This video and the class action that is being discussed between independent pharmacies and one or more PBM’s. The attorney (on the right) mentioned the one word “TYING”, what he is referring to is the part of the Sherman Antitrust Act https://en.wikipedia.org/wiki/Tying_(commerce) Tying (informally, product tying) is the practice of selling one product or service as a mandatory addition to the purchase of a different product or service. In legal terms, a tying sale makes the sale of one good (the tying good) to the de facto customer (or de jure customer) conditional on the purchase of a second distinctive good (the tied good).

TYING could also be involved with pain docs (needle jockeys) mandating that a pt get Epidural Spinal Injections (ESI) in order to get a prescription for oral opiates.  Secondly, if the pt has been getting little/no positive outcomes, then the ESI are not medically necessary and the billing of a ESI to insurance would be insurance fraud, besides violating the TYPING part of Sherman Antitrust.

This class action with the PBM industry could uncover one or more issues of how they are violating numerous laws involving especially pain pts in the limiting or denying appropriate prescribed medications.  If they are violating laws with community pharmacies, what other groups are they violating laws with?  The PBM industry has never been very financially transparent in how they function.

Over the last five years, the top five PBMs are now owned by the top five insurance companies. For a long time, PBMs have been licensed insurance companies. Those top five PBMs control 90%-95% of all prescriptions, with CVS Health/Caremark controlling about 33% alone.

I am seeing an increasing number of large Healthcare/Hospital corporations dropping contracts with various Medicare-C (Advantage) prgms, mostly over slow/low reimbursement and a draconian amount of prior authorizations and “red tape” getting a PA approved.

This may be just the first “wave” of healthcare providers pulling away from Medicare-C prgms. This is third time that the FEDS has tried to get a similar program like the current Medicare – C prgm.  The first  – back in 1970’s – was called Medicare HMO.. It failed after both providers & pts started pulling out and premiums, co-pays & deductibles started going up.  It was placed later with a Medicare-C prgm and followed a similar path and failed.

Maybe this version of Medicare-C in starting down the same path.

What will the community do if one or more chain pharmacies and/or Medicare Part D/Medicare-C decide that they are no longer going to dispense and/or prescribe opioids/controls?  I see a bunch of “keyboard warriors” on many private FB pages, will they use their efforts to reach out to some class action law firms or law firms that focus on civil rights to attempt to get a class action started.  All it takes is 1-2 lead plaintiffs to get one started. If everyone in the community just curls up in the “fetal position” and accepts no pain management as “their fate”… suicides and premature deaths will just skyrocket.

Filed under: General Problems | 2 Comments »

United Healthcare is endorsed by AARP and Humana was just bought/merged with United Health.. for the last few years, we have had Humana Part D and for 2024 – if we keep Humana – our premiums will be UP 84% and the estimated cost of my medication will be UP JUST 400%. and this is what AARP – who is supposed to be supportive of Seniors- ENDORSES?

This year, I am seeing large healthcare corporations DROPPING OUT OF Medicare-C also known as Medicare Advantage prgms, seemingly over poor reimbursement rates and draconian prior approval processes. Is this year just the beginning of a trend of  Medicare-C having fewer and fewer providers in their network?

Is this more a issue of MANAGED PROFITS and MANGLED CARE?

Filed under: General Problems | 1 Comment »

The lawsuit details the conspiracy method and how the criminal indictment is purposed to eliminate Dr. Akula from the American healthcare market to permit his competitors to seize his business and personal assets.

“THE FLIP IS ON,” HOW LOUISIANA STATE OFFICIAL MANEUVERED TO WRESTLE CONTROL OF CANON HOSPICE FROM A SUCCESSFUL INDIAN BUSINESS OWNER, DR. SHIVA AKULA, MD., (HERO OF COVID-19 & KATRINA) IN A PAYROLL SCHEME AND COVERING UP THEIR EMBEZZLEMENT DEBACLE!!!

Filed under: General Problems | Leave a Comment »

Here is a hyperlink https://www.hpso.com/getmedia/261a3590-6368-41e6-857c-f2bf9dbdf6ea/CNA_CLS_PHARM_072823_CF_PROD_SEC-(1).pdf  listing the claims that involve Board of Pharmacy (BOP). It suggests that only 30% of complaints to the state BOP results in no action and dismissed. Does this mean that a Pharmacist denying to fill a Rx for undisclosed clinical reasons, would the BOP consider this unprofessional conduct?

