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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:

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Entertainment

Justin Timberlake addresses ‘tough week’ at first concert since drink-driving arrest

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Justin Timberlake addresses 'tough week' at first concert since drink-driving arrest

Justin Timberlake has performed his first gig since his arrest for alleged drink-driving, telling the crowd it had been a “tough week”. 

The US star is currently on his The Forget Tomorrow World Tour and performed in Chicago on Friday night after being arrested earlier this week.

He told the screaming crowd: “We’ve been together through ups and downs, lefts and rights.

“It’s been a tough week, but you’re here and I’m here, and nothing can change this moment right now.”

The singer appeared emotional as he added: “I know sometimes I’m hard to love but you keep on loving me and I love you right back.”

Timberlake was in Long Island in New York state – having reportedly had dinner with friends – when he was pulled over by police in the early hours of Tuesday.

Officers said the 43-year-old had failed to pause at a stop sign and was seen not being able to stay in his lane.

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Timberlake’s car caught on CCTV

Timberlake was held overnight and formally charged with a DWI (driving while intoxicated) misdemeanour at Sag Harbor Village Justice Court on Tuesday morning before being released.

According to a source talking to Page Six, the officer who pulled Timberlake over “was so young that he didn’t even know” who the star was.

A second source told the celebrity news outlet that during the arrest, Timberlake said: “This is going to ruin the tour.”

Justin Timberlake.
Pic: Sag Harbor/Reuters
Image:
Timberlake’s mugshot after his arrest. Pic: Sag Harbor/Reuters

Timberlake, who rose to fame with boyband NSYNC before finding huge success as a solo artist with hits including Like I Love You, Cry Me A River, SexyBack and Mirrors, is due to perform in Chicago again on Saturday night.

Further shows are scheduled across the US, Canada and Europe between June and December.

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According to court documents filed about the star’s arrest, there was “a strong odour of an alcoholic beverage… emanating from his breath, he was unable to divide attention, he had slowed speech, he was unsteady afoot and he performed poorly on all standardised field sobriety tests”.

Timberlake also told officers he had one martini and was following some friends home, and refused to take a breath test.

His lawyer has said he is “looking forward to vigorously defending” the singer.

Timberlake’s next court date is scheduled for 26 July.

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US

Justin Timberlake addresses ‘tough week’ at first concert since drink-driving arrest

Published

on

By

Justin Timberlake addresses 'tough week' at first concert since drink-driving arrest

Justin Timberlake has performed his first gig since his arrest for alleged drink-driving, telling the crowd it had been a “tough week”. 

The US star is currently on his The Forget Tomorrow World Tour and performed in Chicago on Friday night after being arrested earlier this week.

He told the screaming crowd: “We’ve been together through ups and downs, lefts and rights.

“It’s been a tough week, but you’re here and I’m here, and nothing can change this moment right now.”

The singer appeared emotional as he added: “I know sometimes I’m hard to love but you keep on loving me and I love you right back.”

Timberlake was in Long Island in New York state – having reportedly had dinner with friends – when he was pulled over by police in the early hours of Tuesday.

Officers said the 43-year-old had failed to pause at a stop sign and was seen not being able to stay in his lane.

Please use Chrome browser for a more accessible video player

Timberlake’s car caught on CCTV

Timberlake was held overnight and formally charged with a DWI (driving while intoxicated) misdemeanour at Sag Harbor Village Justice Court on Tuesday morning before being released.

According to a source talking to Page Six, the officer who pulled Timberlake over “was so young that he didn’t even know” who the star was.

A second source told the celebrity news outlet that during the arrest, Timberlake said: “This is going to ruin the tour.”

Justin Timberlake.
Pic: Sag Harbor/Reuters
Image:
Timberlake’s mugshot after his arrest. Pic: Sag Harbor/Reuters

Timberlake, who rose to fame with boyband NSYNC before finding huge success as a solo artist with hits including Like I Love You, Cry Me A River, SexyBack and Mirrors, is due to perform in Chicago again on Saturday night.

Further shows are scheduled across the US, Canada and Europe between June and December.

Follow Sky News on WhatsApp
Follow Sky News on WhatsApp

Keep up with all the latest news from the UK and around the world by following Sky News

Tap here

According to court documents filed about the star’s arrest, there was “a strong odour of an alcoholic beverage… emanating from his breath, he was unable to divide attention, he had slowed speech, he was unsteady afoot and he performed poorly on all standardised field sobriety tests”.

Timberlake also told officers he had one martini and was following some friends home, and refused to take a breath test.

His lawyer has said he is “looking forward to vigorously defending” the singer.

Timberlake’s next court date is scheduled for 26 July.

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US

Arkansas supermarket shooting leaves three dead and 10 wounded as gunman arrested

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Arkansas supermarket shooting leaves three dead and 10 wounded as gunman arrested

A supermarket shooting in Arkansas, US, has left three people dead and 10 others wounded.

Parked cars and shop windows were left riddled with bullet holes after a gunman opened fire on Friday, forcing bystanders to dive for cover.

Among the injured were two police officers who shot back at the gunman – before he was arrested.

The incident took place around 11.30am local time at the Mad Butcher supermarket in Fordyce – a city of just over 3,000 people located 65 miles south of Little Rock.

Colonel Mike Hagar, director of Arkansas State Police, told reporters: “It’s tragic, our hearts are broken”.

The gunman was identified by police as 44-year-old Travis Eugene Posey.

Posey was taken to jail and charged with three counts of murder.

Other charges are still pending and no court date has been set, according to the inmate roster.

Pic: AP
Image:
Police on the scene of the attack in the aftermath of the shooting. Pic: AP

Neither Posey’s, nor the officers’ injuries were life threatening, but among the others the injuries ranged from “not life-threatening to extremely critical”, Col Hagar said.

It wasn’t immediately clear what the motive for the shooting was, nor if it took place predominantly inside or outside the shop.

Roderick Rogers, a member of the city council, witnessed the attack.

He said he saw people fleeing for cover in all directions and added: “People were just jumping into cars to get to safety.”

Law enforcement officers work the scene of the shooting. Pic: AP
Image:
Law enforcement officers work the scene of the shooting. Pic: AP

Amiya Doherty said she was in her mum’s car in the car park of the shop when she heard what she thought were fireworks.

But she then saw a man holding a gun and firing and said she ducked out of view.

“I held my sister’s hand and I told her I love her,” Ms Doherty told Little Rock television station KATV.

Images from the scene showed a slew of bullet holes in the grocery store’s window, and spent shell casings strewn throughout the parking lot.

The shooting took place at the Mad Butcher grocery store in Fordyce, Arkansas. Pic: AP
Image:
The shooting took place at the Mad Butcher grocery store in Fordyce, Arkansas. Pic: AP

Arkansas governor Sarah Huckabee Sanders said she had been briefed on the shooting.

In a post on social media she added: “I am thankful to law enforcement and first responders for their quick and heroic action to save lives.

“My prayers are with the victims and all those impacted by this.”

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Read more from Sky News:
Hollywood legend Donald Sutherland has died
Shocking moment drunk driver ploughs into cyclists
Republican ‘sorry’ for repeatedly pouring water in colleague’s bag

The White House said President Joe Biden has been briefed on the shooting and his team will continue to keep him updated.

David Rodriguez, 58, had stopped at his local petrol station in the town when he heard what he thought were fireworks.

But he too saw people fleeing from the shop and one person lying on the ground.

“The police started to show up, and then there was massive gunfire and ambulances pulling up,” he said.

“The bullets were just flying.”

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