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Jun 11 2024 KFF Health News

Months into a new Biden administration policy intended to lower drug costs for Medicare patients, independent pharmacists say they're struggling to afford to keep some prescription drugs in stock.

"It would not matter if the governor himself walked in and said, 'I need to get this prescription filled,'" said Clint Hopkins, a pharmacist and co-owner of Pucci's Pharmacy in Sacramento, California. "If I’m losing money on it, it's a no."

A regulation that took effect in January changes prescription prices for Medicare beneficiaries. For years, prices included pharmacy performance incentives, possible rebates, and other adjustments made after the prescription was filled. Now the adjustments are made first, at the pharmacy counter, reducing the overall cost for patients and the government. But the new system means less money for pharmacies that acquire and stock medications, pharmacists say.

Pharmacies are already struggling with staff shortages, drug shortages, fallout from opioid lawsuits, and rising operating costs. While independent pharmacies are most vulnerable, some big chain pharmacies are also feeling a cash crunch — particularly those whose parent firms don't own a pharmacy benefit manager, companies that negotiate drug prices between insurers, drug manufacturers, and pharmacies.

A top official at the Centers for Medicare & Medicaid Services said it's a matter for pharmacies, Medicare insurance plans, and PBMs to resolve.

"We cannot interfere in the negotiations that occur between the plans and pharmacy benefits managers," Meena Seshamani, director of the Center for Medicare, said at a conference on June 7. "We cannot tell a plan how much to pay a pharmacy or a PBM."

Nevertheless, CMS has reminded insurers and PBMs in several letters that they are required to provide the drugs and other benefits promised to beneficiaries.

Several independent pharmacists told KFF Health News they'll soon cut back on the number of medications they keep on shelves, particularly brand-name drugs. Some have even decided to stop accepting certain Medicare drug plans, they said.

As he campaigns for reelection, President Joe Biden has touted his administration's moves to make prescription drugs more affordable for Medicare patients, hoping to appeal to voters troubled by rising health care costs. His achievements include a law, the Inflation Reduction Act, that caps the price of insulin at $35 a month for Medicare patients; caps Medicare patients' drug spending at $2,000 a year, beginning next year; and allows the program to bargain down drug prices with manufacturers.

More than 51 million people have Medicare drug coverage. CMS officials estimated the new rule reducing pharmacy costs would save beneficiaries $26.5 billion from 2024 through 2032.

Medicare patients' prescriptions can account for at least 40% of pharmacy business, according to a February survey by the National Community Pharmacists Association.

Independent pharmacists say the new rule is causing them financial trouble and hardship for some Medicare patients. Hopkins, in Sacramento, said that some of his newer customers used to rely on a local grocery pharmacy but came to his store after they could no longer get their medications there.

The crux of the problem is cash flow, the pharmacists say. Under the old system, pharmacies and PBMs reconciled rebates and other behind-the-scenes transactions a few times a year, resulting in pharmacies refunding any overpayments.

Now, PBM clawbacks happen immediately, with every filled prescription, reducing pharmacies' cash on hand. That has made it particularly difficult, pharmacists say, to stock brand-name drugs that can cost hundreds or thousands of dollars for a month's supply.

Some patients have been forced to choose between their pharmacy and their drug plan. Kavanaugh Pharmacy in Little Rock, Arkansas, no longer accepts Cigna and Wellcare Medicare drug plans, said co-owner and pharmacist Scott Pace. He said the pharmacy made the change because the companies use Express Scripts, a PBM that has cut its reimbursements to pharmacies. Related StoriesCovid and Medicare payments spark remote patient monitoring boomAn Arm and a Leg: Attack of the Medicare machinesYour doctor or your insurer? Little-known rules may ease the choice in Medicare Advantage

"We had a lot of Wellcare patients in 2023 that either had to switch plans to remain with us, or they had to find a new provider," Pace said.

Pace said one patient's drug plan recently reimbursed him for a fentanyl patch $40 less than his cost to acquire the drug. "Because we’ve had a long-standing relationship with this particular patient, and they’re dying, we took a $40 loss to take care of the patient," he said.

Conceding that some pharmacies face cash-flow problems, Express Scripts recently decided to accelerate payment of bonuses for meeting the company's performance measures, said spokesperson Justine Sessions. She declined to answer questions about cuts in pharmacy payments.

Express Scripts, which is owned by The Cigna Group, managed 23% of prescription claims last year, second to CVS Health, which had 34% of the market.