The cost of defending a pharmacist license grew 43% in 5 years

https://www.beckershospitalreview.com/pharmacy/the-cost-of-defending-a-pharmacist-license-grew-43-in-5-years.html

Liability claims and incidents involving pharmacists have risen in individual cost, according to a new industry report.

The Healthcare Providers Service Organization worked with the American Pharmacists Association and the Institute for Safe Medication Practices to compile data on pharmacist malpractice claims and license defense cases.

When pharmacists are defending an alleged infraction to their state pharmacy board, the average cost is $7,650 — which is a 43% increase from 2018, and more than twice as expensive as the average expense in 2013, the report found.

The top five most common allegations that cause a pharmacist’s license to be in jeopardy are wrong drug, wrong dose or strength, wrong patient, failing to consult with a practitioner about a concern, and an error in calculation or preparation.

Filed under: General Problems | Leave a Comment »

Medicare Part B premiums to rise by 6 percent in 2024

https://thehill.com/homenews/4253377-medicare-part-b-premiums-rise-by-6-percent-in-2024/

Filed under: General Problems | 1 Comment »

What is it with bureaucrats, they seem to like to “play games” with people’s lives.  Congress screws around with passing annual budgets and this year.. LAST MINUTE that passed a 45 day continued resolution to post pone the job that they knew was due since everyone claim to office. There was the threat of many of the 2 million people who work for the Fed bureaucracy – would not get paid – but just like all the other times that Congress did this.. they could come around after the “financial crisis” was over and pay all the employees the paid that they were due, and got nothing more/less than a extra paid vacation.

Now here we are again with the DEA playing with pt’s quality of life issues and just putting ANOTHER BANDAID on the issue. Practitioners and staff can’t budget long term, pts never knows when the DEA is going to take some sort of action and turn their Quality of Life issues upside down.

Here is a blog post from the first of 2023 the DEA told Newsweek it’s not responsible for pts inability to get prescriptions

I don’t know what is worse, the DEA can say that with a straight face -or – the media believes such statements as FACT !!

DEA again extends telemedicine flexibilities

https://www.cnn.com/2023/10/10/health/dea-extends-controlled-medication-telehealth-flexibilities-wellness/index.html

With a November cutoff looming, the United States Drug Enforcement Administration has for a second time extended temporary rules allowing prescription of controlled medications via telehealth.

These rules, established during the Covid-19 pandemic, are an exception to the conditions of a law known as the Ryan Haight Act, which require at least one in-person medical examination before a doctor can prescribe a controlled medicine, including stimulant medications for attention-deficit hyperactivity disorder, benzodiazepines for anxiety, and drugs for opioid use disorder, sleep or pain, said Dr. Shabana Khan, chair of the American Psychiatric Association’s Committee on Telepsychiatry, in a previous interview with CNN.

As the pandemic public health emergency that allowed for the exception neared its May 11 end date, the DEA received more than 38,000 public comments on two proposals designed to keep some flexibility in the telehealth framework moving forward, Khan said. The proposals would allow telehealth practitioners to prescribe one 30-day supply of buprenorphine — a medication for opioid use disorder — or Schedule III-V non-narcotic controlled medications, without doing an in-person exam first. A patient would have to do an in-person exam before the second prescription of either type of medication, according to those proposals.

The DEA and the Substance Abuse and Mental Health Services Administration announced May 9 that the temporary rules would be extended through November 11, while the DEA and HHS considered the public comments and any revisions to the proposals — buying more time for telehealth patients who might have otherwise experienced a disruption in care.

Now, after holding two days of public listening sessions on the rules in September, the DEA and HHS have further extended the flexibilities through December 31, 2024.

Some medical organizations have praised the decision.

American Medical Association president Dr. Jesse M. Ehrenfeld said in a news release that the organization is “grateful the DEA recognizes patients being treated with these medications … often have challenges securing and traveling to in-person appointments, and that the agency is committed to avoiding lapses in their care.”

The latest extension also applies to all patient-practitioner relationships conducted over telehealth, not just those started before, or on, November 11.

“We are thrilled that the DEA is taking such a thoughtful and thorough approach to creating the right rules around the prescription of controlled substances,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, in a news release. “This is a critical issue for millions of individuals and their families, as well as clinicians wanting to provide care to their patients, wherever and whenever they need it.”

Filed under: General Problems | 1 Comment »

Filed under: General Problems | 2 Comments »