The Battle for America’s Prescription Drug System

https://puttrx.medium.com/the-battle-for-americas-prescription-drug-system-4694e2195b71

Prescription drug cost is one of the few issues everyone can agree needs addressing, yet very few politicians seem able to abandon party-line rhetoric to confront the issue. Wealthy corporate campaign donations are now overriding basic common sense when it comes to reining in obvious systemic problems. Like climate change, we see political party leaders making promises, pointing fingers, but ultimately doing nothing. It’s as if no one can get out of their own way to focus on what’s really important — American patients.

It doesn’t help that the prescription drug industry itself seems more concerned with protecting trade secrets than allowing for actual transparency and issue resolution. From protecting formulas to hiding formularies, the prescription drug sector of America’s vertically-integrated oligarchy of a healthcare system is far closer to the steel and railroad monopolies of the early 1900s than an industry model for the 21st century.

Drug prices are high, so pharmacy benefit managers (PBMs) negotiate “rebates” — which are actually kickbacks — to include their drugs on plan formularies. Insurance companies claim they put patients first but maintain lucrative (for them) relationships with the PBMs.

Prescription drug costs are known to be among the highest healthcare spending points for employers. Local doctors, pharmacies, and hospitals are being taken over by PBM/insurance conglomerates, and those who hang their medical shingle as “independently-owned” face higher barriers to entry than in nearly any other industrial sector.

Where is the breaking point?

If our elected leaders could step above the fray for a moment, they would see it’s easy to draw a direct correlation between PBMs, skyrocketing prescription drug prices, and American healthcare degeneration. America is the only nation in the world that includes PBMs in healthcare, yet we have the highest prescription drug prices in the world.

Does anyone else see the common problem here?

The FTC and the DOJ are currently examining vertical integration legalities. It’s a good start, but it’s not enough. Unless our government is willing to kick healthcare campaign contributions to the curb and focus on what’s best for American patients, nothing will ever be solved.

I implore federal and state governments to mandate full transparency on EVERY aspect of the U.S. healthcare system from campaign contributions to how patient care costs are calculated. The people of this great nation deserve better, and are far more valuable than Wall Street dividends.

Shannon Wightman-Girard

PUTT Operations Manager, Independent Pharmacy Patient

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Investigate Long Wait Times and Closures at Chain Pharmacies

https://resist.bot/petitions/pfdppx

In these unprecedented times, I ask you to immediately investigate closure decisions by corporate chain pharmacies, leading to long wait times and poor patient care. This directly and urgently impacts the health of my family and me. In the midst of a global pandemic, we don’t need more people in the hospital due to inaccessible medications. Such investigations should be required by law and immediately enforced due to the current high risk to public health.

In the last few months, I have experienced extremely long wait times in person and on the phone at a local chain pharmacy. Many have closed or have reduced hours, making it unpredictable and highly difficult to get medicines for myself and/or my loved ones. These medicines are important to maintain our health, or prevent events like a blood clot that could put us in the hospital. Imagine a day without necessary insulin. It is unsafe to go days without needed medicine, and extremely stressful and difficult to hunt around for an open pharmacy and call my doctor to transfer the prescription. The chain pharmacies seem constantly understaffed, often only having 1 or 2 people working behind the counter helping customers, answering phones, working the drive thru, and also giving COVID shots AND tests. This is not sustainable for the pharmacy staff, and THAT puts me and my family’s lives at risk.

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PBM collateral damage: Veneta’s only pharmacy closes

https://www.klcc.org/2022-01-28/venetas-only-pharmacy-closes

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good ole opiophobic Ohio: Doctors office in Niles closed due to FBI raid

https://www.wfmj.com/story/45743467/niles-fbi-raid

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This appears to be a DISASTER IN THE MAKING… we have bureaucrats ( Philadelphia health officials ) that are going to make determination as to what is “OVER-PRESCRIBING OF OPIATES ”  based on some pretty much RAW DATA.  What if those prescribers that they are already targeting – very small number of physicians  in the area are responsible for most of the over prescribing – are all chronic pain practitioners/clinics ?   This is after in a two year period According to city data, the number of opioid prescriptions decreased by 30% between early 2017 and early 2019… Does this suggest that their final target maybe near ZERO OPIATES PRESCRIBED for acute pain and maybe only “token doses” for chronic pain long term ?

