Let’s not forget… healthcare is basically a FOR PROFIT BUSINESS

Posted on April 5, 2018 by Pharmaciststeve


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I hate posting my problems to Facebook and I also hate that it has come to this, but I don’t know what else to do and our endocrinologist has tried everything he possibly could.

Reed was diagnosed with Type 1 Diabetes on November 9, 2017. While in the hospital with Diabetic Ketoacidosis, he also had an allergic reaction to Novolog and had to have an epi pen with him all night. Because of that, our endocrinologist changed his prescription to Humalog, which has worked very well. He stated that the higher Reed’s insulin needs become, the worse the allergic reaction would become. Our Insurance doesn’t cover Humalog, therefore our endo and his diabetic educators have been battling our insurance nonstop since trying to help us get coverage. Almost a week ago we got this letter in the mail, telling us no and also telling us there is no chance to appeal. Our endo doesn’t know what else to do and has never experienced insurance rejecting to this point, so he said to go put our story out there as much as possible. That’s why I’m posting now.

I also want to point out that Humalog, the insulin we need, is $2.00 cheaper than Novolog. Insulin is incredibly expensive. Our not even 2 year old son has to have Humalog to survive. This is more severe than an “unfortunate medical circumstance” as BCBS stated. We will get Reed’s insulin no matter what and can, but we pay insurance for this reason, therefore we believe that in this specific case of an allergic reaction, they should cover it just as they do the more expensive medication.

why would a insurance company provide reimbursement for a single manufacturer’s medication and no EXCEPTIONS to get another brand… even if the pt is ALLERGIC to the preferred medication ?

BECAUSE… the insurance company gets the BIGGEST KICKBACK from that one company if the insurance company promised EXCLUSIVE use of the particular’s company’s product.

The pharma gets to sell more product… the insurance company gets to make more profits.. and the pt is left to deal with whatever QOL they get and/or ends up paying for the most appropriate product out of pocket.  Since Insulin can be several HUNDRED DOLLARS a bottle.. the annual cost to the pt can be substantial.

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My husband is disabled due to severe chronic pain.

Posted on April 5, 2018 by Pharmaciststeve

Dear Steve
My husband is disabled due to severe chronic pain. He is completely compliant with the pain mgmt doctor. She wrote a script out and escripted it to the pharmacy on March 23rd to be picked up after the  31st. We called to make sure it would be ready and was told yes and given the cost. When my husband got there he was told they had to talk to dr.and would call us.Tuesday the doctor still hadn’t called so I called her
the receptionist got on the phone and gave the pharmacist some diagnosis codes and that injections and neurontin this was not good enough for pharmacist. she told me she needed to know what other medicines were tried what other diagnoses there were what other therapies were tried.

Our doctor called back and reached a different pharmacist. doctor told her that 1 she didn’t have a release to speak to her ie hippa 2 it was none of her business 3 that the other pharmacist had no right to deny the legitimate script and that she will not send another one

We are stuck in the middle my husband is in horrible pain. They had the script for a week and never saw anything wrong with it

I’m sorry for rambling Im frustrated and don’t know his rights. We feel like he is in trouble for something he didn’t do.

thanking you in advance for your help

 

 

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CDC refuses responsibility in Chronic Pain Care – Opioid crisis

Posted on April 4, 2018 by Pharmaciststeve

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Reporter doing story about denial of pain care SUICIDES

Posted on April 4, 2018 by Pharmaciststeve

Terry called me and he is doing research to generate a report/story on  – whatever number he can validate – the  number/names of chronic pain pts that have committed suicide because their meds have been reduced or stopped since the CDC released their opiate dosing guidelines two years ago.  If you have information please contact him

Terrence McCoy
Washington Post
Reporter
202-334-5215

 

https://www.washingtonpost.com/people/terrence-mccoy/

 

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Fed Cir: Veterans Can Now Get Disability From Pain Alone, VA Opposition ‘Illogical’

Posted on April 4, 2018 by Pharmaciststeve

www.disabledveterans.org/2018/04/04/fed-cir-veterans-can-now-get-disability-pain-alone-va-opposition-illogical/

The Federal Circuit just reversed years of bad case law finding veterans can receive a service-connected disability for pain alone without a present diagnosis or pathology.

Basically, the Court concluded the Department of Veterans Affairs added additional criteria to what the term “disability” means as it related to disability compensation. The Court called VA’s argument as to the interpretation of what “disability” means “illogical in the broader context of the statute”.

The decision finds the Court of Appeals For Veterans Claims misinterpreted what a disability was when adjudicating the claim of Melba Saunders for her knee pain. The veteran lacked a current specific diagnosis or other identified disease or injury. Nonetheless, the three-judge panel concluded veterans include Melba may still be entitled to a disability rating for such pain.

