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Pain Identified as Dominant Symptom in Long COVID

https://reachmd.com/news/pain-identified-as-dominant-symptom-in-long-covid/2467986/

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Oversight Chair Knocks PBM Execs for July Testimony Under Oath

https://ncpa.org/newsroom/news-releases/2024/08/28/oversight-chair-knocks-pbm-execs-july-testimony-under-oath

Calls on them to provide any necessary corrections to the record within three weeks

Isn’t lying under oath called perjury? According to this article, three top execs of the 3 largest PBMs LIED under oath to the  House Committee on Oversight and Accountability

Chairman James Comer (R-Ky.) called on executives from Express Scripts, CVS Caremark, and OptumRx to correct the record for statements.

What kind of political BS is this, the law says a fine or FIVE YEARS IN PRISON. Those corporations will pay just about any fine that would be imposed. Each of those companies are worth hundreds of millions each.  Throw those 3 exec’s ass in JAIL FOR 5 YEARS and watch all those PBMs rapidly start changing their processes.  Repeal the   https://en.wikipedia.org/wiki/ McCarran%E2%80%93Ferguson_Act McCarran–Ferguson Act  gives the insurance industry an exemption to the Sherman Antitrust Act and then let the FTC have their way with the monopolistic practices of our insurance industry.

ALEXANDRIA, Va. (Aug. 28, 2024) – The National Community Pharmacists Association released the following statement from CEO B. Douglas Hoey, pharmacist, MBA, after House Committee on Oversight and Accountability

Chairman James Comer (R-Ky.) called on executives from Express Scripts, CVS Caremark, and OptumRx to correct the record for statements they made under oath during their appearance before the committee in July:

“PBM-insurers’ days of reckoning are continuing. Congress and the FTC aren’t falling for their nonsense, and the heat on them has never been higher. PBM-insurers exert so much influence on which drugs patients have access to and how much they cost that calling out their mistruths and working to hold them accountable is critical, and we applaud Chairman Comer for doing so. We also need to emphasize that Congress must absolutely pass PBM reforms this year. The time for waiting is over because PBM-insurers showed they will fudge the truth wherever they can and they’ll only change their ways if they are forced.”

In a statement released after the July hearing, Hoey called out

the excuses and at times downright lies the PBM executives were attempting to feed members of the committee about the roles their organizations play in increasing prescription costs and decreasing patient access to health care.  

Making sure to note that under the law,

those who are untruthful in committee testimony under oath run the risk of a fine or five years of imprisonment,

Comer’s letters to the PBM executives specifically highlight their statements that contradict the committee’s and the Federal Trade Commission’s findings about the PBMs’ self-benefitting practices that jeopardize patient care, undermine local pharmacies, and raise prescription drug prices; claims that they do not steer patients to PBM-owned pharmacies; and claims contradicting the committee’s and FTC’s findings regarding contract negotiations, contract opt-outs, and payments to pharmacies. The committee is asking the big three PBMs to provide their corrections to the record by Sept. 11, 2024.

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I have been wanting to post about this but waited till there was some progress. Back the end of Jan 2024 Barb ended up having lumbar surgery. Her pain had reached a level that even upping her doses of opioids over several months could not suppress her increased pain.

She debated on having the surgery for several months before relenting to having it done. The Surgeon what we chose, was recommended by the surgeon that had done my partial knee replacement in mid-2023.

This surgeon is an employee of a very large and very well known and respected ortho surgeon group that has been around for maybe 5+ decades, and the practice is owned by one of the three major hospital system in a city that is the largest city in the state and there is also a nearby medical school.

Barb went back for a 6 weeks follow up. The surgeon seem to start off with THE INCISION IS INFECTED!  After we expanded our pharmacy into providing home medical equipment and then we started dealing with pts who were bed or wheelchair confined and experiencing “bed sores” and/or “decubitus ulcers“. Barb got the opportunity to get certified as a tissue therapist. So she could help pts and their caregivers try to prevent those decubitus ulcers and/or help them to heal those if they already had them. She knew the outwards signs if a broken skin, bedsore, surgical incision was infected, and I learned them via osmosis being married to her.  I knew from clinical standpoint what lab tests would suggest that the pt had an infected decubitus.  A infected decubitus typically had necrotic (dead) tissue around the perimeter, had a bad odor, their blood work should show elevated white blood cell count and pts would have at least a low grade elevated temp.

