https://www.8newsnow.com/investigators/cvs-abortion-medication-mixup-ends-las-vegas-womans-pregnancy-dreams-all-i-got-was-a-sorry/

LAS VEGAS (KLAS) — Timika Thomas does not come from a large family. So, as an adult, she decided to make one and had four lovely, healthy children. She and her husband, in 2019, decided to have one more.

Progressing into her thirties, Thomas was having trouble getting pregnant. She had two ectopic pregnancies, which led to Thomas having her fallopian tubes removed. And even though they weren’t insured for the costs they would endure, they decided to pay for invitro fertilization – IVF.

Doctors sedated Thomas, inserted two eggs inside her body and sent her home with prescriptions, one of which would trick her body into producing enough hormones to kickstart her pregnancy.

“You have to make yourself think it’s pregnant,” Thomas told the 8 News Now Investigators. “We’re taking a lot of supplements to make our bodies think it’s pregnant.”

In previous attempts, Thomas had taken a shot to her buttocks in order to trigger that hormone inside of her, but injecting herself was emotionally trying and she wanted to give her “butt cheek a rest,” she said.

Her doctor prescribed a vaginal suppository in place of the injections. Thomas went to her CVS branch at W. Craig Road and Camino Al Norte in North Las Vegas. She took two of her required doses and knew something was wrong.

“I started cramping really bad,” Thomas said.

No stranger to the IVF process, she expected cramping, but this was not the pain she anticipated.

“My cramping went beyond that,” she said. “It was extreme. It was painful.”

Thomas checked the bottle, looked up the name of the prescription on the label, and the results of her internet search began a yearslong process of mourning.

“The first thing I read is it’s used for abortions,” Thomas said.

Documents obtained by the 8 News Now Investigators outline how two technicians and two pharmacists made a series of errors that led to Thomas being given the wrong medication, which essentially terminated her budding pregnancy on the spot.

“They just killed my baby,” she said to herself at the time. “Both my babies, because I transferred two embryos.”

Among the series of mistakes, those documents say one technician – incorrectly believing she knew the generic name for the brand prescribed by the doctor – entered the wrong name into the prescription. One pharmacist did not catch the error, and another pharmacist failed to counsel Thomas when she came to pick up her medication.

“It [the error] would have been caught because then they would have had to have the medicine in their hand,” Thomas said. “And they would have said, ‘Oh, this is Misoprostol or Cytotek, have you taken this before?’ And I would have said ‘no.’ ”

Thomas lodged a complaint with the Nevada State Board of Pharmacy, which met in September. After she gave heartbreaking testimony about her horrifying experience, the two pharmacists were fined and had their licenses suspended provisionally. If both pharmacists avoid disciplinary action over the next 12 months, pay fines and take continuing education credits, their licenses will be reinstated, according to pharmacy board documents.

CVS, in response to inquiries from the 8 News Now Investigators, provided the following statement:

“We’ve apologized to our patient for the prescription incident that occurred in 2019 and have cooperated with the Nevada Board of Pharmacy in this matter. The health and well-being of our patients is our number one priority and we have comprehensive policies and procedures in place to support prescription safety.  Prescription errors are very rare, but if one does occur, we take steps to learn from it in order to continuously improve quality and patient safety.”

The pharmacy board fined CVS the maximum amount allowed by statute — $10,000.00 – for its vicarious liability of the pharmacists’ errors.

At the hearing, the attorney for the retail behemoth distanced his client from its one-time employees.

“To suspend or take action against a pharmacy license when they really didn’t do anything wrong [it] wasn’t pled they did anything wrong,” the attorney said prior to the board imposing the fine. “The only allegation is that they had these pharmacists.”

Thomas was insulted.

“I felt like that was not okay because he should have took initiative for the company as a whole.”

Both pharmacists apologized.

“It’s a human error,” one pharmacist testified, in between heaving sobs. “It was just a human error and I’m so sorry.”

But sorry barely softens any of the heartache or sorrow Thomas feels even some four years later.

“All I got was a sorry,” she said. “It will never be good enough.”

I hope a lot of chain Pharmacists read the comment from the attorney representing CVS before the NV Board of Pharmacy.  The chains don’t have their back.  In reality,  most/all chains have something in their policies & procedures manuals that all employee must follow/obey any/all Fed/State laws, rules & regulations. The fact that Rx dept staff makes a Rx mis-fill , which is a violation of the State’s Pharmacy Practice Act and thus the chain can claim that the employee(s) violated the chain’s policies & procedures… thus the chain has no responsibility – financial liability for the employees’ actions.

