Connect with us

Published

on

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

Continue Reading

UK

Jury shown CCTV and bodycam footage of brothers allegedly assaulting police at Manchester Airport

Published

on

By

Jury shown CCTV and bodycam footage of brothers allegedly assaulting police at Manchester Airport

CCTV and police bodycam footage allegedly showing three police officers being assaulted at Manchester Airport has been played to jurors.

Mohammed Fahir Amaaz, 20, and his brother, Muhammad Amaad, 26, are said to have struck out after police were called to the airport on 23 July last year, following Amaaz allegedly headbutting a customer at a Starbucks in Terminal 2.

Minutes later, three police officers approached the defendants at the paystation in the terminal’s car park.

A jury at Liverpool Crown Court today watched CCTV footage from opposite angles, which captured what the prosecution says was a “high level of violence” being used by the siblings.

The prosecution says Amaaz resisted as officers tried to move him to arrest him, and Amaad then intervened.

Junior counsel Adam Birkby suggested Amaaz threw 10 punches, including one to the face of PC Lydia Ward, which knocked her to the floor.

His brother Amaad is then said to have aimed six punches at firearms officer PC Zachary Marsden.

Amaaz also allegedly kicked PC Marsden and struck firearms officer PC Ellie Cook twice with his elbow.

He is said to have punched PC Marsden from behind and had a hold of him, before PC Cook discharged her Taser.

Human Rights lawyer Aamer Anwar (centre) arrives with Mohammed Fahir Amaaz (left) and Muhammed Amaad (right) at Liverpool Crown Court, where
Image:
Mohammed Fahir Amaaz (left) and Muhammed Amaad (right) arrive at the court with their lawyer. Pic: PA

The bodycam and CCTV footage, submitted as evidence by the prosecution, allegedly shows the officers’ arrival in the Terminal 2 car park and their attempts to arrest the siblings, as well as their exchanges with them.

PC Ward can be heard saying “Oi, you b*****d” in footage from her bodycam, the prosecution evidence appears to show.

She then appears to fall to the floor and screams.

PC Cook, who is pointing her Taser at one of the defendants, then allegedly says: “Stay on the floor, stay on the floor whatever you do.”

“Get back, get back,” PC Ward appears to say.

The bodycam footage, shown to the jury by the prosecution, shows PC Marsden, who is also pointing his Taser, appear to approach the defendant who is lying on the ground and kick out at him.

Mr Birkby said: “Mr Amaaz, while prone, lifts his head towards the officers. PC Marsden kicks Mr Amaaz around the head area.

“PC Marsden stamps his foot towards the crown of Mr Amaaz’s head area but doesn’t appear to connect with Mr Amaaz.”

Amaaz denies three counts of assault occasioning actual bodily harm to the three police officers and one count of assault to Abdulkareem Ismaeil, the customer at Starbucks.

Amaad denies one count of assault occasioning actual bodily harm to PC Marsden.

Continue Reading

UK

Stephen Doohan: Paramedic who secretly gave pregnant woman abortion drug jailed for more than 10 years

Published

on

By

Stephen Doohan: Paramedic who secretly gave pregnant woman abortion drug jailed for more than 10 years

A paramedic who secretly gave a pregnant woman an abortion drug during sex has been jailed for more than 10 years. 

Stephen Doohan, 33, was married when he met the woman on holiday in Spain in 2021 and began a long-distance relationship.

The High Court in Glasgow heard how the victim travelled to Edinburgh in March 2023 to visit Doohan after learning she was pregnant.

During consensual sex, Doohan twice secretly administered the tablets which led to the woman suffering a miscarriage.

In May, Doohan pleaded guilty to sexual assault and causing the woman to have an abortion. He returned to the dock on Monday where he was jailed for 10 years and six months.

Lord Colbeck said Doohan caused “long-term psychological injury” to his victim.

The judge said: “You put her through considerable pain over a number of days and left her facing a lifetime of pain and loss.”

More on Edinburgh

The court heard how the woman found tablets hidden under the mattress after she became suspicious over Doohan’s behaviour in bed.

Lord Colbeck said: “The complainer then carried out an internet search for abortion tablets and confronted you over your actions.”

After the woman fell ill, Doohan convinced her to lie to medics at the Royal Infirmary of Edinburgh amid fears he would be arrested if she told the truth.

The victim later attended another hospital with her sister and was told she was having a miscarriage.

The Crown Office and Procurator Fiscal Service (COPFS) said Doohan sent the woman gifts including perfume, socks, facial cleansing oil, money to get her hair done and bought tickets for them to attend a football match.

Read more from Sky News:
Mother guilty of murdering three people with poisonous mushrooms
Israeli soldier describes arbitrary killing of civilians in Gaza

The woman complained to the Scottish Ambulance Service in May 2023, sparking an investigation.

The court heard that on 14 March 2023, the day the woman told Doohan she was pregnant, the paramedic used a work intranet to search for abortion drugs.

