Let’s admit it federally … we are spending ONE TRILLION more than we are taking in… have been doing it for over a decade.. our total national debt is some 22-23 TRILLION DOLLARS and while most states have some sort of law on the books that requires them to have a balanced budget… most use “creative accounting” to demonstrate that they are meeting those laws.
The oldest baby boomer will turn 74 Jan 1, 2020 and the youngest will turn 56 in 2020… so in another 9 yrs… all living baby boomers will be on Medicare and will – or could be – drawing a monthly check from social security.
High acuity pts – the sickest of the sick – many times ends up on Medicare disability and/or on Medicaid. Costing both the Feds and the states money to support these people. As the numbers and dollars expended grows… the bureaucrats only view these people as $$$ signs on the Fed/state balance sheet.
From the insurance/PBM perspective… it is a financial (bottom line) benefit for requiring Prior Authorizations , imposing quantity limits or days supply limits, and just out right denial of coverage.
As the many entities that have the authority – or takes the authority – to limit/deny therapy increases… the more pts that will become house, chair, bed confined and by the vary nature these people become PASSIVE PTS and generally PASSIVE PTS get POOR OUTCOMES. Likewise, they are no longer physically capable to fight for a change in their health therapies.
In turn, the pt’s QOL deteriorates, many times their co-morbidity health issues are aggravated resulting if a premature death from “natural causes” or as in the case of a unknown number of suicides are committed by those pts.
Every person who dies prematurely … is one less expense on the various financial balance sheet both in the short and long term.
We have seen that two states NY and RI have implemented Rx opiate tax.. that is being imposed on pharmas, wholesalers and pharmacies and with NY being the first to implement… there are reports of wholesaler not operating in the state have stopped shipping into the state. There has been no information if the pharmacies can pass this added cost along to the insurance/PBM or the pt, but most all contracts that pharmacies have with PBM’s mandate that the pharmacy not charge the pt more than the PBM states is due by the pt’s insurance policy, and PBM in general has not known to be a generous industry. So the PBM industry may look at this as a means of adding to their bottom line as pharmacies decline to stock and fill opiates for chronic pain pts.
So there are many rumors that chronic pain pts are having increased difficulty in finding pharmacies that have stock and/or willing to fill their Rx and bill their insurance company.
The DEA considers it a RED FLAG for a pt to pay cash for a controlled substance when they have insurance and if a pt lives near a border… and thinks that they can go to an adjacent state to get their Rxs filled… DEA also consider it a RED FLAG if a pt travels a LONG DISTANT to get a controlled substance filled. So some pts may find themselves painted into a corner.
Then it was announced today that CMS is implementing new requirements for pts to get their diagnostic tests paid for CMS to implement new appropriate use criteria for advanced diagnostic imaging in 2020
Are the various entities treating our entire healthcare system as a HUGE JENGA GAME… attempting to reduce the overall healthcare expenditures by pulling out pieces of the stack… trying to figure out how many they can pull out without the entire system imploding. Every piece that they pull out… how many “dead bodies” will it represents.
Did you know that there is an increase in organ donations from opiate OD’s and suicides ???
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