Philly to start tracking doctors to target opioid over prescribers

https://whyy.org/articles/philly-to-start-tracking-doctors-to-target-opioid-overprescribers/

Despite their yearslong effort to urge doctors to prescribe fewer opioids, Philadelphia health officials say there are still too many pills being dispensed in the region. They know from state data, provided by the Pennsylvania prescription drug monitoring database, that a very small number of physicians in the area are responsible for most of the over prescribing. But because the state data does not include identifying information, local officials have no way of knowing who to go after.

Thanks to new legislation passed during Philadelphia’s last 2019 City Council session, that’s about to change.

In 2018, health officials issued new prescribing guidance to more than 15,000 doctors in the Philadelphia region. Health Commissioner Thomas Farley said his department sent staff into more than 1,000 offices to work directly with doctors to curb prescriptions and come up with alternative approaches to pain management. By most accounts, it’s working: According to city data, the number of opioid prescriptions decreased by 30% between early 2017 and early 2019.

Even so, Farley said, there are still too many prescription drugs floating around.

“We find that, despite the large amounts of publicity, there are still some doctors out there that don’t understand that their prescribing practices really aren’t good for their patients in the long run,” he said. “They were taught for years to prescribe more opioids.”

Farley said he can tell from the regular reports he gets from the state’s prescription drug monitoring program that most of the city’s opioids are coming from just a few doctors. Roughly 1% of the doctors write a quarter of all opioid prescriptions, and another 10% write half of them. Half of the doctors don’t ever prescribe opioids.

The only problem is, the city knows this from a consolidated report issued by the state that doesn’t include the physicians’ names.

“We can use that for statistics, but we can’t use that for educating individual physicians,” said Farley.

The new law will require pharmacies to send regular dispatches to the city Health Department for all controlled-substance prescriptions. The report will include the name of the prescribing doctor, the type of drug, how much is being prescribed, and how often. Pharmacies will also have to create a unique identification number for each patient, protecting that patient’s anonymity but still tracking patterns.

If health officials notice a pattern of overprescribing, a physician will be flagged and receive education from the Health Department. The city will then be able to track whether the doctor’s prescriptions went down over the next reporting period. If they don’t, Farley said, the Health Department will work with law enforcement to come up with appropriate consequences.

Prescription data-monitoring databases have been criticized for their potential to serve as a direct line between vulnerable patients and law enforcement. While the Philadelphia version won’t identify individual patients, critics have also expressed concern that if doctors know they are being closely monitored, they might be hesitant to prescribe a controlled substance even if it is the best option for the patient. If patients who have become dependent on opioids are tapered off too quickly, research has shown they may turn to less-regulated, illicit opioids such as heroin and fentanyl where the risk of overdose is higher.

Farley stressed that because the effort is specifically to target that subsection of high prescribers, he did not anticipate this being an issue.

Eva Gladstein, the city’s deputy managing director of health and human services, said they wouldn’t have gone the legislative route if they didn’t have to. But the state regulations are narrowly written, she said, and while state officials can see prescribers by name, they interpreted the law as not permitting them to share that information with municipal departments.

“I would say we spent two years working with the state to see if we could get the data so we didn’t need to do this,” Gladstein said.

Farley said the new program was still a few months away from rolling out because they still have to come up with the exact reporting regulations. He said one pharmacy chain was dragging its feet about adopting the new law, but declined to say which.

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House Chairman and physician Mark Newton introduced HB 867, which requires PBMs to calculate patient cost sharing for prescription drugs based on true costs to plans, by taking into account rebates PBMs receive from pharmaceutical manufacturers. PBMs are in opposition to this legislation and trying to point the finger at independent pharmacies for rising drug costs at the counter.

The bill is scheduled for a hearing tomorrow in Chairman Newton’s Special Committee on Access to Quality Healthcare. Below are members of that Committee. Please reach out to committee members prior to 2:00 pm tomorrow and let them know:

1. You are in support in support of HB 867, as it will reduce prices for Georgia patients at the counter by requiring PBMs to factor in rebates received when calculating a patient’s cost share;

2. If PBMs are negotiating rebates, patients should receive the benefit of those discounts at the counter and should not pay cost shares based in inflated pricing at the drug counter; and

3. Community pharmacies do not benefit in any way from this legislation financially, but you are in support because this legislation increases drug pricing transparency and reduces drug costs for patients at the counter.

