Here is Pam Bondi’s re-election TV video in 2014 for Florida Attorney General

And the state AG of Florida is an attorney married to a DEA Agent!

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Optum audit shows possible law violation, lower payments to independent pharmacies

https://mississippitoday.org/2024/11/07/optum-audit-shows-possible-law-violation/

The findings of a recent audit of a major company that manages prescription benefits revealed it may have violated Mississippi law.

The review of Minnesota-based Optum’s business practices by the Mississippi Board of Pharmacy indicated that the company paid independent pharmacies in Mississippi rates lower than chains and Optum-affiliated pharmacies for the same prescription drugs. 

The audit uncovered over 75,000 instances in which Optum-affiliated pharmacies’ lowest payments for a prescription drug were higher than at unaffiliated pharmacies in one year, including chain and independent drug stores. 

Mississippi state law prohibits pharmacy benefit managers from reimbursing their affiliate pharmacies, or ones they own, at higher rates than non-affiliate pharmacies for the same services. 

In some cases, patients footed the bill: consumers were almost twice as likely to pay the full cost of a prescription drug claim without contributions from their insurance plan at independent pharmacies than at affiliated pharmacies. 

The Board of Pharmacy will hold an administrative hearing based on the alleged violations of Mississippi law on Dec. 19. Board staff declined to answer questions about the audit or its findings. 

“I think this proves that we need to have more transparency, we need to have more PBM reform in Mississippi and across the country and even on a federal level,” said Robert Dozier, the executive director of the Mississippi Independent Pharmacy Association, an organization that advocates for 180 pharmacy members.

Optum declined to answer specific questions about the audit. The company has identified errors in the audit’s findings and methodology and submitted them to the Board of Pharmacy, said Isaac Sorenson, a spokesperson for Optum. 

“The pharmacy – and local pharmacists – play a vital role in supporting people’s health and we are committed to paying them fairly,” he said. “…For pharmacies in rural and underserved communities, Optum Rx is deepening its commitment to support their role by launching new programs, expanding existing initiatives and launching a new pharmacy network option for customers.” 

He said the new pharmacy network option will provide pharmacies with increased reimbursements. Generic drugs will be reimbursed at 5% higher rates and brand name drugs at .2% higher rates. 

Optum is owned by health care behemoth UnitedHealth Group Inc., the U.S.’ most profitable health care company and the owner of the nation’s largest health insurance company, UnitedHealthcare. In 2023, the company reaped $32.4 billion in earnings. 

Pharmacy benefit managers are private companies that act as middlemen between pharmacies, drug manufacturers and insurers. They process prescription drug claims, negotiate pricing and conditions for access to drugs and manage retail pharmacy networks. 

Optum is one of the largest three pharmacy benefit managers in the U.S., which together account for 79% of prescription drug claims nationwide. 

The results of the audit echoed some of the conclusions of a Federal Trade Commission report published in July: large pharmacy benefit managers pay their own, affiliated pharmacies significantly more than other pharmacies and set reimbursement rates at untenably low levels for independent drug stores, or retail pharmacies not owned by a publicly traded company or owned by a large chain, said the report. 

Mississippi Today reported last month that many Mississippi independent pharmacists fear they may be forced to close their businesses due to low reimbursement rates from pharmacy benefit managers. 

Pharmacy benefit managers have an incentive to steer customers towards their affiliate pharmacies and compensate them at higher rates, which can disadvantage unaffiliated pharmacies and lead to higher drug costs, said the Federal Trade Commission. 

Optum’s affiliate pharmacies include Optum Home Delivery Pharmacy and Optum Specialty Pharmacy. 

The audit revealed that Optum uses 49 different maximum cost lists, or schedules created by pharmacy benefit managers that determine the highest price they will pay pharmacies for generic drugs. Maximum cost lists are proprietary and confidential, even to the pharmacies that are reimbursed based on the lists, and change continuously.

“I think that’s 48 too many,” said Dozier. “There should only be one MAC list.”

Fifteen are used exclusively at independent pharmacies and 22 are used solely at chain pharmacies. 

An analysis of the maximum allowable cost lists showed that independent pharmacies were reimbursed at rates 74% lower than chain pharmacies on average.

