“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
A flurry of big decisions out of the Obama administration just weeks before President-elect Donald Trump takes office has rekindled Republican concerns about President Obama’s plans for jamming through so-called “midnight regulations” and other leftover items from his wish-list on his way out the door.
In the last week alone, the Obama administration blocked future oil and gas leases in swaths of the Arctic and Atlantic oceans; granted a record number of pardons and commutations for a single day; and scrapped a dormant registry for male immigrants from a list of largely Muslim countries.
Defense officials told Fox News there is an effort underway to transfer up to 22 additional detainees out of Guantanamo Bay. And Obama’s ambassador to the United Nations stunned Israel on Friday by abstaining on a Security Council measure condemning settlement activity, allowing it to pass.
And Obama still has a month left in office. The most recent announcements were made while the first family was on vacation in Hawaii – leaving unclear what Obama has in store for when he gets back to Washington.
Hanging over any final actions is the likelihood that Trump, once in office, will roll back many of them. “The things he’s done this week will be turned around,” former House Speaker Newt Gingrich said of Obama on “Fox News Sunday.” “He’s in this desperate frenzy.”
But Democrats are urging the outgoing president to pursue further actions, as the administration weighs its next steps.
Among the possibilities:
Sixty-four House Democrats recently asked Obama to use his pardon power to preserve his Deferred Action for Childhood Arrivals, which spared millions of illegal immigrants who came to the U.S. as children from deportation. Led by Rep. Luis Gutiérrez, D-Ill., the lawmakers asked Obama in a letter to “exercise your Constitutional authority to provide pardons to young people who are American in every way but on paper.” The goal is to make it more difficult for Trump to potentially deport them.
The White House already has teed up the strong possibility of more clemency for nonviolent drug offenders and others. After Obama pardoned 78 people and granted another 153 commutations on Monday, White House Counsel Neil Eggleston said he expects “more grants of both commutations and pardons before [Obama] leaves office.”
Former President Jimmy Carter has called on Obama to go further in the Middle East and recognize a Palestinian state before leaving office. In a New York Times op-ed, he wrote: “The simple but vital step this administration must take before its term expires on Jan. 20 is to grant American diplomatic recognition to the state of Palestine.”
The White House has expressed reluctance to take some of these steps.
White House spokesman Eric Schultz said “there is a process at the Department of Justice to review pardon applications” and “the president has said he is not going to do anything to circumvent that process.” As for Carter’s appeal, Schultz said, “I don’t think [Carter’s] views are new today, so I don’t have any new positions or views from us on that.”
White House Press Secretary Josh Earnest also said recently that any executive actions the president takes at this stage likely were in the works before the November election.
“What I can rule out are any sort of hastily added executive actions that weren’t previously considered that would just be tacked on at the end,” Earnest said.
Regulation ‘Finish Line’
While Obama weighs his last batch of policy decisions, many regulations already are coming through the pipeline. The final plans reportedly include as many as 98 regulations classified as “economically significant,” meaning each would cost the economy $100 million through compliance and consumer impact.
According to an analysis by the conservative American Action Forum, based on the Federal Register agenda, the administration is eyeing $44.1 billion in “midnight regulations” – or rules pushed in the final two months of an outgoing administration.
“This has been the most active December ever for regulations,” Sam Batkins, AAF’s director of regulatory affairs.
Gina McCarthy, administrator of the Environmental Protection Agency, didn’t conceal her eagerness in a staff memo sent after the election. “As I’ve mentioned to you before, we’re running—not walking—through the finish line of President Obama’s presidency,” McCarthy wrote.
By late November, the EPA announced stronger greenhouse gas emission standards, pushing 54.1 miles-per-gallon fuel efficiency standards for cars and light trucks for model years 2022-2025. In mid-November, the Interior Department finalized a rule to cut methane emissions during oil and natural gas production on federal lands.
Among regulations expected to take effect: the U.S. Citizenship and Immigration Services plans to make it easier for employers to sponsor highly skilled immigrants in the country; the Education Department is working on student debt relief at for-profit colleges; and on the financial services side, the Federal Reserve and the Securities and Exchange Commission are working on matters such as executive pay and mutual fund management.
