loopholes exploited by martin Shkreli are still wide open

" “Hard to accept that these imbeciles represent the people in our government.”

Martin Shkreli is 100 % right

 they and their stupid rules and the sheep /lemming like American population is the main reason why we are the developed nation spending maximum dollars with minimal health returns.

Also maybe he was thinking, If I have to pay a  million $ for an unknown hip-hop album patients should pay at least  &50$ for a medicine which was originally  $13,50.

Drug Goes From $13.50 a Tablet to $750, Overnight

By Andrew Pollack

• Sept. 20, 2015

There's nothing wrong with some well-placed rage. But the hatred of Shkreli seems to have accomplished little. The loopholes he exploited when he jacked up the price of Daraprim, a lifesaving drug for immunocompromised patients, 5,000% are still wide open.In the end, in spite of himself, Shkreli proved that as a culture we don't care about the details, we're transfixed by spectacle, and that we don't want to fix our problems. You really hate Martin? How about actually trying to accomplish real change


 "Nancy Retzlaff, Turing’s chief commercial officer, told the committee about her company’s efforts to get the drug to people who can’t afford it. The arrangement she described sounded like a hodge-podge, an ungainly combination of dizzyingly high prices, mysterious corporate bargaining, and occasional charitable acts—which is to say, it sounded not so much different from the rest of our medical system.


A truly greedy executive would keep a much lower profile than Shkreli: there would be no headline-grabbing exponential price hikes, just boring but reliable ticks upward; no interviews, no tweeting, and absolutely no hip-hop feuds. A truly greedy executive would stay more or less anonymous. (How many other pharmaceutical C.E.O.s can you name?) But Shkreli seems intent on proving a point about money and medicine, and you don't have to agree with his assessment in order to appreciate the service he has done us all. Bv showingBy showing what is legal, he has helped us to think about what we might want to change, and what we might need to learn to live with

New Stupid tactic by the Texas Medicaid Insurance companies and their PBMs

Since the beginning of May 2018, I have started getting papers forms for a number of patients for preauthorization for routine generic medications like Gabapentin, quetiapine, cyclobenzaprine Etc.
They are from  PBMs both Caremark and Express Scripts.

These are mostly Medicaid patients who do not or can not buy these medications, although they are only 4 or 5 $ out of pocket.
What the insurance companies want to achieve by adding more unnecessary work for primary care physicians.

what is Texas Medical Board and the various Medical associations doing?
how can they6 allow nonmedical people running these corporations, to indirectly practice medicine without a medical license?

Why an old teratogenic drug cost so much?

THALIDOMIDE is used to treat multiple myeloma

This was banned after it was given to pregnant woman causing their children to be born with no limbs or very shortened limbs a condition called phocomelia.

after a number of years, scientists and doctors found this may work in the treatment of multiple myeloma. and once again  our good old  pharma companies are scrambling to gather the  silver coins  from dead bodies
Charon's obol is an allusive term for the coin placed in or on the mouth^[1] of a dead person before burial. Greek and Latin literary sources specify the coin as an obol, and explain it as a payment or bribe for Charon, the ferryman who conveyed souls across the river that divided the world of the living from the world of the dead. Archaeological examples of these coins, of various denominations in practice, have been called "the most famous grave goods from antiquity."^[2]
https://en.wikipedia.org/wiki/Charon%27s_obol

Revlimid	14,196		See Prices
	Just add an ammonia molecule to thalidomide and you get LENALIDOMIDE and you can charge  10,000 $ extra! LENALIDOMIDE is a chemotherapy drug that targets specific proteins within cancer cells and stops the cancer cell from growing. It is used to treat multiple myeloma, mantle cell lymphoma, and some myelodysplastic syndromes that cause severe anemia requiring blood transfusions.
	Pomalyst  Just add an ammonia molecule to thalidomide at a different place and you get pomalidomide and you can charge  12000 $ extra.  So this is  the kind of innovation done by the  great scientific minds ?			See Prices
	POMALIDOMIDE is a chemotherapy drug used to treat multiple myeloma. It targets specific proteins within cancer cells and stops the cancer cell from growing.
	Thalomid	4,889		See Prices
	THALIDOMIDE is used to treat multiple myeloma. It is also used to treat moderate to severe new lesions of leprosy and to prevent and keep the skin lesions of leprosy from coming back.

why should an old teratogenic drug cost so much ?

