Thu Oct 3 09:25:49 2024
EVENTS
 FREE
SOFTWARE
INSTITUTE

POLITICS
JOBS
MEMBERS'
CORNER

MAILING
LIST

NYLXS Mailing Lists and Archives
NYLXS Members have a lot to say and share but we don't keep many secrets. Join the Hangout Mailing List and say your peice.

DATE 2018-05-01

HANGOUT

2024-10-03 | 2024-09-03 | 2024-08-03 | 2024-07-03 | 2024-06-03 | 2024-05-03 | 2024-04-03 | 2024-03-03 | 2024-02-03 | 2024-01-03 | 2023-12-03 | 2023-11-03 | 2023-10-03 | 2023-09-03 | 2023-08-03 | 2023-07-03 | 2023-06-03 | 2023-05-03 | 2023-04-03 | 2023-03-03 | 2023-02-03 | 2023-01-03 | 2022-12-03 | 2022-11-03 | 2022-10-03 | 2022-09-03 | 2022-08-03 | 2022-07-03 | 2022-06-03 | 2022-05-03 | 2022-04-03 | 2022-03-03 | 2022-02-03 | 2022-01-03 | 2021-12-03 | 2021-11-03 | 2021-10-03 | 2021-09-03 | 2021-08-03 | 2021-07-03 | 2021-06-03 | 2021-05-03 | 2021-04-03 | 2021-03-03 | 2021-02-03 | 2021-01-03 | 2020-12-03 | 2020-11-03 | 2020-10-03 | 2020-09-03 | 2020-08-03 | 2020-07-03 | 2020-06-03 | 2020-05-03 | 2020-04-03 | 2020-03-03 | 2020-02-03 | 2020-01-03 | 2019-12-03 | 2019-11-03 | 2019-10-03 | 2019-09-03 | 2019-08-03 | 2019-07-03 | 2019-06-03 | 2019-05-03 | 2019-04-03 | 2019-03-03 | 2019-02-03 | 2019-01-03 | 2018-12-03 | 2018-11-03 | 2018-10-03 | 2018-09-03 | 2018-08-03 | 2018-07-03 | 2018-06-03 | 2018-05-03 | 2018-04-03 | 2018-03-03 | 2018-02-03 | 2018-01-03 | 2017-12-03 | 2017-11-03 | 2017-10-03 | 2017-09-03 | 2017-08-03 | 2017-07-03 | 2017-06-03 | 2017-05-03 | 2017-04-03 | 2017-03-03 | 2017-02-03 | 2017-01-03 | 2016-12-03 | 2016-11-03 | 2016-10-03 | 2016-09-03 | 2016-08-03 | 2016-07-03 | 2016-06-03 | 2016-05-03 | 2016-04-03 | 2016-03-03 | 2016-02-03 | 2016-01-03 | 2015-12-03 | 2015-11-03 | 2015-10-03 | 2015-09-03 | 2015-08-03 | 2015-07-03 | 2015-06-03 | 2015-05-03 | 2015-04-03 | 2015-03-03 | 2015-02-03 | 2015-01-03 | 2014-12-03 | 2014-11-03 | 2014-10-03 | 2014-09-03 | 2014-08-03 | 2014-07-03 | 2014-06-03 | 2014-05-03 | 2014-04-03 | 2014-03-03 | 2014-02-03 | 2014-01-03 | 2013-12-03 | 2013-11-03 | 2013-10-03 | 2013-09-03 | 2013-08-03 | 2013-07-03 | 2013-06-03 | 2013-05-03 | 2013-04-03 | 2013-03-03 | 2013-02-03 | 2013-01-03 | 2012-12-03 | 2012-11-03 | 2012-10-03 | 2012-09-03 | 2012-08-03 | 2012-07-03 | 2012-06-03 | 2012-05-03 | 2012-04-03 | 2012-03-03 | 2012-02-03 | 2012-01-03 | 2011-12-03 | 2011-11-03 | 2011-10-03 | 2011-09-03 | 2011-08-03 | 2011-07-03 | 2011-06-03 | 2011-05-03 | 2011-04-03 | 2011-03-03 | 2011-02-03 | 2011-01-03 | 2010-12-03 | 2010-11-03 | 2010-10-03 | 2010-09-03 | 2010-08-03 | 2010-07-03 | 2010-06-03 | 2010-05-03 | 2010-04-03 | 2010-03-03 | 2010-02-03 | 2010-01-03 | 2009-12-03 | 2009-11-03 | 2009-10-03 | 2009-09-03 | 2009-08-03 | 2009-07-03 | 2009-06-03 | 2009-05-03 | 2009-04-03 | 2009-03-03 | 2009-02-03 | 2009-01-03 | 2008-12-03 | 2008-11-03 | 2008-10-03 | 2008-09-03 | 2008-08-03 | 2008-07-03 | 2008-06-03 | 2008-05-03 | 2008-04-03 | 2008-03-03 | 2008-02-03 | 2008-01-03 | 2007-12-03 | 2007-11-03 | 2007-10-03 | 2007-09-03 | 2007-08-03 | 2007-07-03 | 2007-06-03 | 2007-05-03 | 2007-04-03 | 2007-03-03 | 2007-02-03 | 2007-01-03 | 2006-12-03 | 2006-11-03 | 2006-10-03 | 2006-09-03 | 2006-08-03 | 2006-07-03 | 2006-06-03 | 2006-05-03 | 2006-04-03 | 2006-03-03 | 2006-02-03 | 2006-01-03 | 2005-12-03 | 2005-11-03 | 2005-10-03 | 2005-09-03 | 2005-08-03 | 2005-07-03 | 2005-06-03 | 2005-05-03 | 2005-04-03 | 2005-03-03 | 2005-02-03 | 2005-01-03 | 2004-12-03 | 2004-11-03 | 2004-10-03 | 2004-09-03 | 2004-08-03 | 2004-07-03 | 2004-06-03 | 2004-05-03 | 2004-04-03 | 2004-03-03 | 2004-02-03 | 2004-01-03 | 2003-12-03 | 2003-11-03 | 2003-10-03 | 2003-09-03 | 2003-08-03 | 2003-07-03 | 2003-06-03 | 2003-05-03 | 2003-04-03 | 2003-03-03 | 2003-02-03 | 2003-01-03 | 2002-12-03 | 2002-11-03 | 2002-10-03 | 2002-09-03 | 2002-08-03 | 2002-07-03 | 2002-06-03 | 2002-05-03 | 2002-04-03 | 2002-03-03 | 2002-02-03 | 2002-01-03 | 2001-12-03 | 2001-11-03 | 2001-10-03 | 2001-09-03 | 2001-08-03 | 2001-07-03 | 2001-06-03 | 2001-05-03 | 2001-04-03 | 2001-03-03 | 2001-02-03 | 2001-01-03 | 2000-12-03 | 2000-11-03 | 2000-10-03 | 2000-09-03 | 2000-08-03 | 2000-07-03 | 2000-06-03 | 2000-05-03 | 2000-04-03 | 2000-03-03 | 2000-02-03 | 2000-01-03 | 1999-12-03