Barb’s labs nor her surgical incision showed any indication that it was infected, but the surgeon was insistent that he had to debride Barb’s incision STAT.. sent her directly from his office to the hospital and had her admitted. Two days later she was in surgery again. While Barb “survived” the surgery. The overall care that Barb received was no where ideal nor close to best practices and standard of care.

https://www.cms.gov/medicare/quality/quality-improvement-organizations

The above organization QIO, followups on complaints from Medicare pts and the pt’s care in a hospital environment.  I filed a complaint with this organization around the end of April 2024 and just got a return phone call from one of their representatives, as a follow up. This representative was basically quoting from the physician reviewer report/summary. First of all the ortho surgeon NEVER provided any of Barb’s medical records from his practice. The representative said that, my complaints would be forward on to CMS (Center for Medicare/Medicaid Services) to deal with the ortho surgeon’s lack of response of providing medical records.

Most of what I heard, was the reviewer could not document most of my complaints from the medical records from the various providers, starting with the hospital itself down to several vendors who provided Barb’s home services.

When all was said and done, the representative told me that I could have a second reviewer to look over my complaints and also said that I could add any more information.  I had provided them with 7-8 pages of  typed (word processor) detailed complaints and I told the representative that I felts that my complaint was VERY DETAILED!

There was a pause in the conversation and then the representative said “that is a good description”. I asked the representative that if I asked for another reviewer to look at my complaint that if I could ask that the reviewer focus on the what appeared to be that most of the medical documentation – IMO – did not come close to what I understand as what should be a standard of care and best practice.   The representative stated that she would state that and highlight it on my request for a second reviewer to evaluate the quality of medical records that were provided.

Apparently the jury is still out!

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Centene to end Part D broker payments

https://www.beckerspayer.com/payer/centene-ends-part-d-broker-payments.html

Centene will no longer pay commission to insurance brokers enrolling or renewing members in its Medicare Part D plans. 

In a message sent to brokers, published Aug. 25 on Pinnacle Financial Services, Centene said it will continue paying compensation to brokers enrolling members in its Wellcare Medicare Advantage plans. 

In its message, Centene said the Inflation Reduction Act has resulted in “significant changes” to Part D. 

“To continue providing access to high-quality healthcare and Part D coverage that helps families and individuals, we have made a difficult decision — effective Jan. 1, 2025 — to cease new and renewal commissions for PDP beginning with the 2025 plan year,” Centene wrote to brokers. 

In 2024, provisions of the Inflation Reduction Act that eliminate copays for Part D beneficiaries who enter the catastrophic phase of coverage took effect. In 2025, a $2,000 out-of-pocket spending cap will apply to Part D members. 

Medicare Advantage and Part D plans pay brokers compensation for new enrollments and renewals in their plans. 

Jessica Brooks-Woods, CEO of the National Association of Benefits and Insurance Professionals, said in an Aug. 27 statement the decision to cut commissions “threaten not only the livelihoods of Medicare agents but also the communities they serve and the seniors who rely on their expert guidance.” 

The association has reached out to Centene leaders, Ms. Brooks-Woods said, as the decision sets a precedent. 

“We invite the leaders to talk about how these decisions will affect Medicare beneficiaries and their families,” Ms. Brooks-Woods said. “We are asking important questions and looking at all possible options to make sure our seniors and their trusted partners are protected.” 

Centene was the fourth largest Medicare Part D plan sponsor in 2023, according to KFF. The company had 6.6 million Part D members as of June. 

The insurer will also exit six Medicare Advantage markets next year. Centene will no longer offer its Wellcare MA plans in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island and Vermont, but will continue to offer prescription drug plans in those states.

Becker’s has reached out to Centene for comment and will update this article if more information becomes available. 

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Pharmacy Closures Disproportionately Affect Vulnerable Americans

https://www.uspharmacist.com/article/pharmacy-closures-disproportionately-affect-vulnerable-americans

Columbus, OH—How do so-called pharmacy deserts disproportionately affect U.S. residents living in regions with low healthcare practitioner supply and high social vulnerability?

That was the question raised in a recent research letter published in the Journal of the American Medical Association Network Open. “Retail pharmacy chains have been closing thousands of locations throughout the US, possibly playing a role in health care gaps,” the Ohio State University authors wrote. “Similar to the concept of food deserts, areas in which medications are harder to obtain have been deemed pharmacy deserts.”

The study team sourced data through 2020 from TelePharm Map on communities located 10 or more miles from the nearest retail pharmacy. Counties were stratified as high pharmacy desert density if the number of pharmacy deserts per 1,000 inhabitants was in the 80th percentile or higher.

At the same time, the researchers obtained social vulnerability index (SVI) and healthcare practitioner data from the Agency for Toxic Substances and Disease Registry and the Area Health Resources File.

The study calculated the density of primary care practitioners (PCPs; including family medicine, general practice, general internal medicine, general pediatrics physicians) as the number of PCP per 10,000 inhabitants.