An analysis of a generic drug used to treat bacterial infections yielded a payment to an Optum-affiliated pharmacy that was eight times higher than the lowest-paid independent pharmacy on the same day. Chain and affiliate pharmacies were paid over 20 times as much as independent pharmacies for a generic drug used to treat stomach and esophagus problems.

Pharmacies’ attempts to contest low reimbursement rates were often unsuccessful, showed the audit. 

Ninety-eight percent of pharmacy appeals were denied, most commonly because they did not include information about how much the pharmacy paid to acquire the medication from a wholesaler. 

Mississippi law prohibits pharmacy benefit managers from reimbursing pharmacies at rates below their cost to acquire the drug, even when using a maximum allowable cost list. But the audit revealed over 400 times that Optum denied pharmacies’ appeals on those grounds, saying that the maximum cost list was accurate. 

The audit, which studied Optum in 2022, was the first commissioned by the Mississippi Board of Pharmacy after revisions to state law in 2020 gave it more regulatory authority over pharmacy benefit managers. 

It took the board several years to hire staff to enact the law and receive approval to increase its budget due to the high costs of audits, the board’s executive director Susan McCoy told lawmakers at the House Select Committee on Prescription Drugs Aug. 21 at the Capitol.

The board also has pending administrative proceedings with the other largest pharmacy benefit managers in the country, Express Scripts and CVS Caremark. Neither is the result of an audit. Both hearings are scheduled for Nov. 21. 

Optum has already faced scrutiny for its business practices in Mississippi. In August, Attorney General Lynn Fitch filed a lawsuit alleging that Optum and several other pharmacy benefit managers stoked the opioid epidemic by plotting with manufacturers to increase sales of the addictive drugs and boost their profits. The suit also named Evernorth Health and Express Scripts, along with the companies’ subsidiaries.

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Chronic Pain Affects One in Four Americans, CDC Reports

Nearly 9% have pain severe enough to restrict daily activities

https://www.medpagetoday.com/neurology/painmanagement/113052

Chronic pain affected nearly one in four U.S. adults, new CDC survey data showed.

In 2023, 24.3% of adults had chronic pain lasting 3 months or longer, reported Jacqueline Lucas, MPH, and Inderbir Sohi, MSPH, of the CDC’s National Center for Health Statistics (NCHS).

Moreover, 8.5% of U.S. adults had high-impact chronic pain — pain severe enough to restrict daily activities — Lucas and Sohi wrote in NCHS Data Brief

The percentage of adults with chronic pain was higher in women, in people who were American Indian or Alaska Native, in older adults, and in those living in nonmetropolitan areas.

The analysis was based on data from the 2023 National Health Interview Survey (NHIS), a cross-sectional poll conducted annually by the NCHS. Previous NHIS survey data showed the percentage of adults with chronic pain was 20.9% in 2021, similar to the pre-pandemic estimate of 20.4% in 2016.

What accounted for the jump in percentage since last year was unclear, but shifting demographics — including more older Americans now than in years past — may play a role. The methodology of the survey and the interview questions did not change over time, a CDC spokesperson said.

Lucas and Sohi used NHIS data to provide updated percentages of adults who experienced chronic pain and high-impact chronic pain in the past 3 months by selected demographic characteristics.

“Chronic pain and pain that often restricts life or work activities, referred to in this report as high-impact chronic pain, are the most common reasons adults seek medical care, and are associated with decreased quality of life, opioid misuse, increased anxiety and depression, and unmet mental health needs,” they wrote.

Chronic pain was determined by responses of “most days” or “every day” to a survey question about pain frequency in the past 3 months. High-impact chronic pain was defined as adults who had chronic pain and who responded “most days” or “every day” to a survey question asking how often pain limited life or work activities in the past 3 months.

The 2023 survey data showed that women were more likely to have chronic pain than men (25.4% vs 23.2%) and to have high-impact chronic pain (9.6% vs 7.3%).

The percentage of adults with chronic pain in the past 3 months rose with age, ranging from 12.3% in young adults under age 30 years to 36.0% in those 65 and older. Likewise, the percentage with high-impact chronic pain in the past 3 months increased from 3.0% in adults under age 30 to 13.5% of those ages 65 and up.