RELATED: Screwed By VA? Top 5 Must Reads For Disabled Veterans

“We conclude that pain is an impairment because it diminishes the body’s ability to function, and that pain need not be diagnosed as connected to a current underlying condition to function as an impairment.”

The Secretary was unsuccessful in explaining why “pain alone is incapable of causing an impairment in earning capacity” despite trying hard to strain a gnat in his contrarian argument.

His representation did not go down without a fight. They even tried classic law school slippery-slope argument strategies claiming the Court’s holding would result in veterans getting disability ratings for pain when they do not deserve the ratings.

RELATED: California Veterans Wait Longer For Disability Ratings

Yawn.

In short, a veteran’s disability must be linked to an in-service incurrence or aggravation of a disease or personal injury.

Can you imagine how many veterans were screwed by the agency’s improper interpretation of 38 USC § 1110 and its interpretation of what a “disability” actually is?

VA probably knows the amount of money it was saving by screwing veterans with its illogical interpretation of the statute, right down to the penny.

Saunders v Acting VA Secretary Wilkie Quotes

Here were some of my favorite quotes in italics from the case, Saunders v Wilkie:

We next consider whether pain alone can serve as a functional impairment and therefore qualify as a disability, no matter the underlying cause. We conclude that pain is an impairment because it diminishes the body’s ability to function, and that pain need not be diagnosed as connected to a current underlying condition to function as an impairment. The Secretary fails to explain how pain alone is incapable of causing an impairment in earning capacity, and we see no reason to reach such a conclusion. In fact, the Secretary concedes that “pain can cause functional impairment in certain situations, that disability can exist in those cases, and that a formal diagnosis is not always required.” Appellee Br. 26 (emphasis in original).

…

The Veterans Court’s interpretation of “disability” is also illogical in the broader context of the statute, given that the third requirement for service connection is establishment of a nexus between the present disability and the disease or injury incurred during service. If the disability must be the underlying disease or injury, there is no reason for a nexus requirement—and therefore Sanchez–Benitez I eviscerates the nexus requirement.

… 

This holding is also supported by common sense. As Saunders explains, a physician’s failure to provide a diagnosis for the immediate cause of a veteran’s pain does not indicate that the pain cannot be a functional impairment that affects a veteran’s earning capacity.

… 

To establish the presence of a disability, a veteran will need to show that her pain reaches the level of a functional impairment of earning capacity. The policy underlying veterans compensation—to compensate veterans whose ability to earn a living is impaired as a result of their military service—supports the holding we reach today.

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Reporter looking for stories of collateral damage of the opiate crisis crackdown

Posted on April 4, 2018 by Pharmaciststeve

Hi there,

I’m a reporter with the Washington Post, and I’m reaching out in the hopes you might be able to help me with a story. It’s about the increasingly complex geography of opioid proscriptions. As a growing number of states pass stricter legislation targeting over-prescription, and doctors become skittish, obtaining an opioid proscription in many states has become no easy matter. Unevenly-distributed policies has resulted in some longtime pain patients having to travel long distances to obtain proscriptions. I’ve heard this is much the case in Montana, and I was hoping to learn more and talk to a few people who have been forced into this situation. I’m interested in doing a story on what could be considered the collateral damage of America’s war on opioids.

Thanks a lot, and I’m looking forward to hearing from you.

Terry

_______
Terrence McCoy
Washington Post
Reporter
202-334-5215

UPDATE:

04/04/2018 this reporter just called me and he is interested in talking to people who are having to travel long distances to see a prescriber to get the pain management

 

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The death of Kessee is currently under investigation by the Oklahoma State Bureau of Investigation.

Posted on April 3, 2018 by Pharmaciststeve

https://youtu.be/MOz5zcePaEA

NPD Reviews Officer Interactions with Marconia Kessee

 
Date of Press Release: 
Tue, 01/23/2018
Press Release By: 
Sarah Jensen

The Norman Police Department responded to a report of a disturbance inside the waiting area of the Norman Regional
Hospital – Porter Campus, 901 N. Porter Avenue, at approximately 7:30 p.m. on January 16. Upon arrival, officers located a hospital security guard with the individual later identified as 34-year-old Marconia Kessee. Hospital security advised that Kessee had been seen by medical staff and released from the facility, but refused to leave. The officers assisted Kessee into a wheelchair and escorted him outside of the waiting area.

Once outside, two NPD officers attempt to persuade Kessee to seek shelter at the Salvation Army located nearby. Despite repeated attempts, Keesee refused to leave hospital property. Due to his refusal, hospital security cited Kessee for trespassing. Kessee was taken into custody by the two officers and transported to the Cleveland County Detention Center. Prior to transport, Kessee was determined to be fit for incarceration by a hospital physician. The body camera video provided shows the two officers’ contact with Keesee.

