUnite 

Filed under: General Problems | 1 Comment »

Suicide rates rise across Michigan, with few answers

https://www.bridgemi.com/michigan-health-watch/suicide-rates-rise-across-michigan-few-answers

Even as Michigan’s suicide rate rose by a third over two decades -‒ and climbing even higher among young people, rural residents and military veterans -‒ a fundamental question has yet to be fully answered.

Why?

“We need to get to the bottom of why this is happening,” said state Sen. Jim Runestad, R-Oakland County. “I don’t hear that’s being done.”

Runestad contends a commission on suicide can provide at least some answers, and could lead to a rapid, statewide approach to suicide prevention. In May, the Senate unanimously approved his bill authorizing a suicide commission, sending it to the state House Health Policy Committee.

A near-identical version of that measure is slated for a likely vote in committee Thursday. Health Policy chairman, state Rep. Hank Vaupel, R-Fowlerville, said he is “optimistic” of committee approval and that he anticipates a vote by the full House this fall.

“Very definitely we need to look at some of the causes of what’s going on and see what we can do to prevent it. I think it’s vitally important,” Vaupel said.

Under the House bill, a 27-member commission would work with state departments and agencies and nonprofit organizations to study the underlying factors of suicide in Michigan and produce guidance quickly. The measure seeks preliminary findings and recommendations to the legislature in six months, and a report highlighting promising suicide prevention programs in the state within a year. 

The commission is to include suicide prevention researchers, members of the mental health, substance use disorder and medical treatment communities, law enforcement, suicide loss and suicide attempt survivors as well as the ombudsman for Michigan’s veterans’ facilities.

Runestad said he is hopeful the commission’s recommendations would lead to immediate action, including legislative measures if needed. “The thing I want to emphasize is not to delay,” he told Bridge. “There are people dying every day.” 

The measure would place the commission within the state Legislative Council, a bipartisan arm funded by the state Legislature. According to the House fiscal agency, the measure would raise costs by an “unspecified amount,” depending on how much extra staff time it consumes.

While no one’s sure why the suicides are rising, University of Michigan research suggests part of the problem is linked to opiate use. Others point to a lack of medication assisted treatment in Michigan for opioid addiction that advocates say could help to lower the suicide rate.

Runestad could point to a stack of grim statistics that argue for urgent action:

According to the U.S. Centers for Disease Control and Prevention, the overall suicide rate in Michigan spiked 33 percent from 1999 to 2016, compared to a nationwide rise of 25 percent over the same period.

For those ages 15 to 24 in Michigan, suicide is now the second leading cause of death, with the rate jumping nearly 50 percent in less than a decade in this age group, state health data show.

 

Deadly toll

Rural Michigan counties led the state in suicide rates from 1999 to 2017. Click on a county to see the rate.

Source: U.S. Centers for Disease Control and Prevention

And in parts of rural Michigan, suicide rates are twice the state average.

Sparsely populated Alcona County, 100 miles north of Bay City, charted the highest cumulative suicide rate in the state from 2000 to 2017 ‒ at 26.6 per 100,000 people, far above the state average. Its rural neighbor to the west, Oscoda County, was second highest with 25.5 suicides per 100,000.

Four counties in the Upper Peninsula ranked among the top 10 statewide in suicide rates. That includes Gogebic County in the west fringe of the U.P., which had the 10th highest suicide rate in the state.

Ironwood resident Pat Gallinagh has made it his mission to prevent suicide in this rural area, decades after he tried to take his own life. Retired from Ironwood Area Schools after three decades of teaching, he now steers a nonprofit area suicide prevention organization.

Gallinagh said he would welcome any initiative that might reach more people before they end their lives. 

“There are lots of things we could do for prevention,” he said. “The question is whether the state legislature would act on any of the recommendations. You have to look at a statewide effort to do it.”

Gallinagh said he would grade Michigan’s current suicide prevention efforts as a “D.”

“It’s not that people don’t care. It’s just that the money isn’t there.”