American Indian and Alaska Native adults had higher percentages of both chronic pain (30.7%) and high-impact chronic pain (12.7%) than other groups.

Chronic pain percentages were 20.5% in large central metropolitan areas and 31.4% in nonmetropolitan areas. High-impact chronic pain percentages were 7.3% in large central metropolitan areas and 11.5% in nonmetropolitan areas.

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Oxygen Company Too Big to Ban?

We expanded our independent pharmacy into providing Home Medical Equipment (HME) in the early 1980’s. Providing home Oxygen and other respiratory services turned out to be a large part of our HME business. After a decade in the business, with annual inflation being in the 3%-4% range, Medicare never gave HME vendors a increase in what we were paid. As we approached the middle of the 90’s decade, there were rumors stirring that Medicare was going to CUT REIMBURSEMENTS. I knew that we could not take care patient properly after not getting any increase in payments for a decade and then having to deal with a cut in payments. I sold the pharmacy and HME business in late 1996 and 2 yr later Medicare cut reimbursement by about 40% of what we had been paid for abt 15 yrs.  Abt another 15 yrs, Medicare cut reimbursement again and was only paying abt 22% of what we were being paid in the early 1980s. Adjusting for inflation, Medicare was paying about 10% of what they were paying in early 1980 and they add many mandatory services without any reimbursements.  As is stated in this article: Lincare customers aren’t pleased with the services they receive; it only has a 1.3 out of 5 on the Better Business Bureau site.

It would seem that Medicare & Lincare are at a standoff. Taking care of home oxygen/respiratory pts is both labor and equipment intensive and Medicare has ran so many small vendors out of the market place that no small/independent vendor would enter into providing HME services/products to respiratory pts with what Medicare is offering as payment. Medicare apparently found it acceptable for pts to deal with POOR SERVICE, than to pay what the service is worth.

Oxygen Company Too Big to Ban?

https://www.medpagetoday.com/special-reports/features/113015

Despite decades of misbehavior — from overbilling to violating kickback laws — Medicare has never banned Lincare, the largest distributor of home oxygen equipment in the U.S., ProPublica revealed

In 2023, HHS placed Lincare on probation — a “corporate integrity agreement” with a “death penalty” provision. Yet Lincare was already under that form of probation and had been on and off it for years. The company regularly violated the terms of probation with little punishment, according to ProPublica.

Part of the reason Lincare has gotten away with this for so long is because Medicare fraud is so rampant that a lot of bad behavior gets through. Plus, the company has a near-monopoly, begging the question whether it’s too big to ban, the article stated.

In addition, paying multimillion-dollar legal settlements has been affordable to the company. “As long as that [settlement] check is less than the amount you stole, it’s a good business proposition,” Lewis Morris, former chief counsel to HHS’ Office of Inspector General, told ProPublica.

Lincare customers aren’t pleased with the services they receive; it only has a 1.3 out of 5 on the Better Business Bureau site, with one reviewer writing that Lincare is “running a scam where they have guaranteed income” and that “the customer can’t do a thing.”

ProPublica’s reporting found “a dismal picture of a company with a sales culture that depends on squeezing infirm and elderly patients and the government for every penny.”

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Abandoned in Pain: A Family’s Fight Against UCHealth’s Neglect

https://www.coloradoswitchblade.com/p/abandoned-in-pain-a-familys-fight?triedRedirect=true

Exposing the Healthcare System’s Betrayal of Chronic Pain Patients—Share to Demand Accountability

This article is an opinion piece based on my personal experiences and interviews. The views expressed here are my own and do not necessarily represent those of any organization or publication.

I remember it was a cold and windy day as I helped my wife out of our beat-up grey Subaru. I got her walker from the trunk, carefully wrapping the blanket around her shoulders before helping her take each labored step toward the side door of our local medical clinic.

She had six broken ribs that day, a result of the life-saving CPR I had given her, along with the paramedics and the robotic Newton machine that continued compressions as they drilled an IV into her shin bones. It was the first time Shilo died in my arms.

We were lucky to get her back, but her survival was tenuous. For weeks, she hovered between life and death in a medically induced coma, her body battling cascading organ failure. The doctors told us to say goodbye. Those conversations with my daughters remain among the hardest of my life—second only to the next time Shilo died in my arms, this time for good.

