APDF goes to Washington DC to lobby members of Congress

Two Years And $113 Billion Later, D.C.’s ‘America Last’ Crew Has No Plan For Ending The Russia-Ukraine War

When you look into the rearview mirror, “we” seem to like to be “in a war”. The last time that we won a war was 1945 – almost 80 years ago – and that took TWO A-BOMBS.  When Obama came to office we were 9 trillion in debt and when he left we were ~ 20 trillion and in the last 8 yrs we have added nearly 15 trillion. Our National debt is approaching 35 trillion. When Russia first invaded Ukraine, “we” gave them enough “stuff” to not lose this battle but not enough to win this battle. “we” gave them – compared to what Russia had – bows/arrows, slingshots, BB-guns.  As the battle went on, “we” provided Ukraine with a little more powerful and longer-range “stuff” several times. The House just approved 95 billion to be given to Ukraine, Israel, and Taiwan. With Ukraine getting the lion’s share.

Isn’t anyone concerned about those politicians/bureaucrats within the DC Beltway? It took us 235 yrs +/- to amass a 9 trillion national debt and our national debt has nearly quadrupled in 16 yrs?  The Congressional Budget Office projects that our national debt will hit 50 trillion by the end of the decade. This year, the cost of the interest on our national debt will exceed ONE TRILLION DOLLARS more money than we spend on national defense! The proposed budget for the next Federal fiscal year – starting Oct 1, 2024, will be REDUCED for the FOURTH year in a row!

There are 435 members of the House and at least 33 Senate seats up for this election. Is it time to CLEAN HOUSE – vote out all the incumbents? We can start FRESH with at least the House. Members of Congress expect that 95% will get reelected, regardless of what they promised to do and didn’t or promised not to do and did! 

To CLEAN HOUSE would be a BLACK SWAN EVENT!  I suspect that those newly elected members of Congress would listen to their constituents about their concerns.

Two Years And $113 Billion Later, D.C.’s ‘America Last’ Crew Has No Plan For Ending The Russia-Ukraine War

https://thefederalist.com/2024/04/19/two-years-and-113-billion-later-d-c-s-america-last-crew-has-no-plan-for-ending-the-russia-ukraine-war/

You don’t have to be a Putin stooge to see that dumping endless U.S. funds into Kyiv without proper oversight is a terrible idea.

Another week has come and gone, and America’s political leaders are still focused on one thing: shipping more money to Ukraine.

On Friday, the GOP-controlled House advanced a rule allowing the lower chamber to pass what effectively amounts to a massive foreign spending package. The bills under consideration seek to ship U.S. taxpayer dollars to Ukraine, Israel (and Hamas-controlled Gaza), and Taiwan. A “divest-or-ban” bill that would prohibit TikTok from operating in the U.S. under its current China-based ownership will also reportedly be considered.

The aforementioned rule was passed Thursday night by the House Rules Committee with help from Democrats. The rule effectively allows the House to vote on each funding measure separately without having to combine them into one package before sending it to the Senate for consideration.

As Federalist Senior Tech Columnist Rachel Bovard explained, “[I]f each title passes, they will all be fused into one package without a final vote (known as a MIRV),” and that “package is then added as a House amendment to the Senate foreign aid bill (the two are effectively the same); in parliamentary speak, the House concurs in the Senate amendment with a House amendment.”

More Democrats than Republicans voted for the rule during Friday’s vote. The foreign funding bills are expected to be considered by the House on Saturday, according to The Hill.

The Republican-controlled House’s fast-tracking of the measures further puts to shame Mr. “Wartime Speaker” Mike Johnson, who has gone above and beyond to break his repeated pledge to secure the U.S.-Mexico border before advancing foreign funding. This betrayal — combined with his prior surrenders on major policy fights — has prompted at least two House Republicans to back a motion to remove Johnson as speaker.

No Plan and No Statesmen

It’s no secret that the D.C. political class cares more about fortifying Ukraine’s borders than America’s.

Senate Minority Leader Mitch McConnell let the cat out of the bag in May 2022 when he admitted that President Biden and congressional leadership agreed “the most important thing going on in the world right now is the war in Ukraine.” That sentiment was still true for Kentucky’s senior senator nearly a year later, when he regurgitated the same talking point during a Fox News interview.

“[D]efeating the Russians in Ukraine is the single most important event going on in the world right now,” McConnell claimed, as America’s southern border remained open, inflation rose, and the federal government abused its intel agencies to target Republicans.

Of course, neither McConnell nor any other D.C. politico who backs U.S. funding for Ukraine has ever bothered to articulate what America’s strategy is for accomplishing such a feat — and therein lies the main problem.

