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DATE 2019-02-01

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Key: id Value: 547589

Key: archive Value: 2019-02-01

MESSAGE
DATE 2019-02-07
FROM Ruben Safir
SUBJECT Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
From hangout-bounces-at-nylxs.com Thu Feb 7 16:17:36 2019
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Cc: weinsth-at-nysa.us, Hangout , cdeutsch-at-council.nyc.gov
Subject: Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
PBMs and it is your fault
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Continuation of PBM fraud

While the value of what pharmacists do for their communities is not
always obvious, I hope that I have outlined the vital and difficult role
that independent local pharmacist have in both bridging difficult and
often neglected communities, and how we are keepers of the public trust.
Unfortunately, we are being targeted and robbed by the Pharmacy Benefit
Management companies and I hope in this second letter to outline
specific examples. Understand, that all pharmacies sign contracts with
the PBMs for which two companies make up the great majority of patients
prescriptions. Together they have a lock on the medicaid and medicare
business in New York. And together they has colluded to destroy the
foundations of the Pharmacists profession. And among the techniques
that they have used is the contracts stipulate any disclosure of prices
and payments, formularies or other business intelligence is considered a
violation of the contracts provisions and cause for lawsuits and being
dropped from the medicaid and medicare programs through their
exclusions. That means that any information I present to you is cause
for being sued, and a violation of the contract. Because of this,
getting real facts about the fraud perpetrated by CVS/Carmark and
Express Scripts (as well as the rest of the PBMs), is extremely
difficult. Disclosure is violation of contract. The facts, I will
present here are therefor scrubbed as best a I can, and provide insight
into how our city is being raped by these entities and particularly how
Brooklyn and Queens are being targeted.

In the first case, the contracts and terms are legally problematic, but
the Pharmacies have little recourse unless the government steps in an
investigates and regulates the terms. Normal contract law requires that
both parties to a contract have to be freely. Pharmacist are entitled
to practice their careers, and in fact must sign these contracts if they
are to practice there career. Therefor, these contracts of Contracts of
Coercion since these professions can not practice their profession
without capitulating to the contracts. There is no market in the
pharmacy field because all patients are legally required to be covered
under the Affordable Care Act. =


Contract coercion occurs when a contract agreement is entered into
under conditions involving harm or threats of harm. State and federal
laws require contracts to be entered into "knowingly" and "willingly"
by all parties. Thus, if a party signs a contract due to coercion, the
contract generally will not be considered legally enforceable.

`The rule regarding coercion applies both to the entire contract as
well as individual terms in the contract. That is, the parties must
willingly agree to the contract as a whole, as well as the various
terms, definitions, and requirements laid out individually in the
agreement.

Their is no means by which a Pharmacist can practice without
arraignment with caremark and express scripts. The contracts are
coercive and are destroying the profession, and stealing from the
state, and targeting minority communities specifically. Since minority
communities are excessively dependent on medicaid and medicare
contracts, when the state handed medicaid to the manage care
programming, they lost control of oversite. The manage care programs
are getting kickbacks from manufacturers and refusing to compensate
pharmacies fairly. In fact, they are demanding that Pharmacist have to
pay to CVS/Carmark and Express Scripts in order to fill prescriptions,
especially insulin prescription. This behavior is driving prices up
and bankrupting the Pharmacy as they are not compensate for the cost
of the insulin/diabetic injectables but take on extensive audit risk on
every fill. The high cost of these insulin products and other
ineluctable, ranging well into the $500 per prescription range, have
become special targets for auditors, resulting in further loses to the
pharmacist in addition to the general $30 per prescription loss.
Minority communities with high levels of medicaid are specifically
targeted like this. I've experienced this behavior in Bushwich,
Flatbush, Crown Heights, and Queens, while on the Upper East Side and
Tribeca have been paid well and are under much lower pressure for
audits. Pharmacy after Pharmacy in the working a poor communities have
been targeted for action and have suffered from discrimination by the
PBMs include Tu Salud, who was penatized and audited by Carmark, in the
South Bronx, Live Good Pharmacy on Nostrand Avenue who had their
Express Scripts insurance pulled from them on a triviality which in any
other business would have been normal practice, Wyckoof Bleeker was
taken off of Express scripts based on their location in Bushwick, etc
etc etc. Dozens of Pharmacies are being thrown into crisis. Open an
investigation in council and pull their business records that they are
hiding from the city and show how they are making themselves rich as
the expense of the poor working class in NYC and killing our hard
working pharmacies!