Shilo had spent her life battling chronic pain caused by atypical Crohn’s disease and deep adhesion scarring throughout her abdomen. Her condition was so severe that even drinking water caused excruciating pain. For decades, doctors successfully managed her condition, giving her a semblance of normalcy that allowed us to build a life, raise our daughters, and hold onto hope.

Then everything changed. The very doctors and institutions that had cared for her abandoned her, citing fears of regulatory scrutiny and rigid opioid guidelines implemented by the CDC in 2016. When they stopped treating her pain, Shilo turned to alcohol for relief. I understood why—she was trying to numb the unrelenting agony—but I couldn’t allow it around our daughters. I found her an apartment close by, and though we were separated, we remained as close as ever.

After I was able to nurse Shilo back to health and convince her doctor to prescribe pain medication again, her recovery was remarkable. She moved back in, reconnected with our daughters in profound and meaningful ways, and grew closer to me than ever before. Those two years were truly a blessing to our family—two of the best years of my life.

The night she passed for the final time had started as a good day. We celebrated her birthday that weekend, cooked dinner together, and watched a movie. But later that evening, Shilo had her final seizure—the one she couldn’t wake up from.

That night, after the paramedics told me there was nothing more we could have done, I felt her spirit lift from her body. For the first time in decades, she was free from pain. I told her, “It’s okay. You can go. I’ll take care of the girls. You go, experience the universe without pain. I’ll see you when my own time is through.”

A Systemic Crisis

Shilo’s story is not unique. Thousands of chronic pain patients across the country face the same fate, abandoned by the healthcare system meant to protect them. This weekend, I was reminded of this cruel reality when my friend and pain management physician, Dr. Mark Ibsen, reached out with an urgent plea for help.

He told me about Monique Barela, a patient whose story mirrored my wife’s. Monique has been abandoned by her doctors despite her chronic pain being fully documented and protected under Colorado law.

“Monique doesn’t want to die,” her mother told me. “But she can’t live like this anymore.”

Monique’s desperation is not an isolated incident—it’s the result of a systemic failure to provide compassionate and competent care to chronic pain patients.

Monique Barela’s Fight for Survival

Monique’s battle with chronic pain began when she was just eight years old. A bacterial infection from a gym class injury led to years of surgeries, misdiagnoses, and escalating health complications. By her twenties, she was living with Complex Regional Pain Syndrome (CRPS), osteoporosis, and severe arthritis.

For a time, Monique managed her pain with carefully calibrated doses of oxycodone and oxycontin. With her pain under control, she was able to work two jobs and attend school. But in 2016, her providers began tapering her medication, not because her condition had improved, but in response to vague opioid-prescribing guidelines.

“They made me sign a taper form,” Monique explained. “They said if I didn’t, they wouldn’t prescribe anything at all. What choice did I have?”

Her once-stable life unraveled. Malnourished and in unbearable pain, Monique dropped to 87 pounds and was hospitalized. Even then, doctors dismissed her suffering. “They told me to try Tylenol or meditation,” she said, her voice trembling.

Abandoned by the System

Despite Colorado’s SB23-144—legislation explicitly prohibiting forced tapering and mandating individualized treatment plans for chronic pain patients—Monique’s cries for help have been ignored.

“I showed a doctor the law—SB23-144—to prove they wouldn’t get in trouble for treating me,” she recounted. “He refused to even look at it. He just walked out of the room.”

Even when Monique has found doctors still willing to help her, pharmacies have refused to fill her prescriptions, citing vague “red flag” policies. “I’ve driven hours to find a pharmacy that would give me what I need,” Monique said. “And most of the time, they still say no.”

The Insurance Ping-Pong Game

Adding insult to injury, many chronic pain patients are subjected to a cruel cycle of referrals and appointments with specialists who know they won’t provide treatment.

“Doctors know from the start that they’re not going to treat the patient’s pain,” Dr. Ibsen said. “Instead, they refer them to another specialist or clinic. It’s a cycle of false hope and wasted resources.”

Monique has lived this nightmare. “I’ve been sent to so many different clinics, and none of them ever actually treated me,” she said. “Meanwhile, my insurance gets billed for every appointment, every test, and I’m still left in pain.”

