dagblog - Comments for "Drug Lords - the CVS-Aetna cartel"

The ugly truth is that a

artappraiser — Sun, 10 Feb 2019 02:17:18 +0000

In reply to Drug Lords - the CVS-Aetna cartel

The ugly truth is that a certain kind of dissatisfaction is global, and it's probably because of "them", the money driven merchants of medicine

See QB4.

To what extent do you agree or disagree with the following statement. – The healthcare system in my country is overstretched.

on Ipsos poll huge health care survery of: 23,249 online adults aged 16-64 across 28 countries May 25 – June 8, 2018,

PDF here

https://www.ipsos.com/sites/default/files/ct/news/documents/2018-07/global_views_on_healthcare_2018_-_graphic_report_0.pdf

Question QB4 is on page 33.

Overall world: 53% agree overstretched.

Contra my own beliefs, Great Britain is #1, 85% agree overstretched. Hungary # 2. Sweden is # 3, 74% believe overstretched.France #6, 70% think overstretched

Only countries where a third or less thought their system was overstretched: Belgium, Poland, South Korea and Japan. Japan has incredible numbers, everything hunky dory there. Don't know why, haven't looked into it.

Of course we are not privy to

artappraiser — Thu, 07 Feb 2019 06:54:48 +0000

In reply to Wow.

Of course we are not privy to the entire reason, might be because Behemoth Everything Medical Inc. squeezed them down to $0.50 for it. Doing that long as they buy this that and the other thing, including too many size small surgical gloves for their chain of hospitals, they can always make it up from Laura or her insurance company, most probably Laura, cause they will say this insulin is no longer in their formulary, she now needs to use the kind that doesn't work to get the same old co-pay she's used to.

Wow.

PeraclesPlease — Thu, 07 Feb 2019 06:28:30 +0000

In reply to Yup:

Wow.

Yup:

artappraiser — Thu, 07 Feb 2019 06:10:13 +0000

In reply to Drug Lords - the CVS-Aetna cartel

Yup:

There is little to stop drug companies from raising and raising prices like this. And absolutely nothing people like Laura can do about it. https://t.co/GKg0wZYF9F
— Andy Slavitt (@ASlavitt) February 7, 2019

From my one doctor just a

artappraiser — Wed, 06 Feb 2019 20:46:20 +0000

In reply to Drug Lords - the CVS-Aetna cartel

From my one doctor just a couple hours ago. After I said will it help if I also write a challenge to their denial? I've been successful in the past doing this.

He said, not angrily, rather more resigned and cynical no you don't get it. They don't care, they just don't care! They don't care what you say, appealing is only a fake show for appearances sake. They aren't going to read or listen to anything. They are going to do what they are going to do.

It's like this: the formulary for each insurance co. is the bible and if the drug or the treatment that the doctor thinks is right is not on it, you don't get it. So basically they've eliminated the need for doctors after diagnosis. After the doctor puts a diagnosis code for you into the system, you get the treatment, if any, that the formulary says you get. That's it. Over. No more human input required. Very efficient for profit making, like cogs in a machine or an assembly line, comes with a printout for pharmacist, patient. etc. what to do, what drugs and procedures you can get, everything else ruled out.

What that means, for one example: the threat of a pre-existing condition problem is always there, will not go away. Say you have a rare disease that needs special treatment and you know what you require. For the principles of consumer-regulates-the-market Obamacare to work, you would be able to figure which insurer had what you need in their approved formulary and you would go with that one.

But you can't really know that when you are deciding at insurance renewal time. And even if it you could easily access such data, it could change tomorrow depending upon what big deal is being made right then and there between say, a drug company and CVS and Aetna. Deals being made and changed every day. We used to worry about drug company salesmen selling doctors. That's over, no longer, the doctors are out of it. Except the ones working for the deal makers instead of practicing, if any (probably just R.N.'s and drug co. salespersons advising.)

When finished, what the doc said to the one of three nurses in his little sub-clinic who working on prescriptions nearly full time: Lie. Just lie to them and tell them she has tried everything in the formulary already. That's the only thing that might work.

The nurse called me an hour ago, thrilled she had won after 3 mos. of trying, that it had just gotten approved. She sounded surprised. Apparently lying worked. She added we have to fight for nearly every prescription now, it's nearly full time, that's all we are doing.

Edit to add: situation is also constantly changing with providers. As described above, what doctors or hospitals or labs work with your insurance, changing all the time. From week to week. You must constantly check with provider to see if they still take your insurance. The insurance cos. cannot keep straight who they have and who they don't, they have no incentive to have a daily updated database for consumers, they'd rather that the insured pay a bigger part of the bill, you see?

Should that happen to you, I think it's important to keep my doctor's advice in mind: don't challenge, just lie about it all.