More than two years and $113 billion later, Ukraine isn’t any closer to beating Russia than the day Moscow launched its invasion. There has been no explanation from the Biden administration or any “Ukraine First” member of Congress on what they view as a reasonable resolution to the conflict.

Those claiming the end goal is a total defeat of Russia are living in a fantasy land. Russia is a nuclear power and possesses one of the most sophisticated militaries in the world. Barring a sudden collapse of Russian governance, there is no scenario in which Ukrainian soldiers are going to be parading through the streets of Moscow, as blue-and-yellow Ukrainian flags wave atop the Russian White House.

Instead of fantasizing, America’s leaders must recognize the current situation in Eastern Europe for what it is. And that means acting like statesmen and negotiating a settlement to end the bloodshed and blank checks.

You don’t have to be a Putin stooge to recognize that dumping endless amounts of U.S. funds into Kyiv without proper oversight and a clear, obtainable objective is a disservice to the American taxpayer and the tens of thousands of Ukrainians being slaughtered in a war they can’t win.

https://thefederalist.com/wp-content/uploads/2024/04/President_Joe_Biden_and_Vice_President_Kamala_Harris_meet_with_Leader_Chuck_Schumer_Leader_Mitch_McConnell_Speaker_Mike_Johnson_and_Leader_Hakeem_Jeffries_in_the_Oval_Office-1200x675.jpg

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in the Health Care Sector

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in the Health Care Sector

https://www.ftc.gov/news-events/news/press-releases/2024/04/federal-agencies-launch-portal-public-reporting-anticompetitive-practices-health-care-sector

Today, the Federal Trade Commission, Justice Department, and the U.S. Department of Health and Human Services (HHS) launched an easily accessible online portal for the public to report health care practices that may harm competition.

The online portal, HealthyCompetition.gov, allows the public to report potentially unfair and anticompetitive health care practices to the FTC and the Justice Department’s Antitrust Division. The launch of the new portal advances the Biden-Harris Administration’s efforts to lower health care and prescription drug costs and help create more competitive health care markets that are fairer to patients, providers, payers, and workers.

“All too often, we hear how unfair methods of competition and monopolistic practices may be depriving Americans of access to affordable, high-quality healthcare,” said FTC Chair Lina M. Khan. “This joint initiative between, FTC, DOJ, and HHS will provide a crucial channel for the agencies to hear from the public, bolstering our work to check illegal business practices that harm consumers and workers alike.”

“Competition in health care is crucial to ensuring fair and competitive wages across the healthcare sector and affordable and quality healthcare for all Americans,” said Assistant Attorney General Jonathan Kanter of the Justice Department’s Antitrust Division. “Today’s launch of HealthyCompetition.gov – a one-stop shop to report potential violations of our competition laws to the Justice Department and FTC – will allow the agencies to collaborate early and often, helping to promote economic opportunity and fairness for all.”

“Americans depend on competitive health care markets to provide quality choices and lower costs for coverage. That’s why we are working to tackle anticompetitive practices in the health care markets,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration and HHS know it is our responsibility to stop monopolistic, anti-competitive practices that undermine the delivery of health care to Americans. The information provided by the public will help to root out these behaviors.”

Complaints will undergo preliminary review by staff at the FTC and Justice Department, Antitrust Division. If a complaint raises sufficient concern under the antitrust laws or is related to HHS authorities, it will be selected for further investigation by the appropriate agency. This action may lead to the opening of a formal investigation.

The privacy and confidentiality policies that govern information submitted through the portal, including any personal information members of the public choose to provide, can be found at: DOJ Privacy PolicyDOJ Antitrust Division Confidentiality Policy Regarding Complainants, and FTC Privacy Policy.

HealthyCompetition.gov is the latest effort by the FTC, DOJ, and HHS to promote competition in health care markets to ensure that every American has access to high-quality, affordable care. As announced in December 2023, the FTC, DOJ and HHS have continued to partner on new initiatives, which included a joint request for information to seek input on how private-equity and other corporations’ control of health care is impacting Americans.

The Federal Trade Commission develops policy initiatives on issues that affect competition, consumers, and the U.S. economy. The FTC will never demand money, make threats, tell you to transfer money, or promise you a prize. Follow the FTC on social media, read consumer alerts and the business blog, and sign up to get the latest FTC news and alerts.

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PBM rebate schemes to suppress biosimilar Humira cost patients $6B, IQVIA analysis finds

PBM rebate schemes to suppress biosimilar Humira cost patients $6B, IQVIA analysis finds

https://drugstorenews.com/pbm-rebate-schemes-suppress-biosimilar-humira-cost-patients-6b-iqvia-analysis-finds

The Biosimilars Council released a new analysis by IQVIA that reveals a PBM strategy to protect $2 billion in profits by “strangling” the biosimilar market and preventing savings for patients.