As a starting point, Gallinagh said, Michigan can require depression screening for Michigan school students. Research has found that up to 65 percent of adolescents report depressive symptoms, but only a third to a fourth receive treatment. About half of all those who commit suicide nationwide have a current or known mental health problem, according to the  CDC.

“That’s an expensive proposition. A lot of poor school districts couldn’t afford to do that screening,” Gallinagh said.

Adding to the challenge, Michigan schools have the nation’s second-worst ratio of students to school counselors, with 741 students for every counselor, according to the American School Counselor Association, which recommends a 250-to-1 ratio.

Two years ago, the CDC issued a series of recommended strategies to help states reduce suicides. They include housing stabilization programs to keep people on marginal incomes in their homes, improved mental health care in rural areas, advocacy for safe firearm storage, broadened peer support programs in schools and community-based policies to reduce alcohol use.

As disturbing as suicide rates are in Michigan’s rural counties, rates can be far higher among Michigan’s estimated 580,000 veterans, especially younger veterans.

According to the U.S. Department of Veterans Affairs, Michigan veterans had a suicide rate of 26.2 per 100,000 in 2016, well above the overall state suicide rate of 16.9. Among veterans age 18 to 34, the rate was a grim 44.4 per 100,000; with rates at 33 per 100,000 for those age 35 to 54.

The V.A. recorded 159 suicide deaths among all Michigan veterans that year – nearly one every other day. Nationally, an average of 20 U.S. veterans and active duty service members commit suicide a day.

Kellie Cody, the current Michigan veterans ombudsman, said he was instructed not to comment directly on the legislation since he serves within the Legislative Council.

But he said the toll of suicide among veterans underscores the need for action, especially given the rate among young veterans.

He said the rise among younger veterans may be linked to multiple deployments by U.S. troops to Iraq and Afghanistan that followed the terrorist attacks on Sept. 11, 2001.

 

Michigan Health Watch is made possible by generous financial support from the Michigan Health Endowment Fund, the Michigan Association of Health Plans, and the Michigan Health and Hospital Association. The monthly mental health special report is made possible by generous financial support of the Ethel & James Flinn Foundation. Please visit the Michigan Health Watch ‘About‘ page for more information.

Cody said that in turn is tied to high rates of post traumatic stress disorder and traumatic brain injury among those veterans, as a V.A. study found veterans with multiple brain injuries were twice as likely to consider suicide as those with one or no injury. 

“I’m a Vietnam veteran. In that era, you didn’t have multiple deployments. You went once, you did your time and you were out,” Cody said.

He added that rural veterans may be especially vulnerable, because they can be socially isolated and a long distance from mental health care.

In the meantime, school districts have been stirred to action by multiple student suicides, some in the course of a year.

That includes Cedar Springs Public Schools north of Grand Rapids, where three young students took their life over a one-year period in 2015 and 2016. That included an incident where students on a morning bus to school watched in horror as they rode past an eighth grader who had killed himself, the boy’s mother cradling his body near the roadside.

Those incidents prompted the district to invest $400,000 from its $38 million budget to add six mental health professionals to its staff, including three counselors and three other mental health specialists hired in 2018.

“It’s an issue we take very seriously,” Cedar Springs Superintendent Scott Smith said. 

Thus far, a bill has stalled that would provide teachers training to help them spot students at suicide risk. State Sen. Sylvia Santana, D-Detroit, introduced a bill In January that directs the Department of Education and Department of Health and Human Services to develop a course for teachers on “mental health first aid.”  

The bill hasn’t made it out of the Senate Education and Career Readiness Committee. More than two dozen states already require some form of suicide prevention training for teachers and other school personnel.

And aide to committee chair Lana Theis, R-Brighton, told Bridge in late August she was unavailable to discuss the bill. 

But as suicide rates remain high, veterans ombudsman Cody said the issue cries out for a unified system that brings all suicide prevention players together.

“Different counties have their approach to it. But there is no coordinating body to address it statewide,” he said. “When you have a lack of overall coordination, it gets piecemealed.”

