Appetite grows for mail-order pharmacies: Study

https://www.beckershospitalreview.com/pharmacy/appetite-grows-for-mail-order-pharmacies-study.html

Patients are becoming less satisfied with physical pharmacies as popularity rises for online and mail-order services, according to J.D. Power’s 16th annual U.S. Pharmacy Study.

Compared to the company’s 2023 study, customer satisfaction with mail-order pharmacies saw a six-point increase (on a 1,000-point scale). Chain drugstores, meanwhile, received satisfaction scores “far below the brick-and-mortar category average,” J.D. Power said in a July 30 news release. 

The overall patient satisfaction score for brick-and-mortar locations dropped 10 points.

The consumer insights and data company surveyed more than 13,000 pharmacy customers who filled a prescription between September and May. Customers cited long wait times, lower trust in pharmacists and difficulties in ordering prescriptions as common issues. 

Digital and mail-order pharmacies had their own issues. For online pharmacies, many consumers shared confusion on whether their insurance covers the service. For mail-order pharmacies, only 18% of these customers said their pharmacy offers a well-designed digital experience.

J.D. Power also asked customers about their preferred pharmacies. They voted Good Neighbor Pharmacy the No. 1 chain drugstore, Sam’s Club the best mass merchandiser, Publix the top supermarket and Amazon Pharmacy’s PillPack as the favorite mail-order option.

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My experience of average Rx prices back in the late 1960s and early 1970s makes me question this AI’s stated average Rx price in 1970. Back in the summer of 1967, I was working as a pharmacy student for a small local/regional chain pharmacy. I got assigned the task of calculating the average Rx cost/retail of 1000 new Rxs. The pharmacy stored Rxs on. I tried to find a graphic, but none were found, there were 1000 paper Rxs on each “wire storage unit” Being the pharmacy student, I was given the task of calculating the retail & cost of 1000 new Rxs. So I started with the most recent “full” storage unit.  I had to go thru each Rx in the file, pull the Rx bottle from the shelf, and calculate the medication cost for the particular Rx. No electronic calculators in 1967, but there were slide rules. I had been using a slide rule since I was in High School. The final results were in the $4-$5 range – I don’t remember the exact number. I do remember when I opened my independent pharmacy in 1976, I did all projected gross revenue and gross profit was calculated on an average of $5/Rx.  The chat states that in 1970 the average Rx price was $2.12, which seems to be out of sync with what I saw back then. I have often stated that today the average Rx was approaching $60/Rx. But the chat is quoting an average price from Medicare Part D data, which probably produces a higher average price because Medicare Part D Rxs is dealing with Rxs for the disabled and/or Seniors. Using a “back of napkin calculation”… $5/Rx in 1970 and 54 yrs later, an average CPI of 3% would suggest that Rxs today would be in the $40/Rx range, but that doesn’t take into consideration, that total Rx market has flipped from 90% brand name in 1970 to 85% generic in 2024. All things being equal, with the exception that the PBM industry is now in charge of determining the price of 80%-90% of all Rxs, maybe the average Rx price would be in the $30s today. So, one must ask, why are our Rxs at least $30 higher than would otherwise be expected? Could it be padding the bottom line of the PBM industry’s net profits?

What was the average prescription price in 1970 as compared to the average prescription price today and the percentage of generics of all Rxs for both time frames

To compare the average prescription price and the percentage of generics of all prescriptions between 1970 and today, we need to look at historical data and current statistics. Here is a detailed comparison:

1. High Launch Prices

Pharmaceutical companies set high initial prices for new drugs, which often increase over time. This is particularly evident in branded drugs, where launch prices have been rising significantly year over year.

2. Lack of Competition

The U.S. patent system grants manufacturers monopolistic control over the market for brand-name drugs, limiting competition and allowing prices to remain high. Even when patents expire, inadequate competition among generics can keep prices elevated.