The Biosimilars Council, a trade association representing manufacturers of biosimilar medicines, released a new analysis of IQVIA data revealing health plans and patients missed out on savings up to $6 billion as a result of rebate schemes by pharmacy benefit managers. The report highlights the strategy created by pharmacy benefit managers to protect $2 billion in profits by suppressing adoption of lower-cost versions of the brand drug Humira, once the best-selling drug in the world.

“Rebate and fee revenue tied to the list price continues to maintain a stranglehold on coverage decisions, to the detriment of patients and ultimately payers,” said Craig Burton, executive director of the Biosimilars Council. “Even when plans cover the biosimilars, they place the biosimilar on parity with the higher-priced brand and remove any incentive for patients to use the lower-cost biosimilar. It is critical that Congress enact legislation to rein in such PBM abuses.”

In the past year, multiple biosimilar alternatives to Humira launched in the U.S. Despite price discounts of greater than 80%, biosimilar adoption has been disappointingly slow, achieving less than 2% market share, the council said.

[Read more: A new environment for biosimilars]

IQVIA found that adalimumab biosimilars offer up to $6 billion in potential savings to the U.S. healthcare system; however, switching all U.S. patients would lead to an estimated 84% decrease in PBM profits. Because the majority of branded adalimumab is dispensed by large specialty pharmacies, a switch also would represent a potential loss of revenue for these business that frequently share corporate ownership with PBMs. IQVIA also found that, even when rebates are taken into account, lower wholesale acquisition cost biosimilar options have lower net costs for employers and patients, the council noted.

The IQVIA analysis shines a light on the perverse incentives causing this slow adoption: continued PBM reliance on rebates and fees that are tied to brand drug high list prices; and, PBM practice of rewarding their vertically-integrated in-house specialty pharmacy networks compared to independent specialty and retail pharmacies.

“Today’s report highlights a key barrier to biosimilar adoption,” said David Gaugh, interim president and CEO of the Association for Accessible Medicines. “PBM decisions to continue covering the brand Humira resulted in a loss of $6 billion in potential savings for patients and commercial and employer health plans—all because full coverage of the biosimilars would have reduced PBM and their vertically integrated specialty pharmacy profits by about $2 billion. It is critical that Congress and the Administration move quickly to ensure rapid adoption of biosimilars, to the benefit of patients.”

Pts BEING ROBBED at the pharmacy counter and totally unaware of it

According to this, Caremark flipped the Rx to Goodrx, and the pt was charged ~ $46. GoodRx charged the pharmacy a $38.50 “administration fee” and the pharmacy was left with a $16 LOSS and the money that the pt paid at the pharmacy did not apply to their annual deductible.  I saw a video the other day from a pharmacy/pharmacist who has gone to an ALL CASH on prescriptions and he was charging wholesale cost plus $10. Under this example, at such a pharmacy, the pt would have paid $33.86, and this pt would have saved some 30%. CVS Health/Caremark would have made ZERO and the pharmacy/pharmacy would have a profit of $10

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in Health Care Sector

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in Health Care Sector

https://www.justice.gov/opa/pr/federal-agencies-launch-portal-public-reporting-anticompetitive-practices-health-care-sector

The Justice Department, Federal Trade Commission (FTC) and the Department of Health and Human Services (HHS) today launched an easily accessible online portal for the public to report health care practices that may harm competition.

The online portal, HealthyCompetition.gov

, allows the public to report potentially unfair and anticompetitive health care practices to the Justice Department’s Antitrust Division and FTC. The launch of the new portal advances the Biden-Harris Administration’s efforts to lower health care and prescription drug costs

and help create more competitive health care markets that are fairer to patients, providers, payers and workers.

“Competition in health care is crucial to ensuring fair and competitive wages across the healthcare sector and affordable and quality healthcare for all Americans,” said Assistant Attorney General Jonathan Kanter of the Justice Department’s Antitrust Division. “Today’s launch of HealthyCompetition.gov

 – a one-stop shop to report potential violations of our competition laws to the Justice Department and FTC – will allow the agencies to collaborate early and often, helping to promote economic opportunity and fairness for all.”

“All too often, we hear how unfair methods of competition and monopolistic practices may be depriving Americans of access to affordable, high-quality healthcare,” said FTC Chair Lina M. Khan. “This joint initiative between FTC, DOJ and HHS will provide a crucial channel for the agencies to hear from the public, bolstering our work to check illegal business practices that harm consumers and workers alike.”

