Fake Prescription Drug Rx Example

Altered and Poorly Written Rx for Vicodin

By Dr. David Edward Marcinko MBA

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Poorly-written Rx for vicodin

Drug: Rx Vicodin

Disp: # 10

Sig: Take I, as needed for pain.

Refills: 1 2 3 4 or 5

AM2685591

David Edward Marcinko, MBBS DPM MBA

The patient abuser may change drug quantity numbers, copy or remember the doctors’ DEA number, or take extra Rx pads. For this reason, a physician’s Rx pad should contain his/her name, address and telephone number. The doctor’s DEA number should not be pre-printed on the pad, for fear of mis-use.

Example:

  • Increase the quantity 10, to 100, by adding a zero, so that the additional capsules can be used, sold or bartered with on the street.
  • Change the directions to take 2 capsules, rather than 1 in order to produce greater euphoria.
  • Increase the Rx refills, from one to two, by extending the underline, or checking an additional quantity box.
  • Pre-printed DEA number can be stolen, sold or reused.
  • Pre-printed (not original) physician signature can be reproduced and widely distributed for more prescriptions.

Altered Rx for vicodin

Drug: Rx Vicodin

Disp: # 100

Sig: Take II, as needed for pain.

Refills: 1 2 3 4 or 5

AM2675591

David Edward Marcinko, MDBBS DPM MBA

 The doctor drug addict, or a doc in need of funds, may write for more narcotic agent than needed, and receive the additional pills back from the patient-shill for personal consumption, sell them on the street himself for money, or receive a monetary kickback from the patient-shill.

A pharmacist may also indirectly alter a prescription using the above methods, or simply short-change the patient with fewer narcotic capsules than the prescription intends. This is more difficult to do with pills or tablets in the out patient setting, but easy to do in the in-patient setting when liquid IV drugs are used, by dilution and placing less than the full amount in IV bottles or bags. The harm to patients, of course, may be fatal.

Well-written Rx for vicodin

Drug: Rx Vicodin

Disp: # 10 (ten) capsules

Sig: Take one or two capsules, po, prn pain.

Refills: 1 2 3 4 or 5

AM2685591

David Edward Marcinko, MBBS DPM MBA

Example:

  • Drug quantity can-not be changed.
  • Directions can-not be changed. Route of administration (by mouth) indicated.
  • Rx refills clearly indicated.
  • Handwritten, not pre-printed, DEA number.
  • Original physician signature, only.

Doctor Rx prescription abuse foibles are legendary in the DEA and include a Maryland podiatrist who wrote prescriptions for more than 1,235 Mepergan Fortis capsules ostensibly for his wife following minor foot surgery. Or, the Florida physician who prescribed more than 2,150 Vicodin capsules for a patient with whom he was having an extra-marital affair in order that his consort not disclose the fling to his wife. Or, the osteopath from New Jersey who wrote more than 100 narcotic prescriptions every 8 hour day, for more than a year, to any patient standing in a line in front of his office. And, finally the California dentist whose excuse for writing more than 1,845 narcotic tablet prescriptions in a six month period for the same patient was that they would be needed in his next reincarnation. Yes, all of these incidents are laughable if not for their serious consequences to the involved individuals, and society, alike. The bastards!

Fortunately, unlike drug local domestic drug kingpins or international narco-traffickers who ply their trade virtually undetected, these naive white-collared nerds, always get caught by the Drug Enforcement Agency. Their Rx abuse tactics are so amateurish!

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Prescription Drug Rx ABUSE

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By Dr. David Edwarrd Marcinko MBA

Rx DRUG ABUSE

Traditional medicinal agents come in a variety of ways, known as dispensing vehicles. Drugs may be in liquid, pill or inject able form, they may be compounded in capsules, caplets, gelatin tablets, powders or suppositories, or they may come in creams or ointments for the eye, anus and vagina. They may be ingested into the stomach, placed and dissolved under the tongue, put into the eyes, popped, injected or smeared and transported through the human skin from patches.   