3. Market Exclusivity and Patent Protection

Drug companies use patent protections and exclusivity programs to maintain high prices. These protections prevent generic competition, which would typically drive prices down. The practice of “evergreening,” where companies make slight modifications to extend patent life, exacerbates this issue.

4. Research and Development Costs

The high costs associated with research, development, and regulatory approval of new drugs are often cited as justifications for high prices. Pharmaceutical companies need to recoup these substantial investments, which contributes to the high cost of medications.

5. Lack of Price Transparency

The opaque nature of drug pricing, involving confidential negotiations and rebates among manufacturers, insurers, and pharmacy benefit managers, makes it difficult for consumers to understand and compare prices. This lack of transparency can lead to higher prices and less informed decision-making.

6. Limited Bargaining Power

Unlike many other countries, the U.S. does not have a central negotiating body to leverage lower prices from pharmaceutical companies. Instead, negotiations are fragmented across numerous health plans, resulting in weaker bargaining power and higher prices.

7. Mergers and Acquisitions

Consolidation within the pharmaceutical industry through mergers and acquisitions reduces competition. This consolidation can lead to monopolistic practices and higher drug prices.

8. Insurance Benefit Designs

Insurance plans with significant patient cost-sharing provisions can increase out-of-pocket costs for patients, making medications less affordable. Additionally, the design of these benefits often lacks incentives to control drug prices effectively.

9. Regulatory Delays

Delays in the approval process for generic drugs by the FDA can also contribute to higher prices, as fewer generics are available to compete with brand-name drugs.

10. Lobbying and Political Influence

The pharmaceutical industry spends billions on lobbying efforts to influence drug pricing policies. This lobbying power can hinder regulatory and legislative reforms aimed at reducing drug prices.

Conclusion

The rising cost of prescription drugs in the United States is driven by a combination of high launch prices, lack of competition, market exclusivity, high R&D costs, lack of price transparency, limited bargaining power, industry consolidation, insurance benefit designs, regulatory delays, and significant lobbying efforts. Addressing these issues requires comprehensive policy reforms and increased transparency to ensure medications are affordable and accessible to all.

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7 payers exiting Medicare Advantage markets in 2025

https://www.beckerspayer.com/payer/5-payers-exiting-medicare-advantage-markets-in-2025.html

Seven insurers are exiting Medicare Advantage markets in 2025, a number that is likely to grow in the fall.

There are 3,959 Medicare Advantage plans available nationwide in 2024. The average number of plans available to beneficiaries is 43, unchanged from 2023. 

Seven insurers exiting Medicare Advantage markets in 2025: 

BCBS Arizona will not offer MA prescription drug plans in Arizona in 2025, Becker’s confirmed.

Centene will exit a handful of unspecified Medicare Advantage markets, CEO Sarah London said July 26. 

Clear Spring Health will withdraw its Medicare Advantage prescription drug plans from South Carolina and Virginia, Becker’s confirmed. The company will still offer plans in Illinois, Georgia (MAPD), and Colorado.

BCBS Kansas City is exiting the Medicare Advantage market at the end of 2024, citing increasing regulatory requirements and financial headwinds. 

Aetna is bracing to lose up to 10% of its 4.2 million Medicare Advantage members next year as it prioritizes profitability and exits an unknown number of counties where it believes it can’t be profitable, executives said in May.

Humana expects to exit unspecified Medicare Advantage markets in 2025 and see a membership decline, company executives told investors in April.

Cigna Group reached a deal to sell its Medicare business to Health Care Service Corp. for $3.3 billion in January. The deal is expected to close in the first quarter of 2025 and includes 596,977 MA members, 450,000 Medicare supplement members and 2.5 million members in part D plans. 