“Americans depend on competitive health care markets to provide quality choices and lower costs for coverage. That’s why we are working to tackle anticompetitive practices in the health care markets,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration and HHS know it is our responsibility to stop monopolistic, anti-competitive practices that undermine the delivery of health care to Americans. The information provided by the public will help to root out these behaviors.”

Complaints will undergo preliminary review by staff at the Justice Department’s Antitrust Division and FTC. If a complaint raises sufficient concern under the antitrust laws or is related to HHS authorities, it will be selected for further investigation by the appropriate agency. This action may lead to the opening of a formal investigation.

The privacy and confidentiality policies that govern information submitted through the portal, including any personal information members of the public choose to provide, can be found at DOJ Privacy Policy, DOJ Antitrust Division Confidentiality Policy Regarding Complainants and FTC Privacy Policy

HealthyCompetition.gov is the latest effort by the Justice Department, FTC and HHS to promote competition in health care markets to ensure that every American has access to high-quality, affordable care. As announced in December 2023, the Justice Department, FTC and HHS have continued to partner on new initiatives, which included a joint request for information to seek input on how private-equity and other corporations’ control of health care is impacting Americans.

Type of Pharmacy Malpractice

According to this video. It would appear that Dr Dan Laird, MD, JD may represent chronic pain pts who are being discriminated against and denied their prescribed therapy. Go to abt 5 minutes into the video where he talks about Legal/Civil Liberties Violations by pharmacists refusing to provide chronic pain pts with their legally prescribed pain medications.

 

 

