MESSAGE
| DATE | 2019-01-26 |
| FROM | Ruben Safir
|
| SUBJECT | Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
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On 1/23/19 11:57 PM, Ruben Safir wrote:
>
> The profession of pharmacy is being strangled to death by the Pharmacy
> Benefit Management Companies, especially Express Scripts and CVS
> Carmark. Pharmacist do valuable jobs, and earn their pay by working
> with the entire scope of the healthcare system. My entire life has been
> committed to helping patients across New York City, amongst nearly all
> ethnic groups and economic classes and a through a wide swath of
> neighborhoods in the five boroughs, from the Upper East Side of
> Manhattan to East New York. I’ve worked for Veterans, in hospitals, in
> chain drug stores and in independent pharmacies. Independent pharmacy
> has been the linchpin to my career. There have been years, even
> decades, when chain drug stores and hospitals had refused to hire
> Orthodox Jews. Without independent pharmacy, my career would have ended
> in the 1990’s. It was only because of the pharmacist shortage that
> civilian positions started to open among chains and hospitals, and only
> as floating pharmacists, or working through agencies.
>
> In my years of experience in independent pharmacy, I’ve come to work
> with and help communities on a deeply personal level. I’ve had to work
> with Holocaust survivors that had been inadvertently become addicted to
> narcotics while looking after their mental health and families. I’ve
> had to work with AIDs patients as they were dying and to mediate with
> their families and the broader medical establishment as they were used
> as human guinea pigs for experimental treatment that most often didn’t
> work. I have had to call hospital clinics to intercede for impoverished
> patients who left outpatient facilities at major city hospitals, with
> Maalox prescriptions, as they were doubled over in pain at my counter,
> obviously in life threatening conditions, but ignored by the clinics due
> to their minority status and their history of drug abuse. Twice such
> interactions had saved patients from bleeding ulcers which would have
> killed them, as evident by their being then admitted for emergency
> services and surgery after I reached attending doctors directly.
>
> I’ve also had to deal with my fair share of attempts at fraud. I’ve had
> to turn down Immigrant patients with books of prescriptions, trying to
> get money for prescriptions multiple times, and try to figure out when
> they really needed treatments or were just conning the system. Drug
> abusers, pimps, scam artists, workman comp scammers, etc have all had to
> be vetted at my door. And while not perfect, I have dealt with these
> cases with honesty and to the best of my ability, and in return, I have
> been appreciated by families of all backgrounds, in conditions that are
> unique to New York City.
>
> In today’s hostile environment, every day I go to work knowing that law
> enforcement looks at me as a criminal more than an asset. And every day
> I come home without being investigated, I feel like I’ve put my head in
> the lions mouth and escaped, yet one more time.
>
> More than once I have left employment over ethical issues from
> hospitals, chains and independent ownership. I’ve seen Duane Read put
> thousands of dollars of inventory in conditions that render the drugs at
> best impotent in a Midtown location. I’ve dealt with hospitals who let
> premature babies die because of failure to get needed IV orders to
> floors on over night shifts. I’ve seen numerous pharmacies being run
> without pharmacist, especially in Elmhurt Queens because of a basic
> failure of the Board of Pharmacy to enforce the law. I reported
> narcotics loses to one hospital administration and was then fired. I’ve
> had to deal with corruption in OMIG which nearly cost me my career for
> no cause other than doing my job and keeping the public trust.
>
> What I do, is deep in the trenches of the healthcare system and it
> provide an invaluable service to the community. But my career has been
> destroyed by the fraud and greed of the Pharmacy Benefits Management
> companies who has promised New Yorkers to control costs and to improve
> access, but instead act to prevent access, and have raised costs.
> Specifically they have targeted the city’s outer boroughs, Brooklyn, the
> Bronx and even Queens for discriminatory practices designed to crush my
> profession for their own profits, and the biggest targets of all are in
> minority communities.
>
> To be continued...
>
>From the NY Times:
BTW - the Pharmacy loses money for EVERY INSULIN that is prescribed
regardless of the "formulary" requirments (about $40 a prescription)
https://www.nytimes.com/2019/01/18/opinion/cost-insurance-diabetes-insulin.html?fbclid=IwAR0ueEilPKvn1FPGLuXD1GhnVkRgLDvEwd9o3QynD7pw5XyvvikBezeyWX8
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~`
The Insulin Wars
How insurance companies farm out their dirty work to doctors and patients.
By Danielle Ofri
Dr. Ofri practices at Bellevue Hospital in New York.
Jan. 18, 2019
Image
CreditCreditIllustration by Joan Wong; Photographs by Westend61/Getty
Images and malerapaso/Getty Images
“Doctor, could you please redo my insulin prescription? The one you gave
me is wrong.” My patient’s frustration was obvious over the phone. She
was standing at the pharmacy, unable to get her diabetes medication.
We had gone through this just the week before. I’d prescribed her the
insulin she’d been on, at the correct dosage, but when she showed up at
her pharmacy she learned that her insurance company no longer covered
that brand. After a series of phone messages back and forth, I’d redone
the prescription with what I’d thought was the correct insulin, but I
was apparently wrong. Again.
Between 2002 and 2013, prices tripled for some insulins. Many cost
around $300 a vial, without any viable generic alternative. Most
patients use two or three vials a month, but others need the equivalent
of four. Self-rationing has become common as patients struggle to keep
up. In the short term, fluctuating blood sugar levels can lead to
confusion, dehydration, coma, even death. In the long term, poorly
controlled diabetes is associated with heart attacks, strokes,
blindness, amputation and the need for dialysis.