P.S. Comes to mind now that

artappraiser — Wed, 06 Feb 2019 20:31:23 +0000

In reply to From my one doctor just a

P.S. Comes to mind now that the way Obamacare works, when you sign up for an insurer, it is only a contract between consumer and company as to the items required by the laws of Obamacare. I.E. physical and mammogram once a year required, emergency coverage required, this limit on total costs, that limit for annual out-of-pocket for that level plan, etc. Everything else is up for grabs, they can give what they like and they can take away what they like, not a contract for anything in particular except what's listed in the law.

Some examples of the

artappraiser — Mon, 04 Feb 2019 14:02:16 +0000

In reply to Drug Lords - the CVS-Aetna cartel

Some examples of the nightmares:

Patients Suffer When Health Care Behemoths Quarrel Over Contracts

By Barbara Feder-Ostroff @ Kaiser Health News-Feb 1, 2019

[....] Anthem Blue Cross of California, one of the state’s largest health insurers, is battling with Sutter Health over how much it should pay to care for tens of thousands of its enrollees in Northern California. Sutter operates 24 hospitals in the region and lists about 5,000 doctors in its network.

“It’s not the peace of mind I thought I was buying to have the entire Sutter network — which is the biggest game in Northern California — be out-of-network,” said Lerman, whose family is insured through his wife’s job as a California State University professor [....]

when insurers and providers fail to reach an agreement on time, it can force patients to pay higher prices for care that is no longer covered by their health plans. At the least, it can cause considerable anxiety.

“It is a game of chicken, and at the end of the day somebody blinks and they come to an agreement,” said Wendell Potter, a former senior executive at health insurance giant Cigna who became a critic of the industry and a strong proponent of sweeping health care reform. “The big losers in this are patients, because there’s a period of uncertainty and angst and a real possibility that the physicians and hospitals you want to go to are no longer in-network.” [....]

As large hospital systems merge with competitors and snap up medical practices, “it’s much more difficult for insurers to say, ‘OK, we’re letting you go,’” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

In western Pennsylvania, nearly 50,000 people with Medicare managed-care plans from Highmark Health will lose in-network access to University of Pittsburgh Medical Center hospitals and doctors starting July 1, because of a slow-moving divorce between the two regional health giants.

Among those patients is Judy Hays, a 75-year-old retired office manager from the Pittsburgh suburb of Crescent Township who relies on UPMC’s physicians and hospitals to treat a rare form of leukemia. Now, she plans to change doctors mid-treatment because she wants to keep her insurance, which she said has paid for her expensive medications. “It’s very tough. These people have been taking care of me for the last nine years. I can’t have any interruption in my care,” Hays told Kaiser Health News. “I’m very angry about it.”

In Georgia, WellStar Health System, with 11 hospitals and numerous medical offices, plans to stop accepting Anthem’s individual policyholders as in-network patients on Feb. 4, amid a contract dispute between the two companies [....]

Sutter has quarreled with other insurers, including Blue Shield of California in a dispute that affected about 270,000 consumers before the two sides reached a deal that took effect in February 2015.

Sutter’s market dominance in California and its high prices for inpatient care have long drawn criticism. One patient reported that Sutter charged $1,555 for a 10-minute ER visit to treat a cut finger, including $55 for a gel bandage and $487 for a tetanus shot.

Last year, state Attorney General Xavier Becerra sued the giant health system, alleging it had illegally overcharged patients and drove out competition in California. Sutter has contended that Becerra overstepped his authority and that limiting Sutter’s ability to negotiate with insurers will harm consumers [....]

15 years since I quit

PeraclesPlease — Mon, 04 Feb 2019 06:10:35 +0000

In reply to Tip of the iceberg of their

15 years since I quit fighting against insurance and just left the country - except loss of income, but otherwise no regrets. Iy would have been a nightmare.

Tip of the iceberg of their

artappraiser — Sun, 03 Feb 2019 21:06:28 +0000

In reply to Drug Lords - the CVS-Aetna cartel

Tip of the iceberg of their plotting, it's clearly the way they would like it all to work, not just with opiods:

How your health information is sold and turned into ‘risk scores’

Information used to gauge opioid overdose risk is unregulated and used without patient consent.

By Mohana Ravindranath @ Poltico.com, 02/03/2019 06:56 AM EST

Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores.

While the data collection is aimed at helping doctors make more informed decisions on prescribing opioids, it could also lead to blacklisting of some patients and keep them from getting the drugs they need, according to patient advocates.

Over the past year, powerful companies such as LexisNexis have begun hoovering up the data from insurance claims, digital health records, housing records, and even information about a patient’s friends, family and roommates, without telling the patient they are accessing the information, and creating risk scores for health care providers and insurers. Health insurance giant Cigna and UnitedHealth's Optum are also using risk scores.

