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?”

The fatal flaw, or poison pill, of our entire healthcare system … is we’ve tried to make it a system.

Robert Nelson MD of the Georgia Chapter, Free Market Medical Association, writes in:

The fatal flaw, or poison pill, of our entire healthcare system, is that we’ve tried in vane to make it a system.

We set aside everything we knew about human behavior and motivation and behavioral economics and pretended it didn’t exist. We based interventional policy on myths such Roemer’s Law. We tied it to employment by using the tax code. We handicapped markets with McCarran-Ferguson. We handicapped Physicians and other providers with HIPAA. We perverted insurance with all manner of mandate such that it violated every principle of what insurance is supposed to do. This has created Health insulation rather than health insurance.

Then the geniuses thought they can fix it with HMO and then PPOs and now ACOs and all the rest of the alphabet soup that they serve up. All of this has one thing in common and that is price opacity. We have not had a market failure we’ve had one giant pricing failure. We put healthcare on an island and treated it differently and treated it weirdly and regulated it excessively.

Many have gotten wealthy but patients are suffering and doctors are demoralized.

New Medicare MACRA/MIPS Penalty Hits Solo & Small Groups Hardest – Open Letter to AOA and AMA

Dear AOA and AMA leadership,
Has anyone at AOA and AMA that enthusiastically supported MACRA actually taken the time to read it this week(links below)? It is a statisticians nightmare. When applied to the practice of medicine, it is a plague. It is more onerous than meaningful use and the sustainable growth rate that it replaces. Not only does it penalize solo and small practice physicians, but controls the practice of medicine through reimbursement and procedure micromanagement based on government MIPS data. 
We practicing physicians knew this when the AOA and AMA were busy jumping on the government bandwagon for change at any price. We are out of the frying pan and into the fire, ladies and gentlemen.
What will the AOA and AMA do to champion the cause of solo and small practice private medicine in the face of ACA, ACO and MACRA disaster? Try DPC-Direct primary care unhindered by government and third parties.
Everyone at AOA and AMA should attempt to read it as we concerned physicians are this week.
Commentary:
Whole MACRA here:
Best wishes for good health,

Craig M. Wax, DO
Family Physician
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax

MACRA/HR2 is a death knell for professional integrity and a danger to patients

Doctor Robert Geist writes his Senators:

Please vote NO on HR-2, the current SGR “doc fix” bill. Repeal is necessary; but not this version.

Here is what the bill really does: “…shifting Medicare reimbursement from fee-for-service to pay- for-performance.” This is Orwellian double-speak for P4P “value” pay; the PPACA cost control stratagem, which only reproduces decades of the failed HMO capitation experiment.

Why is this not good?

1) The bill is a death knell for professional integrity—a serious danger to patients. Doctors at the bedside are literally paid (“bonus rewards”) for restricting use of “payer” money (government/corporate) for patient care under the guise of “stewardship”, “value pay”, “choosing wisely”, or whatever slogans can sell this bedside gatekeeper rationing bill. Continue reading