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Have President Roosevelt was re-elected for his FOURTH TERM, Congress imposed term limits on our Presidents.  How President Biden wants term limits of 18 yrs on the SCOTUS. Who has Congress never considered imposing term limits on? – CONGRESS THEMSELVES. Just look at how many members of Congress are in their 80’s!  Airline pilots MUST RETIRE at 65 y/o Congress wants to raise it to 67 y/o but the FAA response: FAA tells Congress not to raise the mandatory retirement for pilots until it can study the issue

Commercial airplanes are so highly automated these days, that the challenges of flying a plane are a lot less taxing than 20-30 yrs ago. Back in the 70’s, I got my pilot license and eventually got an instrument rating (could fly “in the clouds”) as well as certified to fly a high-performance plane & retractable gear and was a partner in a plane. I have not flown in years, but I am confident that – at my age – I could “dust off” my pilot skills and safely fly again.

The Lower Courts’ Disregard for Supreme Court Precedent in Ruan v. United States

hhhhttps://doctorsofcourage.org/the-lower-courts-disregard-for-supreme-court-precedent-in-ruan-v-united-states/

In a legal landscape where the judiciary is expected to uphold the law with consistency and integrity, recent events highlight a troubling trend: the lower courts’ apparent disregard for Supreme Court rulings. This phenomenon is vividly illustrated in the cases stemming from the landmark decision in Ruan v. United States. Despite the Supreme Court’s clear directives, the lower courts have continued to impose harsh sentences, seemingly rendering the high court’s decisions meaningless. The absurdity of such legal incongruities is exemplified by the contrasting fates of Dr. Michael Fletcher and Dr. Kendall Hansen.

In 2022, the Supreme Court partially overturned the convictions of Dr. John Patrick Couch and Dr. Xiulu Ruan, ruling that prosecutors must prove that a doctor knew their conduct was outside the scope of professional medical practice. This decision was expected to significantly impact similar cases, offering hope to many convicted under the ambiguous standards previously applied.

However, the Supreme Court’s decision did not result in the anticipated relief for Drs. Couch and Ruan. Despite the high court’s ruling, Senior U.S. District Judge Ginny Granade maintained their lengthy prison sentences. This blatant disregard for the Supreme Court’s directives underscores a troubling trend: lower courts snubbing the highest court’s authority, thus undermining the legal system’s integrity.

Dr. Michael Fletcher, an interventional pain medicine specialist from Crestview Hills, Kentucky, faced similar charges. Convicted of illegally prescribing opioids, his case reveals the inconsistencies and apparent disregard for judicial precedent that plague the lower courts. Despite being found guilty of prescribing legal opioids to his patients—a far cry from street corner drug dealing—the severity of his punishment starkly contrasts with that of his colleague, Dr. Kendall Hansen.

Dr. Hansen, indicted alongside Dr. Fletcher, was charged with writing prescriptions for employees and instructing them to give him the pills. Despite the serious nature of these accusations, Dr. Hansen was acquitted in February 2024, while Dr. Fletcher faced conviction. This discrepancy raises critical questions about the application of justice and the influence of legal representation in these cases.

One significant factor contributing to Dr. Fletcher’s conviction appears to be the disparity in legal representation. Dr. Hansen’s attorney, Ronald Chapman, had extensive experience in health-related criminal trials, contrasting sharply with Dr. Fletcher’s attorney, who likely lacked documented experience in this specific healthcare field of law. This difference in legal expertise likely played a pivotal role in the divergent outcomes of their cases, highlighting the importance of specialized legal defense in complex medical-legal cases.

The ongoing disregard for Supreme Court rulings by lower courts extends beyond individual cases, reflecting a broader crisis in the judicial system. The refusal to adjust sentences in light of new legal standards, as seen in the cases following Ruan v. United States, suggests a troubling autonomy among lower courts that undermines the consistency and predictability essential to the rule of law.