There’s no guarantee of the accuracy of the algorithms and “really no protection” against their use, said Sharona Hoffman, a professor of bioethics at Case Western Reserve University. Overestimating risk might lead health systems to focus their energy on the wrong patients; a low risk score might cause a patient to fall through the cracks [....]

I already had an inkling about this dealing with Optum Rx under United insurance, the responses from them when they turn down a prescription. Except here's the problem: they are incredibly inaccurate! They say: patient hasn't tried the protocol medicine first! When patient has, for years! This is no human you or the doctor are arguing with, and no one to turn to. It costs money to have humans deal with problems. The point is to get you to give up if you are risky and will cost them money.

Along these lines, one doctor told me this: they purposely program prescriptions to allow renewal right at the exact time it runs out, hoping the patient cannot get the refill in time and will skip a few days. In the skipping of a few days by many patients is a slim profit margin. He has learned to beat the system by writing prescriptions a different way, but it doesn't always work. As a patient, if you don't have a doctor this understanding, there is basically no recourse. You complain about it at CVS, you can't talk to a pharmacist-they are worked like cogs and don't talk to customer-you talk to the cashier kid who is trained to say it's the doctor's problem. Most doctors will say it's the insurer's problem. The insurer don't talk to you, as Optum RX is the entity that handles their prescriptions. Optum RX is robots. There must be some humans working there but I haven't found them yet.

Once again, the point is to get you to give up and just live with your illness with improper care, to not be so expensive and individual, to be a cog of predictable costs.

Just like it is the point of the adjuster involved in any claim you make of any other kind of insurance to accept less than you were expecting.

I deal with it every week, it

artappraiser — Sun, 03 Feb 2019 20:29:39 +0000

In reply to Drug Lords - the CVS-Aetna cartel

I deal with it every week, it's a fucking nightmare. Dealing with being forced to use CVS for prescriptions is like walking straight into a Kafka novel. In the line, everyone is depressed, their soul beaten to death. Anybody who thinks everything is hunky dory under Obamacare just hasn't had to access it much. If you get one of the doctors ready to crack if not retire or go exclusively out of pocket with patients, and you sound like you know something about what's going on, they will share an earful of conspiracy theories. Conspiracy theorizing is all they got left, they feel zero power to affect things.

It's an escalating war of the behemoths, is what it is. This was more than a year ago:

UnitedHealth is stepping past CVS Health with its latest deal

Published: Dec 10, 2017 12:47 p.m. ET

[....] while CVS Health CVS, -0.50% is aiming to emulate UnitedHealthUNH, -0.55% by folding in health insurance with its pharmacy-benefit manager business, UnitedHealth’s acquisition shows it is one step ahead, according to Mizuho analyst Sheryl Skolnick.

“So while others may look to build what UNH/Optum had, Optum moves the bar yet again, establishing itself as the leading physician platform for the transformed health care sector of the future,” Skolnick said.

The recent deals also demonstrate health care companies’ push to diversify. As health care costs continue to grow year after year, companies hope that more insight into and control over the patient experience will help cut costs.

UnitedHealth was the pioneer in this: It has long had Optum as its in-house pharmacy-benefit manager unit, which has become increasingly profitable for the health insurer [....]

I suspect ma ny mid-term voters who told pollsters "health care" was the number one issue all are people who have to access. Yes of course they are grateful more have insurance now, but they'd like to see it become something other than "fighting the man" nearly full time if they are sick.

In a way, I have black humor visions when I see Dems talk Medicare for all or Medicare buy-in pie in the sky. If they ever get to the stage of actual practical steps, we are going to see these behemoths fight to stay alive like nothing we have seen before in politics in the history of the country. Maybe it won't be so bad, maybe if threatened for destruction, they'll start treating the worker providers and patients better to appear a better option than government. That would be temporary, but I'll be dead when they start with the shit again.

One thing people don't realize about current Medicare is the behemoths have a big hand in it. Nobody goes with plain vanilla Medicare, virtually everyone over 65 is in a private managed care plan or at least has a private supplemental. The get the Medicare money and try to make it look like they cover more with it while profiting. Woe to those who are chronically ill and find their choices are extremely limited. I.E., no you can't have that drug, it's not in our formularly, no you can't have that procedure, it's not standard protocol., no you can't go to that LTAC hospital, you have to go to this lousier one in plan, by ambulance, even if it kills you. Every step of the way.

My one doctor and his two colleagues in practice together have 3 nurses that mainly spend all day in a little room challenging prescription denials all day. He and they are employees of Advantage Care Physicians, part of Emblem Health, a big northeastern conglomerate non profit, formed to fight the bigger guys. For the patient like myself, little diff from for-profit, as it's still all about money and standardization.