In North Carolina, pharmacist Brent Talley said he recently lost $31 filling a prescription for a month's supply of a weight control and diabetes drug.

To try to cushion such losses, Talley's Hayes Barton Pharmacy sells CBD products and specialty items like reading glasses, bath products, and books about local history. "But that's not going to come close to making up the loss generated by the prescription sale," Talley said.

His pharmacy also delivers medicines packaged by the dose to Medicare patients at assisted living facilities and nursing homes. Reimbursement arrangements with PBMs for that business are more favorable than for filling prescriptions in person, he said.

When Congress added drug coverage to Medicare in 2003, lawmakers privatized the benefit by requiring the government to contract with commercial insurance companies to manage the program.

Insurers offer two options: Medicare Advantage plans, which usually cover medications, in addition to hospital care, doctor visits, and other services; as well as stand-alone drug plans for people with traditional Medicare. The insurers then contract with PBMs to negotiate drug prices and pharmacy costs with drug manufacturers and pharmacies.

The terms of PBM contracts are generally secret and restrict what pharmacists can tell patients — for example, if they're asked why a drug is out of stock. (It took an act of Congress in 2018 to eliminate restrictions on disclosing a drug's cash price, which can sometimes be less than an insurance plan's copayment.)

The Pharmaceutical Care Management Association, a trade group representing PBMs, warned CMS repeatedly "that pharmacies would likely receive lower payments under the new Medicare Part D rule," spokesperson Greg Lopes said. His group opposes the change.

Recognizing the new policy could cause cash-flow problems for pharmacies, Medicare officials had delayed implementation for a year before the rule took effect, giving them more time to adjust.

"We have heard pharmacies saying that they have concerns with their reimbursement," Seshamani said.

But the agency isn't doing enough to help now, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. "They haven't taken any action even after we brought potential violations to their attention," she said.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism. Source:

KFF Health News

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US

Epstein files appear to show Andrew asking Ghislaine Maxwell for ‘inappropriate friends’

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Epstein files appear to show Andrew asking Ghislaine Maxwell for 'inappropriate friends'

A trove of newly released Epstein files include emails that appear to involve Andrew Mountbatten-Windsor, while another suggests Donald Trump travelled on the billionaire’s private jet “many more times than previously has been reported”.

The US Department of Justice released at least 11,000 more files on Tuesday.

It went on to claim that some of them “contain untrue and sensationalist claims” about President Trump.

Here are some of the latest news lines from this release of Epstein files. Being named in these papers does not suggest wrongdoing.

Who is ‘The Invisible Man’?

Among the documents released is an email sent to Ghislaine Maxwell that speaks about “the girls” being “completely shattered” at a Royal Family summer camp at Balmoral.

It is dated 16 August 2001 and sent by a person referred to as “The Invisible Man”, who signed off the message as “A” – and is believed to be Andrew.

Sky News has come to that conclusion from reviewing the email address used, which is assigned to the Duke of York in Epstein’s contacts book and the chain of correspondence.


Who is ‘A’? James Matthews looks at the evidence

In the correspondence, “The Invisible Man” asks Maxwell: “How’s LA? Have you found me some new inappropriate friends?”

Andrew Mountbatten-Windsor has previously denied any allegations against him.


Andrew pictured laying on women

The Peru trip

Another email appears to show Maxwell arranging “two-legged sight seeing” for “The Invisible Man” during a trip to Peru.

She appears to forward to “The Invisible Man” part of a conversation between herself and another person.

The email says: “I just gave Andrew your telephone no. He is interested in seeing the Nazca lines. He can ride but it is not his favorite sport ie pass on the horses.”

“Some sight seeing some 2 legged sight seeing (read intelligent pretty fun and from good families) and he will be very happy. I know I can rely on you to show him a wonderful time and will only introduce him to friends that you can trust,” Maxwell said.

The context of the email is unclear and there is no suggestion of any wrongdoing.


Epstein survivor speaks to Sky News after latest release of files

Trump on Epstein’s jet?

The latest bunch of files also includes an email from an unidentified prosecutor dated 7 January, 2020, in which President Trump is mentioned.

The email accuses him of travelling on Epstein’s private jet “many more times than previously has been reported”.

It adds that President Trump “is listed as a passenger on at least eight flights between 1993 and 1996, including at least four flights on which Maxwell was also present”.