Chronic Pain Patients Fight Back Against DEA

Chronic Pain Patients Fight Back Against DEA

https://www.gofundme.com/f/chronic-pain-patients-fight-back-against-dea

Dr. David Bockoff’s Pain Patients Are Fighting for Justice!
FIGHTING FOR JUSTICE FOR DR BOCKOFF AND HIS CHRONIC PAIN PATIENTS
__________________________
My name is Kristen Ogden and I advocate for chronic pain patients.
My husband, Louis Ogden, is one of the chronic pain patients I’m talking about.
Consider the fact that Louis has suffered from pain since he was a child.
Some of you already know the background of our efforts to intervene in the case of DEA vs. Dr. David Bockoff. If you don’t, we invite you to go first to https://www.daily-remedy.com/as-i-sat-in-court-watching-the-dea/ and to https://www.daily-remedy.com/a-patients-plea-for-justice/.
If you have pain, or you know someone who does, or fear some day you will have pain, as we all age, then you may want to consider what we’re doing in court.
The why of our cause is straightforward.
We are seeking justice for doctors to use their skills and justice for pain patients who desperately need relief from unremitting pain.
In our fight with the DEA administrator and the relevant courts, we knew we had to retain counsel.
When I first spoke to John P. Flannery, a former federal prosecutor, and special counsel on the Hill, and trial lawyer for decades, Mr. Flannery asked what outcome did we wish.
Without hesitation, I said, individually and collectively we want the right to be let alone, to have access to pain medications for my husband, Louis, and for all of these patients in the same straits. That’s what we want.
Mr. Flannery launched our effort with our full support with a Motion to Intervene in the case of DEA vs. David Bockoff, as “interested persons,” suffering because Dr. Bockoff was cut off summarily from continuing our pain prescriptions.
We hoped to get the prescriptions we needed for our unremitting pain, and to exonerate Dr. Bockoff so he could get back to work caring for his patients.
Prescriptions for controlled pain medications can only be possible if there’s a qualified pain specialist to write the scrips … preferably one who is knowledgeable, compassionate, and who “gets it” about chronic pain and the patients who suffer from it.
We filed the Motion to Intervene, and, as expected, the DEA Administrative Law Judge (ALJ) denied our motion.
The way DEA runs the Administrative Law Court leaves patients with no voice in the situation.
Everything is behind closed doors. There is no public record of what the DEA and its counsel and its administrative judge are doing. We believe that’s a first amendment violation of our right of access to what the government is doing.
Next we appealed.
The next step available to us was to appeal the ALJ’s decision to the U.S. Court of Appeals for the District of Columbia Circuit. So we did.
We filed rounds of briefs and exhibits but we suspect the court hardly read what we said.
We argued to a 3-judge panel the merits of our case.
The judgment of the Appeals Court, issued February 20, 2024, missed the mark entirely.
It truly seems like the 3 judges who sat on this panel in January 2024 didn’t take the time to read the brief, or the prior proceedings, all of which we submitted to the court.
One could easily conclude that the judges really don’t want to “hear” us, no matter our life or death concerns.
In their order they made the amazing claim that we made “no creditable” factual claim when we gave individual bios of our petitioners’ history of pain and treatment.
If we didn’t have so many data points from the past treatment of and indifference to pain patients we might think this was a typo, but it does fit what the government always claims, that pain patients are really addicts.
They clearly didn’t take us seriously, describing a document we submitted as “a series of narratives purporting to be by pain patients or their spouses.”
The Court’s 3-judge order of February 20, 2024 was full of the ways the court “felt” and “believed” our petition fell short, even as the court’s beliefs contradicted the holdings in other cases in the same court house.
It is no exaggeration that the court did not acknowledge the substance, the merits of our concerns, at all.
I have great respect for the law but the best I can say is that the judges seem to be limited in their view of our situation … bound by what’s been called “the bias of settled habit” … a habit of accepting as true what they’ve grown accustomed to accepting without applying themselves to fearlessly face and critically evaluate what’s been presented to them.
The Court – like many others in our “culture” – buys into the accepted trope that opioid pain medications are all “bad” and the people who rely on these medications are also bad – – drug seekers, drug diverters, or drug traffickers.
These prejudices defy the reality that pain, acute and chronic, is real and our bodies can’t curb the pain by our body’s own devices.
So our public policy about pain is based on irrational thought and fear, rather than the findings of medical science. It’s the same irrational fear that has gripped our society for 100 years or more.
The government doesn’t want to address our claim that patients matter and they deserve to be treated as ill and not accepted as collateral damage because of a flawed public policy that is indifferent to our risk of pain, illness, death and possibly suicide.
So what’s to be done? The Court order of February 20, 2024 stated we have an opportunity to petition for rehearing “en banc”… that is, to take our argument to all 15 of the Appeals Court judges participating.
So we – the group of Dr. Bockoff’s patients and their spouses/families who started this effort to intervene – are not finished yet. We want to take advantage of this opportunity to petition these judges to suspend their preconceived bias and their disbelief and instead render their full critical attention to the facts, at last, and to consider what the DEA’s actions have done to this group of patients and to Dr. Bockoff.
We have seen information compromised, laws ignored, and facts side-stepped in this case.
We insist we care about humanity and illness.
This is a chance for the Court to prove that’s what they’re about.
In order to continue fighting for acknowledgement and for access to necessary medical care and medications, we are seeking to raise funds to help cover the additional legal effort that will be required.
Please consider what you may do to help these petitioners. It matters to you if you are or know someone who suffers as they do. If you join our argument, you may be helping yourself – even if you don’t need help now.
Why should you donate to our cause?
There’s a bull’s eye on the lab coat of every doctor who prescribes pain medication.
There are slanders by the government that patients don’t need these drugs, that they are drug seekers, not suffering pain patients.
It’s hard to say what kind of lie is worse but there has to be a lie that is so inhumane it merits a special category.
If the measure of a nation, if the standard of civilization, is how we treat our own, then by that standard, we are failing our nation’s promise in the constitution to promote and provide for the general welfare.
In recent years, the so-called War on Drugs, proclaimed when we were young, and never apparently “won,” has targeted thousands of pain specialists and chronic pain patients, putting doctors out of practice, confiscating their medical practice, taking their assets without due process, and sending many physicians to prison for trying to care for their patients.
Thousands of chronic pain patients are suffering from untreated or undertreated pain.
SO THAT’S WHY –
We need financial help to continue this fight.
• We want to continue legal action to help ourselves and Dr. Bockoff.
If successful, we hope this could set a precedent that would help other doctors and patients.
• DEA’s practices are driven by the same 100-year old irrational beliefs, by misinformation and disinformation and conducted in secrecy, without transparency.
We reject the DEA practice of excluding patients from access to information and from the dialogue.
• The notion that we are merely “purporting” to be pain patients and families seriously and substantially harmed by DEA reveals the false but pervasive prejudice against citizens who suffer terribly.
The bias and stigma against chronic pain patients need to be exposed to the public for what they are … untruths based in irrational fear, misinformation and disinformation. We seek truth and transparency.
• We believe that our constitutional rights are being violated – the rights of doctors and patients – and that we should all be concerned about the fate of our freedom and our rights.
The depth to which our government has stooped to interfere in the practice of medicine and to interfere with the right to privacy and the doctor-patient relationship is inhumane, shocking and terrifying.
You have a chance to help us fight back! No donation is too small.
Whether it’s $10,000, $1000, $100, or $10/month, every donation will be greatly appreciated and will be used to fight this fight.
Donations will be deposited in a dedicated bank account and then transferred to the firm Campbell Flannery P.C. in response to monthly billings!
Please donate today!
LASTLY –
We invite you to honor the memories of these Dr. Bockoff patients.
These pain patients suffered from the loss of Dr. Bockoff’s medical care and are no longer with us because of the DEA Administrator’s suspension of Dr. Bockoff’s ability to prescribe them pain medication:
Danny & Gretchen Elliott of Georgia,
Jessica Fujimaki of Arizona, and
Rebecca Snyder of California

