Do You Really Want A Unique Patient ID?

The House just passed a bill that eliminates the prohibition on the use of federal funding to assign all Americans a unique medical identifier. Former Congressman Ron Paul, M.D., got that prohibition enacted in 1998.

            The identifier is supposed to improve “efficiency”—of what? Government surveillance of all Americans? The agenda of government-favored special interests, who might want to silence persons with political views they don’t like? Persons who might see you as a threat to their success in business, academia, or other ventures?

            What might be in your record? A prescription for Valium or other drug prescribed during a distressing life crisis? This could be a psychiatric “red flag” causing denial of your gun rights. A diagnosis of a sexually transmitted disease? An admission that you had a temper tantrum or used an illegal drug at a party? Could this derail a job application or cause you to lose child custody or foreclose a political career?

            Can you be honest with your doctor if anything in the record might someday be used against you?

            “Make no mistake. The [patient identifier] would be the end of privacy and the foundation of a national health data system,” warns Twila Brase, president of the Citizens’ Council for Health Freedom and author of Big Brother in the Exam Room.

            The damaging information in the record might not even be yours. A hurried data-entry person might have clicked the wrong item on a drop-down menu or even cut-and-pasted something from another patient’s electronic health record.

            The prohibition on funding for the unique identifier needs to be restored, states the Association of American Physicians and Surgeons (AAPS).

Further information:

       

Another Whitewash of GPO Culpability in Soaring Costs and Shortages in the Drug Supply Chain?

By Marion Mass, MD and Craig M. Wax, DO

It appears the House Energy and Commerce Health Subcommittee on Health is preparing to whitewash the culpability of GPOs in causing drug shortages and soaring prices at its May 9th hearing on the drug supply chain.

Will any Committee Members be willing to ask any of the hard hitting questions below?

1. Multiple government panels have pointed to the GPO (Group Purchasing Organizations) role as a root cause of drug shortages. This is causing an increase in overall costs. In Chairman Pallone’s spin memo announcing the hearing they are spun as ” GPOs help hospitals and physicians aggregate purchasing volume to negotiate discounts with manufacturers and distributors.” Americans are NOT seeing lower healthcare costs. Can anyone on the panel tell me why the GPO are given this free pass?  Perhaps Chairman Pallone needs a new title: honorary spin doctor.

2. Hopkins surgeon and author Dr. Martin Makary has written about these GPOs as a root cause of shortages and high prices in the Journal of the AMA: https://jamanetwork.com/journals/jama/article-abstract/2708613 .

Dr Resnick, you are the board chair of the AMA. what can you say about Dr Makary’s assertions that the GPO are causing supply chain disruptions and cost increases to the American patient? Can you comment particularly on how this is affecting rural communities?

3. Dr. Resnick,  has any section of the AMA explored the issue of the legalized kickbacks, (AKA rebates) enjoyed by the GPO and by the PBM? [“Fun” Fact about Jack Resnick, MD: in addition to serving as chair of the AMA Board of Directors… Guess what? He’s also on the board of the scandal-plagued National Quality Forum.

4. Question for Kave Niksefat of Amgen. Your company makes biologic medications. These biologics were given significant patent protection via the backdoordeals used to pass the ACA as evidenced in Stephen Brills Book, America’s Bitter Pill. Can you comment on your company’s role in these deals? As a result of patent protection, how much money has Amgen made above what it would have had there been competition?

5. Question for Lynn Eshenbacher, as the leader in a large hospital network, can you comment on investigations led by state attornies general regarding Amgen (also on the panel) regarding how an amgen anemia drug was getting overfilled by hospitals and clinics who received kickbacks? This overfill was paid for by medicare dollar. Are you aware of any such overfills now going on, or any bonuses given to your hospital system or other hospital systems encouraging the use of specific products? This could be via manufacturers themselves or the GPO that arrange the contracts for 90% of hospitals. https://www.healthleadersmedia.com/finance/15-states-sue-amgen-alleging-kickback-scheme .

6. Question for Jeffrey Hessekiel: Your company manufactures cancer medications. It is well known that chemotheraputics are in shortage. Here is a piece written by Liza-Marie Johnson, MD, a pediatric oncologist and bioethicist at St. Jude Children’s Research Hospital in Memphis, Tenn https://blogs.stjude.org/progress/cancer-drug-shortages-threaten-most-vulnerable-patients/ . describing shortages of drugs for children with cancer. Are these shortages impacting rural hospitals worse than non-rural? Can anyone else on the panel back up her assertions that the shortages are of ” older but proven drugs that are no longer profitable for their manufacturers. The older and cheaper a drug is, especially a generic, the more likely it is to be scarce.” Why is this? What is the ROOT cause of these shortages? if physicians like her desire the drugs, and they are older medications not on patent, what exists to prevent a multitude of companies from making life saving medications.

