I can’t count the number of times that someone with the community has says… “no one understands what I am going thru”

Wouldn’t it be nice if everyone understood “living with chronic pain” and the impact that the insurance/PBM industries have on getting proper treatment. Because of the McCarran Ferguson Act  https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act  the insurance/PBM industry is exempt from Sherman Antitrust.  While that law had a valid reason when it was passed in the 1940’s, that reason no longer exists …BUT… it is still a law on the books and numerous have tried to get it repealed since the late 80’s, without any luck. Mostly because the insurance/PBM industry has one of the largest pots of money to using for lobbying Congress.

The insurance/PBM industry has expanded the use of this law way past its original intent.  They can collude, fix prices and do other things that is ILLEGAL in the normal business world.  They directly/indirectly affect what your medications can cost you, if the particular medication that your prescriber wants you to have is even paid for or will only pay for a “similar” medication that the insurance/PBM industry will make more profits on.

One of the largest insurance/PBM companies is CVS Health, they own abt 10,000 community pharmacies, specialty pharmacies, mail order pharmacy, and the largest Nursing Home Pharmacy (Omnicare)  PBM Caremark, Aetna Insurance, Silver Scripts Part D insurance.

This one entity can dictate how much – or how little – their retail competitors gets paid for the prescriptions they fill for their own pts. They can dictate that pts end up paying higher co-pays if the pts don’t want to patronize one of CVS’ own pharmacies. Those in the insurance/PBM industry can mandate that you can only fill meds at one of their mail order pharmacies.

When I read about another independent pharmacy closing their doors because the insurance/PBM industry has made it unprofitable to stay in business,  many stating that the insurance/PBM were – on average – paying them 25% less than the cost of buying the medication(s) from the wholesaler… and… guess who ends up buying the closing pharmacy pt records/files ?  Typically CVS – but not always… just most of the time.

NOW THE NEW FOCUS…  how many of you and other have been in Face Book jail ?…  The BIG TECH – silicon valley have a similar law to protect them from being sued from what is posted on their various web venues — it is called section 230. Magazine and Newspapers are not protected by the section.  Our First Amendment freedom of speech only applies to the government limiting free speech.

IF you haven’t been paying attention those big techs of silicon valley  Face Book, Twitter, Google, Amazon, Instagram and others have been playing games…  during the election period they put a lot of people in web jail. Many “talking heads” on TV have reported that they have loss tens of thousands of followers.  Less than a year ago a new competitor to Twitter www.parlar.com came on line and promised a uncensored community …  After the crap at the capital last week, all of these tech companies decided to permanently SILENCE PRESIDENT TRUMP… no only closed his twitter account, they shut down some of the companies that the Trump organization has websites that sold products was shut down.  President Trump opened an account on PARLAR..  So the “boys” of silicone valley decided that they didn’t want Parlar to provide a web outlet to Trump..  Apple and Android took the Parlar app off of their app website a couple of days latter Amazon – where Parlar rented space on their “cloud” (Amazon Web Services) notified that within 24 hrs … they were pulling the plug on the Parlar website/domain.  There is a whole litany of other companies that followed suit and withdrew their services from Parlar.  This company is estimated to be worth ONE BILLION DOLLARS… yet this TECH BULLIES were able to just pull the plug because they did not agree with Trump’s politics… and their actions are protected by section 230.

Does this sound a lot like what the insurance/PBM industry is doing to the community?  There are a lot of people out there feeling a similar pain that the community has been feeling – from being controlled by people/entities that you have no/little chance of changing.

A new Congressional session starts in another week or so… and there are a lot of people in their country that are very upset and Section 230 is part of that anger… If the Congress can find the cajones to repeal section 230, they might be able to convince them to also repeal the McCarran Ferguson Act…. to put the insurance/PBM industry out of the “collusion game” ?

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Robert D. Rose Jr.

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For those of you who are not following what is going on after the “activity” at the capital bldg.  Face Book, Twitter, Instagram have cancelled/deleted President Trump’s accounts. Section 230 was passed by Congress to exempt – what has become the big tech companies – an exemption from lawsuit because they were suppose to provide a uncensored medium … unlike newspapers, magazines and the like who can be held liable for what is published in their product.

One “talking  head” on TV this AM stated that he now has 60,000 fewer followers over the last few days.  Face Book shut down the website https://www.walkawaycampaign.com/      and closed out the accounts of people associated with the FB page.