Suicide prevention resources 

Call:National Suicide Prevention Lifeline, at 800-273-8255. It’s a network of more than 150 crisis centers that provides a 24-hour hotline to anyone in suicidal crisis or emotional distress.

Text: Crisis Text Line: 741741, is a national service that connects the texter with a live, trained crisis counselor 

Connect: To Michigansuicide hotlines, located in many communities across the state.

Reach out: ToOK2SAY, a state-funded student safety program which allows students to confidentially report tips on potential suicide and other risks to student safety. The tips can be reported by phone, at 8-555-OK2SAY (855-565-2729); by text message at 652729 (OK2SAY); or by email, at OK2SAY@mi.gov

Communicate: People can be hesitant to approach someone showing signs of despair. But experts say getting a friend or loved one to talk openly of suicidal thoughts can save a life. 

If you are a military veteran in crisis — or you’re concerned about one — the V.A. offers 24/7 confidential support. Call the Veterans Crisis Line at 1-800-273-8255 and Press 1, send a text message to 838255, or chat online.

Filed under: General Problems | 2 Comments »

Fraud Alert: Genetic Testing Scam

https://oig.hhs.gov/fraud/consumer-alerts/alerts/geneticscam.asp

The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing.

Genetic testing fraud occurs when Medicare is billed for a test or screening that was not medically necessary and/or was not ordered by a Medicare beneficiary’s treating physician.

Scammers are offering Medicare beneficiaries “free” screenings or cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes. Fraudsters are targeting beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits.

Beneficiaries who agree to genetic testing or verify personal or Medicare information may receive a cheek swab, an in-person screening or a testing kit in the mail, even if it is not ordered by a physician or medically necessary.

If Medicare denies the claim, the beneficiary could be responsible for the entire cost of the test, which could be thousands of dollars.

Protect Yourself

• If a genetic testing kit is mailed to you, don’t accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender’s name and the date you returned the items.
• Be suspicious of anyone who offers you “free” genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.
• A physician that you know and trust should assess your condition and approve any requests for genetic testing.
• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician’s office requests your Medicare information, do not provide it.
• If you suspect Medicare fraud, contact the HHS OIG Hotline.

Related Material: Senior Medicare Patrol’s Information on Genetic Testing Fraud

Filed under: General Problems | 1 Comment »

Filed under: General Problems | 2 Comments »

FDA Changes Opioid Labeling to Give Providers Better Information on Tapering Noting that the agency remains focused on striking the right balance between policies that reduce the rates of opioid addiction while still allowing patients and health care providers access to appropriate pain treatments, Food and Drug Administration (FDA) has announced required changes to the prescribing information for all opioid analgesic medications used in the outpatient setting. The changes, announced in a Drug Safety Communication, provide expanded information to health care providers on how to safely decrease the dose in patients who are physically dependent on opioids. FDA intends for this information to be used when health care providers and patients have decided together that a decrease in dose or discontinuation of opioids is appropriate. “Rapid discontinuation can result in uncontrolled pain or withdrawal symptoms. In turn, these symptoms can lead patients to seek other sources of opioid pain medicines, which may be confused with drug-seeking for abuse,” the agency said in the communication. “Patients may attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances.”In addition to these changes, an FDA press release also announced that additional policies related to the opioid crisis are forthcoming. These include a requirement for immediate-release formulations of opioids to be made available in fixed-quantity packaging that contain doses more typical of what patients may need for common acute pain conditions and procedures. The full press release is available in the News and Events section of the FDA website

https://nabp.pharmacy/wp-content/uploads/2016/06/Kentucky-Newsletter-September-2019.pdf

 

Filed under: General Problems | 2 Comments »

U.S. judge approves CVS purchase of insurer Aetna

https://www.reuters.com/article/us-aetna-m-a-cvs/u-s-judge-approves-cvs-purchase-of-insurer-aetna-idUSKCN1VP2WO

WASHINGTON (Reuters) – A federal judge reviewing a Justice Department decision to allow U.S. pharmacy chain and benefits manager CVS Health Corp (CVS.N) to merge with health insurer Aetna said on Wednesday that the agreement was in fact legal under antitrust law.