A valid drug prescription is a written order, by a doctor, to a pharmacist. In this country, prescriptions are written by physicians, podiatrists, osteopaths, dentists. and some optometrists, physician assistants and nurse practitioners. In addition to the name of the patient and that of the medical prescriber, the prescription contains the name of the drug (not necessarily a narcotic), its quantity, instructions to the pharmacist, and directions to the patient. Narcotic prescriptions may not be prescribed to a drug addict to prevent withdrawal symptoms, as there must be some other therapeutic purpose for such an order.

The art of medicinal prescription writing, and pharmaceutical compounding, has declined in modern medicine for several reasons. Most drugs are made by pharmaceutical companies, and the role of the pharmacist, in most cases, consists only of compounding and error prevention. Many drugs are even automatically dispensed, and tracked, in the hospital setting with bar coding technology and modern inventory tracking mechanisms. Also, the practice of writing long and complicated prescriptions, containing many active ingredients, adjuvants, correctives, and elegant vehicles, has been abandoned in favor of using pure compounds.

Drugs may be prescribed by their official names, which were first given by the United States Pharmacopeia (USP), in 1920, or by the National Formulary (NF), since 1906. Unofficial or generic names may be used, known as New and Non-Official Drugs (NND) or by the United States Adopted Names (USAN), or by the manufactures trade name. For example, the generic narcotic meperidine or pithidine, is also known by the trade named, demerol. The designation USAN does not imply endorsement by the American Medical Association (AMA) Council on Drugs (CODs), or by the USP.

Of course, there is an advantage and disadvantages to prescribing drugs by their trade name, or generic names. Advantages of generics include economies of scale for both the patient and pharmacist, and although the active ingredient in generics are identical to trade drugs, they are often less expensive since research and development costs are absent, and various binders, colorizing agents, preservatives or dispersing agents are of an inferior quality, and hence cheaper for the patient. Appearance, size and taste issues are common. For the pharmacist, generics are cheaper since a multiplicity of very similar drugs need not be shelved.

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For example, the tablet or capsular form of many drugs contains inactive ingredients, such as: ammonio methacrylate copolymer, hydroxypropyl methylcellulose, lactose, magnesium stearate, povidone, red iron oxide, stearyl alcohol, talc, titanium dioxide, triacetin, yellow iron oxide, yellow iron oxide with FD&C blue No.2 (80 mg strength tablet only), FD&C blue No.2 and other ingredients. And yes, I’ve seen an addict do into shock, or die from acute anaphylaxis, after taking drugs containing ingredient he was highly allergic to.

Shock is a life-threatening condition where blood pressure falls too low to sustain life. It occurs when low blood volume (due to severe bleeding, excessive fluid loss or inadequate fluid uptake), inadequate pumping action of the heart or excessive dilation of the blood vessel walls (vasodilation) causes low blood pressure. This in turn results in inadequate blood supply to body cells, which can quickly die or be irreversibly damaged.

Anaphylactic shock is the severest form of allergy that is a medical emergency. It is a Type I reaction according to the Gell and Coombs medical classification, and is often severe and sometimes fatal systemic reaction in a susceptible individual upon exposure to a specific antigen (such as wasp venom or penicillin) following previous sensitization, or drug use. Characterized especially by respiratory symptoms, fainting, itching, itching and swelling of the throat or other mucous membranes and a sudden decline in blood pressure! The victim literally cannot breathe and drowns in its own congested and fluid filled lungs

So, patients in need of routine drugs for acute or chronic conditions like arthritis, high blood pressure, asthma, acne, hay fever, performance enhancing steroids or, so called life style drugs, like Viagra for a limp woody, or hair growth stimulator Rogaine, may get a good deal by going to Canada or Mexico for generics. But for important drugs, like nitroglycerine fro your heart, blood thinner coumadin, birth control pills or various anti-cancer agents, stick with brand names.

The main disadvantage of trade drugs is increased cost, due to R & D, patents, trademarks, marketing and company advertising expenses. Of course, trade drug are first to market, and hence may be beneficial as a new treatment modality, or injurious if significant side affects or other complications arise.