Special Committee on Access to Quality Healthcare:

david.knight@house.ga.gov 404.463.2248

patty.bentley@house.ga.gov 404.656.0287

sharon.cooper@house.ga.gov 404.656.5069

john.corbett@house.ga.gov 404.656.5105

spencer.frye@house.ga.gov 404.656.0265

matt.hatchett@house.ga.gov 404.656.5025

penny.houston@house.ga.gov 404.463.2248

todd.jones@house.ga.gov 404.463.2246

randy.nix@house.ga.gov 404.656.5146

larry.parrish@house.ga.gov 404.463.2246

clay.pirkle@house.ga.gov 404.656.7850

brian.prince@house.ga.gov 404.656.0116

richard.smith@house.ga.gov 404.656.5141

calvin.smyre@house.ga.gov 404.656.0109

mark.newton@house.ga.gov 404.656.7853

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Political Science: DeSantis SLAMS Biden’s FDA for Abruptly Closing Florida’s ‘Lifesaving’ Treatment Sites ?

https://www.toddstarnes.com/politics/desantis-fda-biden-monoclonal-antibody-treatment-sites/

Florida Gov. Ron DeSantis (R) is demanding the Biden administration reverse its “sudden and reckless” decision to pull Emergency Use Authorizations for monoclonal antibody treatments.

The Food and Drug Administration (FDA) cut off Florida’s monoclonal antibody treatment sites Monday, citing the omicron variant, impacting more than 2,000 Floridians who had treatments scheduled Tuesday.

“Without a shred of clinical data to support this action, Biden has forced trained medical professionals to choose between treating their patients or breaking the law,” DeSantis said in a statement.

“This indefensible edict takes treatment out of the hands of medical professionals and will cost some Americans their lives,” he added. “There are real-world implications to Biden’s medical authoritarianism – Americans’ access to treatments is now subject to the whims of a failing president.”

The Florida Department of Health said it was not given any advanced notice of the FDA’s “abrupt” decision to pull the treatments that can prevent severe illness, hospitalization, and death in high-risk patients who get COVID.

“As a result of the @US_FDA’s abrupt decision to remove the EUAs for two monoclonal antibodies, monoclonal antibody treatment sites will be closed until further notice,” it wrote. “Florida disagrees with the decision that blocks access to any available treatments in the absence of clinical evidence.”

“Rather than giving Americans the option for various COVID treatments, the FDA and the Biden Administration issued their royal decree, taking away the very thing that is proven to reduce hospitalizations and save lives,” said Lieutenant Governor Jeanette Nuñez. “Monoclonal antibody treatments like Regeneron have had a positive impact for thousands of Floridians. For the CDC and FDA, which have been consistently inconsistent throughout the entire pandemic, to restrict treatment does nothing but put individuals at risk.”

“In our field of medicine, when someone comes to you seeking a treatment that could save their life, it is essential to have treatment options to ensure health care providers can make the best decisions for their patients,” said Surgeon General Dr. Joseph Ladapo. “The Federal Government has failed to adequately provide the United States with adequate outpatient treatment options for COVID-19. Now, they are scrambling to cover up a failure to deliver on a promise to ‘shut down the virus.’”

DeSantis has been an advocate for the treatments from Regeneron and Eli Lily, and he said last year that “come hell or high water” he will fight to get them despite the Biden administration seizing the supply of Regeneron and cutting supply to Florida.

The FDA said it pulled the emergency use “because data shows these treatments are highly unlikely to be active against the omicron variant.”

“Sick,” Jack Posobiec, Human Events Daily host, tweeted along with the story.

“The FDA is trying to make it so that people in Florida die of Covid. They’ll kill people to harm Republicans,” Mike Cernovich tweeted. “Steel yourselves for the evil that is being unleashed.”

New treatment sites were opened in the Sunshine State just last week.

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Hospital Removes Man from Transplant List Over Vaxx Status

https://www.toddstarnes.com/national-news/hospital-removes-man-from-transplant-list-over-vaxx-status/

A Boston hospital has removed a patient from the front of the transplant list because he refused to get the COVID vaccine.

DJ Ferguson, 31, is in desperate need of a heart transplant at Brigham and Women’s Hospital, a Harvard Medical School teaching facility, but due to a new policy, he is now being denied the “life-saving” operation.

“My son has gone to the edge of death to stick to his guns and he’s been pushed to the limit,” David Ferguson, his father, told CBS. “It’s his body. It’s his choice.”

The hospital said in a statement, “And like many other transplant programs in the United States – the COVID-19 vaccine is one of several vaccines and lifestyle behaviors required for transplant candidates in the Mass General Brigham system in order to create both the best chance for a successful operation and also the patient’s survival after transplantation.”

The mortality rate for transplant recipients who fall ill with COVID is more than 20 percent, according to UCHealth.