While the attorney representing CVS at the NVBOP meeting .. did not state the employees violated the chain’s policies and procedures…but… The pharmacy board fined CVS the maximum amount allowed by statute — $10,000.00 – for its vicarious liability of the pharmacists’ errors.

At the hearing, the attorney for the retail behemoth distanced his client from its one-time employees.

“To suspend or take action against a pharmacy license when they really didn’t do anything wrong [it] wasn’t pled they did anything wrong,” the attorney said prior to the board imposing the fine. “The only allegation is that they had these pharmacists.”

I hope that all chain Pharmacists, understand that they really need to personally have their own professional liability insurance, because the chains really don’t have their back and will use situations – such as this – they will try to dodge any lawsuits over the damages caused by their employees in the Rx dept.

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Some 25-30 yrs ago, we were “traveling” and before satellite radio, when I was always searching for some radio channel that was playing a musical genre that I wanted to listen to.  I listen to a report on UK/England  – and their national healthcare system – and they had a pilot program that trying to develop that would predict when a person was admitted to a hospital – IF THEY WOULD BE DISCHARGED ! Fortunately, the system proved to be ONLY 90% ACCURATE.  The goal of the program was the computer to predict when a pt was admitted to the hospital that no matter what healthcare was provided the pt, the pt would DIE. So if a pt was predicted NOT TO BE DISCHARGED, the pt would only be provided supportive care – something like HOSPICE CARE, because the computer had determined that the pt was going to die in the hospital and NOT BE DISCHARGED.

Is this the path that United Health is on ? With this: UnitedHealthcare (UHC) — the nation’s largest health insurance company, which provides Sullivan’s Medicare Advantage plan — doesn’t have a crystal ball. It does have naviHealth, a care management company it bought in 2020, and one of several businesses that use computers to help insurance companies make coverage decisions.

When the “managed healthcare” programs started in the 1970’s… after a few years… some were referring to those programs as “mangled care”. The pts that were the “most satisfied” with the HMO programs were those people who needed little care.

Feds Rein in Predictive Software That Limits Care for Medicare Advantage Patients

— A computer program isn’t always a crystal ball for care

https://www.medpagetoday.com/special-reports/features/106668

Judith Sullivan was recovering from major surgery at a Connecticut nursing home in March when she got surprising news from her Medicare Advantage plan: It would no longer pay for her care because she was well enough to go home.

At the time, she could not walk more than a few feet, even with assistance — let alone manage the stairs to her front door, she said. She still needed help using a colostomy bag following major surgery.

“How could they make a decision like that without ever coming and seeing me?” said Sullivan, 76. “I still couldn’t walk without one physical therapist behind me and another next to me. Were they all coming home with me?”

UnitedHealthcare (UHC) — the nation’s largest health insurance company, which provides Sullivan’s Medicare Advantage plan — doesn’t have a crystal ball. It does have naviHealth, a care management company it bought in 2020, and one of several businesses that use computers to help insurance companies make coverage decisions.

Its proprietary “nH Predict” tool sifts through millions of medical records to match patients with similar diagnoses and characteristics, including age, preexisting health conditions, and other factors. Based on these comparisons, an algorithm anticipates what kind of care a specific patient will need and for how long.

But patients, providers, and patient advocates in several states said they have noticed a suspicious coincidence: The tool often predicts a patient’s date of discharge, which coincides with the date their insurer cuts off coverage, even if the patient needs further treatment that government-run Medicare would provide.

“When an algorithm does not fully consider a patient’s needs, there’s a glaring mismatch,” said Rajeev Kumar, MBBS, the president-elect of the Society for Post-Acute and Long-Term Care Medicine, which represents long-term care practitioners. “That’s where human intervention comes in.”

The federal government will try to even the playing field next year, when the Centers for Medicare & Medicaid Services (CMS) begins restricting how Medicare Advantage plans use predictive technology tools to make some coverage decisions.

Medicare Advantage plans, an alternative to the government-run, original Medicare program, are operated by private insurance companies. About half the people eligible for full Medicare benefits are enrolled in the private plans, attracted by their lower costs and enhanced benefitsopens in a new tab or window like dental care, hearing aids, and a host of nonmedical extras like transportation and home-delivered meals.