Today, the prime source for drug information is probably the well known, Physicians Desk Reference (PDR). Now, in its 58th edition, the PDR® provides the latest information on prescription, but not illegal street drugs. It is considered the standard reference that can be found in virtually every physician’s office, hospital and pharmacy in the United States. The current edition is over 3,000 pages long, and is where you can find data on more than 4,000 drugs, by brand and generic name, manufacturer and product categories. The PDR also provides usage information and warnings, drug interactions, plus full-size, full-color photos cross-referenced to specific drugs. For the layman, it also includes: phonetic spelling for each listing, a key to controlled substances, adverse reactions and contraindications, pregnancy ratings, dosages and all other FDA-required information. Of course, on the street, or in Mexico, none of this information matters.

Latin abbreviations, sometimes still used by doctors on prescription blanks include:

Rx = take thou (receipe)

po = by mouth (para orbis)

prn = as needed (pro re’nata)

hs = at bed time (hora somnae)

BID = twice daily

TID = three times daily

QID = four times daily

M = Mix

Traditionally, a medical prescription is written in a certain order, well known to drug abusers, and DEA agents, and consist of six basic parts:

  • Superscription: This is the Rx, or recipe. In Latin it means take thou.
  • Inscription: Represents the ingredients and amounts.
  • Subscription: Represent the description for drug dispensing, and may be represented by the letter M, for mix.
  • Signature:  Often abbreviated as Sig, and contains the directions for patient use.
  • Refill Status: Indicates the number of refills allowed.
  • DEA Number: This is nine-character alpha-numeric sequence, used by all licensed physicians who prescribe narcotic agents. An example is AM2685591. The second letter is the first letter of the doctor’s last name, (ie, Marcinko) and the first two digits add up to the third (ie, 2+6=8).

Finally, in addition to the basic parts of a prescription, it should have the patient’s name, and physician signature written in ink, followed by degree designation, such as MD, DPM, DO or DDS, etc.

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Perhaps the most egregious narcotic prescribing habits recently encountered by DEA agents have been by doctors of all degrees and medical designations. Reasons are generally two-fold. First, the doctor may become a drug addict himself, either by accident or through initial legitimate therapeutic use, and over-prescribe the narcotics. Or, increasing office costs, and decreased reimbursement fee reductions of many managed medical care have so economically destabilized the medical community, that economically impoverished doctors desperately sell prescriptions to finance their personal lifestyles, automobiles, clothes, fancy vacations or own addictions.

For example, a staggering medical student loan debt burden of  $100,000-$250,000 is not unusual for new practitioners. In fact, the federal Health Education Assistance Loan (HEAL) program reported that for the Year 2001, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid and other federal healthcare programs and had their cases referred for non-payment of debt.

These facts indicate that the current healthcare reimbursement climate has caused more pain and tumult to doctors than the pubic realizes. Older medical practitioners are retiring prematurely, mature providers are frustrated and in despair, and young physicians have no concept of the economic servitude to which they are about to be subjected. Frustration is high and physician suicides have been documented. Many doctors get divorced at the start of their careers. Even the U.S. Inspector General has declared healthcare providers to be public enemy  #2,behind international narco-traffickers, for their federal drug, fraud and abuse initiatives.  Still, the statistic above lends itself to narcotic drug prescription abuse, either on the part of the doctor or patient, since only these two parties that can directly alter a prescription for illicit drug use, as illustrated by this poorly written prescription for a narcotic pain killer, vicodin.

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The COMPOUNDING PHARMACY?

By Staff Reporters

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DEFINITION:

What is compounding in a pharmacy?

Drug compounding is often regarded as the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. Compounding includes the combining of two or more drugs. Compounded drugs are not FDA-approved.

CITE: https://www.r2library.com/Resource/Title/082610254

What is the difference between a regular pharmacy and a compounding pharmacy?

Both types of pharmacies prepare medications prescribed for a patient by a doctor. The main difference is that a regular pharmacy provides commercial medications in standardized dosages, while a compounding pharmacy can customize medication based on a patient’s specific needs.

Are compounded drugs FDA approved?

Compounded drugs are not FDA approved. And what this means is FDA does not verify the safety effectiveness or quality of compounded drugs before they’re marketed.

FDA: https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers

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Survey on Healthcare Financial Affordability

By Staff Reporters

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Gallup: Healthcare Affordability Survey – 3 Takeaways

 •  56% of the U.S. adult population report no recent occurrences of being unable to afford care or prescribed medicine.
 •  36% of the U.S. adult population report recent occurrences of being unable to pay for care or medicine or lack easy access.
 •  8% of the U.S. adult population report recent occurrences of being unable to pay for household care, being unable to pay for prescribed medicine and feeling that they would not have access to affordable quality care if needed today.