Judge Richard Leon of U.S. District Court for the District of Columbia had been examining a government plan announced in October to allow the merger on condition that Aetna sell its Medicare prescription drug plan business to WellCare Health Plans Inc (WCG.N). Both deals have already closed.

Leon had initially balked at approving the merger conditions and insisted on hearing from critics of the deal, but finally decided to grant the motion to approve the consent agreement.

But he took aim at the common practice of companies’ closing multibillion-dollar deals while the court review, required by the Tunney Act, was still in process.

“If the Tunney Act is to mean anything,” Leon wrote, “it surely must mean that no court should rubberstamp a consent decree approving the merger of ‘one of the largest companies in the United States’ and ‘the nation’s third largest health-insurance company,’ … simply because the Government requests it!”

In December, Leon said he was “less convinced” than the government that the asset sale to WellCare would resolve antitrust concerns. Since then, Centene Corp (CNC.N) agreed to acquire WellCare for $15.27 billion.

Assistant Attorney General Makan Delrahim, head of the Justice Department’s Antitrust Division, said he was pleased with Leon’s decision.

CVS said the judge’s decision reinforced that CVS and Aetna have already merged.

“CVS Health and Aetna have been one company since November 2018, and today’s action by the District Court makes that 100 percent clear. We remain focused on transforming the consumer health care experience in America,” CVS spokesman T.J. Crawford said in an emailed statement.

Critics of the CVS-Aetna deal included the American Medical Association and the AIDS Healthcare Foundation.

Another critic, U.S. PIRG, expressed skepticism that savings from the merger would end up in consumers’ pockets.

“Again and again, CVS Caremark has used its market power to both increase the cost of medications for consumers and rip off the government, instead of passing on savings its promised to consumers,” PIRG said in a statement.

Pending Leon’s approval, CVS agreed to temporarily allow Aetna to independently make critical product, pricing and personnel decisions.

CVS has been in the process of converting itself into a healthcare company and said in June that it would offer expanded health services such as nutrition counseling and blood pressure screenings in 1,500 stores by the end of 2021.

Most consent agreements that the antitrust agencies strike with companies to resolve competitive concerns are approved by federal courts with little fuss under the 1974 Tunney Act, which requires courts to ensure the agreements are in the public interest.

Companies generally do not wait for final court approval before closing their transactions.

Filed under: General Problems | 2 Comments »

How Pill Middlemen Like CVS Are Bilking the Health Care System

https://www.theamericanconservative.com/articles/how-pill-middlemen-like-cvs-are-bilking-the-health-care-system/

The outrage mob was at it again last week. This time, the target of their ire was, of all things, CVS Pharmacy. The fracas was the result of some clever antagonistic marketing by Pill Club, a San Francisco-based startup. It’s a company that acts as a sort of online pharmacy, providing customers with birth control pills and other contraceptives.

Angry with CVS Caremark over the high prices it was charging, Pill Club publicly insisted that the company was depriving women of health care. Of course, feminist Twitter outrage ensued and #CVSDeniesCare and #BoycottCVS quickly popped up. CVS, for its part, tried to quell the storm by releasing a statement saying Pill Club had been offered the same rates as any other pharmacy.

So it goes: CVS fell victim to yet another “leftist mob” demanding special treatment. For that, conservatives might be tempted to defend CVS against the slings and arrows of outrageous fortune. But the company doesn’t deserve it—not by a long shot.

CVS Caremark is a pharmacy benefit manager (PBM), a middleman between drug manufacturers and pharmacies—including online distributors like Pill Club. PBMs are hired by health insurers in order to negotiate prices, handle insurance claims, and oversee the distribution of drugs. Ostensibly, they should reduce drug prices, using their network to negotiate, making life easier for pharmacies, customers, and insurers alike. But this isn’t always the case.

