Our Congress passed a 1000+ page continued resolution to continue the funding of our government through the end of our fiscal year (09/30/2024). With 1.2 Trillion dollar patch to our federal spending, members of Congress had < 24 hrs to those 1,000+ pages BEFORE THEY HAD TO VOTE ON THIS BILL. Congress is required by law to have a budget passed for the next fiscal year before the fiscal year begins on Oct 1st of each year. With about 85% of the members of Congress up for re-election in Nov. I wonder how many millions of dollars from the insurance/PBM industry flowed into re-election campaign funds of those members of Congress up for re-election?

Here is a recent blog post about 30% of independent Pharmacist expect to close their doors by the end of 2024. That you be from 4,000- 6,000 independent pharmacies, mostly in rural areas. https://www.pharmaciststeve.com/cash-crunch-pushes-independents-to-the-brink-data-shows-pbms-the-cause/

Here is another post from today https://www.pharmaciststeve.com/medicare-advantage-is-under-fire-what-it-means-for-your-health-and-wallet/    Another example of how the insurance/pbm industry is putting profits over patient care/safety

Congress strips out PBM reform at the final hour, teeters toward shutdown with a funding deadline

https://ncpa.org/newsroom/qam/2024/03/20/congress-strips-out-pbm-reform-final-hour-teeters-toward-shutdown-funding

This week, Congress agreed to fund the government for the rest of fiscal year 2024, mere days before a looming government shutdown, with votes looking to happen this weekend. This agreement would fund nearly 70 percent of the government including the Departments of Defense, Homeland Security, Labor, Health and Human Services, and Education. NCPA is sad to share that PBM reform is not included in the final funding agreement, having been stripped out at the last moment. It was instead decided that a “skinny” health care package would replace the robust legislative package that committees had agreed upon late last week, which included several major NCPA legislative priority policies. The committees had finalized their package after Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) held a press conference with pharmacy leaders, pharmacists and patients — including NCPA CEO Douglas Hoey, pharmacy owner and former NCPA president Michele Belcher, and pharmacy owner Jack Holt — to discuss the urgent need for Congress to finalize bipartisan pharmacy benefit manager (PBM) reforms. Later that day Sens. Wyden and Crapo issued a letter to Finance Committee members reaffirming their commitment to enacting meaningful PBM reforms during this Congress. Additionally, last Friday, 21 Senators and 51 Representatives sent letters to their respective leadership calling for immediate action on PBM reform. The calls, led by Sens. Jon Tester (D-Mont.) and James Lankford (R-Okla.) in the Senate and Reps. Buddy Carter (R-Ga.) and Debbi Dingell (D-Mich.) in the House, highlighted the bipartisan support PBM reform has received in both chambers and the urgent need to act to preserve patient access to medications and pharmacies.

While PBM reform has been stripped out this time,

it made it to final negotiations a promising outlook and even more reason to fight for final passage. NCPA will continue to work with policy leaders to get PBM reform passed this year.

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Medicare Advantage Is Under Fire. What It Means for Your Health—and Wallet.

https://www.barrons.com/articles/medicare-advantage-medigap-choice-healthcare-retirement-3bb736e4

Insurers may cut back on benefits as their profits get squeezed. Why a Medicare/Medigap plan could be a better deal for consumers.

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Timothy E. King, MD “The Rat King Mother of All Fraud” Dr. King’s assertion that prescriptions of opioids should be deemed illegitimate if there is no objective evidence of functional improvement among patients. This premise, however, fails to account for the inherently subjective nature of pain – a critical factor in assessing the effectiveness of pain management.

JAIL!!! FOR DR. TIM E. KING, MD, DOJ-DEA’S DR. JOSEPH MENGELE, MD, THEIR TW0 CLONES OF INHUMANITY AND EUGENICS; JAIL !!! OVERSIGHT!!!! FOR THE KING RAT!!! JAIL!!!

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In America, covered medications on the list of covered drugs and drug prices are so deceptive that they we are losing so many beajtiful people. Another life is lost for the profits of a billion dollar industry. It’ll only get worse as too many remain silent.

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A recent study aiming to find factors that increase risk of opioid overdose in chronic pain patients instead found that overdose is vanishingly rare, despite the researcher’s best efforts to obscure the truth. This recent Systemic Review and meta-analysis of almost 24 million patients set out to find what risk factors lead to opioid overdose in chronic pain patients. The results were not what the authors expected, with the data showing that while there were factors that increased the risk of overdose, the ABSOLUTE risk of overdose in chronic pain patients was less than 1%. That’s right. Less than 1% We covered another recent study which showed that addiction is also vanishingly rare. So the question begs to be asked – WHY are chronic pain patients being force tapered off their safe and effective long-term opioid therapy? This is a ground-breaking study, but not for the reasons the researchers hoped. They cherry-picked the data and selectively reported to hide the facts – that overdose is incredibly rare in chronic pain patients. Here’s link to the study – Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies Take note of the authors, they include David N. Juurlink and Jason W. Busse. If you found this information valuable, please consider giving the video a thumbs up, subscribing for more content, and sharing it with your network. Your support helps us continue to bring you high-quality, evidence-based research and STOP the FORCED TAPERS and undertreatment of chronic pain.

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It seems like over the last few months several supporters and or support groups for the chronic pain community have been going through a metamorphosis.  There also seem to be a lot fewer chronic painers that are even “active” within the community.  There seems to be less unity and interest in going in one direction toward a solution. Everyone has their own ideas and heads off in their own directions.

I started this blog about 12-13 yrs ago. The other day, I was searching for a blog post that I had recently made, in searching for the blog posts Word Press came up with numerous posts and I realized that the subject I was looking for, the search brought up not only a recent post but multiple blog posts where I had written a post on the same subject every 1-2 yrs going back to the beginning of my blog.