Source: Gallup, “Benchmarking Healthcare Affordability and Perceived Value,” March 31, 2022.

CITE: https://www.r2library.com/Resource/Title/082610254

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PROBE: Medicare Advantage [Part C] Plans Deny Needed Care to Tens of Thousands of Patients

By Staff Reporters

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Medicare Advantage Organizations (MAOs) delayed or denied payments and services to patients, even when these requests met Medicare coverage rules, according to a report released by federal investigators on Thursday.

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A verbatim link: https://thehill.com/policy/healthcare/3470005-probe-finds-medicare-advantage-plans-deny-needed-care-to-tens-of-thousands/

Confirmation link: https://www.msn.com/en-us/news/politics/watchdog-private-medicare-plans-denied-nearly-1-in-5-claims-that-should-have-been-paid/ar-AAWHZuT?li=BBnb7Kz

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CITE: https://www.r2library.com/Resource/Title/082610254

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What is the plan for a future with COVID?

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Q: What is the plan for a future with COVID?
A:
A new 136-page report written by dozens of experts provides a comprehensive roadmap to the next normal both to address the pandemic and protect against future biosecurity threats. The group identified 12 key areas of focus, including long COVID, equity, and vaccines. The report also addressed concerns about how the end of the pandemic will disrupt the U.S. health care system when policies introduced during the public health emergency come to an end. 

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Just “Say No” to Drugs

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A Flash-Back in History

[By Staff Reporters]

This photo was sent in by one of our ME-P readers for your enjoyment.

Nancy

[First Lady Nancy Reagan at a “Just Say No” to Drugs Rally at the White House in the 1980’s]

More:

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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A 4/20 [Medical] Cannabis Culture Day Pictorial

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About Four-Twenty Day

[By Anonymous DEA Agent]

Today is … 420, 4:20, or 4/20 (pronounced four-twenty)

And, it refers to consumption of cannabis and, by extension, a way to identify oneself with cannabis subculture. Observances based on the number include the time (4:20 p.m.) as well as the date (April 20).

Again … that’s today as this ME-P was published @ 4:20 p.m., EST!

THE DEA DESTROYS A POT FARM

PHOTOS: 

  1. Photo taken after the “grow” was eradicated. There is still no “pot” of gold at the end of the rainbow.
  2. DEA taking one of many seized vehicles/equipment.
  3. The marijuana farm was operating under the name “Brian’s Green Thumb Farm.”
  4. Inside the barn, Agents found rows and rows of drying marijuana.
  5. Over 2,000 pounds of drying marijuana from the barn, bagged and ready for destruction.
  6. Air view of the massive “grow” from the guard tower.
  7. One of two sleeping shelters, each guarding the middle perimeter. In the back, one of four tents, each positioned in the corners for guards.
  8. The plant being ripped out of the ground by the backhoe.

© iMBA Inc. All rights reserved.

Assessment

Link: http://en.wikipedia.org/wiki/420_(cannabis_culture)

In 2019: Carl’s Jr. was become the first major fast-food chain to debut a cannabis-infused burger.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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PODCAST: Patient Centricity in Value Based Care?

By Eric Bricker MD

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Dr. Sachin MD MBA Jain wrote an outstanding article on Value Based Care in the April 12, 2022 issue of Forbes stating that the Patient Must Come First in Value Based Care.

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RELATED PODCAST: https://medicalexecutivepost.com/2021/12/13/podcasts-the-case-against-value-based-care/
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PODCAST: 50% of Medical Treatments Have Unknown Effectiveness

By Eric Bricker MD

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ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Opioid Use Disorder (OUD) Study

By Staff Reporters

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DEFINITION: Physical and psychological reliance on opioids, a substance found in certain prescription pain medications and illegal drugs like heroin.

Opioids are prescribed to treat pain. With prolonged use, pain-relieving effects may lessen and pain can become worse. In addition, the body can develop dependence. Opioid dependence causes withdrawal symptoms, which makes it difficult to stop taking them. Addiction occurs when dependence interferes with daily life. Taking more than the prescribed amount or using illegal opioids like heroin may result in death.