THALIDOMIDE is used to treat multiple myeloma

this was banned after it was given to pregnant woman causing their children to be born with no limbs or very shortened limbs a condition called phacomelia.

after a number of years, scientists and doctors found this may work in the treatment of multiple myeloma. and once again  our good old  pharma companies are scrambling to gather the  silver coins  from dead bodies
Charon's obol is an allusive term for the coin placed in or on the mouth^[1] of a dead person before burial. Greek and Latin literary sources specify the coin as an obol, and explain it as a payment or bribe for Charon, the ferryman who conveyed souls across the river that divided the world of the living from the world of the dead. Archaeological examples of these coins, of various denominations in practice, have been called "the most famous grave goods from antiquity."^[2]
https://en.wikipedia.org/wiki/Charon%27s_obol
 

Revlimid	14,196		See Prices
	Just add an ammonia molecule to thalidomide and you get LENALIDOMIDE and you can charge  10,000 $ extra! LENALIDOMIDE is a chemotherapy drug that targets specific proteins within cancer cells and stops the cancer cell from growing. It is used to treat multiple myeloma, mantle cell lymphoma, and some myelodysplastic syndromes that cause severe anemia requiring blood transfusions.
	Pomalyst  Just add an ammonia molecule to thalidomide at a different place and you get pomalidomide and you can charge  12000 $ extra.  So this is  the kind of innovation done by the  great scientific minds ?			See Prices
	POMALIDOMIDE is a chemotherapy drug used to treat multiple myeloma. It targets specific proteins within cancer cells and stops the cancer cell from growing.
	Thalomid	4,889		See Prices
	THALIDOMIDE is used to treat multiple myeloma. It is also used to treat moderate to severe new lesions of leprosy and to prevent and keep the skin lesions of leprosy from coming back.

One more way Pharmaceuticals and insurance companies price gouze you.

 Did you know that there is a Gag law applicable to your pharmacist so much so he can not tell you about a cheaper way to get the same drug?

Drug Reimbursement Legislation Looks to Regulate PBMs, End Pharmacist Gag Rules

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Monday, April 30, 2018

Author: 

Marsha K. Millonig, MBA, BPharm

Pharmacists, how many times have you seen a patient pay for more their medication than they should, all because you’re prohibited from telling them about ways to save money?

How often have you had to tell a patient that the cost for their chronic medication has gone up yet again? This probably happens multiple times a day, leaving you frustrated and reaching for your own antacid or pain reliever.

These situations are now being heard by legislators, who are introducing bills that will address some of the related activities behind these situations, including price increases by manufacturers and contract provisions that prevent pharmacists from sharing information about less expensive alternatives.

Many states are introducing legislation, often referred to as “The No Gag Rule on Pharmacists Act” that will prohibit health insurance companies and pharmacy benefits managers (PBMs) from contractually preventing pharmacists from telling their customers about cheaper ways to buy prescription drugs. These bills generally have bipartisan support and would allow pharmacists to tell patients when their usual and customary (cash) price is less than the copay determined by the patient’s insurer. This situation often arises when the prescription is for a generic drug but could also apply to therapeutic alternatives. Too many times, a less expensive alternative is available, yet patients don’t know or aren’t comfortable enough to ask their doctor or pharmacist.

Current Pharmacy-PBM Relationship

Pharmacies have been subject to DIR fees and claw backs when the difference between the actual cost and the copay is “recouped” by the pharmacy benefit manager. As an example, if the patient’s copay is $25 and the pharmacy’s cash price is $15, the PBM expects that the $25 would have been collected and will charge the pharmacy the $10 difference. Multiply that $10 by hundreds of patients and thousands of pharmacies, and it’s easy to understand the motivation behind the contract language. What’s the line from Jerry Maguire: “Show me the money”?

Pharmacies need to submit the claim to determine the PBM pricing. If the PBM then reverses the claim, not only does that take extra time and likely result in an additional transaction fee, the PBM loses the clinical data associated with that claim and can’t accurately perform drug utilization review for the member in the future.

Shining a Light on the Issues

Fifteen states have either approved (CT, GA, ME, NC) or introduced (AZ, CA, FL, MN, MO, MS, NH, NY, PA, SC, VA, WA) legislation that would eliminate these practices. These states, and others, have introduced 80 bills this year that would impose regulations on PBMs. Included in these bills are language regarding transparency and new standards for PBM pharmacy reimbursement, customer charges, rebate revenue, and PBM limitations on pharmacist communication with customers about costs. More information can be found on the National Academy for State Health Policy website.