The email’s sender and receiver have been redacted. However, at the bottom of the email it says assistant US attorney, Southern District of New York. The name has also been redacted.

President Trump has denied any wrongdoing in relation to his relationship with Epstein, and being on any of Epstein’s flights does not indicate any wrongdoing.

Read more:
Trump defends ‘big boy’ Clinton after Epstein files release
Why Andrew photo in Epstein files is awkward for Royal Family

Limousine driver report about Trump

One of the documents in the release shows a report made to the FBI that was recorded on 27 October 2020.

It includes an unverified claim by a limousine driver that he overheard the US president discussing “abusing some girl” in 1995.

The driver also mentions Trump said “Jeffrey” while on the phone during a journey to Dallas Fort Worth Airport in Texas.

A significant part of the statement, along with the driver’s identity, has been redacted.

The US justice department has said that some of the documents in the latest Epstein files release “contain untrue and sensationalist claims made against President Trump that were submitted to the FBI right before the 2020 election”.

“To be clear: the claims are unfounded and false, and if they had a shred of credibility, they certainly would have been weaponized against President Trump already,” it said.

Postcard mentions ‘our president’

Also among the documents is a postcard that claims to have been sent by Jeffrey Epstein, but has been refuted by the justice department.

In it, the sender tells the recipient: “Our president also shares our love of young, nubile girls.”

It’s not clear who “our president” refers to and the context of the postcard is also unclear.

The US justice department initially said it was “looking into the validity” of the postcard but later said on X that the “FBI has confirmed” the postcard is “FAKE”.

It cited reasons including a claim that the writing does not appear to match Epstein’s and another that the letter was postmarked three days after his death.

Row over unreleased documents

It is believed that many files relating to Epstein are yet to be made public.

There has been anger at the justice department’s slow release of the files, with politicians threatening to launch legal action against Attorney General Pam Bondi.

The deadline for the release of all the documents has passed.

“The DOJ needs to quit ⁠protecting the rich, powerful, and politically connected,” Republican congressman Thomas Massie said.

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US

Epstein survivor speaks of moment she met Andrew on private island

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Epstein survivor speaks of moment she met Andrew on private island

A survivor of Jeffrey Epstein has spoken of the moment she met Andrew Mountbatten-Windsor on the disgraced financier’s private island.

Lisa Phillips says that revealing the true extent of Epstein’s abuses is important for the protection of future generations.

Andrew Mountbatten-Windsor has previously denied any allegations against him.

Speaking to US correspondent James Matthews on the day a new tranche of documents was released, she said she believes the “really important stuff” wasn’t released.


What’s in the largest batch of Epstein files?

She recalled meeting Epstein in 2000 when she was working as a fashion model.

Ms Phillips said she was working on an island near Saint Thomas in the Caribbean and went over to Epstein’s island for a day, and met Epstein himself at dinner that evening.

More on Jeffrey Epstein

“It took a few hours of him speaking to me one-on-one at the table, basically asking me a lot of questions about my life and my relationship with my family and my ambitions.”

She said Epstein was “very big” on her goals and became excited when he heard she had lived in Oxford, England, as a child.

“He asked me if I wanted to meet a prince, and I said yes.”

Epstein files latest: New batch of documents released

Ms Phillips explained that a man walked up and was introduced to her, and that he spoke to some people there and then said goodbye.

“It was very brief,” she said, adding that only years later did she realise that this was the former prince, Andrew.

She was asked about an email in the recently released files that appears to show Andrew Mountbatten-Windsor asking Ghislaine Maxwell about “inappropriate friends”.

“That is a very revealing email, isn’t it?” Ms Phillips said. “It’s very creepy, disturbing, and I mean, that’s why she’s in jail, right?”

The context of the email is unclear, and there is no suggestion of any wrongdoing.

Andrew Mountbatten-Windsor has previously denied any allegations against him and Sky News has contacted Andrew’s representatives for comment on the latest release.

Asked about the impact being in Epstein’s orbit has had on her life, Ms Phillips said: “It hasn’t felt good to know that so much of my past that I worked hard for was really just smoke and mirrors and part of a bigger web.”

On the delays in releasing the files, she claimed “the really important stuff wasn’t released”.

She also spoke about her and other survivors’ ongoing fight for justice.

“We’re still doing our research, and we will still be bringing whatever we find to the proper authorities. And we’re not going to give up.”

