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

Taming the MACRA Beast of Quantitated Madness

Guest Post from Barbara Duck: http://ducknetweb.blogspot.com/

The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True

I’ve been watching this for years with the way healthcare is changing in the US today and we certainly need and do use constructive and good measurements in what the industry does, but just like in the financial world, we’re starting to cross some borders here into madness where mathematical models with “no” proof of concept even are producing numbers that don’t compute and host environments that are hostile to the future of providing good care.  In other words, it’s time to take to take a step back and look at where we are and it’s not pretty nor productive in a lot of business areas today. 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

MOC: This Abuse Has to End NOW

Dr. Ken Lee weighs in on KevinMD blog post “The Real Cost of MOC is Stunning” :

This profession is too used to abuse . It begins in pre-med, medical school and our training as “students” where our US labor rights are violated. Even college athletes have won a Federal case to get classified as employees of the colleges that were using them as “students”.

We have to influence our colleagues to stop swallowing each cup of poison they want us to drink. The costs of MOC for Int Med exceeds what I get paid from any contract I have with United, Aetna or Cigna, making the MOC a huge loss anyway you look at it. The summer months are supposed to be slow for medical care but I was seeing 23 patients a day with another 90 minutes of computer work at night to just do the documentation, MU, PQRS etc.

The only way I could do MOC is to not sleep or sacrifice my family time which my wife says will never happen again as she has seen hundreds of hours lost in the past due to the re-certification exams. I have lost entire weeks of my life for this certification scam.

The human cost of MOC is not fully exposed and must be. The hundreds of hours of our scarce free time is lost for trivial pursuit that we all know does NOT improve patient care ( 2 JAMA studies 2014 prove this ) . The psychological toll of fear , potential loss of income and actual loss of money on this coercion is glossed over, as if we were all CEOs making $4million a year at a non-profit hospital.

I never see written interviews of the families who suffer the absence of a parent who is hostage to recertification /MOC; what does it do to them? This abuse has to end now . People call us doctor which seems to elevate us but in reality we have become almost slaves. One of my long times friends finally got his BA degree and he runs a hospital physician system that employs 22 MD/DOs ; they have to answer to him . So much for the doctor title.

Ken Lee , Internal Medicine, private practice.