7. For Leigh Purvis, please describe the AARP relatonship with the following:

With insurance companies: What percent of AARP revenue comes from selling Medicare Advantage plans, supplement plans and Part D Plans?

With United health care’s PBM Optum: Do you or anyone on this panel encourage Medicare Advantage members to have home care visits? Are you aware of these visits increasing risk scores and causing more medicare money on these patients? https://ip4pi.wordpress.com/2019/01/24/corporate-giants-and-the-government-revolving-door-create-costly-and-fragmented-care/

If The AARP has a  relationship with United: can you comment on the DOJ’s investigations into how United is defrauding taxpayers? https://www.acsh.org/news/2017/02/21/department-justice-believes-united-healthcare-defrauding-medicare-10885

8. Most important question for all on the panel and for every member of this committee: Do you support legalized  kickbacks for any industries in the hospital supply chain, notably GPO and PBM who do no research, no manufacture and no distribution? The kickbacks are costing the American Public $200 billion PER YEAR

Freedom does not force people off plans but gives more options.

A case-in-point on how the media can mislead you, sent in by Beverly Gossage of http://www.hsabenefitsconsulting.com/

1) CNBC professes to tell you who will lose their insurance if the ACA is repealed. Not might…WILL…they say. :/ Their number is 25 million.

2) They outline 3 groups but fail to mention that most people are in all 3 subsets. So their number is erroneous.

3) Truth: none of these people would be forced off a plan. Of course, there would be a ramp off the ACA and the current plans would be grandfathered as new options would become available subject to state regs not federal. States can amend their regs to tailor them to their state.

4) Freedom does not force people off plans but gives more options.

$$$ from PBMs, GPOs, and Pharma Flooding into the US Congress DC Swamp

Desperate to preserve the status quo, PBMs and Pharma are flooding the swamp with dollars to buy the votes of policymakers.

Beverly Gossage of hsabenefitsconsulting.com sends in this intel from MorningConsult.com:

  • In the first quarter of 2019, the trade group representing pharmacy benefit managers, the Pharmaceutical Care Management Association, spent $1.49 million on lobbying, breaking its previous spending records for a three-month span, as pharmacy benefit managers fight a proposal from the Trump administration that would fundamentally alter the current rebate system. The pharmaceutical company trade group, PhRMA, spent $9.91 million during the quarter.

Dr. Marion Mass notes that the “1.4 million spent by PBM‘s in the first quarter represents three large companies mostly. That’s about a half 1 million for company… The trade group Pharma Represents approximately 35 companies… While it’s a lot to spend a quarter of a million dollars per company, it’s half the amount per company that the PBMs are spending.

Don’t forget the lobbying dollars, reminds Dr. Mass, that Group Purchasing Organizations, (PBMs’ cousins that manage medical supplies and drugs in hospitals) are lavishing on Congress to keep their kickback dollars flowing:

Just two examples of  GPO lobbying efforts include:

Vizient, Inc.:

vizient

https://www.opensecrets.org/lobby/clientsum.php?id=D000058234&year=2018

Premier, Inc.:

premier

https://www.opensecrets.org/orgs/toprecips.php?id=D000028434&cycle=2018

The propaganda and bribes from the PBMs and GPOs may be losing their effect as more and more members of Congress are waking up to the reality that middlemen are harming patients by driving up costs, in often hidden ways, without adding any corresponding benefits.

Senator John Cornyn, writes: “One family from the Dallas area told me they struggle to pay for their nine-year-old son’s insulin, which must be filled in a three-month supply, and costs $1,200. … Finding the culprit behind these increasing prices isn’t easy…. Part of the reason it’s so complex is because of the pharmacy benefit managers who negotiate prices with manufacturers. The rebates they provide should lower the price for patients, but the terms of these rebates, including dollar amounts and incentives, are often cloaked in secrecy, making it nearly impossible to follow the money. This lack of transparency for the consumer is alarming, and it’s clear that without action, the problem will only get worse.”

https://www.statesman.com/opinion/20190428/cornyn-prescription-for-affordable-medications 

[Sen. Cassidy is pictured in the above Tweet helpfully exposing the magnitude and growth of revenue retained by PBMs.  Will he be as outspoken about ending the graft by GPOs given that he is the top recipient of contributions connected to Premier, Inc. the GPO for 76 percent of U.S. community hospitals?