PROTEST EXPRESS SCRIPTS

PROTEST EXPRESS SCRIPTS

When:  Friday May 17, 2024

Time: 09:00 AM – 01:00 PM  CDT

Where the Public sidewalk in front of Express Scripts HQ

Address: 1 Express Way, St Louis, MO

 

 

 

 

 

 

 

 

 

 

 

 

 

Please share with everyone you know 💚💙

ON MAY 17, 2024, PATIENTS, CAREGIVERS, COMMUNITY MEMBERS, PHARMACISTS, PHYSICIANS, ASSOCIATIONS & ORGANIZATIONS WILL COME TOGETHER TO BOLDLY TAKE A STAND AGAINST ONE OF THE THREE LARGEST PHARMACY BENEFIT MANAGERS AND MAIL ORDER PHARMACIES IN THE NATION, EXPRESS SCRIPTS!

Many patients across the nation are forced or steered to Express Scripts against their will as it is the only option of coverage allowed by the pharmacy benefit manager (PBM) or insurance company. Express Scripts is a PBM and mail order pharmacy. Express Scripts often uses their own PBM to steer patients to their own pharmacy. Patients have faced life-threatening delays, interruptions in treatment, and some have been forced to receive medications such as room temperature medications not stored at the temperatures proven safe by drug manufacturers as the only option of coverage.

Express Scripts also uses their PBM portion of their business to restrict access to medications by restricting medications on the list of covered medications. Physicians are hiring additional staff to deal with long exhaustive obstacle courses to obtain the medications needed for their patients.

Express Scripts has a 1-star rating on the Better Business Bureau that highlights this Pattern of Complaints:

“Better Business Bureau is advising consumers to use caution when considering doing business with Express Scripts. BBB has received a pattern of consumer complaints alleging delays or failure to ship correct prescriptions or medications; failure to accept returns or medications which were shipped in error; failure to issue refunds; debiting credit or debit cards for prescriptions not shipped and poor customer service.”

When patients are so graciously allowed by their PBM to use their local pharmacies, PBMs like Express Scripts also oversee reimbursements to competitor pharmacies & often reimburse competitor pharmacies below their cost, causing closures of local pharmacies in the most underserved rural and urban areas across America.

Upon advocating for regulation, legislation, & protection from these pharmacies, advocates find themselves against one of the wealthiest lobbyist organizations in America, the Pharmaceutical Care Management Association (PCMA) that has in the last year doubled the amount they’re investing in lobbying by the millions. The Boards of Pharmacy also often have strong ties and even members sitting in regulatory positions making it almost impossible for protection & justice. It’s time to demand it! Patients deserve ethical treatment and safe access to their local pharmacies.

Often, many are “too sick to fight” & many pharmacists fear retaliation for speaking publicly about these issues.

This is why we need your voice. We look forward to meeting you there!

https://uniteforsafemedications.com/protest

You’re busier from open to close, but making less than you did the last year, every year

Imagine filling 7000 Rxs/month and losing money. Filling an Rx Every TWO MINUTES – from opening to closing and losing money!

Small Wyoming Pharmacies Pushed Out Of Business, Say Industry Is Like Mafia

https://cowboystatedaily.com/2024/04/14/small-wyoming-pharmacies-pushed-out-of-business-say-industry-is-like-mafia/

Eric Saul realized a dream of being his own boss in 2019 when he opened a little pharmacy in Casper.

His independently owned pharmacy grew faster than any of the other local ones at the time that were being supplied by pharmaceutical distributor Cardinal Health. By 2024, it was a thriving business, filling 7,000 prescriptions in a month.

“The killer of it was, we grew 20% from January last year to January this year,” Saul told Cowboy State Daily. But despite that growth, “we made 15% less from insurance companies.”

That had both Saul and his employees on this crazy hamster wheel. The faster the business grew, the faster it went nowhere at all.

That’s when Saul decided to close his thriving pharmacy. Despite its popularity, he could see no way to become solvent in the current system, no light at the end of the tunnel.

“It’s just insane,” Saul said. “You’re busier from open to close, but making less than you did the last year, every year.”

Saul’s isn’t the only one facing these issues. He knows of at least five other independent pharmacies across the Cowboy State that have closed in the past year for similar reasons.

Among them is Gene Barbour, who owned the Medicap Pharmacy in Cheyenne. While Barbour said he was ready to retire, part of what drove that decision sooner rather than later was the very dynamic outlined by Saul.

“It’s the reimbursements,” he told Cowboy State Daily. “I can’t tell you how many thousands of scrips over the last few years that I’ve sold for less than the price of a bottle of aspirin over the counter.”