According to an administration official, the number of active rules at the end of this administration still is 15 percent lower than at the end of the George W. Bush administration. The administration also notes that some economically significant regulations help the economy.
Republican Roll-Back
Congressional Republicans are bent on stopping or reversing the onslaught of new rules.
In a Dec. 5 letter, 20 Republican senators asked Obama to “honor the will of the American people and refrain from working on or issuing any new, non-emergency regulations while carrying out your remaining term in office.”
House Majority Leader Kevin McCarthy, R-Calif., in a Nov. 15 letter to federal agency heads signed by other House committee chairmen, asserted, “we will work with our colleagues to ensure that Congress scrutinizes your actions—and, if appropriate, overturns them.”
The Congressional Review Act of 1996 allows Congress, with the president’s signature, to rescind regulations and prohibit agencies from imposing rules that are substantively the same.
That, however, would have limits even when Trump takes office, Batkins said.
“Congress can rescind regulations when it gets back, using the CRA, but the House and Senate will be working on health care, the economy and infrastructure,” Batkins told FoxNews.com. “Congress has a lot on its plate. Of the 100 or more midnight regulations that could fly through, there probably won’t be more than a dozen they would be interested in repealing.”
Asked at a November press conference about GOP calls to hold off on finalizing rules in his final weeks in office, Obama defended their rulemaking pace: “The regulations that we have issued are ones that we’ve been working on for a very long time. … These aren’t things that we’ve been surprising people with
NEW ORLEANS – Allegations of prescription-cost overcharging by pharmacy benefit managers and health-insurance companies have spawned at least 10 new lawsuits since early October, according to www.bna.com.
The lawsuits allege that benefit managers OptumRx and Humana Pharmacy Solutions Inc. have worked in concert with insurers including Cigna, UnitedHealth and Humana to overcharge customers by employing a “clawback” of the difference of a drug’s cost and the individual customer’s co-payment amount.
The plaintiffs also claim that these alleged overcharging schemes are being hidden from patients by the benefit managers, insurers and pharmacies.
“Discussion of how to claw back part of the copays seems more about lawyers trying to sue and settle for a big payday than actual patients who are harmed,” Devon Herrick, senior fellow for the National Center for Policy Analysis, told the Louisiana Record.
Many of the recent lawsuits have been filed in response to an investigation conducted by New Orleans television station Fox 8 into prescription-drug costs. The station said the investigation revealed that some insured patients would pay less for the prescription drugs in question if they had no prescription coverage at all.
Herrick said if patients are worried about whether their copays are more than the negotiated price of the drug in question, they can ask their pharmacists about the cash price or the insurance price, or do their own research on comparable prices.
“It doesn’t take too much effort on the part of a patient to find out that Wal-Mart’s $4 30-day prescriptions (or $10 90-day prescriptions) are sometimes less expensive than a $10 or $20 co-pay on their drug plans,” he said.
Herrick said the “cash” price of medical services is often less than the insurers’ negotiated price of medical procedures, and, occasionally, even drug copays are slightly more than the negotiated price. Reasons for these price differences, he said, include whether someone has met their deductible or not and whether the pharmacy, clinic or physician is competing on price.
“Ultimately, I believe it should be up to the health-plan sponsor and their agents to design benefits,” Herrick said.
According to Herrick, PBMs and health plans, including both insurers and employer plans, establish policy about formularies, copays and other aspects of a drug plan.
Herrick said industry data show that nearly one-quarter of prescriptions have no copay, about one-third have a copay of $5 or less, and nearly 75 percent have copays of $10 or less.
“Tiered copays are used by health plans and drug plans to create incentives to steer enrollees to the appropriate drug, which is usually a generic,” Herrick said. “On the individual level, this sounds like small potatoes. A generic may cost the insurers $2 less than the copay; a brand-name drug may cost the insurers $200 more than the copay.”
“Patients should not have to pay more than a network drugstore’s submitted charges to the health plan,” the Pharmaceutical Care Management Association told the Louisiana Record in a statement.
The association said PBMs are projected to save Louisiana’s employers, unions, government programs and consumers $9.5 billion on drug benefit costs over the next decade.