It is past time to excise the middlemen! One big step in the right direction would be to ensure that middlemen stop pocketing kickbacks disguised as rebates. Any discounts should be passed through directly to patients. And administrative fees paid to the middlemen must not be tied to list prices gamed to earn the biggest payment.

Here’s how to start unwinding the perverse incentives:

Help be a part of the solution. Learn more at: http://nomiddlemen.org.

No More Middlemen! Reduce Drug costs and stop medication shortages!

Guest post by By: Holly L. Thacker, MD

Why Is There An Increase in Medication Costs?

I recently read a heart wrenching story about a young man with type 1 diabetes who died from preventable ketoacidosis. Since the cost of life saving insulin has sky rocketed, he was parsing out his insulin until his next paycheck as he couldn’t afford his insulin and died just three days before he was to get his next paycheck.

In my three decade career in the field of medicine, I have seen the emergence of so called ‘middlemen’ who control the market. These Group Purchasing Organizations (GPO) and Pharmacy Benefit Managers (PBM), dubbed as “Programs Bilking Millions” by our Cleveland Clinic Chief Pharmacy Officer Scott Knoer, emerge due to a loop hole in a federal law that allows for legalized kickbacks to these middlemen who control the market. This has led to increased costs of medicines and medical supplies and critical drug shortages.

For years, many of my patients used CanadaDrugs.com to get the same medicine at a fraction of the cost. However, this website has been shut down and it is illegal to get medications from another country. Daily, my nurses and Specialized Women’s Health fellows give patients information on how to reduce cost of their medications, including looking through coupons and trying to find rebates, ironically funded by some of these middlemen! We have told our patients to ask about the ‘cash price’ for medications as they are sometimes cheaper in cash without insurance as opposed to using medication insurance that is controlled by the PBMs.

I find that many of my patients are NOT aware of these GPO and PBM contracts. These contracts are highly lucrative for the middlemen and are this highly guarded and sadly a well-kept secret.

What Can Be Done About Expensive Medications?

1. We need to REPEAL this safe harbor loophole to reduce medication costs and end deadly drug shortages.

2. You can contact your two U.S. Senators and your U.S. House Representative.

3. Call and email your elected representatives. You can google to find your representative and call or email in just a few minutes.

4. Watch the video. Share this information with your friends and family.

5. I have become involved in the group Physicians Against Drug Shortages (PADS).

This is a bi-partisan issue, one that affects everyone regardless of political stripes. Both sides of the aisle are lobbied regularly to keep these kickbacks and control of the market in place.

Repeal of GPO Kickback Safe Harbor

It is critical that the GPO Kickback Safe Harbor {42 CFR § 1001.952} gets repealed as it:

  • Increases health care costs
  • Causes the unprecedented drug price spikes
  • Causes dangerous, even fatal shortages that began in 2006

It has been estimated that by eliminating these kickbacks in the healthcare supply chain we can save between $30 to $90 BILLION per year based upon published analyses.

If we can restore the drug marketplace so that inexpensive and available generic medications can become available to patients and rejuvenate the generic drug manufacturing industry in the U.S., it would allow for more competition, better prices and more available life-saving medications and supplies. Competition creates low prices and abundant supply. Competition lowers prices and improves quality. However, middlemen cartels inflate prices and can cause scarcity.

Be Strong. Be Healthy. Be in Charge!

-Holly L. Thacker MD

Fact Checking Sen. Menendez ACA Diatribe

Dear Senator Menendez,

As a N.J. citizen, taxpayer, physician, husband and father, I must offer factual correction on your healthcare policy ACA diatribes.

You tweeted:

Nothing could be further from the truth in your partisan message:

1. Insurance coverage is not healthcare.
2. Forcing citizens into ACA Medicaid at taxpayer expense is foolhardy.
3. ACA through “guaranteed issue(preexisting conditions)” destroyed the risk pools that kept prices stable. Now ALL commercial plans premiums have doubled and tripled.
4. The individual insurance market was decimated by ACA, destroying any semblance of insurance competition.
5. ACA put most private practice independent physicians, that are more efficient and cheaper, out of business and working for hospitals. As you know, hospitals inflated pricing schemes also extorts taxpayer dollars
6. ACA also pushed insurers toward “narrow networks.” eliminated patients long-term relationships with physicians and further limited their choice of physician and facility.
7. ACA and forced government dependence will bankrupt the country and its citizens, as a whole and individually.
8. Remember the three big lies of Obamacare? Keep your doctor. Keep your insurance. Each family will save $2500. All proven false partisan narrative.
9. Attacking the president of the United States is a waste of time, money and energy when he would gladly work with you on these issues.