Ruben Safir =






On Fri, Feb 01, 2019 at 03:09:05PM -0500, Ruben Safir wrote:
> A few years ago, NYS brought third party manage care programs in to the N=
Y State medicaid program.
> Since that time, the PBMs and the manage care programs have been using th=
ere placement between the
> patients, New York State and the healthcare system to debunk tax payers a=
nd patients of millions of
> dollars. In doing so, they have put pharmacy in its crosshairs and are fo=
rcing hard working pharmacists
> as a class from their practices. Classic anti-competitive behavior has be=
en used to force all medicaid
> patients to CVS Pharmacies. Reimbursement to pharmacists has been dropped=
below acquisition costs
> to the profession. We have to pay about $20 for each insulin prescription=
we fill for patients. Blood
> pressure drugs are being dispensed at below costs.
> =

> What is the value of a patients life?
> =

> =

> According to the PBMs, about 37 cents. That is what they are paying for A=
modipine 10mg, a vital
> commonly blood pressure medication. They pay 16 cent for aspirin to preve=
nt strokes and heart
> attacks, 23 cents for lisinipril, a blood pressure drugs, 6 cents for mul=
tivitamins, and so on. The
> majority of scripts are now being paid less than a half dollar. Pharmacie=
s can fill these prescriptions all
> day, and never recoup the cost of the power of even the label printer to =
fill these prescriptions.
> Additionally, these are all substantially below the acquisition costs. Ju=
st try to find aspirins for 16
> cents. Try to find ANYTHING in the US economy at that price. This is lowe=
r than the price of a
> Superman comicbook in the 1970=E2=80=99s.
> =

> This PDF shows how pharmies are being targeted to elimination from the he=
althcare system by greedy PBMs
> =

> =

> -- =

> 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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  1. 2019-02-01 Ruben Safir <ruben-at-mrbrklyn.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  2. 2019-02-01 Ruben Safir <ruben-at-mrbrklyn.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  3. 2019-02-01 From: "Free Software Foundation" <info-at-fsf.org> Subject: [Hangout - NYLXS] Free Software Supporter Issue 130, February 2019
  4. 2019-02-03 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Stevie Wonder
  5. 2019-02-04 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #393 - Google Summer of Code 2019 -
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  7. 2019-02-06 Ruben Safir <ruben.safir-at-my.liu.edu> Subject: [Hangout - NYLXS] New York Artificial Intelligence In Healthcare
  8. 2019-02-06 From: "American Museum of Natural History" <GilderCenter-at-amnh.org> Subject: [Hangout - NYLXS] Gilder Center Project Update
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  12. 2019-02-07 From: "IEEE Spectrum Tech Alert" <reply-at-media.ieee.org> Subject: [Hangout - NYLXS] Mayhem,
  13. 2019-02-07 Ruben Safir <ruben-at-mrbrklyn.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  14. 2019-02-07 From: "American Museum of Natural History" <learn-at-amnh.org> Subject: [Hangout - NYLXS] Start Planning for the Upcoming Semester with an
  15. 2019-02-08 Ruben Safir <ruben-at-mrbrklyn.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  16. 2019-02-10 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] bio-linux - it grows on you
  17. 2019-02-10 Ruben Safir <ruben.safir-at-my.liu.edu> Subject: [Hangout - NYLXS] Fwd: New York Artificial Intelligence In
  18. 2019-02-10 Ruben Safir <ruben-at-mrbrklyn.com> Re: [Hangout - NYLXS] Community Pharmacy is being destroyed by the
  19. 2019-02-11 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] partical issues
  20. 2019-02-11 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #394 - Pull Request Club
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  27. 2019-02-15 Healthcare Update News Service <admin-at-healthcareupdatenewsservice.com> Subject: [Hangout - NYLXS] Population Health News: Machine Learning and
  28. 2019-02-18 Gabor Szabo <gabor-at-szabgab.com> Subject: [Hangout - NYLXS] [Perlweekly] #395 - What is DevOps for you?
  29. 2019-02-15 From: "American Museum of Natural History" <learn-at-amnh.org> Subject: [Hangout - NYLXS] Take a Look at Our Upcoming Session and Register
  30. 2019-02-21 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Employee Scheduling Software
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  33. 2019-02-23 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Hangout - NYLXS] Fwd: nixCraft Linux / UNIX Newsletter
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