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UK

Epstein files appear to show Andrew asking Ghislaine Maxwell for ‘inappropriate friends’

Published

on

By

Epstein files appear to show Andrew asking Ghislaine Maxwell for 'inappropriate friends'

A trove of newly released Epstein files include emails that appear to involve Andrew Mountbatten-Windsor, while another suggests Donald Trump travelled on the billionaire’s private jet “many more times than previously has been reported”.

The US Department of Justice released at least 11,000 more files on Tuesday.

It went on to claim that some of them “contain untrue and sensationalist claims” about President Trump.

Here are some of the latest news lines from this release of Epstein files. Being named in these papers does not suggest wrongdoing.

Who is ‘The Invisible Man’?

Among the documents released is an email sent to Ghislaine Maxwell that speaks about “the girls” being “completely shattered” at a Royal Family summer camp at Balmoral.

It is dated 16 August 2001 and sent by a person referred to as “The Invisible Man”, who signed off the message as “A” – and is believed to be Andrew.

Sky News has come to that conclusion from reviewing the email address used, which is assigned to the Duke of York in Epstein’s contacts book and the chain of correspondence.


Who is ‘A’? James Matthews looks at the evidence

In the correspondence, “The Invisible Man” asks Maxwell: “How’s LA? Have you found me some new inappropriate friends?”

Andrew Mountbatten-Windsor has previously denied any allegations against him.


Andrew pictured laying on women

The Peru trip

Another email appears to show Maxwell arranging “two-legged sight seeing” for “The Invisible Man” during a trip to Peru.

She appears to forward to “The Invisible Man” part of a conversation between herself and another person.

The email says: “I just gave Andrew your telephone no. He is interested in seeing the Nazca lines. He can ride but it is not his favorite sport ie pass on the horses.”

“Some sight seeing some 2 legged sight seeing (read intelligent pretty fun and from good families) and he will be very happy. I know I can rely on you to show him a wonderful time and will only introduce him to friends that you can trust,” Maxwell said.

The context of the email is unclear and there is no suggestion of any wrongdoing.


Epstein survivor speaks to Sky News after latest release of files

Trump on Epstein’s jet?

The latest bunch of files also includes an email from an unidentified prosecutor dated 7 January, 2020, in which President Trump is mentioned.

The email accuses him of travelling on Epstein’s private jet “many more times than previously has been reported”.

It adds that President Trump “is listed as a passenger on at least eight flights between 1993 and 1996, including at least four flights on which Maxwell was also present”.

The email’s sender and receiver have been redacted. However, at the bottom of the email it says assistant US attorney, Southern District of New York. The name has also been redacted.

President Trump has denied any wrongdoing in relation to his relationship with Epstein, and being on any of Epstein’s flights does not indicate any wrongdoing.

Read more:
Trump defends ‘big boy’ Clinton after Epstein files release
Why Andrew photo in Epstein files is awkward for Royal Family

Limousine driver report about Trump

One of the documents in the release shows a report made to the FBI that was recorded on 27 October 2020.

It includes an unverified claim by a limousine driver that he overheard the US president discussing “abusing some girl” in 1995.

The driver also mentions Trump said “Jeffrey” while on the phone during a journey to Dallas Fort Worth Airport in Texas.

A significant part of the statement, along with the driver’s identity, has been redacted.

The US justice department has said that some of the documents in the latest Epstein files release “contain untrue and sensationalist claims made against President Trump that were submitted to the FBI right before the 2020 election”.

“To be clear: the claims are unfounded and false, and if they had a shred of credibility, they certainly would have been weaponized against President Trump already,” it said.

Postcard mentions ‘our president’

Also among the documents is a postcard that claims to have been sent by Jeffrey Epstein, but has been refuted by the justice department.

In it, the sender tells the recipient: “Our president also shares our love of young, nubile girls.”

It’s not clear who “our president” refers to and the context of the postcard is also unclear.

The US justice department initially said it was “looking into the validity” of the postcard but later said on X that the “FBI has confirmed” the postcard is “FAKE”.

It cited reasons including a claim that the writing does not appear to match Epstein’s and another that the letter was postmarked three days after his death.

Row over unreleased documents

It is believed that many files relating to Epstein are yet to be made public.

There has been anger at the justice department’s slow release of the files, with politicians threatening to launch legal action against Attorney General Pam Bondi.

The deadline for the release of all the documents has passed.

“The DOJ needs to quit ⁠protecting the rich, powerful, and politically connected,” Republican congressman Thomas Massie said.

Continue Reading

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