The results indicated that, among 3,143 counties reviewed, 1,447 (46%) had at least one pharmacy desert, of which 818 (56.5%) were categorized as having low and 629 (43.5%) as having high pharmacy desert density, respectively.

“Counties with a high vs. low pharmacy desert density had a higher SVI (high SVI: 238 [38.0%] vs. 294 [36.0%]; low SVI: 194 [31.0%] vs 246 [30.0%]; P = .006),” according to the article. “Areas with a high pharmacy desert density had lower median [IQR (interquartile)] PCP density (3.65 [1.12-5.96]) vs. regions with low (5.01 [3.21-7.53]) or no pharmacy (4.86 [3.10-7.40) desert density (P <.001).”

On multivariate analysis, after controlling for age and sex, the researchers determined that both high SVI (odds ratio [OR], 1.35; 95% CI, 1.07-1.70; P = .01) and low PCP density (OR, 2.27; 95% CI, 1.80-2.86; P <.001) were associated with a higher likelihood for a county to have a high pharmacy desert density.

“In the U.S. CVS announced plans to close 900 stores in the next 3 years, and Rite Aid filed for bankruptcy,” the authors wrote. “As pharmacies close, more and more individuals are left without easy access to medications, with disproportionate consequences for certain communities. Patients in higher SVI counties with a lower PCP density had a 30% to 40% higher likelihood to reside in regions with pharmacy deserts.”

The researchers noted that their findings underscore how disparities compound to create barriers to access basic healthcare, noting the association between SVI and the number of chronic conditions.

“For example, diabetes and hypertension tend to be more prevalent among black patients living in rural areas,” the authors wrote. “Poor access to pharmacies is often associated with lower medication adherence. Patients in socially vulnerable communities may lack the means to travel to other pharmacies or may have limited access to broadband internet to find telepharmacy options. Furthermore, pharmacies often offer diagnostic, preventive, and emergency services.”

Complicating the situation is that high pharmacy desert density counties tend to also have a lower PCP density. “Patients residing in these regions face increased barriers to accessing primary health care needs,” the authors concluded.

The authors suggested that in future studies, weighted regression and inverse probability weighting could provide more insights into disparities in healthcare access.

That high SVI and low PCP density that were associated suggested that “people already at highest risk of being neglected by the health care system are most likely to be affected by pharmacy closures. More efforts are needed to maintain access to pharmacies in underserved communities.”

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Guess how much the insurance/PBM industry was DEMANDING in a kickback/rebate/discount from Lilly for them to paid for this medication for one of their beneficiaries?

Eli Lilly selling Zepound vials at 50% discount: 4 notes

https://www.beckershospitalreview.com/pharmacy/eli-lilly-selling-zepound-vials-at-50-discount-4-notes.html

Eli Lilly has started selling single-dose vials of its blockbuster weight loss drug Zepbound for roughly half of its usual monthly list price. 

Patients with a prescription who are paying out of pocket can now purchase a month’s supply of the drug through LillyDirect ( https://lillydirect.lilly.com/ )— the company’s direct-to-consumer platform that launched in January. Eli Lilly is offering a four-week supply of 2.5-milligram and 5-milligram single-dose vials for $399 and $549, respectively. The list prices for GLP-1 weight loss drugs are typically around $1,000 a month.

“This new option helps millions of adults with obesity access the medicine they need, including those not eligible for the Zepbound savings card program, those without employer coverage and those who need to self-pay outside of insurance,” Eli Lilly said in an Aug. 27 news release.

Three more notes:

• Zepbound typically comes in a single-dose autoinjector pen. The new vials will require patients to administer the medicine using a needle and syringe. The drugmaker said the vials will expand the supply of Zebound in the U.S. because they are simpler to produce than the autoinjector pens.
• Eli Lilly added a self-pay pharmacy channel to its LillyDirect website, where patients with a valid prescription can purchase the vials. The drugmakers said this will ensure patients receive “genuine” Zepbound amid a rise in counterfeit and compounded products, which use the same active ingredient as brand-name drugs but are not tested or regulated by the FDA.
• The move stands to raise pressure on Novo Nordisk surrounding the prices of its GLP-1 drugs, analysts told Bloomberg. The drugmaker’s Ozempic is listed at $969 per month in the U.S., and Wegovy at $1,349 per month. The company’s CEO, Lars Fruergaard Jørgensen, is set to testify on the drug’s prices at a Senate Health, Education, Labor and Pensions Committee hearing Sept. 24. Mr. Jørgensen recently told NBC News the two drugs can reduce overall costs associated with obesity care.

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