Lord Colbeck said: “You planned out what you did to your victim using resources available to you as a paramedic.”

In addition to his prison sentence, Doohan was also added to the sex offenders’ register and banned from contacting his victim.

Fiona Kirkby, procurator fiscal for high court sexual offences, said: “Stephen Doohan’s calculated and heinous actions caused the loss of the victim’s pregnancy, robbing her of plans she had for the future.

“He has now been held accountable for this fundamental breach of trust.

“While offences like this are thankfully rare, I hope this prosecution sends a clear message to all those who seek to inflict sexual harm towards women.

“Our thoughts remain with the victim, who must be commended for reporting her experience and seeking justice.

“We recognise that reporting sexual offending can be difficult but would urge anyone affected to come forward and seek support when they feel ready to do so.”

The Scottish Ambulance Service branded it an “appalling case”.

A spokesperson added: “We recognise the courage it must have taken for the victim to come forward and speak out.

“As soon as we learned of these very serious allegations and charges, we immediately took action, providing ongoing support to her whilst liaising with Police Scotland throughout the investigation.

“We know nothing will change what has happened to the victim and all we can hope is this sentence provides some comfort to them.”

Continue Reading

UK

UK farmers have ‘nothing more to give’ as they fear govt will compromise welfare in US-UK trade deal

Published

on

By

UK farmers have 'nothing more to give' as they fear govt will compromise welfare in US-UK trade deal

UK farmers have “nothing more to give” as they fear the government will use agriculture to further reduce US tariffs in a trade deal with the White House.

The UK is trying to reduce steel tariffs to zero, from a current reduced rate of 25%, but Downing Street refused to confirm if it was confident ahead of Donald Trump’s deadline of 9 July.

Tom Bradshaw, president of the National Farmers’ Union (NFU), said UK agriculture had already been used to reduce Trump-imposed tariffs on cars but any other concessions would have serious repercussions for farmers, food security and the UK’s high animal welfare standards.

Politics latest: Downing Street refuses to rule out wealth tax

He told Sky News: “It just feels like we, as the agricultural sector, had to shoulder the responsibility to reduce the tariffs on cars from 25%.

“We can’t do it anymore, we have nothing more to give.

“It’s clear the steel quotas and tariffs aren’t sorted yet, so we just want to be very clear with the government: if they’re sitting around the negotiating table – which we understand they are – they can’t expect agriculture to give any more.”

More on Donald Trump

Tom Bradshaw, the head of the NFU, speaking to Sky News
Image:
Tom Bradshaw, the head of the NFU, said farmers cannot give any more

‘Massively undermine our standards’

Since 30 June, the US has been able to import 13,000 tonnes of hormone-free British beef without tariffs under a deal made earlier this year, which farmers feel was to reduce the car import levy Mr Trump imposed.

The UK was also given tariff-free access to 1.4bn litres of US ethanol, which farmers say will put the UK’s bioethanol and associated sectors under pressure.

Allowing lower US food standards would “massively undermine our standards” and would mean fewer sales to the European Union where food standards are also high, Mr Bradshaw said.

It would leave British farmers competing on a playing field that is “anything but fair”, he said, because US food can be produced – and sold – much cheaper due to low welfare which could see a big reduction in investment in UK farms, food security and the environment.

Read more:
Trump tariff deadline extended as new threats issued to BRICs nations

Please use Chrome browser for a more accessible video player

Can the UK avoid steel tariffs?

‘The US will push hard for more access’

He said the US narrative has always suggested they want access to British agriculture products “as a start and they’ll negotiate for more”.

“The narrative from the White House on 8 May, when a US-UK trade deal was announced, was all about further access to our agriculture products – it was very different to what our government was saying,” he added.

“So far, the UK has stood firm and upheld our higher welfare standards, but the US will push very hard to have further access.

“No country in the world has proved they can reduce the 10% tariffs further.”

US poultry welfare is lower than the UK, with much more intensive farming that means the meat has to be washed with antimicrobials. Pic: AP
Image:
US poultry welfare is lower than the UK, with much more intensive farming that means the meat has to be washed with antimicrobials. Pic: AP

US ‘will target poultry and pork’

The Essex farmer said he expects the US to push “very hard” to get the UK to lower its standards on poultry and pork, specifically.

US poultry is often washed with antimicrobials, including chlorine, in an attempt to wash off high levels of bacteria caused by poor hygiene, antibiotic use and low animal welfare conditions not allowed in UK farming.

US pig rearing methods are also quite different, with intensive farming and the use of feed additive ractopamine legal, with both banned in the UK.

A government spokesperson told Sky News: “We regularly speak to businesses across the UK to understand the impact of tariffs and will only ever act in the national interest.

“Our Plan for Change has delivered a deal which will open up exclusive access for UK beef farmers to the US market for the first time ever and all agricultural imports coming to the UK will have to meet our high SPS (sanitary and phytosanitary) standards.”

Continue Reading

Trending