This not only disrupts the lives of the accused but also propagates a climate of fear among medical professionals, ultimately affecting patient care.  The cases of Dr. Michael Fletcher and Dr. Kendall Hansen starkly illustrate the absurdity and injustice that can result when lower courts ignore Supreme Court rulings. The legal system’s integrity depends on the consistent application of law across all judicial levels. The Supreme Court’s decisions should serve as definitive guides for the lower courts, ensuring fairness and uniformity in the administration of justice.

As Dr. Fletcher continues to fight his conviction, his case stands as a poignant reminder of the need for judicial accountability and the protection of medical practitioners from unjust legal persecution. The fight for justice, as highlighted in these cases, is far from over. It is imperative for the legal community and society at large to scrutinize and challenge these judicial inconsistencies to restore faith in our legal system. https://x.com/DrLizaMD/status/1816865615086518506

Why do we dismiss women’s pain so easily? I am calling on family doctors and gynecologists to provide a small amount of actual pain medication- yes *GASP* a small amount of opioid pain medication to be used for IUD placement and removal. Even women who have just delivered babies think it’s excruciating. Thanks to “The Retrievals” podcast by @NewYorkTimes_official for reminding me about this. And now that i know that my fav tik tok feminist @hope_peddler and fav tik tok addiction medicine doc @Taylor Nichols, MD are friends too, I’m gonna tag them to get their thoughts too! 

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All one has to look at to get the validity of the overall answer from this AI chat is the 5 citations at the bottom of the text. FOUR were from the CDC and ONE from the Medical Board of CALF.

Many consider healthcare a HUMAN RIGHT, so the “so-called experts” that put the two versions of the CDC opioid dosing guidelines together, must not share that idea of what is considered basic human rights

## Impact of CDC Opioid Dosing Guidelines on Chronic Pain Management

The CDC’s opioid dosing guidelines, initially released in 2016 and updated in 2022, were designed to improve the safety and effectiveness of pain management while addressing the opioid crisis. These guidelines have had a mixed impact on chronic pain patients.

### **Positive Outcomes**

1. **Improved Safety and Communication**:
– The guidelines emphasize the importance of careful assessment before initiating opioid therapy, selecting appropriate dosages, and conducting regular follow-ups. This has led to better communication between clinicians and patients about the risks and benefits of opioid therapy, ultimately improving the safety of pain management practices[1][3].

2. **Reduction in Opioid Prescriptions**:
– The 2016 guidelines contributed to a decline in the overall number of opioid prescriptions. This was achieved by encouraging the use of non-opioid therapies and safer prescribing practices, which helped reduce the risk of opioid use disorder and overdose[2][3].

3. **Emphasis on Non-Opioid Therapies**:
– Both the 2016 and 2022 guidelines recommend maximizing the use of non-opioid therapies when appropriate. This shift has encouraged healthcare providers to explore and integrate alternative pain management strategies, potentially improving patient outcomes and quality of life[5].

### **Challenges and Negative Outcomes**

1. **Undertreatment of Pain**:
– The guidelines have been criticized for inadvertently leading to the undertreatment of pain. Misinterpretation and rigid application of the guidelines by some healthcare providers and institutions resulted in patients experiencing inadequate pain relief, withdrawal symptoms, and psychological distress[2][4].

2. **Disruption in Care**:
– The implementation of the guidelines led to the abrupt closure of several pain management centers, leaving many chronic pain patients without proper referrals or treatment plans. This disruption in care has had potentially dangerous consequences for these patients[2].

3. **Inflexibility and Misapplication**:
– The initial guidelines were sometimes applied as rigid standards rather than flexible recommendations. This misapplication led to issues such as rapid tapering or abrupt discontinuation of opioid therapy, which can be harmful to patients[5].

4. **Health Inequities**:
– The guidelines highlighted disparities in pain management, with evidence showing that certain patient populations, such as Black patients, are less likely to receive appropriate pain care. The updated 2022 guidelines aim to address these inequities by emphasizing individualized, patient-centered care[4].