Insurers receive a monthly payment from the federal government for each enrollee, regardless of how much care they need. According to the Department of Health and Human Services’ inspector general, this arrangement raises “the potential incentive for insurers to deny access to services and payment in an attempt to increase profits.” Nursing home care has been among the most frequently deniedopens in a new tab or window services by the private plans — something original Medicare likely would cover, investigators found.

After UHC cut off her nursing home coverage, Sullivan’s medical team agreed with her that she wasn’t ready to go home and provided an additional 18 days of treatment. Her bill came to $10,406.36.

Beyond her mobility problems, “she also had a surgical wound that needed daily dressing changes” when UHC stopped paying for her nursing home care, said Debra Samorajczyk, a registered nurse and the administrator at the Bishop Wicke Health and Rehabilitation Center in Shelton, Connecticut, the facility that treated Sullivan.

Sullivan’s coverage denial notice and nH Predict report did not mention wound care or her inability to climb stairs. Original Medicare would have most likely covered her continued care, said Samorajczyk.

Sullivan appealed twice but lost. Her next appeal was heard by an administrative law judge, who holds a courtroom-style hearing usually by phone or video link, in which all sides can provide testimony. UHC declined to send a representative, but the judge nonetheless sided with the company. Sullivan is considering whether to appeal to the next level, the Medicare Appeals Council, and the last stepopens in a new tab or window before the case can be heard in federal court.

Sullivan’s experience is not unique. In February, Ken Drost’s Medicare Advantage plan, provided by Security Health Plan of Wisconsin, wanted to cut his coverage at a Wisconsin nursing home after 16 days, the same number of days naviHealth predicted was necessary. But Drost, 87, who was recovering from hip surgery, needed help getting out of bed and walking. He stayed at the nursing home for an additional week, at a cost of $2,624.

After he appealed twice and lost, his hearing on his third appeal was about to begin when his insurer agreed to pay his bill, said his lawyer, Christine Huberty, supervising attorney at the Greater Wisconsin Agency on Aging Resources Elder Law & Advocacy Center in Madison.

“Advantage plans routinely cut patients’ stays short in nursing homes,” she said, including Humana, Aetna, Security Health Plan, and UHC. “In all cases, we see their treating medical providers disagree with the denials.”

UHC and naviHealth declined requests for interviews and did not answer detailed questions about why Sullivan’s nursing home coverage was cut short over the objections of her medical team.

Aaron Albright, a naviHealth spokesperson, said in a statement that the nH Predict algorithm is not used to make coverage decisions and instead is intended “to help the member and facility develop personalized post-acute care discharge planning.” Length-of-stay predictions “are estimates only.”

However, naviHealth’s website boasts about saving plans money by restricting care. The company’s “predictive technology and decision support platform” ensures that “patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions.”

New federal rulesopens in a new tab or window for Medicare Advantage plans beginning in January will rein in their use of algorithms in coverage decisions. Insurance companies using such tools will be expected to “ensure that they are making medical necessity determinations based on the circumstances of the specific individual,” the requirements say, “as opposed to using an algorithm or software that doesn’t account for an individual’s circumstances.”

The CMS-required notices nursing home residents receive now when a plan cuts short their coverage can be oddly similar while lacking details about a particular resident. Sullivan’s notice from UHC contains some identical text to the one Drost received from his Wisconsin plan. Both say, for example, that the plan’s medical director reviewed their cases, without providing the director’s name or medical specialty. Both omit any mention of their health conditions that make managing at home difficult, if not impossible.

The tools must still follow Medicare coverage criteria and cannot deny benefits that original Medicare covers. If insurers believe the criteria are too vague, plans can base algorithms on their own criteria, as long as they disclose the medical evidence supporting the algorithms.

And before denying coverage considered not medically necessary, another change requires that a coverage denial “must be reviewed by a physician or other appropriate health care professional with expertise in the field of medicine or health care that is appropriate for the service at issue.”

Jennifer Kochiss, a social worker at Bishop Wicke who helps residents file insurance appeals, said patients and providers have no say in whether the doctor reviewing a case has experience with the client’s diagnosis. The new requirement will close “a big hole,” she said.