Our Frankenstein’s monster of a health care system has created an abundance of “rent-seekers,” the term economists give to firms that exploit highly regulated markets and make profits they otherwise couldn’t. And PBMs like CVS are the worst of the bunch. They use monopolistic conditions, secrecy, and deception to inflate their profits at the expense of consumers, exploiting their role in America’s decidedly non-market health care system. As Republican Congressman Doug Collins once said, “they act as monopolistic terrorists on the market.”

CVS Caremark, Express Scripts, and OptumRx are some of the worst rent-seekers in the American economy. In a 2018 article, The Economist argued that PBMs, not drug manufacturers or insurers, were the recipients of the greatest excess profits in the U.S. health care system. According to the magazine, “excess profits from healthcare firms are equal to $200 per American per year” and “middlemen capture $126 of excess profits a year per American.” 

One of the main ways that PBMs seek rent is through their negotiation of rebates from drug manufacturers. And generally, to retain a PBM’s favor, drug manufacturers will readily cough them up. In turn, PBMs split the dough between themselves and the insurance company—placing the majority of it in their own pockets, of course.

Just how much, then, do they make off these rebates? Since the payments are kept strictly confidential, it’s hard to pin down the exact number. But considering the fact that insurers received $89 billion in rebates from PBMs in 2016, it’s safe to say they make a lot.

And it gets worse.

There are plenty of instances where a customer would actually be able to purchase drugs at a lower price without insurance. But PBMs don’t like this competition, so their contracts with pharmacies often include gag clauses—preventing pharmacists from even telling customers that cheaper options are available. According to the USC Schaeffer Center for Health Policy and Economics, prescription drugs are overpaid for 23 percent of the time.

PBMs like CVS have made a pretty penny off America’s failing system of employer-sponsored insurance. If the market were ever truly freed, they would be crushed. Prescriptions are a product, and they would finally be treated like one. After all, I don’t need a third party to negotiate the price I pay for a car. Why should my medicine be different?

America has embraced a broken system of employer-sponsored health insurance. Industry lobbyists have done everything in their power to ensure that alternative forms of health care coverage are limited. And it’s not as though government has proven to be much help. In 2018, Congress passed a law eliminating gag clauses and urging greater price transparency. But this proposal has drawbacks that ultimately limit its effectiveness. 

Something’s gotta give. As long as consumers are several steps removed from the actual processes governing drug prices, they’ll continue to be taken advantage of. It’s not as if these third parties are doing anything to stave off addictions or help Americans make wiser decisions about their medicine. All PBMs do is make people poorer in exchange for nothing. That’s why CVS doesn’t deserve anyone’s sympathy. If the outrage mob wants to take on one of the biggest bullies in the health care system, then let them fight.

Filed under: General Problems | Leave a Comment »

Scott Fitzgerald is news director at chanel 2 KJRH. He said email him & he will put a news crew on The Pain Patient Crisis. scott.fitzgerald@kjrh.com. Get the word out. Show him we are for real.

Filed under: General Problems | 12 Comments »

‘Business decision’: Former DEA official works for opioid lawyers but set standards for how many pills were made

https://legalnewsline.com/stories/513448671-business-decision-former-dea-official-works-for-opioid-lawyers-but-set-standards-for-how-many-pills-were-made

In 2016, he was approached by attorney Richard Fields, who found major success in asbestos and breast implant litigation by taking on the insurance companies that issued policies to the corporate defendants.

Rannazzisi was hired as a consultant for Fields’ opioid team at $500 an hour. He testified that he has made more than $100,000, but less than $250,000.

Other sources of income include a one-time agreement with Motley Rice, which snagged a part on the opioid leadership team, to help with data from a federal database, and speaking fees.

“If it’s a parents group that lost children or loved ones, it’s free,” he said. “They pay me to come out and talk and – they pay me my expenses so they will pay my flight. Generally, I don’t even take hotel.

“If it’s a group of doctors, it might be anywhere from $2 to $5,000… (I)t just depends on the group and it depends on what they could pay.”

Asked what is the most he’s charged for a speaking engagement on the opioid crisis, he said it was $5,000.

Rannazzisi still has copies of DEA documents, having been told he couldn’t get rid of them yet. He denies sharing them with the Post and “60 Minutes.” He also says he hasn’t shared them with plaintiffs lawyers.