With reimbursements not even covering the price of the drug inside a pill bottle, that left Barbour subsidizing bottles, labels and his employees’ time to fill the prescriptions, not to mention the store’s overhead, like rent and utilities. It all just became increasingly unmanageable.

The entire pharmacy sector is broken, Saul and Barbour say, and small independent shops like theirs, which had hoped to provide an independent service in the marketplace, have no shot at all.

Their stories are just a window into how broken their industry is.

Saving Consumers Money, Or The Fox Guarding The Hen House?

The biggest issue both Saul and Barbour cited is vertical integration in the pharmaceutical industry.

Vertical integration refers to pulling disparate services under one umbrella so they’re no longer provided by separate companies.

It’s happened in a big way in the pharmaceuticals industry. The biggest players are now health insurer, pharmacy, and PBM, all in one.

PBM stands for pharmacy benefit manager. These are companies that started out as a way to make life easier for pharmacies. Without them, pharmacists confront a confusing maze of companies to send benefit claims through, one that would take an entire accounting department devoted only to that.

So PBMs took over that role for pharmacies. And they also played middleman, helping to negotiate lower costs for their customers.

Vertically integrated companies like Express Scripts and CVS contend that also being the PBM has helped them negotiate lower prices for members. It’s also helped them more readily control which drugs go on their lists of available medications, called formularies, to ensure everything on that list is proven safe and effective.

But questions have arisen about the role of PBMs in the marketplace, and that has sparked a Federal Trade Commission investigation into the six largest PBMs. That began in 2022 and is still ongoing.

The six under FTC scrutiny include CVS Caremark, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems.

CVS protest 4 14 24

The Walmarts Of The Pharmaceutical Industry

Pulling PBMs under the very same large umbrella is part of what Saul and Barbour believe has killed any chance of real competition in the sector for independent pharmacies.

“CVS was the major one that caused me to close,” Barbour told Cowboy State Daily. “They owned a large portion of our business, you know, of our customer base. And they have their own pharmacy, they have their own warehouses.”

And they have their own PBM.

“So (CVS) is the insurance company, the PBM and the pharmacy,” Saul told Cowboy State Daily.

With such a large customer base — 40% of the market — that’s made the CVS brand akin to Walmart in the retail sector. They’re big enough to tell independent competitors what reimbursements they must take to become part of serving their customers.

It’s the same dynamic that, for years, has allowed Walmart to tell its suppliers what prices they’ll take to be on the retailer’s shelves. As a result of that, independent retailers often find they can buy products for their stores off of Walmart’s shelves for less than they can buy them direct from a wholesaler.

That had Saul and Barbour losing money on thousands of prescriptions each month.

“I was losing $1.35 on every scrip I filled for (this one) co-op,” he said. “The pills inside the bottle were $1.35 more than the insurance paid. So, I wasn’t paid for that bottle, that label or that lid. Or my pesky staff who want paid, or the light bill, the heating bill, the cooling bill, the floor space. Just for the pills inside the bottle, I was paid less than they cost me sitting on the shelf.

“That’s disgusting.”

Code Of Silence

Talking about the situation publicly though, was dangerous, Saul and Barbour told Cowboy State Daily.

“If I talked negative about an insurance company, I’d get two audits in the next week,” Saul told Cowboy State Daily. “And these audits are $400,000 worth of drugs that takes me two days to print everything out.”

If the audit found even a minor mistake, such as a 28-day scrip where the patient got 30 pills instead of 28, Saul said the insurer could claw back the entire reimbursement, leaving him with no reimbursement at all for dispensing the medication.

And, with all the large insurers now having their own vertically integrated PBMs, independents like Saul and Barbour found they had little choice but to go along.

“Three PBMs now own 80% of the market,” he said. “So, when they come to you with a contract every year, you have no negotiating strength. It’s take it or leave it, and every year it gets worse and worse. Which is interesting, with (consumers) premiums going up and (our) payments going down.

“The only place I can figure it’s going are the pharmacy benefit managers.”

Membership Or Mafia Shakedown?

Saul has been told about strong-arm tactics that force drug manufacturers to pay huge rebates to get their products on the list of medications, or formularies, of the largest insurers.

In fact, that is one of the issues FTC is examining in its investigation, though the federal agency says it’s been difficult to understand that because of a lack of transparency in the whole process.

Saul told Cowboy State Daily he was informed by an employee of one large drug manufacturer that it was being strong-armed to pay $250 million to be on the formulary of one large health insurer.

The stakes for that drug manufacturer were extremely high, Saul added. Without being on the list, the drug manufacturer would get shut out of a huge swath of the marketplace.