This practice raises serious legal and ethical questions. By repeatedly billing insurance for services that don’t address the patient’s needs, healthcare providers exploit the system while patients suffer.

A Call to Action

UCHealth has a choice: to honor the law and provide compassionate care or to perpetuate a system that abandons those who need it most.

To my readers: Speak out. Share Monique’s story. Demand accountability from UCHealth and other providers. Contact your legislators and insist they enforce SB23-144.

If this is an issue you or a loved one are facing, I urge you to contact Governor Jared Polis himself. He signed this law into effect, and it is failing our fellow Coloradans. Plead with him to demand accountability and ensure this legislation is upheld.

No family should endure what mine has. Shilo deserved better. Monique deserves better. Chronic pain patients deserve better.

Read the full text of SB23-144 here.

Shilo’s story, along with our family’s harrowing journey through the medical system as she faced chronic pain—her triumphs, setbacks, and ultimate sacrifice—will form the backbone of my next non-fiction book, currently titled Shilo’s Story. This memoir will explore our unconventional life together as creatives, artists, and writers while shedding light on our healthcare system’s systemic failures. It will highlight the resilience of those the system abandons and honor the enduring legacy of a woman whose courage continues to inspire. Stay connected for updates on this deeply personal and important project.

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Using a COLA calculator, a SINGLE DOLLAR in 2003 is $1.66 in 2023 dollars. These charts indicate that the major insurance companies have increased their profits and spending on lobbying by 5- 10 times what was done over two decades.  Does it seem that these insurance companies primary focus was on “healthy profits”?

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@everyone

https://discourse.nomineesforthepeople.com/t/steve-ariens/36342

Your support and votes are appreciated – see link above

Here is a video of a Federal attorney that elaborates how they use normally “innocent statements” from prescribers and pharmacist and daisy chain various otherwise “innocent activities” into violations of the Controlled Substance Act and the number of charges against the healthcare professionals start to stack up. US Attorney Admits that He was Directed to Target Doctors Who had NO criminal intent ( » US Attorney Admits that He was Directed to Target Doctors Who had NO criminal intent )
Here is an article from FIVE SENATORS Elizabeth Warren Advocates to Formalize Barriers for Pain Patients » Elizabeth Warren Advocates to Formalize Barriers for Pain Patients calling for the DEA to increase the DENIAL of pain medications to chronic pain patients. Here is a video on how the PBM industry now operates https://youtu.be/jp1_6SDfxlE?si=GCegamZsrAjGSmOV
Here is Senator Eliz Warren’s interaction with the CEO of United Health and all the control that they have over our healthcare system and all the profits they are taking out of our healthcare budgets, that should be devoted to pt care. If this group is hoping to improve pt’s QOL while controlling medical costs. It is going to need someone that understands where are the $$ are being sucked out of the system and to the bottom lines of many medical middlemen. I may be one of but a few people who can related to all those involved from the medical practitioner perspective and the pt’s perspective. I am retired and have no allegiance to any corporation and I have a wife that has been a intractable chronic pain pt for 3+ decades.

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pic.twitter.com/d6BiayAjwy

— Elon Musk (@elonmusk) November 11, 2024

To prove Pres Trump’s “facts”, I recently applied a COLA (Cost of Living Adjustment) to what my last year’s tuition at Butler U – my Alma Mater – was and the calculation was abt $6,000/semester in today’s dollars. My interest is because our only Grandson is headed off to college this time next year.

This year Butler U’s tuition is in the mid $25K/semester, and Pharmacy majors at Butler U – their tuition is HIGHER the last year of the 6 yr program.

Our only Daughter graduated from Butler U in 1993 – I think! As I Remember that her first year – Fall of 1989 .. total cost was abt $12,000 and her final year 1992-1993 was pushing $20,000 total.

Back in 1970, by working my ass off and pinching pennies, I was able to graduate with $500 in debt, which was about three weeks net pay that I got once I got my Pharmacist license. Today, it is not unusual for a newly minted pharmacist to leave college with a student loan debt approaching $200,000. Which is about THREE YEARS net pay once they get licensed.

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Bill Gates belongs in jail. pic.twitter.com/HW7SjVb5EL

— Steven Miller, MD, PhD (@SageListener) November 9, 2024

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