The leading Medicare Advantage plans oppose the changes in comments submitted to CMS. Tim Noel, UHC’s CEO for Medicare and Retirement, said Advantage plans’ ability to manage beneficiaries’ care is necessary “to ensure access to high-quality safe care and maintain high member satisfaction while appropriately managing costs.”

Restricting “utilization management tools would markedly deviate from Congress’ intent in creating Medicare managed care because they substantially limit MA [Medicare Advantage] plans’ ability to actually manage care,” he said.

In a statement, UHC spokesperson Heather Soule said the company’s current practices are “consistent” with the new rules. “Medical directors or other appropriate clinical personnel, not technology tools, make all final adverse medical necessity determinations” before coverage is denied or cut short. However, these medical professionals work for UHC and usually do not examine patients. Other insurance companies follow the same practice.

David Lipschutz, JD, associate director of the Center for Medicare Advocacy, is concerned about how CMS will enforce the rules since it doesn’t mention specific penalties for violations.

CMS’ deputy administrator and director of the Medicare program, Meena Seshamani, MD, PhD, said that the agency will conduct audits to verify compliance with the new requirements, and “will consider issuing an enforcement action, such as a civil money penalty or an enrollment suspension, for the non-compliance.”

Although Sullivan stayed at Bishop Wicke after UHC stopped paying, she said another resident went home when her Medicare Advantage plan wouldn’t pay anymore. After 2 days at home, the woman fell, and an ambulance took her to the hospital, Sullivan said. “She was back in the nursing home again because they put her out before she was ready.”

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Recall alert: Blood pressure medication recalled after oxycodone pill found on production line

This sounds like some sort of sabotage by a disgruntled employee.  Sort of reminds me of situation abt 40 yrs ago https://www.history.com/news/extra-strength-tylenol-poisonings-1982, where someone took some Tylenol Extra Strength from a store and tampered capsules of Extra-Strength Tylenol. Someone had opened the capsules and replaced the pain-relieving medicine with deadly doses of potassium cyanide.  They then proceeded to put the bottles of Tylenol Extra Strength back on the retail shelf they took them from, killing seven people.

While Oxycodone 5 mg taken by someone who it was not prescribed to, probably may not cause any personal harm … unless the person is severely allergic to Oxycodone and/or opioids in general.  However, the finding of any Oxycodone 5 mg in a few bottles of betaxolol, will cost the pharma KVK-Tech, Inc a untold amount of $$ in doing a recall to one or more lot numbers of the medication.

KVK-Tech, Inc. is voluntarily recalling a single lot of 10-milligram betaxolol tablets “as a precautionary measure” after a single oxycodone hydrochloride tablet was found on the same production line, according to the U.S. Food and Drug Administration.

Betaxolol is a drug used to combat high blood pressure. Oxycodone hydrochloride is a drug used for pain relief and is a narcotic that’s a “popular drug of abuse,” per the U.S. Drug Enforcement Administration.

The 10-mg betaxolol pills are white, round and film-coated, with one side displaying a “K” and the number “13.” The pills were packaged in white plastic bottles, each filled with 100 tablets, and distributed to wholesalers and retailers nationwide. Bottles in the affected lot — Batch Number: 17853A — have an expiration date of June 2027.

According to the FDA, the company found a single, five-milligram oxycodone hydrochloride tablet on the packaging line during line clearance — the process of making sure equipment is free of materials — after the recalled betaxolol batch was packaged.

“The betaxolol package insert warns about slowing in the heart rate in elderly patients which is likely to be exacerbated by inadvertent opioid administration,” the FDA release warns. “Additionally, some patients prescribed low-dose betaxolol might have compromised heart and lung function that is also likely to be exacerbated by an opioid.”

“Therefore, inadvertent exposure to a controlled substance, such as oxycodone, in that patient population is likely to result in significant slowing in breathing, known as respiratory depression, which is a serious health risk,” the release reads.

The FDA notes that betaxolol and oxycodone hydrochloride tablets look similar. KVK has not received any reports of foreign tablets in bottles of betaxolol tablets.

According to the FDA release, if you received pills from the recalled lot, stop using them and immediately return them to KVK-Tech. The company will reimburse you for the cost of purchasing the medication, the release states.

You can contact KVK-Tech at 215-579-1842, Ext: 6002, or by email at customerservice@kvktech.com.