Key: Value:

Key: Value:

MESSAGE
DATE 2018-05-31
FROM Ruben Safir
SUBJECT Subject: [Hangout - NYLXS] The Pharmacy Scam continues
https://www.wsj.com/articles/why-cvs-loves-obamacare-1527633490
Why CVS Loves ObamaCare
Medicaid expansion helps big business reduce competition. Ohio is a case
study.
Why CVS Loves ObamaCare
Photo: shannon stapleton/Reuters
By The Editorial Board
May 29, 2018 6:38 p.m. ET
370 COMMENTS

Big business feasts on big government, and ObamaCare has been a bonanza
for companies that have figured out how to exploit it. Witness how CVS
Health is dining out on Ohio’s Medicaid expansion.

In addition to retail pharmacies, CVS operates a pharmaceutical benefit
manager (PBM) that acts as a middleman between insurers, pharmacies and
drug manufacturers. PBMs decide which drugs are listed on a formulary,
how much pharmacies are reimbursed and how much insurers pay.

Ohio contracts with five managed-care organizations (MCOs) to administer
Medicaid benefits, four of which outsource their drug benefits
management to CVS Caremark, the CVS PBM. The state uses drug claims data
to set its annual drug budget. So if claims increase, the state will
allocate more Medicaid funds for drugs the following year.
Foreign Edition Podcast

Yet CVS appears to be billing the state for far more than what it is
paying pharmacies, driving up taxpayer costs. CVS’s actual drug payments
aren’t transparent to the state or MCOs.

CVS is also attempting to drive independent pharmacists out of business
and expand its retail market share. We spoke with eight current or
former independent pharmacists in Ohio who complained that CVS has
slashed payment rates below the pharmacists’ wholesale drug costs. They
say CVS is pocketing the increased “spread pricing”—that is, the
difference between what the PBM pays pharmacies and charges the state.

The precondition for this Medicaid machination is ObamaCare. In the last
decade Ohio’s Medicaid enrollment has swelled by more than half to 21.4%
of the state population, driven in large part by ObamaCare’s expansion
to people earning up to 133% of the poverty line. Medicaid is now the
biggest insurer in many rural areas where independent pharmacies
predominate.
***

Independent pharmacists say they first noticed a decline in Medicaid
payment rates three years ago. CVS slashed them further last fall. For
35 years Larry Hildebrand ran a pharmacy in Marengo, a town with a few
hundred people. When he started to lose money from declining Medicaid
payments, he sold his pharmacy to CVS, which bought his drug inventory
and prescription files. After he closed, his customers had to travel 25
more miles to get prescription filled at CVS.

Dominic Bartone has been a pharmacist for 41 years and operated three
retail pharmacies in Dayton and two in Lebanon. After CVS cut payment
rates last fall, his Lebanon pharmacies were losing money on between 40
to 50 prescriptions a day. When Mr. Bartone complained to the MCOs about
below-cost reimbursements, he didn’t get a response. Eventually he had
to stop delivering prescriptions to patients in institutions. In
February he and his business partners sold the stores to CVS.

Most pharmacists don’t want to be publicly identified because their CVS
contract bars them from disclosing payment rates. But one said he was
getting paid 18 cents per capsule of the generic antidepressant
duloxetine while his wholesale cost is about 23 cents. According to
Centers for Medicare and Medicaid Services data, PBMs in Ohio last fall
were charging Medicaid $1.53 per duloxetine pill. The spread pricing for
a 60 mg dosage of duloxetine during the first nine months of 2017
totaled $6.3 million.

Several pharmacists said that they were losing between $60 and $100 last
fall on each prescription of buprenorphine, a generic opioid addiction
treatment.

Ohio state Senator Dave Burke, who runs an independent pharmacy and
serves on the state Joint Medicaid Oversight Committee, says two-thirds
of the Medicaid drug claims he processes are below his drug acquisition
cost. He’s fortunate that Medicaid patients make up less than a quarter
of his customers.

CVS payment rates, he says, are “take it or leave it.” Independent
pharmacists have no negotiating leverage. If pharmacists refuse to
accept Medicaid prescriptions, they risk losing CVS contracts for
Medicare Part D and commercial plans that typically pay more.

Some pharmacists said that after the Medicaid payment reductions they
received solicitations from CVS Pharmacy Regional Director of
Acquisitions Shane Stockton saying: “I’m a pharmacist myself. I know
what independents are experiencing right now; declining reimbursements;
increasing costs, a more complex regulatory environments. Mounting
challenges like these make selling your store to CVS Pharmacy an
attractive and practical option.”
***

In the last three years, Ohio has lost 164 independent pharmacies while
CVS has added 68. A CVS Caremark spokesperson told us that the company
maintains a firewall between its PBM and retail pharmacies as required
by a 2007 Federal Trade Commission merger agreement. CVS also says it
pays independent pharmacies on an aggregate basis more than chains,
though the spokesperson didn’t define aggregate.

When Arkansas Independent Pharmacies obtained insurance explanation of
benefits data from Medicaid patients, they found that CVS Caremark
billed Medicaid plans more than twice as much on average as what their
pharmacies got paid. Data from fully-insured commercial health plans
showed that CVS paid itself over $60 on average more per prescription
than independent pharmacists.