NPD was later notified that Kessee was found unresponsive in his cell approximately two hours after being booked into
the detention center. Detention center staff called 911, and a medical response by the Norman Fire Department and EMSSTAT was initiated. Kessee was transported by EMSSTAT back to Norman Regional Hospital – Porter Campus where he was pronounced deceased.

Protocol following an incident of this nature includes a review of the body camera footage of the department’s interactions with Kessee. Following the review of the video, it generally appears that the officers followed basic protocol. There is no indication at this time that the actions of the two officers contributed to the death of Kessee. However, the department has launched an administrative review of the actions and disparaging comments made by the two officers. By policy, the officers have been placed on administrative leave pending the outcome of the internal investigation. The officers involved are Master Police Officer Kyle Canaan who has been with NPD since October 9, 2009 and Officer Daniel Brown who has been with NPD since October 4, 2013. The internal investigation is ongoing.

The death of Kessee is currently under investigation by the Oklahoma State Bureau of Investigation. 

Watch the full body camera video of NPD’s interaction with Marconia Kessee:https://youtu.be/MOz5zcePaEA

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AG Session: Feds will not fulfill its role as a leading protector of basic constitutional rights under his leadership

Posted on April 3, 2018 by Pharmaciststeve

Sessions Says to Courts: Go Ahead, Jail People Because They’re Poor

https://mobile.nytimes.com/2017/12/28/opinion/sessions-says-to-courts-go-ahead-jail-people-because-theyre-poor.html

Last week, Attorney General Jeff Sessions retracted an Obama-era guidance to state courts that was meant to end debtors’ prisons, where people who are too poor to pay fines are sent. This practice is blatantly unconstitutional, and the guidance had helped jump-start reform around the country. Its withdrawal is the latest sign that the federal government is retreating from protecting civil rights for the most vulnerable among us.

The Justice Department helped shine a light on the harms of fine and fees when it investigated Ferguson, Mo., three years ago after the killing of the teenager Michael Brown by a police officer. As one of the lawyers on that case, I saw firsthand the damage that the city had wrought on its black community.

Ferguson used its criminal justice system as a for-profit enterprise, extracting millions from its poorest citizens. Internal emails revealed the head of finance directing policing strategy to maximize revenue rather than ensure public safety. Officers told us they were pressured to issue as many tickets as possible.

Even the local judge was in on it, imposing penalties of $302 for jaywalking and $531 for allowing weeds to grow in one’s yard. He issued arrest warrants for residents who fell behind on payments — including a 67-year-old woman who had been fined for a trash-removal violation — without inquiring whether they even had the ability to pay the exorbitant amounts. The arrests resulted in new charges, more fees and the suspension of driver’s licenses. These burdens fell disproportionately on African-Americans.

At the time of our investigation, over 16,000 people had outstanding arrest warrants from Ferguson, a city of 21,000. Untold numbers found themselves perpetually in debt to the city and periodically confined to its jail.

These problems were not unique to Ferguson. A Georgia woman served eight months in custody past her sentence because she couldn’t pay a $705 fine. A veteran battling homelessness in Michigan lost his job when a judge jailed him for bringing only $25 rather than the required $50 first payment to court. A judge in Alabama told people too poor to pay that they could either give blood or go to jail.

In 2015, the Justice Department convened judges, legislators, advocates and affected people to discuss this problem and devise solutions. Participants repeatedly asked the Justice Department to clarify the legal rules that govern the enforcement of financial penalties and to support widespread reform.

And so we did. Relying on Supreme Court precedent from over 30 years ago, the 2016 guidance set out basic constitutional requirements: Do not imprison a person for nonpayment without first asking whether he or she can pay. Consider alternatives like community service. Do not condition access to a court hearing on payment of all outstanding debt.

The Justice Department also provided financial resources to the field. It invested in the efforts of a national task force of judges and court administrators to develop best practices. And it created a $3 million grant program to support innovative, homegrown reforms in five states.

Along with private litigation and advocacy, these efforts have helped drive change around the country. Missouri limited the percent of city revenue that can come from fines and fees and announced court rules to guard against unlawful incarceration. California abolished fees for juveniles and stopped suspending the driver’s licenses of people with court debt. Louisiana passed a law requiring that judges consider a person’s financial circumstances before imposing fines and fees. Texas, where the court system’s administrative director said the guidance “was very helpful and very well received by the judges across the state,” issued new rules to prevent people from being jailed for their poverty. The American Bar Association endorsed the Justice Department’s guidance, and the Conference of State Court Administrators cited it in a policy paper on ending debtors’ prisons.