The #WalkAway Campaign is a true grassroots movement, founded by former liberal, Brandon Straka on May 26th, 2018. The #WalkAway Campaign encourages and supports those on the Left to walk
away from the divisive tenets endorsed and mandated by the Democratic Party of today.

Yesterday Parler  https://www.parler.com/  who started up a few months ago as a competitor to Twitter and  once again was suppose to be a uncensored platform and yesterday Apple and Android took their app out of their app store and they were notified today that GOOGLE – which is the server farm (CLOUD) where Parler leased space in which they operated from… that  Parler was being taken off of GOOGLE’S servers… basically terminating a business that has an estimated value of ONE BILLION DOLLARS.

I have seen very little out of the media about this and using the word COLLUSION… because COLLUSION is ILLEGAL in this country.

There has been many that have called for section 230 to be repealed and/or change that all those big tech companies in silicon valley are no longer covered by this section.  Some are calling for the breakup of these large companies, it has happen before…. they broke up MA BELL’s monopoly in 1984.

How does this apply to those dealing with chronic health issues and being denied/limited the medications/therapies that they need?   Congress gave  the insurance industry in 1945  an exemption to  The Sherman Antitrust Act by  https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act. At the time, it was seemingly a worth while exemption for the insurance industry.  But the need for that exemption is no longer necessary, but the insurance/PBM industry have pushed this exemption way outside of the envelope of the law’s original intent.  There has been numerous entities trying to get the McCarran Ferguson Act repealed since the late 80’s.  I know of at least one Congressional session that it was included in HR1 – which always include the most important things that the House wants to take up for the opening Congressional session.  Unfortunately, the insurance/PBM industry has one of the largest buckets of money for lobbying Congress to get bills passed or defeated. 

Some in Congress may see the relationship between how the “boys” in silicon valley are acting with their monopoly and how the insurance/PBM industry is acting with their exemption from Sherman.  If the community had a non profit with a “war chest” to lobby Congress, maybe members of Congress could be shown how to “connect the dots” between how these two different industries are using their monopolist position to screw with a large portion of the USA citizens.

Just remember if you keep trying to communicating and educating your members of Congress  – via emails. faxes,phone calls – that there is a 40% chance that your member of Congress has a LAW DEGREE .. who is primarily interested in enforcing the laws and the DEA and the media keeps telling them that the opiate crisis is CAUSED by the prescribing of legal opiates.  The CDC regurgitates stats that Tens of Thousands of people OD on “drugs” and implying that all their deaths were from Rx opiates.  They don’t distinguish that abt 15,000 deaths are from bleed outs from the use/abuse of NSAID’s and the typical OD’s toxicology has 4-7 different substances, one typically being ALCOHOL and if there is a pharma grade opiate in toxicology ..there is only a very small percent that were legally obtained.

I expect with the new administration, that the cut to the opiate production quotas will be equal to or greater than any previous annual reductions.  I read yesterday, that Veterinarians are having problems in getting adequate supplies of medication to treat animals for pain and/or surgery.  We might even reach the point where we have to euthanize our fur babies because their time is up… we may have to return to the days when you just shot them in the back of the head… because enough meds will not be readily available for a humane euthanasia.

When ACA (Obamacare) was first passed, Part D prescriptions were suppose to be a 20%/80% split…the pt paid 20% and the part D paid 80%  on prescriptions by 2020.  What really happened… our Part D did not have a deductible in 2019 but instituted a $435 deductible in 2020… the deductible was more than the annual cost of premiums.  In 2021, they have started no longer covering two of my medications and at least one of Barb’s and several more are now in higher tiers – higher copays.  In 2020, I met my deductible in October.  I had to pay premiums for 12 months and basically got some coverage for TWO MONTHS.  If you think about it, meds that are now NOT COVERED,  just results in a higher annual out of pocket costs for the pts.

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Administration finalizes requirement for hospitals to post rates paid by health plans

https://www.hfma.org/topics/news/2019/11/administration-finalizes-requirement-for-hospitals-to-post-rates.html#

• By January 2021, hospitals must post online the rates they negotiate with individual health plans and rates for 300 “shoppable services.”
• A hospital advocate has promised to challenge the new requirements in court.
• A separate proposal would require health plans also to post rates negotiated with individual providers.