Ferguson, a father of two with a third on the way, has been in the hospital since November when his lungs and heart filled with blood and fluid due to a hereditary heart condition

His family is weighing all options but worry that he is too weak to be transferred to another hospital as they run out of time.

“At this point DJ is unable to leave the hospital until he gets the heart surgery he needs. Without the surgery his lungs and heart will continue to fill up with blood and fluid (on top of everything else that’s going on),” said Ferguson’s wife, Heather Dawson, on Facebook.

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PBM collateral damage:rural residents cant get their medicines or covid 19 help with pharmacies shuttering

https://www.npr.org/2022/01/22/1075049595/rural-residents-cant-get-their-medicines-or-covid-19-help-with-pharmacies-shutte

Americans have been going to their local pharmacy for more than just prescriptions during the pandemic. They’ve been going there for masks, COVID-19 tests and vaccines. But even with that increased business, retail pharmacies, big and small, are closing their doors. Oregon Public Broadcasting’s April Ehrlich reports that these closures are straining small towns where options were already limited.

APRIL EHRLICH, BYLINE: Lisa Raffety has rheumatoid arthritis and needs to take an anti-inflammatory medicine every day. If she can’t get it on time, the consequences are severe.

LISA RAFFETY: I’ll go two to three days at the most, and then I’m pretty much – I can’t walk.

EHRLICH: She lives in Baker City, a small town in eastern Oregon that had one of its four pharmacies closed last year. Fifty-five-year-old Raffety says, since then, lines at the remaining pharmacies started going out the door.

RAFFETY: And it hurts to stand for any length of time, to be on my feet. It’s a hard, cement floor.

EHRLICH: Raffety says some people bring their dinners and eat them in line. Store clerks have to bring out wheelchairs for people who can’t stand that long. Last year, the Pacific Northwest retailer Bi-Mart announced it was getting out of the pharmacy business, closing nearly 60 pharmacy counters in three states. Many of them were in rural areas.

EHRLICH: And now the pharmacies that remain are picking up the slack.

RICK CHESTER: It happened immediately – like, overnight.

EHRLICH: Rick Chester owns Medicap Pharmacy in Talent, a small town in southern Oregon. He says business has been hectic since the Bi-Mart closed its pharmacy nearby. Then chain stores like Rite Aid started severely limiting their pharmacy hours, sometimes closing it for weeks straight.

CHESTER: And so everything is just more of a pressure cooker for everybody here. And you don’t really know when it’s going to end.

EHRLICH: Another pressure – insurance companies pushing people toward mail-order prescriptions, even though that doesn’t always work for people in rural areas. Bi-Mart’s spokesman Don Leber says there are several factors that went into the decision to close its pharmacies.

DON LEBER: We were really forced to make a decision we never wanted to make.

EHRLICH: He says one big issue is affecting pharmacies across the country – increasing fees, specifically from the middlemen that bridge pharmacies and insurance companies, called pharmaceutical benefit managers, or PBMs. Oregon Senator Ron Wyden has had his eye on these companies recently, which he says are charging excessive fees that are pushing smaller pharmacies out of business.

RON WYDEN: For rural communities in Oregon, this is a five-alarm emergency.

EHRLICH: Basically, when someone gets a prescription through an insurance or Medicare plan, the PBM is supposed to reimburse the pharmacy for the drug cost and some overhead. But in recent years, PBMs started decreasing the amount they reimburse when pharmacies don’t meet certain sales markers. Wyden has called on Congress to increase its oversight of pharmaceutical benefit managers. And some states like New York have started regulating PBMs at the state level.

WYDEN: The rules are so vague and so inconsistent. They can kind of decide, gee, we really weren’t making enough money, but we’ll say the pharmacy’s inefficient and just throw some more costs at them.

EHRLICH: According to a report by the U.S. Centers for Medicare and Medicaid Services, PBMs have increased their fees for Medicare plans by more than 91,000% in the last two years. PBM reimbursements have gotten so low that sometimes pharmacies say they actually lose money when they fill prescriptions from certain insurers. And some pharmacies, like the ones at Bi-Mart, just can’t make it work financially. The PBM Trade Association disputes that PBMs are the reason for rural pharmacy closures. Regardless, when pharmacies close, people like Lisa Raffety have an even harder time getting the medicines they need.

RAFFETY: I haven’t figured out when the best time to come and stand in line would be. I don’t want to know ’cause I don’t want to do this anymore.

EHRLICH: But standing in line is something she and many rural residents will have to get used to as more and more pharmacies close.

For NPR News, I’m April Ehrlich in Portland, Ore.

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