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Walgreens walkout: Your pharmacy might be closed next week

https://www.cnn.com/2023/10/06/business/walgreens-pharmacists-walkouts-protest-working-conditions/index.html

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The June 2022 SCOTUS ruling that the DEA must NOT USE OBJECTIVE CRITERIA in judging prescribers in what they prescribe to pts dealing with SUBJECTIVE CRITERIA.

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THE EYES OF MEDICINE ARE UPON DEHUMANIZATION OF MEDICAL PROTOCOLS BY LAW ENFORCEMENT

SENZENI NA?? THE RISE OF THE SUBJECT MATTER COCK SUCKERS (SMCS), ( DR. TIMOTHY KING, MD, DR. ANDREW KOLODNY, MD, et al.) THE ADOPTION OF EUGENIC PRINCIPLES BY THE UNITED STATES DEPARTMENT OF JUSTICE/DEA IN THE DEHUMANIZATION OF PAIN CARE AND MEDICAL PROTOCOLS

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In listening to the attached video, remember … that one of the basics of the practice of medicine is the starting, changing or stopping a pt’s therapy. Pay attention to what the pharmacist is saying, telling the prescriber!

This is a video of a recent discussion between a prescriber and a pharmacist, regarding a pt that has lost her regular prescriber because of retirement.  I know who the prescriber is on the phone call, but I do not know who the Pharmacist is,  but suspect because of a few things stated by the Pharmacist… he works for a CHAIN.

Notice that the Pharmacist did not look at the pt’s PDMP history… all he is focused on is either the MME and/or Narxcare score, ignore the pt’s long term history of being on these medications for years.

He seems to be fixated on some arbitrary number and a “line drawn in the sand”  I suspect that this pharmacist works for one of the three chain pharmacies that made an agreement with 50 state AG’s & others. In which they agreed to reduce the opioids and/or controls that they dispense. https://www.pharmaciststeve.com/dea-surrogates-are-trying-to-throttle-the-availability-of-controlled-meds-to-pts/ This Pharmacist seems to be VERY RELUCTANT to explain what and where the criteria behind the “RED FLAG” that he is quoting came from and “hell bent” on refusing to dispense any medications above this seemingly arbitrary MME/day.

Since the Controlled Substance Act was signed into law in 1970, Pharmacists have not been allowed to change a C-II Rx for any reason – including verbal order from the prescriber.  Maybe, part of the lawsuit settlement to reduce the amount of controls those 3 chains dispensed. Gave them a special dispensation on that part of the CSA, as long as they are reducing the number of opioids they dispense?

I find it quite appalling that this Pharmacist had no interest to know if this pt was a confirmed ultra fast metabolizer by pharmacogenomics – which would be justification for the pt to have a higher dose and/or he no concern .. he was happy to enter into his pharmacy computer system a “corresponding responsibility rejection”, which would voided the pt’s C-II Rx and would most likely intentionally the pt into cold turkey withdrawal.

Last week 12 Kansas City area CVS locations close as pharmacists walk out over working conditions  I wonder if these Pharmacists walked out because CVS dictated how they were to practice pharmacy, what meds they can fill, what meds they can’t fill, and they are to limit how many controlled med doses they can provide to a particular pt?

Remember the first sentence of this blog… did the Pharmacist change the pt’s Rx? Was the Pharmacist willing to stop the pts medications? What part of the practice of medicine was this Pharmacist attempting to practice? Is the state board of pharmacy aware of this?  Do they really care … if they are aware?

Some Apple products will not play the above audio/video file

here is a audio only file that seems to play on Apple products

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Two Large Medical Groups Shun Medicare Advantage Plans

https://www.medpagetoday.com/special-reports/exclusives/106483

MEDICARE OPEN ENROLLMENT STARTS OCT 15th, 2023

here is another Medicare -C (Advantage) announced this week – dropping Humana Medicare-C (Advantage) in Kentucky & Southern Indiana 

Humana-insured patients lose coverage at Baptist Health Medical Group

Signaling what may be an emerging national trend, two influential medical groups with San Diego-based Scripps Health are cancelling their Medicare Advantage contracts for 2024 because of low reimbursement and prior authorization hassles, leaving 30,000 enrolled seniors to look for new doctors, or different coverage.

“Negotiations with the payers for MA with our medical foundation groups and Scripps Health were unsuccessful and we have been forced to withdraw from those plans due to annual losses that exceeded $75 million,” Scripps CEO Chris Van Gorder told MedPage Today in an early morning email.