### **Conclusion**

While the CDC’s opioid dosing guidelines have contributed to safer prescribing practices and a reduction in opioid misuse, they have also presented challenges in chronic pain management. The guidelines have sometimes led to the undertreatment of pain and disruptions in care due to their misapplication. The updated 2022 guidelines aim to rectify these issues by promoting flexibility, individualized care, and the use of non-opioid therapies. Ongoing efforts are needed to ensure that chronic pain patients receive compassionate, effective, and equitable pain management.

Citations:
[1] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[2] https://www.mbc.ca.gov/Download/Publications/pain-guidelines.pdf
[3] https://www.cdc.gov/media/releases/2022/p1103-Prescribing-Opioids.html
[4] https://www.cdc.gov/media/releases/2022/t1109-prescribing-opioids.html
[5] https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/healthcare-admin-applying-guidelines.html

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Back in the day when the PBMs showed up – late 1969-1970. The vast majority of the community pharmacies were independent – somewhere in the mid-40K – independent pharmacies.

Back then the fed DOJ came out and made it quite clear that if more than one pharmacy tried to form groups that would negotiate when the PBMs over contract terms – they would be charged with collusion and “price fixing”.

Back in the mid-late 80’s a PBM came into the New England marketplace and offered the local pharmacies a contract with such draconian reimbursement rates, that the vast majority of the local pharmacies declined to sign the contract.

Once again the Fed DOJ notified that if the pharmacies did not sign the contract, the DOJ would charge all the pharmacies that declined to sign the contract with COLLUSION.  Imagine, independent pharmacies being offered a contract with reimbursement rates considerably lower than the “going rate” of other PBMs and knowing that if they accepted this contract – most likely other PBMs in the area would be lowering their reimbursement rate to align with what the new PBM in the area was paying.

Maybe someone from New Mexico should reach out to Representative Stansbury. She stated that she thinks that healthcare is a HUMAN RIGHT!

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Historically, the pharma industry has not functioned on a 20% gross margin profit, as was stated in this article I know when the brand name pharmas dominated the pharma industry, the industry – on the whole – had the highest NET PROFIT of any industry. This is just another casualty of the Insurance/PBM industry’s goal to take $$ from the medication side of healthcare to pad their bottom line. The only thing that the Insurance/PBM industry is interested in is THEIR PROFITS that they generate in the USA.

Another US drugmaker on the verge of closure

https://www.beckershospitalreview.com/pharmacy/another-us-drugmaker-on-the-verge-of-closure-report.html

A generic drugmaker likely will shut down if it does not receive federal assistance, The Wall Street Journal reported July 26.

USAntibiotics’ 394,000-square-foot plant in Bristol, Tenn., makes millions of amoxicillin presentations every day, but it is far from breaking even as the generic medication industry struggles to compete with overseas companies, whose costs often are lower.

The pharmaceutical company is the nation’s only manufacturer of amoxicillin products, according to its website. USAntibiotics’ branded presentations are Amoxil (amoxicillin) and Augmentin (amoxicillin clavulanate).

Its facility has made the crucial antibiotic since 1978, and in 2008, it was supplying nearly all amoxicillin doses in the U.S. Now, without an infusion of cash, it eventually will shut down, according to the Journal.

The drugmaker usually sells a 30-pill amoxicillin package for $5 to customers, such as pharmacies and other healthcare providers. It costs $4 to manufacture the package, but the extra $1 is not enough to cover facility costs and other expenses.

Since USAntibiotics’ amoxicillin patent expired in 2002, larger generic drugmakers have entered the amoxicillin industry — often offering lower prices.

The drugmaker all but closed the plant in 2020; five employees chose to keep the facility going in a temperature-controlled environment without pay. Rick Jackson, founder and CEO of Jackson Healthcare, then invested more than $8 million to revive the facility after fielding a call from a bankruptcy trustee in 2021.

If you manage a manufacturing facility, be sure to replace your filter bags regularly to improve the facility’s indoor air quality.