All of a sudden, I got the impression that I had been traveling in a virtual circle. Either my advice was useless/ineffective and/or the pt lacked the Chutzpah to try and advocate for themselves.

The community may have passed the point of no return. The effects of the agreement with the 41 state AGs, the three largest drug wholesalers, and the three largest chain pharmacies have yet to reach full traction.  President Biden’s for lower Rx prices, the segment of the industry he overlooks is the Insurance/PBM industry which is probably the biggest reason for high Rx prices. Of course, since the Insurance/PBM industry has one of the largest pots of money to lobby Congress.  But the PBM industry seems to be prepared for “taking a financial hit”.  It seems that they have changed their reimbursement rates to especially independent pharmacies. I shared this post a few days ago Cash crunch pushes independents to the brink, data shows PBMs the cause

In a recent survey of independents, 30% expect to close their doors this year, that could be as many as 5,000 independent pharmacies no longer around.  Rite Aid is in bankruptcy and closed some 600 stores and what is going to happen to the remaining 1500 is up in the air. Both Walgreens and CVS are planning on closing 200-300 stores each for the next few years. These chains are closing stores – NOT BECAUSE they are NOT PROFITABLE, but because they are not making ENOUGH PROFIT. Many of these stores are in rural areas and as they run the independents out of business and decide to close their stores because they are not making as much profit as they would like, many pts will find themselves in a “pharmacy desert”. The closest pharmacy could be 25-30 miles away.

Please follow this FB page https://www.facebook.com/groups/2117694318443765/user/100042730215813 Loretta Boesing is fighting against mail-order pharmacies and their lack of concern about mailing meds without much concern for keeping the meds within the recommended storage temperature per the FDA, USP and NF. This is the path that the Insurance/PBM industry is leading us down. As “pharmacy deserts” evolve pts in those areas will start getting mass communications from their PBM encouraging them to get their Rxs filled “conveniently ” via THEIR MAIL ORDER PHARMACY.

I am no longer going to share hyperlinks to other FB pages that are not mine.  Anyone who wishes to share my blog posts on other FB pages there are links at the bottom of this post. I am a little tired of others telling me that some of post are POLITICAL and then listen to them tell people to contact their representative in Congress. Then listen to them bitch because they didn’t get a response or the response they got had nothing to do with what they can contacted their member of Congress about.

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At the bottom of this post is a graphic that outlines where the dollars you pay for your medications go. The entities that get the largest chunk of the money, are the ones that have no R&D costs, no inventory costs, and no delivery/distribution costs. They pay the pharmacy $10 for an Rx, then demand a discount/rebate/kickback from the pharma so that their meds are on the PBM’s approved formulary and do not require prior authorization.  Then charge the insurance many times what they paid the pharmacy for the medication.  If you notice in this article, the PBM industry is not part of the cost-savings. Of course, the 5 major PBM’s are owned by major insurance companies.  Back in the day, when there were no PBMs, there were virtually no generics, there was no shortage of medications, there were no prior authorizations, and the average Rx’s price was $4 -$5 each. If nothing had changed, maybe the average Rx price would be $40-$50 each, but with the percentage of generics we now use, maybe the average Rx price would be in the $20-$30 range. If this administration does not see price savings from the PBM industry, collectively we may experience fewer new/improved medications coming to market. No one else does Research and Development (R&D) for new meds, and no one else markets these new meds to doctors.  Maybe that is what the Feds want, lowering the life expectancy so that fewer dollars will be paid out by SS and Medicare.  When SS was first started > 50% of people did not live to 65 y/o and when Medicare was started in 1965, was just as the Baby Boomers were graduating from high school, and I suspect that the federal bureaucrats looked at the then largest population was going into the workforce and the youngest Baby Boomer was just being born in 1964

When I was born, my life expectancy was 65 y/o, now that I have passed that age, my life expectancy is in the low to mid-80s. How much did the pharma industry contribute to that fact?

All drugmakers send in counteroffers in Medicare price negotiations

https://thehill.com/policy/healthcare/4506575-all-drugmakers-send-in-counteroffers-in-medicare-price-negotiations/

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Should “we” vote for a candidate on a single issue that the politician’s position agrees with your personal opinion

Should “we” believe what a politician claims they will do or not do?

Let’s face it, we have two political parties, and it appears that those two political parties have “rigged” the system so that it is nearly impossible for a new political party to get their “foot in the door”

Should “we” start by looking at the “planks” in each party’s political platforms?

I will focus this post on looking at those in the chronic pain community.

Over the last decade, decisions by politicians and certain state/federal agencies have had adverse effects on the QOL and even life itself of many within the community.

What is their position on treating chronic pain?  Strong support for some MME/day limit? Strong support for treatment only using BUPE or NSAIDs or Acetaminophen?  Do they have someone in the family or friend that has addiction problems or has OD’d?

There are ten states with “death with dignity” laws on the books and several other states are considering such laws

What is their position on treating addicts, putting them in jail, decriminalizing all drugs, or putting them on Bupe or Methadone with no limits

What is their position in dealing with drug dealers? Just leave them alone or charge them with murder for people dying from the illegal substances they are selling

What is their position on the execution (capital punishment) of people convicted of murder?

What is their position on abortion?  Strongly pro-life with little/no exceptions for medically necessary abortion? Abortions within limited days into gestation? Strongly pro-abortion, even up to and including the day of delivery.

All these questions have to do with the politician’s view of the importance of life itself. If a politician has a family/friend who ODd from opioids and supports reducing the availability of Rx opioids to pts with a valid medical necessity, but has little/no concern about street dealers selling illegal drugs that is the primary cause of OD’s

“We” may find that the majority of politicians personally have very mixed ideas about the “value of life”

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