He said the losses are due to “low reimbursement, denials, and administrative costs to manage high utilization and out of network care.”

Van Gorder emphasized that about 30,000 enrollees will have to make a change in their coverage or pick another doctor. About 1,000 physicians and advanced practitioners such as physician assistants are members of the two groups.

“We certainly regret any inconvenience to them,” he said, but “that kind and size of loss is unsustainable by Scripps. We will remain in MA with our IPAs [independent physician associations] as those contracts are structured differently and of course, traditional Medicare.”

The two medical groups affected are Scripps Coastal and Scripps Clinic Medical Group. Five other Scripps medical groups will continue to take MA plans, he said. Affected beneficiaries should receive a notice directly from the plans.

Enrollees “can continue to see Scripps through traditional Medicare at all our hospitals and affiliated medical groups or can switch to an independent medical group (IPA) that still maintains a MA contract at Scripps Mercy, Scripps La Jolla, and Scripps Encinitas hospitals,” he added.

Patients can also switch to Kaiser Medicare Advantage during re-enrollment starting Oct. 15, or to another hospital system whose physicians still take MA plans.

However, switching to traditional Medicare without a supplemental plan — also called a Medigap plan — means patients incur 20% of all physician, lab, imaging, and emergency room costs, along with a $1,600 deductible per hospitalization episode this year. In California and in 44 other states, supplemental plans can reject applicants with common health conditions such as cancer, high blood pressure, a prior hospitalization, or joint replacement. In addition, these plans are expensive, with increasing monthly premiums as one gets older.

But Van Gorder said he had no choice. “We are a patient care organization and not a patient denial organization and, in many ways, the model of managed care has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals – not to mention that the reimbursement is insufficient in most government programs as we all know.”

“Now with intermediaries taking their profit and offering insurance to beneficiaries for free in many cases [the extra benefits like trips to the doctor], the end of the economic food chain is once again the hospitals and physicians.”

Van Gorder said patients should ask themselves, “‘Am I receiving the care I need if my hospital and physician are not even covering their costs? How long is that sustainable?'”

Where these patients will go is an open question.

More than half of all Medicare beneficiaries are now enrolled in MA plans nationally. In San Diego County, the fifth largest in the country, that percentage is 54%opens in a new tab or window of those eligible.

Nate Kaufman, a San Diego-based health system consultant, wasn’t surprised at Scripps’ news.

“I advise all hospitals to terminate their Medicare Advantage plans with anybody unless they’re getting over 115% of Medicare,” Kaufman told MedPage Today.

The problem is complicated, but in a nutshell the issue is a lack of funds to go around to pay hospitals and doctors the cost of care.

“Medicare’s contracts with Medicare Advantage plans pay less than what Medicare pays for traditional Medicare enrollees on the expectation that the plans will save money,” Kaufman said. “Then, the MA plan takes a piece off the top. The remaining funds go into two buckets. One for MA plan pharmacy benefits and the other for hospital and physicians. And that requires a major reduction in utilization to maintain profitability.”

Kaufman said all of this is made worse by the issue of prior authorization, which is now under Congressional scrutinyopens in a new tab or window.

“It creates hassles for everybody and cost,” he said. “The foundation upon which Medicare Advantage was built, which was that there’s excess money somewhere, has disappeared after the insurance company takes their cut off the top and captures the pharmacy rebates.”

Additionally, providers are seeing delays in getting paid, which carries its own cost. And because enrollees pay very low or no premiums, there are less funds for most of the providers, he said.

The issue is likely to keep many independent insurance agents busy. Christopher Westfall of Senior Savings Network, who is licensed to write Medicare contracts in 47 states, also sees providers ending their MA relationships as a national trend.

He said it can be extremely frustrating for his agents when seniors either don’t check their plan or choose the wrong plan thinking their provider is in network, only to find out after Jan. 1 that their doctors are in different plans, or have dropped out.

Many health systems have announced that they’re terminating their MA contracts, or are strongly considering it.

The Mayo Clinic in Jacksonville, Florida, and Scottsdale, Arizona, told beneficiariesopens in a new tab or window last October that it would no longer take most MA plans. If those patients sought care, it would be considered out-of-network, leaving them with a higher share of the costs.