To justify reversing guidance that has had so much positive impact, Mr. Sessions asserts that such documents circumvent the executive branch’s rule-making process and impose novel legal obligations by fiat. Nonsense. The fines and fees guidance created no new legal rules. It discussed existing law and cited model approaches from local jurisdictions. The document also put state-level actors on notice that the department would take action to protect individual rights, whether by partnership or litigation.

Viewed in that light, the true intent of Mr. Sessions’s decision comes into focus. Sessions pulled 25 guidance documents last week. Sixteen of those involved civil rights protections — including 10 related to the Americans With Disabilities Act and one on the special harms that unlawful fine and fee practices can have for young people. Withdrawing these documents is consistent with the Trump administration’s hostility to civil rights in a host of other areas: abandoning oversight of police departments, reinterpreting anti-discrimination statutes to deny protection to L.G.B.T. individuals and switching sides in key voting rights cases.

The push to abolish debtors’ prisons will continue, as community advocates and local officials press on. It would be preferable, of course, for the federal government to fulfill its role as a leading protector of basic constitutional rights. Unfortunately, Mr. Sessions has made clear that under his leadership it will not.

Chiraag Bains (@chiraagbains) is a former senior counsel in the Justice Department’s Civil Rights Division. He is now a senior fellow at Harvard Law School’s Criminal Justice Policy Program and a fellow with the Open Society Foundations.

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We care… just not that much…

Posted on April 3, 2018 by Pharmaciststeve

 

I called expressscripts and BC/BS FEP mail order CVS caremark, I was told fentanyl patches required NO special cooling packs sending to central Fl. I questioned when my brand has a 6°F range 72°-78°? They insist that they are not required to be sent to keep the temperature. This is ridiculous as fentanyl is heat activated. My fear is these will be worthless when received. How can they get away with this knowing the range is so small and just barely manageable in a house never mind a mail truck or mailbox?

If you notice that most medications – even OTC’s – have a temp storage range requirement. Those storage requirements must be met by the manufacturer, wholesaler and pharmacy. Once a pharmacy hands off a prescription to a delivery service… they are not obligated to maintain those temperature storage requirements.  Here is a recent post that addressed how ambient temperature can cause a medication to deteriorate.

How Does Temperature Affect Mail Order Medicines?

Those temperature are required by at least the FDA…  I am not sure if the state board of pharmacy has the authority or the INTEREST in enforcing those requirements.

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Where are the defenders of the under represented and those being discriminated against ?

Posted on April 3, 2018 by Pharmaciststeve

AARP Member Card

ACLU sues Gov. Bevin for blocking and banning people on social media

These two organizations, in particular, openly profess to “protect” people from abuse, discrimination and the like.

I have heard about untold number of chronic pain pts reaching out to both of these organizations and either their effort to reach them was IGNORED or they were sent a letter/email stating that they did not have enough resources to handle the particular issue.

I have heard about one or more chronic pain pts sending the ACLU dozens of pages of documentation on the various federal regulations that are routinely being violated when it comes to chronic pain pts..  I have not seen any press releases from the ACLU about them taking any legal actions.

The above lawsuit by the ACLU involves a couple of activists in KY that Gov Bevin has blocked from posting on his Facebook and Twitter accounts..  REALLY… that is actionable and all the abuse/discrimination against the chronic pain community is beyond their ability to consider action ?  REALLY…

Our founding Fathers set our government up as having three distinct segments… but have they remained separate and distinct ?

Executive branch..  Pres Trump has surrounded himself with ATTORNEYS… many of whom are directly/indirectly  involved in the war on drugs and the theoretical opiate crisis

Judicial branch .. The Supreme Court and encompasses our entire judicial system

Legislative branch – Congress ( Senate & House of Representatives ) – with about 40% of the members of Congress are attorneys.

Maybe it is me… but.. all three branches seem to be highly infiltrated with ATTORNEYS

For those of us who have had to deal with attorneys at some point in time, it is quite obvious that they are well trained in generating billing hours – and revenue – not only for themselves but for other attorneys that may be involved in whatever issue there is.

The DEA is part of our judicial system..  they have been successful in turning a 43 million/yr budget in 1970 into a 81 billion/yr war on drugs and starting with 1200 employees now with abt 12,000 and just added another 250… Even though they have 20 odd regional offices.. they just opened a new one in Louisville KY, and this doesn’t count all those in the judicial system at the city, county, state level that are involved with the war on drugs.

Maybe we are all missing the point… maybe it is consider UNPROFESSIONAL CONDUCT for one attorney to sue another attorney or the judicial system itself?  After all … sharks don’t eat sharks – do they ?

 

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