Mainstream media is watching as well. Recent articles in the Detroit Free Press, New York Times, Salt Lake Tribune, and the Washington Examiner, among others, have all helped to educate the public about these issues.

The Detroit Free Press article cited a study published in the Journal of the American Medical Association by researchers at the University of Southern California’s Schaeffer Center for Health Policy & Economics, which “suggested the practice goes beyond anecdotes or the allegations in consumer lawsuits.

“The study, based on pharmacy claims data from 2013, found that customers had overpaid for their prescriptions nearly a quarter (23 percent) of the time, with an average overpayment of $7.69 on the transactions. The researchers found over-payments were more likely on claims for generic drugs, rather than brand-name drugs.

“’Clearly, this is going on (at a) much higher frequency than most people imagine,’ Geoffrey Joyce, a co-author of the study, told Kaiser Health News. ‘You’re penalizing people for having insurance.’”

A 2016 survey of 640 pharmacists by the National Community Pharmacists Association found that 59% of pharmacists had encountered “gag clause” restrictions at least 10 times in the previous month.

In addition to the legislative activity at the state level, there’s also federal activity. Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) have introduced bills (with companion legislation in the House), that would bar gag clauses. The Patient Right to Know Drug Prices Act would apply to plans offered through private employers or health exchanges, and the Know the Lowest Price Act would apply to individuals covered by Medicare Advantage and Medicare Part D plans.

“Insurance is intended to save consumers money,” Sen. Collins said in a statement. “Gag clauses in contracts that prohibit pharmacists from telling patients about the best prescription drug prices do the opposite.”

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

what antibiotic to use for sinus infection

what antibiotic to use for sinus infection 

Are antibiotics necessary to treat sinus infections and sinusitis?

For sinusitis caused by virus infection, no antibiotic treatment is required. Frequently recommended treatments include pain and fever medications (such as acetaminophen [Tylenol]), decongestants and mucolytics (medication that dissolve or breakdown mucous, for example, guaifenesin.

Bacterial infection of the sinuses is suspected when facial pain, nasal discharge resembling pus, and symptoms persist for longer than a week and are not responding to OTC nasal medications. Acute sinus infection from bacteria is usually treated with antibiotic therapy aimed at treating the most common bacteria known to cause sinus infection, since it is unusual to be able to get a reliable culture without aspirating the sinuses.

The five most common bacteria causing sinus infections are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes. The antibiotics that are effective treatment for sinus infection must be able to kill these bacterial types. Although amoxicillin (Amoxil) is an acceptable first antibiotic for an uncomplicated acute sinus infection, many physicians choose amoxicillin-clavulanate (Augmentin) as the first-line drug for treatment of a suspected bacterial sinus infection because it is usually effective against most of the species and strains of bacteria that cause the disease.


In the penicillin allergic individual, cefaclor (Ceclor), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin (Zithkromax), sulfamethoxazole (Gantanol), trimethoprim (Bactrim, Septra) ciprofloxin (Cipro), and other antibiotics may be used as first choices. If a patient is not improving after five days of treatment with amoxicillin, the patient may be switched to one of the above drugs or amoxicillin-clavulanate (Augmentin). Generally, an effective antibiotic needs to be continued for a minimum of 10-14 days. However, it is not unusual to need to treat sinus infection for 14-21 days. Some antibiotics are now thought to also reduce inflammation, independent of the anitbacterial activity.

The double helix is indeed a remarkable molecule

The double helix is indeed a remarkable molecule. Modern man is perhaps 50,000 years Old, civilization has existed for scarcely 10,000 years and the United States for Only just over 200 years; but DNA and RNA have been around for at least several billion years. All that time the double helix has been there, and active, and yet we are the first creatures on Earth to become aware Of its ish
Francis Crick

what the role of a primary-care physician should be

The question of what the role of a primary-care physician should be, and how it should be valued, has perhaps never been more urgent. That figure, typically a general practitioner, family doctor or internist, is a patient’s first and often most personal connection to the rest of the health care system. But well-known corporations are betting that Americans would prefer to have health care “delivered” by a trusted brand rather than a trusted physician. At least 10 of the nation’s largest tech companies, including Apple, Microsoft and Alphabet, Google’s parent company, have designed tools and software for medical use and increased their involvement in health care start-up deals in recent years; the size of those deals went to nearly $3 billion in 2017 from under $300 million in 2012. Amazon, in partnership with Berkshire Hathaway and JPMorgan Chase, has announced its intent to disrupt the industry — among other ways, by reinventing primary-care delivery. Walmart now offers primary-care services in some of its stores