Samaritan Health Services in Corvallis, Oregon, endedopens in a new tab or window its MA contracts with UnitedHealthcare, one of the largest Medicare Advantage contractors in the country.

Regional Medical Center in Cameron, Missouri terminatedopens in a new tab or window contracts with Cigna’s MA plans in 2023, and planned to drop Aetna and Humana MA contracts in 2024. Cameron’s Regional CEO Joe Abrutz blamed the plans’ practice of “delaying any action on reimbursement.”

Stillwater Medical Center, a 117-bed hospital in Oklahoma, called it quitsopens in a new tab or window last year with all of its in-network MA plans, blaming rising operating costs and a 22% prior authorization denial rate, compared with a 1% denial rate for traditional Medicare.

Brookings Health System, a 49-bed hospital in South Dakota, won’t be in networkopens in a new tab or window with any MA plan starting in January to preserve its financial sustainability.

St. Charles Health System in Oregon encouragedopens in a new tab or window its seniors not to enroll in MA this year as it re-evaluates its participation in Medicare Advantage contracts.

And Baptist Health Medical Group in Louisville, Kentucky failed to agree on termsopens in a new tab or window by its deadline with Humana’s Medicare Advantage plan and alerted their patients to seek other options.

Officials for the Medicare Advantage industry had not returned requests for comment as of press time.

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CVS is permanently closing hundreds of stores for a surprising reason

https://www.thestreet.com/retailers/cvs-is-permanently-closing-hundreds-of-stores-for-a-surprising-reason

The drugstore and health-care chain announced a slew of changes planned before the end of 2024.

It’s no secret that U.S. drugstore landscape has been consolidating at a jarring pace now that the pandemic has passed. 

Rite Aid  (RAD) – Get Free Report has been reportedly toying with the possibility of filing Chapter 11 bankruptcy and liquidating many of its stores. It currently has some $3.3 billion in debt. The proposed deal would permanently shutter 400 to 500 of the chain’s current 2,100 stores and hand them over to creditors or other interested buyers. 

With the the pandemic now firmly behind us and brick-and-mortar retail at a crawling recovery pace compared with more robust corners of the market, drugstores have been ripe for change and, perhaps inevitably, consolidation. 

Walgreens  (WBA) – Get Free Report recently parted ways with its intrepid covid-era chief executive, Rosalind Brewer, who abruptly left on Sept. 1. The drugstore is now seeking someone with “deep health-care experience to lead in today’s dynamic environment,” according to Executive Chairman Stefano Pessina. 

It’s clear that if a U.S. drugstore isn’t implementing change, change is being forced on it, and more often than not that spells trouble. And that’s before accounting for the sharp spike in shoplifting and other retail crime, which has cut deeply into drugstores’ bottom lines and forced some to either shutter or chain up frequently stolen goods. 

CVS  (CVS) – Get Free Report is one chain that has managed to weather the post-covid recovery with as much ease and grace as is possible in the sector. The largest drugstore in America said in mid-September that it would launch a new company, called Cordavis, which would aim to bring down drug prices for customers by producing biosimilar medications and negotiating directly with drugmakers. 

The prospect is exciting for both customers and investors because CVS has not only market opportunity but also the scale to compete with the large drugmakers.

But it’s been active not only on the partnership and growth front. CVS is also consolidating, thanks to a recent policy change that will shutter hundreds of locations at a rapid clip. 

CVS is shuttering hundreds of stores

A policy change first put forward in 2021 meant that hundreds of CVS locations would close as the chain worked to cut costs and get ahead of losses. 

“The company has been evaluating changes in population, consumer buying patterns and future health needs to ensure it has the right kinds of stores in the right locations for consumers and for the business. As part of this initiative, CVS Health will reduce store density in certain locations and close approximately 300 stores a year for the next three years,” the company said in late 2021. 

The drugstore has already shuttered locations in Des Moines, Iowa; Berkeley, Calif.; San Francisco; Albany, N.Y., Houston, Kansas City, Mo., and Tallahassee, Fla.

“We consider many factors when making store-closure decisions, including maintaining access to pharmacy services, local market dynamics, population shifts, a community’s store density, and ensuring there are other geographic access points to meet the needs of the community,” a spokesperson said of the decision. 

As many as 900 stores are expected to close through the end of 2024. 

Walgreens also said during its Q3-earnings call in June that it planned to close as many as 450 stores across the U.S. and U.K. to simplify the business. 

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