Symptoms of addiction include uncontrollable cravings and inability to control opioid use even though it’s having negative effects on personal relationships or finances.

Treatment varies but may include discontinuing the drug. Medications such as methadone can help alleviate the symptoms of withdrawal and cravings. Pairing medication with inpatient or support programs generally has the most success.

CITE: https://www.r2library.com/Resource/Title/082610254

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Bicycle Health Study – 4 Findings

A recent survey of nearly 1,000 patients with opioid use disorder (OUD) about recovery, telehealth, and stigma found in regards to recovery:

 •  95% Describe their overall outlook on recovery as positive; just 1% describe as negative.
 •  76% Report having a strong support system to help navigate treatment.
 •  43% Returned to treatment immediately after relapse, 34% took over 3 months to start over.
 •  30% Blame individuals for the opioid crisis (over drug companies, doctors, and the government.)

Source: Bicycle Health, “Cost, Access are Biggest Barriers to OUD Recovery, But Telemedicine Can Help, According to New Report from Bicycle Health,” March 23, 2022

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Update on COVID-19 Booster Shots

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Update on COVID-19 booster shots
In case you missed it: If you or a loved one are 50 or older, or are moderately or severely immunocompromised, you can get an additional Pfizer or Moderna COVID-19 booster shot at no cost to you.

The CDC recommends an additional booster shot for certain individuals to increase protection from severe disease from COVID-19. People over the age of 50, or who are moderately or severely immunocompromised, can get an additional booster of Pfizer or Moderna 4 months after their last dose.

This is especially important for those 65 and older who are at higher risk from severe disease and most likely to benefit from getting an additional booster.

Learn More: Remember: Medicare covers the COVID-19 vaccine, including booster shots, at no cost to you. Find a COVID-19 vaccine location near you.

Sincerely
The Medicare Team

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MORE: https://www.medicare.gov/medicare-coronavirus?utm_campaign=20220406_cvd_prv_gal&utm_content=english&utm_medium=email&utm_source=govdelivery

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PODCASTS: Hospital Posts Laboratory Prices to Physician EMRs

Doctors Order Less Laboratory Tests

By Eric Bricker MD

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PODCAST: How Prescription Drug Coverage Really Works

By Eric Bricker MD

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DICTIONARY HEALTH INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4


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Meth Mouth and TEETH!

More About Meth Mouth and Teeth [MMT]

By Anonymous DEA Agent

METH: Crystal meth is the common name for crystal methamphetamine, a strong and highly addictive drug that affects the central nervous system. There is no legal use for it.

It comes in clear crystal chunks or shiny blue-white rocks. Also called “ice” or “glass,” it’s a popular party drug. Usually, users smoke crystal meth with a small glass pipe, but they may also swallow it, snort it, or inject it into a vein. People say they have a quick rush of euphoria shortly after using it. But it’s dangerous. It can damage your body and cause severe psychological problems

Meth Mouth Teeth is severe tooth decay and tooth loss, as well as tooth fracture, acid erosion, and other oral problems, potentially symptomatic of extended use of the drug methamphetamine. The condition is thought to be caused by a combination of side effects of the drug and lifestyle factors, which may be present in long-term users.

However, the legitimacy of meth mouth as a unique condition has been questioned because of the similar effects of some other drugs on teeth. Images of diseased mouths are often used in anti-drug campaigns.

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EDITOR’S NOTE: I do not know if this is a legitimate picture or not. But, I do suggest that we all “Just Say No to Drugs”. And; as a dental school drop out, I have an affinity for all pro-dentite colleagues.

MORE: https://www.maine.gov/dhhs/mecdc/population-health/odh/documents/downloadable-brochures/meth-mouth.pdf

Conclusion

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Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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PHARMACISTS PODCAST: Job Effectiveness?

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54% of Pharmacists Lack Time to Complete Their Job Effectively

According to the “2022 Medication Access Report“:

 •  54% of pharmacists said they lack time to complete their job effectively.
 •  Of the 54%, 81% cited inadequate staffing and 73% cited time-consuming administrative tasks.
 •  Physicians felt strained by unprecedented demands, with 42% reporting burnout and 69% feeling depressed.