The exorbitant prices confound patients and doctors alike since insulin
is nearly a century old now. The pricing is all the more infuriating
when one considers that the discoverers of insulin sold the patent for
$1 each to ensure that the medication would be affordable. Today the
three main manufacturers of insulin are facing a lawsuit accusing them
of deceptive pricing schemes, but it could be years before this yields
any changes.
There are several reasons that insulin is so expensive. It is a biologic
drug, meaning that it’s produced in living cells, which is a difficult
manufacturing process. The bigger issue, however, is that companies
tweak their formulations so they can get new patents, instead of working
to create cheaper generic versions. This keeps insulin firmly in
brand-name territory, with prices to match.
But the real ignominy (and the meat of the lawsuit) is the dealings
between the drug manufacturers and the insurance companies. Insurers use
pharmacy benefit managers, called P.B.M.s, to negotiate prices with
manufacturers. Insurance programs represent huge markets, so
manufacturers compete to offer good deals. How to offer a good deal?
Jack up the list price, and then offer the P.B.M.s a “discount.”
This pricing is, of course, hidden from most patients, except those
without insurance, who have to pay full freight. Patients with insurance
live with the repercussions of constantly changing coverage as P.B.M.s
chase better discounts from different manufacturers.
All insurance companies periodically change which medications they
cover, but insulin is in a whirlwind class by itself because of the
staggering sums of money involved. “Short-acting” is supposed to be a
category of insulin, but now it appears to be its category of insurance
coverage. My patient’s “preferred insulin” changed three times in a
year, so each time she went to the pharmacy, her prescription was rejected.
On the doctor's end, it’s an endless game of catch-up. Lantus was
covered, but now it’s Basaglar: rewrite all the prescriptions for all
your patients. Oops, now it’s Levemir: rewrite them all again. NovoLog
was covered, then it was Humalog, but now it’s Admelog. If it’s Tuesday,
it must be Tresiba.
It’s a colossal time-waster, as patients, pharmacists and doctors log
hours upon hours calling, faxing, texting and emailing to keep up with
whichever insulin is trending. It’s also dangerous, as patients can end
up without a critical medication for days, sometimes weeks, waiting for
these bureaucratic kinks to get ironed out.
Lost in this communal migraine is that this whole process is corrosive
to the doctor-patient relationship. I knew that my patient wasn’t angry
at me personally, but her ire came readily through the phone. No doubt
this reflected desperation — she’d run out of insulin before and didn’t
want to end in the emergency room on IV fluids, as she had the last
time. Frankly, I was pretty peeved myself. By this point I’d already
written enough insulin prescriptions on her account to fill a sixth Book
of Moses. I’d already called her insurance company and gotten tangled in
phone trees of biblical proportions.
This time I called her pharmacy. A sympathetic pharmacist was willing to
work with me, and I stayed on the phone with her as we painstakingly
submitted one insulin prescription after another. The first wasn’t
covered. The second wasn’t covered. The third was. But before we could
sing the requisite hosannas, the pharmacist informed me that while the
insulin was indeed covered, it was not a “preferred” medication. That
meant there was a $72-per-month co-payment, something that my patient
would struggle to afford on her fixed income.
“So just tell me which is the preferred insulin,” I told the pharmacist
briskly.
There was a pause before she replied. “There isn’t one.”
This was a new low — an insurance company now had no insulins on its top
tier. Breaking the news to my patient was devastating. We had a painful
conversation about how she would have to reconfigure her life in order
to afford this critical medication.
It suddenly struck me that insurance companies and drug manufacturers
had come upon an ingenious business plan: They could farm out their
dirty work to the doctors and the patients. Let the doctors be the ones
to navigate the bureaucratic hoops and then deliver the disappointing
news to our patients. Let patients be the ones to figure out how to
ration their medications or do without.
Congress and the Food and Drug Administration need to tame the Wild West
of drug pricing. When there’s an E. coli outbreak that causes illness
and death, we rightly expect our regulatory bodies to step in. The
outbreak of insulin greed is no different.
It is hard to know where to direct my rage. Should I be furious at the
drug manufacturers that refuse to develop generics? Should I be angry at
the P.B.M.s and insurance companies that juggle prices and formularies
to maximize profits, passing along huge co-payments if they don’t get a
good enough deal? Should I be indignant at our elected officials who
seem content to let our health care system be run by for-profit entities
that will always put money before patients?
The answer is all of the above. But what’s most enraging is that drug
manufacturers, P.B.M.s and insurance companies don’t have to pick up the
pieces from the real-world consequences of their policies. That falls to
the patients.
Danielle Ofri is a physician at Bellevue Hospital and the author of
“What Patients Say, What Doctors Hear.”
--
So many immigrant groups have swept through our town
that Brooklyn, like Atlantis, reaches mythological
proportions in the mind of the world - RI Safir 1998
http://www.mrbrklyn.com
DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
http://www.nylxs.com - Leadership Development in Free Software
http://www.brooklyn-living.com
Being so tracked is for FARM ANIMALS and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
--
So many immigrant groups have swept through our town
that Brooklyn, like Atlantis, reaches mythological
proportions in the mind of the world - RI Safir 1998
http://www.mrbrklyn.com
DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
http://www.nylxs.com - Leadership Development in Free Software
http://www2.mrbrklyn.com/resources - Unpublished Archive
http://www.coinhangout.com - coins!
http://www.brooklyn-living.com
Being so tracked is for FARM ANIMALS and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
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