Mr. Jackson told the Journal it has been challenging to sell supply. Hospital leaders are in favor of buying pharmaceuticals manufactured in the U.S., but group purchasing organizations and wholesalers typically focus on the lowest price, he said.

Mr. Jackson said he is seeking help from the federal government, but if it does not come within the next 18 months, he plans to close the factory.

“It’s not a failure yet,” Mr. Jackson told the Journal. “If there is a way to do it, we’ll figure it out.”

A similar tale played out for Akorn Operating Co.

In February 2023, the Illinois-based drugmaker laid off all its workers and closed all manufacturing sites after years of financial struggles in the tumultuous generic industry. Akorn was the only U.S. manufacturer of four medications, and its sudden closure caused more drug shortages.

If history repeats, the current amoxicillin shortage might worsen.

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“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey, VP Pharmacist

The residents of these Senior Citizen living centers are mostly low-income citizens. This administration is taking action against low-income citizens and their First Amendment freedom of religion rights. Knowing that it would involve $$$ and law firms to challenge this Administration’s dictates, knowing that the residents of these centers probably did not have the financial resources.

Thank goodness for https://aclj.org/  The American Center for Law and Justice came to the rescue of these poor Senior Citizens.

https://www.toddstarnes.com/faith/biden-admin-bans-senior-citizens-from-holding-bible-studies/

The Biden/Harris Administration is targeting Christian senior citizens

The American Center for Law and Justice ( https://aclj.org/) reports that the administration is banning elderly believers from holding Bible studies inside government-funded senior living centers. 

In just the past year at least 10 centers have banned Bible studies and other religious events. The complexes have told Christians that their facilities must be neutral.

The ACLJ says it’s nothing more than discrimination and they are demanding the Department of Housing and Urban Development cease and desist. 

Time and time again, senior citizens fall victim to illegal religious discrimination. Oftentimes, Bible studies and prayer groups are formed in complexes because many of the residents are physically unable to attend church. As discussed above, federal laws and regulations are already in place to combat religious discrimination by senior living facilities. The rise in the cases we have seen, however, seem to reflect more of a misunderstanding of the applicable statutes and regulations. For example, most residents we have assisted have been denied access to an apartment’s community room or prevented from having religious decorations in an effort by management to be “neutral” or “more inclusive.” In no way does the Fair Housing Act permit complexes to discriminate on the basis of religion, which would include preventing religious activity in the name of neutrality. We have explained to each complex that this practice of excluding religious groups while including any other groups violates federal law. Following these explanations, we have been able to reach quick resolutions in most of the matters after laying out the clear and longstanding Fair Housing Act. But nonetheless, the fact that such legal action was necessary demonstrates a widespread lack of awareness of what the Fair Housing Act actually prohibits.

ACLJ

Some senior centers have banned Christmas and Easter decorations and others have actually banned Bibles and other religious materials. 

It appears that HUD is violating its own policies which strictly forbid any discrimination based on religious beliefs. 

In their quest to be inclusive – the Biden/Harris Administration has excluded senior saints. There has to be a very special place in the afterlife for godless bureaucrats who bully Christian grandmothers – hopefully a tent next to the Lake of Fire.

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Everyone should watch the first half of this TV show. Investigation of how military healthcare HIDES and refuses to disclose to families how the military healthcare system refuses to provide the medical records of their loved one who is harmed or dies under military healthcare.

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We bought everything needed to make $3 million worth of fentanyl.

All it took was $3,600 and a web browser

https://www.reuters.com/investigates/special-report/drugs-fentanyl-supplychain/

At the tap of a buyer’s smartphone, Chinese chemical sellers will air-ship fentanyl ingredients door-to-door to North America. Reuters purchased enough to make 3 million pills. Such deals are astonishingly easy – and reveal how drug traffickers are eluding efforts to halt the deadly trade behind the fentanyl crisis.

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