The Trump administration will require hospitals to post online the rates they negotiate with health plans, as well as rates for 300 “shoppable services,” by 2021.

The final rule from the Centers for Medicare & Medicaid Services (CMS), which prompted one hospital advocate to immediately promise to file a lawsuit, requires hospitals to post online all their standard charges (including gross charges, payer-specific negotiated charges, de-identified minimum and maximum negotiated charges and discounted cash prices) for all items and services in a single digital file and in a machine-readable format.

Details of price posting requirements include:

• Describing each item or service
• Displaying prominently and clearly identifying the hospital location
• Ensuring the data is easily accessible, without barriers, is free and does not require an account or password or for a user to submit personal information
• Updating the data at least annually

Additionally, hospitals must post online their standard charges for at least 300 “shoppable services” (including 70 CMS-specified and 230 hospital-selected) that the hospital provides. This information must be made available in a consumer‑friendly manner.

“CMS believes these requirements will allow healthcare consumers to make apples-to-apples comparisons of payer-specific negotiated charges across healthcare settings,” a CMS fact sheet stated.

The posted rates must include charges for services that the hospital customarily provides in conjunction with a primary service that is identified by a common billing code.

CMS will deem a hospital compliant with the new requirements if the hospital maintains an Internet-based price estimator tool that meets specified requirements, including real-time estimates for consumers on their costs for a shoppable service offered by the hospital.

Failure to comply with the requirements could lead CMS to impose fines of up $300 per day (totaling $109,500 annually) and to publicize a hospital’s lack of compliance on its website.

The rule also established a process for hospitals to request a hearing before an administrative law judge to appeal the civil monetary penalty. The judge’s decision can be reviewed by the CMS administrator.

What was tweaked?

The final rule included some changes from the proposed rule, most significantly delaying implementation of the new requirements until Jan. 1, 2021.

Other changes included:

• Modifying definitions for the de-identified minimum negotiated charge and the de-identified maximum negotiated charge
• Modifying the definition of shoppable services to remove reference to a “service package”
• Allowing hospitals that do not provide 300 services that can be scheduled by consumers in advance to list as many such services as it provides
• Modifying the data elements of standard charges that hospitals must publicize
• Removing the separate requirement to list all associated ancillary services

What’s next?

Within a couple hours of the rule release, the Federation of American Hospitals (FAH) promised to join individual hospitals in suing to stop implementation of the new requirements on the basis that CMS lacks the authority to establish them.

“This final regulation on hospital transparency fails to meet the definition of ‘price transparency useful for patients,’” Chip Kahn, president and CEO of FAH, said in a written statement. “Instead, it will only result in patient overload of useless information while distorting the competitive market for purchasing hospital care.”

Beth Feldpush, senior vice president for America’s Essential Hospitals, said the new requirements would “unfairly advantage health plans in negotiations with providers and threaten essential hospitals’ ability to participate in networks and maintain access to services.”

“These policies undermine hospitals’ ability to negotiate equitable payments while giving consumers little actionable information with which to make informed care decisions,” Feldpush said in a statement.

Insurer requirement also proposed

A separate proposed rule would require health plans also to post the individual rates they negotiate with providers.

Although, there was no implementation date provided, an administration official said the rule would go into effect one year after the end of the 60-day comment period, which follows its publication in the Federal Register.

The rule also would allow health plans with provisions that encourage consumers to shop for services from lower-cost, higher-value providers, and that share the resulting savings with consumers, to take credit for such “shared savings” payments in their medical-loss ratio calculations, according to a CMS fact sheet.

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Just after Joe Biden got his SECOND COVID-19 shot, he announced that he is going to mandate that the shots that were in reserve so that people who got their first shot would have inventory so that they can get their second shot on in a time frame as proposed by the original clinical trials. I am not aware of any clinical studies that suggests that get just one shot and/or not getting the second time on the time frame indicated by the clinical trials.

Apparently, he is counting on additional supplies of COVID-19 vaccine becoming available in time, but the initial supply from Pfizer was suppose to be 200 million doses was CUT IN HALF  because Pfizer had trouble acquiring raw material to make the COVID-19 vaccine. So there is no guarantee that additional supplies of COVID-19 vaccine will be available when it is needed.

I am not aware of any clinical trials as to the outcome if a pt gets vaccinations produced by two different companies ( Pfizer & Moderna). Will they have the anticipated 95% effective immunity level ?