While out-and-out kickbacks are not legal, negotiations to lower prices in the form of rebates are legal. But these negotiations have been kept confidential, hidden behind the PBM. Thus, it’s never clear if any of these “rebates” come back to consumers in the form of reduced costs.

From his observations, Saul believes it doesn’t. His own customers’ premiums never went down, he said, while his own reimbursements just kept getting lower and lower.

“They’re making billions of dollars just charging drug companies to be on their formularies,” Saul said. “And PBMs are coming out with record billions and billions of profit every year.”

State Change Stymied

What’s happening to squeeze small independent pharmacies out is happening nationwide, Saul said, and real solutions probably have to also come from that level. But he has been among Wyomingites pushing for changes at the state level that could help in the short-term.

That started a couple of years ago during a budget session. Saul said the Wyoming Legislature seemed to understand what needed to be done at the time, but simply ran out of time to get a bill over the finish line.

“The second year, it did make it past legislators, and then Gov. Gordon line-item vetoed everything out of it,” Saul said.

More recently, lawmakers approved a bill requiring insurers to provide reimbursements to pharmacists for drug prescriptions in a reasonable amount of time.

That bill, Saul said, is just too little too late.

“I mean, I haven’t had a problem with delayed payments,” he said. “So, I’m not sure why we were fighting that battle. I’m usually paid within a month of everything that I dispense except for maybe two insurance companies that probably totaled less than a hundredth of a percent of everything I did.”

Saul is particularly miffed with Gordon’s line-item veto.

“He literally signed a bill that was a title and definitions and of no help to pharmacies,” he said.

Meanwhile, Saul said, Wyoming has lost five independent pharmacies in the last 14 to 16 months.

“The last one was in Cheyenne,” he said. “There was one in Casper, two in Gillette, one in Pinedale. That’s pretty much proof that this is unsustainable.”

Gordon’s Take

A representative of the governor’s office referred Cowboy State Daily to the veto letter Gordon wrote to accompany his line-item vetoes on Senate File 151.

In the letter, Gordon agreed that the rising costs of health care, including prescription drug prices, are a matter of great concern for Wyoming, that is why he’s established the Governor’s Health Task Force to better understand the “cost drivers in Wyoming and to develop meaningful solutions to address the state’s high costs and limited access.”

Gordon said Wyoming’s low patient volumes are part of what’s driving increased costs and that proposed solutions often result in “cost-shifting (to consumers), instead of actually reducing expenses or making the system whole and more affordable.”

Cost-shifting onto consumers is what he feared would happen with SF 151, Gordon wrote, “despite the good work done by all involved to provide local relief.”

Gordon also highlighted a lack of agreement during testimony about the effects of the bill on the cost of health care for Wyoming consumers.

“During the interim, the Insurance commissioner mediated discussions with all parties in hopes of developing legislation that would have positive impacts,” Gordon said. “Unfortunately, after months of collaborative work, these efforts were unsuccessful, and we seem to have arrived back where we started.”

But, Gordon added, he has been concerned about the loss of small-town pharmacies for many years, and remains so.

“Corporate consolidation, vertical integration and increasing prices in the pharmaceutical market have all contributed to increase burdens placed rural pharmacies,” he wrote. “They are under greater stress than perhaps at any time before. As with many providers in the health care system, rural pharmacies are often left to manage operations with insufficient funds, subsidizing certain prescriptions and increasing compliance costs for accountability.”

Too Little Too Late

Gordon tried to take some of the sting out of his line-item vetoes by signing a governor’s directive to the Wyoming Department of Administration and Information to negotiate increased payments for independent pharmacists that participate in the group insurance program for Wyoming state employees and officials.

The increased amount was up to $10 per brand name label, or $12 per generic brand.

That also was too little and also too late, Saul told Cowboy State Daily.

“That was good, but it’s only 5% or 6% of your scrips,” Saul said. “It doesn’t make up for the negative ones that you have that aren’t, you know, Wyoming government insurance.”

Gordon also wrote in his letter that he hoped other health care group plan administrators and insurance providers would follow suit, and he encouraged lawmakers to continue working on the issues to craft a “thoughtful” compromise that would protect the sustainability of Wyoming’s independent rural pharmacies, while controlling costs to consumers.

The latter is something Saul said he is planning to pursue. Now that his business has closed, he has plenty of time to shake things up, and he no longer has to worry about retaliatory audits if he complains.

“In two weeks, there’s a fly-in in Washington, D.C., where the NCPA (National Community Pharmacists Association) has a meeting scheduled with legislators,” he said. “And my wife and I are literally thinking about flying out there. I mean, we’ve closed within the last month, and why have we closed? Well, let me just tell you.”