ObamaCare requires MCOs to spend at least 85% of all taxpayer dollars on
patient medical claims and care improvements. The rest can be split
among overhead, marketing and profits. Contracting with PBMs allows MCOs
to off-load administrative costs and thus take more profit. Rising drug
claims also let them pocket more money. Mr. Burke, the Ohio legislator,
says this dynamic encourages a “don’t ask, don’t tell” relationship
between PBMs and MCOs.

States ostensibly have an incentive to curb their Medicaid spending and
scrutinize PBM payments. Yet many may be turning a blind eye because
they can pass on the bills to the federal government, which picks up 63%
of the costs for Ohio’s pre-ObamaCare population and 94% for the
expansion population.

But as neighborhood pharmacies close, health-care access for low-income
patients diminishes. That at the very least should concern politicians.

Appeared in the May 30, 2018, print edition.



--
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 and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
_______________________________________________
Hangout mailing list
Hangout-at-nylxs.com
http://lists.mrbrklyn.com/mailman/listinfo/hangout

  1. 2018-05-01 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Comp Sci work without the Comp Sci Degree
  2. 2018-05-01 Rich Bowen <rbowen-at-apache.org> Subject: [Hangout - NYLXS] [users-at-httpd] ApacheCon North America 2018
  3. 2018-05-03 IEEE Engineering in Medicine and Biology Society <noreply-at-embs.org> Subject: [Hangout - NYLXS] 9th IEEE EMBS Conference on Neural Engineering
  4. 2018-05-03 From: "IEEE Spectrum Tech Alert" <reply-at-media.ieee.org> Subject: [Hangout - NYLXS] Spy Gadget to Detect Deadly Chemicals,
  5. 2018-05-04 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Opening Up a Crack House near you!
  6. 2018-05-05 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Anger at the SBS B82 is boiling over
  7. 2018-05-06 Ruben Safir <mrbrklyn-at-panix.com> Subject: [Hangout - NYLXS] FSF and Google!
  8. 2018-05-09 From: "Ruben.Safir" <ruben.safir-at-my.liu.edu> Subject: [Hangout - NYLXS] Howard chaykin
  9. 2018-05-10 IEEE Engineering in Medicine and Biology Society <noreply-at-embs.org> Subject: [Hangout - NYLXS] See What's New This Week in EMBS!!!!
  10. 2018-05-07 From: "Matthew A. Postiff" <postiffm-at-comcast.net> Re: [Hangout - NYLXS] IDE to develop app with GTK3 on windows using
  11. 2018-05-07 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #354 - PDL - Perl Data Language
  12. 2018-05-14 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Politics made simple - predictions from a
  13. 2018-05-15 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Changes on Flatbush Avenue
  14. 2018-05-17 From: "IEEE" <privacynotice-at-ieee.org> Subject: [Hangout - NYLXS] Action Required: IEEE Privacy Policy Update
  15. 2018-05-17 From: "American Museum of Natural History" <learn-at-amnh.org> Subject: [Hangout - NYLXS] Sign Up Now For Our Summer 2 Courses
  16. 2018-05-21 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #356 - search.cpan.org moving to
  17. 2018-05-24 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] The Best in Mail Order Brides available
  18. 2018-05-25 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Death in the Linux family
  19. 2018-05-25 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] The good news about facebook
  20. 2018-05-25 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Eric Snowden Podcast
  21. 2018-05-25 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Patent Threats in the US economy
  22. 2018-05-25 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Lake Placid
  23. 2018-05-27 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Movie of the Week
  24. 2018-05-27 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Coding for Profit
  25. 2018-05-27 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] 2001 is in the theaters this weekend
  26. 2018-05-28 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #357 - Shutter,
  27. 2018-05-31 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] The Pharmacy Scam continues
  28. 2018-05-24 From: "IEEE Spectrum Tech Alert" <reply-at-media.ieee.org> Subject: [Hangout - NYLXS] Ruben,

NYLXS are Do'ers and the first step of Doing is Joining! Join NYLXS and make a difference in your community today!