Take Action by Jan 11: Eliminate the #GPO #PBM Middlemen #Safeharbor Creating Drug Shortages and High Prices

“Drug shortages are pretty much a daily disaster right now for most hospitals,” reported Pharmacy Times on December 10. Meanwhile, “The US Food and Drug Administration (FDA) is not just seeing an increase in drug shortages but also a spike in the intensity and duration of shortages,” writes Zachary Brennan, summarizing conclusions from an FDA event last month.

This summer FDA Commissioner Scott Gottlieb, MD convened a Drug Shortage Task Force “to seek root causes of drug shortages and potential enduring solutions.”

The Task Force has issued a request for public comment as it prepares a report to Congress, and the deadline to submit solutions is January 11. Please help us, your colleagues, and your patients, take advantage of this opportunity to share a few key ideas with the Task Force.

Here’s how you can help! Continue reading

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The Ho$pice Hu$tle?

What’s going on with the recent flurry of acquisitions and divestment in the Hospice industry. IP4P asked HIT-industry veteran Barbara Duck (@MedicalQuack) to weigh in:

“Optum certainly kept this very quiet when they sold their hospice facilities to Compassus; however, they are not out of the business, they want to manage it instead, just as they manage surgeons and physicians with Surgical Care Affiliates and OptumCare doctors.  The worst nightmare for those in hospice has come true, the thought of Optum utilization managers running around Compassus Hospice facilities as they intend now to use Optum Hospice Services to manage them.  Hospice care by the algorithms is what we are looking at here with even more undue and not proven analytical scoring of patients taking place at their last days of their lives.  I think the screen from the PowerPoint presentation on the revenue growth here tells the story of what this company’s (Compassus) goals are, revenue and not patient care being the first priority. Continue reading

PBMs Invade Medical Records and Cash-Pay RX Discount Cards

We wrap up 2017 with a guest post from friend of IP4PI Barbara Duck (@MedicalQuack):

This should not really come as a big surprise as what hasn’t the pharmacy benefit managment business touched?  So what is OptimizeRX?  Most have probably not heard of this software but it is a connect to EMRs that will send your prescription right to the pharmacy.  Oh, now you say, well imagethe PBMs do that and they do but what they have been missing is a way to collect data on patients who are not using their PBM prescription card or those who do not have one.  It’s all about getting more data about you to “score” and of course sell those scores to insurers and other interested parties.  Once the pharmacy has the transaction, it does not fall under HIPAA rules as it’s a prescription, linked to an EMR to provide a transaction.  As we all know, your medications in an EHR are protected but again, I’ll repeat this for those who still think HIPAA is covered at the pharmacy, it is not.  It’s been a sore spot for years with privacy. Continue reading

Killer Algorithms at the Drug Store

Guest post by Barbara Duck, @MedicalQuack: http://ducknetweb.blogspot.com/

Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug Store

Here we go again.  If you haven’t figured this out yet, when you buy a Cigna Health insurance policy you get a two for one with 2 insurers.  Cigna provides the insurance benefits and then it’s pharmacy benefit manager, PBM OptumRX (biggest revenue sector subsidiary of United Healthcare) that runs all their formulas via the computer and tells the pharmacist what to charge you.  (Video at the break below-watch it!)

If You Are Insured byCigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Continue reading

Consumers at Risk! The Truth About Prescription Discount Cards

One thing we all hate is the high prices we pay in the US today for our prescriptions.  Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price.  It shouldn’t have to be that way,image but it is as that’s how the systems have been built.  There are a ton of discount prescription cards floating around out there and they all vary in one way or another, but the big thing to remember about all of them is that they are a marketing firm that can and will sell your data to make money.  In addition, the discount cards act just like a pharmacy benefit manager with getting all your information when you use them to fill a prescription.  In addition, some of them offer referral fees so they can increase the size of their data base of patient information.  Data means money today and it can be repackaged and resold over and over, and yes, that’s us. Continue reading

Patients Suffer When the Government Plays Doctor

Guest Post by Gina Reghetti, D.O.

I believe that the United States’ Addiction problem is no accident. I believe it was created and supported via the USA’s government in an attempt to “dumb-down” our people, and easily control them through mandates and force. They wish to totally infiltrate medicine through their healthcare agendas, and knock doctors out of their own profession, and take medicine over entirely so that they can easily control peoples’ lives.

No other diseases, except Opioid Addictions are now regulated and controlled through the judicial system, the legal system, through “Drug-Courts” where judges over-rule the decisions of doctors when they treat patients that are suffering from Opioid Addictions. The judges are not helping the individuals, they are harming them by not following the advice of the patients’ doctors!

The Government, or the Judicial system, never request help from the treating physicians but always goes against what the doctors’ orders are. This tells me very clearly that their agendas are not to help individuals but are to seriously harm them, keep them labeled, and down, so that continued failure is in their future, not wellness, and success. Continue reading

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Guest Post From Barbara Duck, Proprietor of The Medical Quack Blog

imageFirst question out of the barrel might be “how can that be”.  It’s really not too difficult to figure out.  A short while back United Healthcare bought a pharmacy benefit manager named Catamaran, and actually took on $10 billion in debt to acquire them.  This has been in the news for a while actually, so how did you end up with United Healthcare.  It’s easy, Catamaran is the Pharmacy Benefit Manager for Cigna, so when United bought the company, it became a subsidiary of United Healthcare, so there you go.  The company is now a subsidiary of the huge too big to fail health insurer, who actually gets 2/3rds of their revenue from insurance policies and the rest from selling software and algorithms for a big chunk of the other third. Continue reading