Twelve years ago, former DEA propagandist Belita Nelson quit her job after spending six years (1998-2004) as an international media representative for the anti-drugs agency. Since leaving the DEA, Nelson has become an advocate for cannabis reform and the expanding of research into marijuana treatments.
Nelson — who, during her time there, eventually became the DEA’s chief propagandist — told a crowd at the Marijuana for Medical Professionals Conference in Denver, Colorado last month that the DEA’s war on cannabis is exactly the corrupt, money-grubbing scheme that most believe it to be.
“Marijuana is safe, we know it is safe. It’s our cash cow and we will never give up,” she said, according to Angela Bacca’s report for Illegally Healed.
Ultimately, Nelson quit her job in 2004 due to a fundamental disagreement with the agency over its illogical and hardball stance against the cannabis plant. She had been a firsthand witness to marijuana helping a friend struggle through side-effects from chemotherapy. Finally, when she learned that cannabis was also effective in breaking addicts off of serious opiate addictions, Nelson resigned.
“[When they hired me] they forgot to get me to sign a confidentiality agreement — and boy did I know the dirt. They called me in and said ‘name your price, $10,000 a month? $20,000? What do you want Belita?’” she said during her presentation in Denver.
But instead of cooperating, Nelson stormed from the office screaming, “You know this is safe and you are keeping it from people who are sick! I am not taking your money and you better worry about what I am going to say.”
This is certainly not the first time that Nelson has spoken publicly about the DEA’s stance on cannabis in the years since she left — but, in light of the incoming administration (including particularly disappointing prospects for the U.S. Attorney General position), hers are the type of stories that may make the ultimate difference in the months and years ahead.
“…If you think the DEA are the good guys, they are not,” she said. “They are really not. We are talking corruption on steroids.”
A year or so ago another chronic painer and myself tried to start of non-profit to accumulate a “legal war chest” to fund legal challenges to denial of care of chronic pain pts. Our goal was to get about 0.1% of the chronic pain community to contribute the cost of a fast food meal ($5 – $7.50) ONE TIME.. reaching that goal would have generated millions of dollars to fund legal actions… after abt 30 days.. the fund had a total of abt $600 that had been contributed by a couple of dozen people .. including two people that contributed $100 each. In 30 days we had not even accumulated enough to pay for the legal cost of creating a non-profit… donations were refunded and the project ABANDONED…
Prior to the recent national election where 435 Representatives in the House and 34 Senators were up for re-election… I repeatedly pushed the concept to “VOTE THE BUMS OUT”.. and abt 98% of the incumbents got re-elected… so the vast majority of the chronic pain community either didn’t vote.. or voted for the incumbent… ANOTHER FAILED PROJECT….
A couple of weeks ago.. I created a concept that would take some participation of those in the chronic pain community to create a list on Twitter to be able to send tweets to all of Congress and the media with just sending out a single tweet… I asked for help creating the lists… less than a HANDFUL of chronic painers came forward with a interest in moving forward with the project. ANOTHER PROJECT THAT IS GOING TO BE DESTINED TO FAIL ?
If those in the chronic pain community does not get the attention of those who are passing laws… reinterpreting the existing laws.. that are going to continue to adversely effect those in the chronic pain community… the downhill path of pain care in this country is not going to change.
The bureaucracy is starting to acknowledge that addiction is a mental health disease, but as of yet.. they have not acknowledged that the prescribing opiates to treat pain… will not cause a person to develop the MENTAL HEALTH DISEASE of ADDICTION..
The prescribing of legal opiates peaked in 2012 and has been declining every since… all the while the number of OD’s from illegal Heroin, Fentanyl and other illegal substances have DRAMATICALLY INCREASED.
If those in the chronic pain community wants things to change.. then collectively they are going to have to get their ass in gear… there is no handful of advocates that are going to change the current course of where things are going in regards to how/when chronic pain pts are treated.
Over the last 5 yrs I have seen chronic painers and others who have tried to step up to the plate to advocate for better treatment of those with chronic pain.. for them to shortly realize that they were a solo voice or just one of a few vocal advocates and they seemingly “disappeared” from being an advocate.