I would be glad to work with you and other legislators on competitive free-market plans and assure quality and give patients best choice and restore personal responsibility and freedom.

Sincerely
Craig M. Wax DO
Independent family physician, media host and healthcare policy expert

Senator Menendez: Stand Up Against Killer Kickbacks

Call Senator Menendez office today! (202) 224-4744 

Give him key questions to ask at tomorrow’s Senate meeting on PBM‘s. Please read below and call today. 

Dear Senator Menendez,

You are aware that the Senate Finance Committee meets on Tuesday, April 9, 2019,  to question Pharmacy Benefit Managers.I am truly sorry that none of the Senatorial staff from NJ could attend the meeting on April 1, at the Library of Congress. I am proud to have been intimately involved in the planning and execution of that meeting along with many others that have fresh working solutions for our health care crisis.  Patient advocates and physicians from across the aisle and across the country came together. We were especially moved by the presence of the Black Healthcare Coalition,  a group of 3000 pastors from across the country who are leaders for their African-American congregations.  It has been eye-opening for the Black Healthcare Coalition to learn their congregations are being targeted by the PBMs and GPOs, as is the rest of the nation.  The Safe Harbor for Legalized kickbacks for PBM and GPO cause artificial medication shortages and forces those with preexisting conditions to pay exorbitantly at the pharmacy counteror skip taking their medication(s) altogether. As Pastor Stephan Broden   framed the issue of legalized kickbacks, “It’s time for us to take this to the streets… because people are getting hurt.“

Congress is responsible for legalizing kickbacks for the GPO’s in 1987.  In 2003, the PBM’s  had legalized kickbacks extended to their industry.  The pay-to-play scheme for GPO is controlling which brand medications, solutions and devices are available in hospitals.   The PBM pay-to-play scheme is controlling what prescription meds are covered by insurance plans.   Patients and physicians are confronting life-threatening issues for patients, and neither the patients or physicians have any control.

Of the 150 drug shortages currently listed by the FDA,  roughly 90% of those medications have a single manufacturer because they bought the right to “sole-source contracting.” This unethical business practice by the PBMs was exposed in the second Senate Finance Committee hearings on February 26, 2019. I saw you both in attendance at that hearing, Senators.  I watched the hearing; many patients and physicians watched it, many of your constituents, and some are copied on this email.

Senator, you took an oath, just as physicians have taken an oath.  And we are fulfilling the Hippocratic Oath in the best way we know how, by speaking out for our patients who are hurt by continual drug shortages,  and high prices at the pharmacy counter and on hospital bills.Social media, The Black  congregations, the Hispanic population (Dr Wust Smith,  Pa pediatrician,  who is writing for the Hispanic outlook magazine and also attended the conference ) and the 1.8 million member Association of Mature American Citizens (also  in attendance Monday)  are all solidly behind repealing kickbacks for organizations who are robbing the American public of $200 billion a year while offering no research and development no manufacturing,  not even distribution of medications. As Pastor Broden says, “ We are gonna shine light and Make noise!”

Will you stand up for patients and the citizens of New Jersey, Senator Menendez, and ask the PBMs the following questions this Tuesday?

  1. How much do they take in rebates (kickbacks) from drug manufacturers and others. He should follow up with where do the so-called rebates go? They are supposed to go to the plan sponsor, employer, or individual purchasing the policy to keep prices down. They actually drive up prices and costs for all.
  2. Senator Menendez should insist that the PBMs make their rebates(kickbacks) transparent and report them to HHS, CMS, Congress and the public at large.
  3. Senator Menendez should advocate for the transparency and public report for all processes and payments by PBMs.
  4. Recommend that he advocate Senate and House to repeal the PBM safe harbor of 2002 that empowered PBMs to extort drug manufacturers for kickbacks called rebates, at the expense of patients, third parties, states, fed, and all taxpayers.
  5. Full repeal of 2002 PBM safe harbor for not only Medicare and Medicaid but also all payers including commercial and individual payors.

Senator, we are here to help you  take steps that are righteous and good in order to get our patients what they need which is affordable prescription medications, transparency of price and accessible quality healthcare.

Lastly, we would like to know  your position on the kickbacks themselves? Are you going to support Senator Braun’s Bill which will codify the Azar rebate rule as well as extend kickback repeal to the general insurance marketplace?

Simply put we are asking you, “do you stand for patients or do you stand for profits?”