Fields, meanwhile, has few clients in the MDL when compared to some of his plaintiff lawyer colleagues – he represents just a handful of American Indian nations.

He does have the State of Delaware as a client, though. State cases are being heard in state courts, and the first state trial shows how lucrative that can be.

Private lawyers in Oklahoma have scored $80 million from settlements and stand to make another $90 million should a verdict against Johnson & Johnson be affirmed.

Delaware hired Fields and three other teams, referred to as the “Fields Team” in the contract, on a tiered contingency fee. It starts at 21% for recovery up to $50 million, then slides down a few percentage points for each $50 million added.

And Fields’ opioid lawsuit on behalf of the Cherokee Nation was the first to name pharmacies as defendants. In Congressional testimony, he said distributors were operating under the misconception that they had a quota to fill.

“This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices, that distributed them out to people who had no legitimate need for those drugs,” Rannazzisi told “60 Minutes.”

There’s no denying the rise of opioids since the 1990s, but the question facing judges is who to blame. Private lawyers and the government officials who have hired them on a contingency fee basis contend that manufacturers, distributors and pharmacies ignored red flags and made it easier for addicts to get their hands on pills like OxyContin.

A popular defense is that the dispersal of opioids was regulated and federal officials approved what was happening. The combined quotas for oxycodone and hydrocodone nearly tripled from 2005-2015, when Rannazzisi was director of the DEA’s Office of Diversion Control.

The ODC increased the number of registrants allowed to prescribe and dispense opioids to more than 1.6 million under Rannazzisi, an increase of 45%. At the same time, the ODC took in registration fees that helped fund the department’s $300 million budget while more than 176,000 Americans died from their addiction.

In 2017, Democrat senators (including Dick Durbin) targeted DEA quotas, which rose every year Rannazzisi was in office. It took until 2018 for the DEA to issue a rule that requires it to consider the potential for abuse when it considers yearly quotas for production of prescription drugs.

Once the DEA sets quotas, it allocates a portion of them to the registered companies. Also at its disposal to track where opioids are going is a database called ARCOS which, Rannazzisi testified in 2007, was being used to identify excessive volume purchases.

Defense attorneys attempted to make the point, though, that the DEA under Rannazzisi rejected requests from companies that wanted to see their own ARCOS data, which could have aided in finding suspicious orders.

“Would you agree that access to ARCOS helps registrants combat diversion of controlled substances?” he was asked.

“Not necessarily,” he answered. “Because industry had other tools at their disposal to see downstream transactions that were not listed as business or proprietary.”

Rannazzisi said he did not know if those other tools include information contained within ARCOS.

As to the rise in quotas, defense attorneys pointed out that in the year Rannazzisi took office, the quota for hydrocodone was 37,604 kilograms. In his last year, Rannazzisi helped set the quota at 99,625 kilograms.

For oxycodone, the 2005 quota was 50,490 kgs. By 2015, it was 137,500 kgs.

“Now, by increasing the quota year after year, DEA was telling registrants and the public (that) pain medication should be available to support the legitimate medical needs; isn’t that correct?” he was asked.

“No. That’s not correct,” he said.

Rannazzisi shifted the blame for not flagging suspicious orders to the companies he was monitoring.

“And it was DEA’s policy not to tell registrants than an order is or is not suspicious, correct,” he was asked.

“Well, that’s a business decision that only the… distributor could make. They’re the only ones who know their customer. And they know what their customers are doing. And they know the… population around the customer’s business. They know what is in the area that could warrant an increase or not.

“So, DEA couldn’t make that decision. It had to come as a business decision from the distributor.”

The attorney asked, “So it was DEA’s policy not to tell registrants that order is suspicious?” and Rannazzisi reiterated his previous answer.

Asked why the DEA didn’t tell registrants to stop sales, he said there were “due process concerns.”

From Legal Newsline: Reach editor John O’Brien at john.obrien@therecordinc.com.

 

Filed under: General Problems | Leave a Comment »