There is suppose to be 100 + million chronic painers… those within the bureaucracy are not going to change their thoughts about treating chronic pain… when they only hear from a few hundred or less about the denial and abuse of chronic painers that is going on and that they are creating..
Look at it from their perspective.. if there are 100 million chronic painers and they are not hear much “noise” from that group of people.. there can’t be much of a problem to those people… if they are not SPEAKING UP.
There’s much debate about drug prices. Who pays and how much is complicated. Manufacturers get blamed (sometimes rightly) for high prices, and pharmacists face sick, angry patients whose prescriptions cost too much. Most of the time, there is an invisible third-party between the pharmacist and the patient. It’s time to look at the multi-billion dollar industry in the middle of nearly every prescription drug transaction.
Insurance companies use pharmacy benefit managers – PBMs – to handle the prescription drug part of their plans. The PBM tells the drug manufacturer it will provide insurance coverage in return for a lower price. A few PBMs represent millions of patients which can be leveraged to demand greater rebates from manufacturers. Insurers like this because they hopefully can get rebates from the PBM when covering your prescriptions.
Your pharmacy actually purchases the drugs. Since the pharmacy paid for the medication, you’d think the pharmacy would set the copay. Wrong. That’s dictated by the PBM.
When you take a prescription to the pharmacy, it takes time to fill the order. One reason is that your pharmacy contacts the PBM to see if your prescription is covered, and how much copay you’ll be responsible for. The pharmacy generally expects to recoup what it paid for the medication, plus a dispensing fee, covering the cost of employing pharmacy staff, the computer systems, and other pharmacy expenses.
Here’s an example of how the math works. The pharmacy buys your prescription drug for $50 and your copay is $10. The pharmacy needs to recoup $40 from the PBM, plus a little more for overhead. Ohio pharmacists are finding that in many instances, $40 never arrives. While that doesn’t happen on every prescription, it’s increasingly common for PBMs to under-reimburse the pharmacy. This is one reason Ohio lost more than half of its independent pharmacies in the last 20 years.
Your local pharmacy isn’t the only one getting stiffed by PBMs. Patients are too. They just don’t know it, and the pharmacist is forbidden to tell them.
Let the numbers explain again. Your pharmacy buys the drug for $50, but this time the PBM tells them to charge you a $70 copay. Your pharmacist is obligated to charge you whatever the PBM says. Where does that extra $20 go? The PBM performs a “claw-back,” collecting the overcharge from the pharmacy. Under PBM claw-back schemes, it’s not a copay – it’s a “you-pay.” The pharmacy got $50 to cover their acquisition cost for the drug (but nothing to cover operating expenses), your insurance paid nothing toward the prescription, and the PBM got the extra $20. The patient is stuck paying more than what the cost of the drug would have been if they hadn’t used insurance at all.
A recent story in The Wall Street Journal explains how PBMs’ pressure for greater rebates from drug makers may play a role in driving drug price increases, which in turn force hikes in copays and premiums. These business practices put PBM profits ahead of patients. And perhaps the most unsavory part is that many PBMs place pharmacies under a contractual gag order that prohibits the pharmacist from saying anything to the patient or plan sponsor about the true drug costs. Reuters reports that a lawsuit accuses UnitedHealth Group Inc., the nation’s largest insurer, for allegedly charging copays for medicines that were higher than negotiated costs, and keeping the difference.
Louisiana law now allows pharmacists to work with consumers to get them the best price, regardless what the PBM says. That’s a start, but it’s only one state, and it doesn’t prohibit all claw-backs. Those serious about controlling the costs of health care should get serious about pulling back the curtain on secret PBM tactics that raise prices and do nothing to enhance patient care.
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Not a very Merry Christmas for a Marine in Texas. He was asked to leave a Walgreens in Mesquite because he brought his dog in with him. Cris Goodson suffers from PTSD and his dog is registered as a service dog, but apparently the manager of the store didn’t understand ADA rules and wanted Goodson and his dog out of th store.
Walgreens says it’s investigating the matter. Has this ever happened to you or a loved one?
Former DEA Spokesperson: Marijuana is ‘Cash Cow’ and ‘We Will Never Give Up’