Surprisingly little is known, though, about what the relationship between a patient and his or her primary-care doctor is actually worth, in terms of that patient’s overall well-being or medical costs, regardless of who bears them. In fact, David Meltzer, an economist and a primary-care physician at the University of Chicago, may be the first and only researcher in the country trying to quantify that relationship’s value in a randomized clinical trial, the most rigorous scientific method.

as more working Americans signed up for employer-sponsored health insurance, many of them — 41 percent, in one survey — “severed established relationships with their physicians in order to seek new providers,” according to a 1996 study in The American Journal of Public Health. The same study estimated that more than a third of Americans on Medicare who were 65 and older and who had a regular physician had been seeing him or her for a decade or more — and those with the longest ties had lower medical costs and were less likely to be hospitalized than those with the shortest
One afternoon I watched one doctor, Ram Krishnamoorthi, examine L.A. Kizer, who had just turned 70. He was wearing a new-looking ball cap with a trout on it and pulling an oxygen tank. “Did you go fishing?” Krishnamoorthi asked. He had been Kizer’s doctor for more than two years, but he could never tell when such an innocuous question might turn out to be significant: If Kizer said yes, Krishnamoorthi could try using the activity to motivate healthful behavior, or he might find out that someone who could be tapped as a source of support had accompanied Kizer on the outing.

“Used to,” Kizer said. He suffered from congestive heart failure and was still breathing heavily from the trip down the hall.

“Let me see you walk over,” Krishnamoorthi said. “This is a lot worse than before. What happened?”

‘THE AWESOME PART OF IT IS, I DON’T HAVE TO LOOK STUFF UP ABOUT MY PATIENTS. I DON’T HAVE A PERFECT MEMORY; IT’S JUST THAT I’VE SEEN THEM A BUNCH OF TIMES.’

“I saw you two weeks ago,” Kizer said, “and it feels like I woke up and I can’t move.” He added that he had gained four pounds. Krishnamoorthi rolled up his pants legs and probed his ankles. He pressed a stethoscope to his back. A doctor who had not seen Kizer so recently would have no reason to investigate his sudden decline (and Kizer, who said he didn’t like doctors, might not have told an unfamiliar doctor that anything had changed). “How’d you get here?” Krishnamoorthi asked.

“Bus.”

“How many?”


“One.”

“It’s fluid,” Krishnamoorthi said, referring to Kizer’s added weight and difficulty walking and breathing. He asked if Kizer wanted to be admitted to the hospital, where he could get additional medications; Kizer declined. Krishnamoorthi eventually agreed to let him go home if he turned off his tank, waited for 10 minutes and had his blood-oxygen level checked. This would take up more of Krishnamoorthi’s time — without generating additional reimbursement — but it would mean vast savings for the health care system if it helped him prevent Kizer from having an emergency on the bus later. Heeding Kizer’s preference probably made him more likely to keep future appointments.

“Why am I doing so bad?” Kizer asked as Krishnamoorthi clipped an oxygen meter to his finger. “Is it all the meds?”

“I don’t know. Maybe.” Krishnamoorthi read the meter display: “98 percent. I think you’re safe. Don’t croak on the bus.”

“If I do, you won’t find out.”

“I’ll find out. They call the doctor first. What’d you do for your birthday?” A physician in a hurry might not have noticed the date — or accepted his first answer.

“What I’m doing now. Nothing.”

“Did you have guests over?”

“Yes.”

“What did you do?”

“Played cards.”


“Did you eat chips while you were playing cards?”

“A couple. You know I do.”

“Do you think that might be part of the reason for the weight?” Extra sodium can cause fluid buildup.


What I couldn’t quite believe was that these lengthy conversations were economically sustainable. Nationwide, primary-care physicians often can’t afford to spend more than 15 minutes with each patient, because of the way the health care system values their time. I had seen Krishnamoorthi and colleagues take that long to sort through patients’ medications, often more than a dozen, which they asked patients to gather up and bring to appointments. During one visit, Grace Berry, another doctor, Google-mapped a patient’s new address to locate a nearby pharmacy, transferring her prescriptions there and helping her secure reliable transportation to and from the clinic.


Interesting thing I noticed   2 of the primary care physicins  whose  stories  are given in the article  both are  Indians .