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
I’m still trying to find a Civil Rights lawyer for us but NOBODY will take our case. It would be great if someone else would also try, but… I’ve called more than I can count. No lawyers want to get involved with the government, is my guess. IF I find one, I’ll be asking for others to help pay for them. Steve, what do you think are the chances of me getting financial support for a lawyer? I’d hope others would be willing to help but then I never thought it would be so hard to get others to write and/or call their “representative” and senators! It’s unreal. They aren’t better than us but much MUCH more corrupt. They AREN’T special, worthless when it comes to Americans but willing to send billions to other countries for THEIR wars.
One good thing about President Trump is that we didn’t hear the constant beating of the war drums! Now Biden’s getting us in to WW3 in two different countries! I’m tired of people saying they “aren’t in to politics” but this IS political!! If others don’t try, we’ll never live again. I’m so dreading this winter. We had a few rainy days and they were hell on my body. I prayed for death. It’s not only me, so I’d think people would be more willing to make calls and send emails and letters. It’s NOT hard.
How long can they get away with torture? So many lawyers and a few senators have been working on C19 scams and that gets all the attention. I guess nobody thinks they’ll ever need pain relief and others that do don’t know how to use a phone
IMO.. the entities to sue are the large hospital systems with office practices, chain pharmacies, drug wholesalers, Insurance/PBM industry.. and here is why Anyone can sue the government, but you can get any monetary award… just get a verdict that they violated a law and then it is thrown back to the DOJ to take some action. I saw a post yesterday that was 2nd-3rd hand information – that Walgreen has decided to stop filling C-II’s.. don’t know if it was related to one store or the whole chain or if it was just “disinformation” Here is a hyperlink on national class action law firms https://usalegal.com/20-class-action-law-firms-nationwide/.. Each of those corporations involved in healthcare… has deep pockets and there are untold number of people that are being harmed by their policies to limit/deny pain management to pts. that is what law firms look for.. and will most likely take on a class action on a contingency basis.. I suspect that chronic pain pts really don’t any money – just appropriate pain management with oral meds