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DATE 2019-01-01

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MESSAGE
DATE 2019-01-26
FROM Ruben Safir
SUBJECT Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
From hangout-bounces-at-nylxs.com Sat Jan 26 21:54:04 2019
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From: Ruben Safir
To: weinsth-at-nysa.us, cdeutsch-at-council.nyc.gov, Hangout
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Subject: Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
PBMs and it is your fault
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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=E2=80=99ve worked for Veterans, in hospita=
ls, 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=E2=80=99s. It was only because of the pharmacist shortage th=
at
> 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=E2=80=99ve come to w=
ork
> with and help communities on a deeply personal level. I=E2=80=99ve had t=
o work
> with Holocaust survivors that had been inadvertently become addicted to
> narcotics while looking after their mental health and families. I=E2=80=
=99ve
> 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=E2=
=80=99t
> 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=E2=80=99ve also had to deal with my fair share of attempts at fraud. I=
=E2=80=99ve 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=E2=80=99s hostile environment, every day I go to work knowing th=
at 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=E2=80=99ve put my h=
ead 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=E2=80=99ve seen Duane Rea=
d put
> thousands of dollars of inventory in conditions that render the drugs at
> best impotent in a Midtown location. I=E2=80=99ve dealt with hospitals w=
ho let
> premature babies die because of failure to get needed IV orders to
> floors on over night shifts. I=E2=80=99ve 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=E2=
=80=99ve
> 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=E2=80=99s outer boroughs, Brookl=
yn, 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=3DIwAR0ueEilPKvn1FPGLuXD1GhnVkRgLDvEwd9o3QynD7pw5XyvvikBezeyWX8

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~`
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

=E2=80=9CDoctor, could you please redo my insulin prescription? The one you=
gave
me is wrong.=E2=80=9D My patient=E2=80=99s 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=E2=80=99d prescribed her t=
he
insulin she=E2=80=99d been on, at the correct dosage, but when she showed u=
p at
her pharmacy she learned that her insurance company no longer covered
that brand. After a series of phone messages back and forth, I=E2=80=99d re=
done
the prescription with what I=E2=80=99d 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=E2=80=99s produced in living cells, which is a diffic=
ult
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 =E2=80=9Cdiscount.=E2=
=80=9D

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. =E2=80=9CShort-acting=E2=80=9D is suppos=
ed to be a
category of insulin, but now it appears to be its category of insurance
coverage. My patient=E2=80=99s =E2=80=9Cpreferred insulin=E2=80=9D changed =
three times in a
year, so each time she went to the pharmacy, her prescription was rejected.

On the doctor's end, it=E2=80=99s an endless game of catch-up. Lantus was
covered, but now it=E2=80=99s Basaglar: rewrite all the prescriptions for a=
ll
your patients. Oops, now it=E2=80=99s Levemir: rewrite them all again. Novo=
Log
was covered, then it was Humalog, but now it=E2=80=99s Admelog. If it=E2=80=
=99s Tuesday,
it must be Tresiba.

It=E2=80=99s a colossal time-waster, as patients, pharmacists and doctors l=
og
hours upon hours calling, faxing, texting and emailing to keep up with
whichever insulin is trending. It=E2=80=99s 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=E2=80=99t a=
ngry
at me personally, but her ire came readily through the phone. No doubt
this reflected desperation =E2=80=94 she=E2=80=99d run out of insulin befor=
e and didn=E2=80=99t
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=E2=80=99d already
written enough insulin prescriptions on her account to fill a sixth Book
of Moses. I=E2=80=99d already called her insurance company and gotten tangl=
ed 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=E2=80=99t
covered. The second wasn=E2=80=99t covered. The third was. But before we co=
uld
sing the requisite hosannas, the pharmacist informed me that while the
insulin was indeed covered, it was not a =E2=80=9Cpreferred=E2=80=9D medica=
tion. That
meant there was a $72-per-month co-payment, something that my patient
would struggle to afford on her fixed income.

=E2=80=9CSo just tell me which is the preferred insulin,=E2=80=9D I told th=
e pharmacist
briskly.

There was a pause before she replied. =E2=80=9CThere isn=E2=80=99t one.=E2=
=80=9D

This was a new low =E2=80=94 an insurance company now had no insulins on it=
s 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=E2=80=99s an E. coli outbreak that causes illne=
ss
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=E2=80=99t g=
et 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=E2=80=99s most enraging is that dr=
ug
manufacturers, P.B.M.s and insurance companies don=E2=80=99t have to pick u=
p 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
=E2=80=9CWhat Patients Say, What Doctors Hear.=E2=80=9D
-- =

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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  41. 2019-01-24 Healthcare Update News Service <admin-at-healthcareupdatenewsservice.com> Subject: [Hangout - NYLXS] Health Datapalooza: Hear Directly From Health
  42. 2019-01-25 Stephan Bosch <stephan-at-rename-it.nl> Re: [Hangout - NYLXS] problem in setting up proxy
  43. 2019-01-26 Ruben Safir <mrbrklyn-at-panix.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  44. 2019-01-28 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #392 - Time to submit talk/workshop
  45. 2019-01-28 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Libre Planet in Boston
  46. 2019-01-28 Ruben Safir <ruben-at-mrbrklyn.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  47. 2019-01-29 mrbrklyn <mrbrklyn-at-panix.com> Subject: [Hangout - NYLXS] Fwd: New York University Special Invite: HireNYC
  48. 2019-01-28 From: "HireNYC 2019 Alumni Career Fair" <jesse-at-gohiretalent.net> Subject: [Hangout - NYLXS] New York University Special Invite: HireNYC 2019
  49. 2019-01-31 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Community Pharmacy is being destroyed by the PBMs
  50. 2019-01-31 From: "IEEE Spectrum Tech Alert" <reply-at-media.ieee.org> Subject: [Hangout - NYLXS] 3D Printing: New Technique Turns Out Objects 100
  51. 2019-01-31 From: "American Museum of Natural History" <learn-at-amnh.org> Subject: [Hangout - NYLXS] Take a Peek at Our Next Session's Courses!

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