What is also interesting is the <D> governors requesting those doses being released. It has been reported that Gov Cuomo is sitting on a “boat load” of COVID-19 vaccine that is about to EXPIRE because like how he has treated businesses/schools in NY shutting them down and allowing them to reopen … only to shut them back down.  It has been reported that Cuomo decided to give vaccinations to addicts/substance abusers/in rehab ahead of people over 65 y/o.  Cuomo is also the governor that mandated – back in the spring – that seniors with COVID-19 be sent back to their nursing homes – which was incapable of dealing with their health issues – and tens of thousands DIED.

Could this just be the PREFACE of what we can expect over the next FOUR YEARS ?

FDA Statement on Following the Authorized Dosing Schedules for COVID-19 Vaccines

Joe Biden to speed release of coronavirus vaccines, ending Trump practice of holding back shots for second dose

https://www.chicagotribune.com/coronavirus/vaccine/ct-nw-coronavirus-vaccine-updates-20210108-iw2krxn7vnbhfg3eyyib3xr7gy-story.html

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Wikileaks just dumped all of their files online. Everything from Hillary Clinton’s emails, McCain’s being guilty, Vegas shooting done by an FBI sniper, Steve Jobs HIV letter, PedoPodesta, Afghanistan, Syria, Iran, Bilderberg, CIA agents arrested for rape, WHO pandemic. Happy Digging! Here you go, please read and pass it on….. https://file.wikileaks.org/file/… These are Clinton’s emails: https://file.wikileaks.org/file/clinton-emails/ Index file!   https://file.wikileaks.org/file/?fbclid=IwAR2U_Evqah_Qy2wxNY12FMqFC5dAFUcZL5Kl4FIfQuMFMp8ssbM46oHXWMI Send to everyone you can as fast as you can!

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It was announced today as Biden – as he got his SECOND COVID-19 shot  – that he was going to mandate that all vaccine held in reserve so that people who got their first shot would get their second shot …  is to be released to everyone to get their first shot.

There are no studies – that I am aware of – that shows that a person getting a COVID-19 from two different manufactures is going to produce a 90%+ effectiveness that is what studies have showed of a person getting the two shots from the same manufacturer.

Biden claimed that he was going to FOLLOW THE SCIENCE… but there is no science to justify this…

I get the opinion that this administration/Congress is going to ram-rod a whole lot of new “controls” – new regulations on the citizens of our country… that are not going to set very well with the majority of citizens.  Pelosi & Schumer could care less, because Pelosi has already indicated that this is her last term – she is now 80 and Schumer is up for re-election in 2022 and AOC has already made “some noise” about running for his seat… after all two years ago she defeated another <D> incumbent for the seat that she now holds.. Chuck is currently ONLY 70.

Here is a video dated 09/01/2020 a compilation of media talking heads, “hollywood” and bureaucrats/politicians called for UNREST … etc….etc..  That got what they wanted a few days ago and now they are all outraged that it happened.

I am concerned that some of those “new controls” will be directed at the community and their need for pain management using opiates.

Anyone in the community that believes that the members of administration/Congress that is suppose to represents you… are your basic “dreamers” …they could give a rat’s ass about what you need/want.

I am wondering how long it is before the community wake up.   How many  petitions have been signed, how many comments have been made during public comment periods on proposed changes, how many times do you have to write to your members of Congress about denial of care …only to get a letter back  about the opiate crisis ? AND … nothing has moved in a positive direction more in a NEGATIVE DIRECTION.

Corporations/people spend 9+ million/day lobbying the 535 members of Congress.  The last election was estimated that 12-14 BILLION was spent and the Georgia Senate run off was estimated to cost upwards of 500 million.  The Georgia election was largely funded by entities OUTSIDE OF THE STATE.

It use to be thought that politicians cared about two things votes and dollars… after what has been said about the past election… what counts is dollars and people who can collude to make sure that the person they want to win…  gets sufficient number of votes to win…  the total votes being exclusively from living/legally registered voters is just an illusion.

What will be interesting if those handful of states that were the most troublesome this time will do anything to make changes to make the number of votes that they report has any credibility. After the voting mess in Florida in 2000 over their punch card system… everything was changed and this past election they were able to report the number of votes cast a couple of hours after the polls closed.

One infamous politician said one time ” IT TAKES A VILLAGE”… the chronic pain community – when it comes to getting something done – is nothing more than a few wandering souls.

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