Source: CoverMyMeds via PR Newswire, February 8, 2022

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Drugs, Money and the Middleman

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PIPELINE TO PROFITS

A little more about that … Kaiser Health News infographic!

untitled

By Dr. David E. Marcinko MBA via Georgia Pharmacy Association

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Recently, KHN ran an infographic from Kaiser Health News that gave a rough explanation of how the money flows in the sale of a brand-name drug.

After thinking about it a bit, Greg Reybold, Vice President of Public Policy & Association Counsel for the Georgia Pharmacy Association, noticed some fundamental flaws.

The infographic helps shed light on a process that lacks fundamental transparency,” he said, but it doesn’t reflect all of the practices engaged in by some PBMs.”

Furthermore, he added,

“There are times, unbeknownst to patients, when some PBMs charge patients copays that are significantly higher than the cost of the drugs themselves, or they steer patients to brand name drugs for which the PBM receives a rebate when there is a less costly generic available.”

He also noted the infographic:

“reflects that the pharmacy make a profit — when in fact there are many times pharmacies lose money on prescriptions they fill through low reimbursements, the imposition of different types of fees, and aggressive audits.”

http://www.gpha.org/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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PODCAST: The Causes of High Healthcare Costs Explained

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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AHIP: Botox Marked Up 78% in Hospitals Over Pharmacies 

By Staff Reporters

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AHIP: Botox Marked Up 78% in Hospitals Over Pharmacies 

•  Botox markups: 78% in hospitals, 17% in physician offices
 •  Herceptin markups: 131% in hospitals, 40% in physician offices
 •  Keytruda markups: 104% in hospitals, 21% in physician offices
 •  Ocrevus markups: 59% in hospitals, 13% in physician offices
 •  Opdivo markups: 112% in hospitals, 18% in physician offices
 •  Prolia markups: 215% in hospitals, 49% in physician offices
 •  Remicade markups: 124% in hospitals, 15% in physician offices
 •  Rituxan markups: 85% in hospitals, 7% in physician offices
 •  Tecentriq markups: 95% in hospitals, 25% in physician offices
 •  Xolair markups: 76% in hospitals, 16% in physician offices

Notes: Drugs with the highest total spend in 2019, which are also commonly delivered through specialty pharmacies. The drug cost estimate in physician offices and hospitals does not include the cost of administering the drugs.
Source: AHIP, “Hospital Price Hikes: Markups for Drugs Cost Patients Thousands of Dollars,” February 2022

CITE: https://www.r2library.com/Resource/Title/082610254
 

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FINANCIAL HEALTH INSURANCE CO-PAY CARDS & DRUG COUPONS?

The “Real Deal”

A co-payment is a fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible.

Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20.

  • If you’ve paid your deductible: You pay $20, usually at the time of the visit.
  • If you haven’t met your deductible: You pay $100, the full allowable amount for the visit.
  • Partial deductible payments incur hybrid fees.

Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Invite Dr. Marcinko | The Leading Business Education Network for Doctors,  Financial Advisors and Health Industry Consultants

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Co-Pay Cards May Be Creating More Controversy Instead of Solutions

Instead of reducing the actual price of their excessively priced medications, many companies have opted to provide co-pay cards / coupons as an affordable solution. However, co-pay cards may only lower the cost for some consumers and patients.

Novartis: https://www.copay.novartispharma.com/nvscopay/#

Pfizer: https://www.pfizerpro.com/co-pay-cards-patient-savings-offers

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See the source image

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But – The insurer is still left to pay the high price, which will eventually be passed back on to the patient / consumers in the form of higher health insurance deductibles. So – It doesn’t really seem like much of a solution when we all end up paying for these co-pay cards / coupons; does it?

Find out more here. (Source: Rebecca Mayer Knutsen, MM&M, 8/26/16)

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MEDICAL OFFICE CREDIT CARDS:

We stopped taking credit cards altogether. The only credit cards we take are for call-in payments of balances. We have placed ATM machines in our lobbies and we educate patients in advance of their visits that we only take cash or check. Our cash income has increased, our credit card fees have decreased, and we make $1.50 from each transaction through our ATM. Our patients have taken to the idea so much that they use the ATM for personal cash for other transactions because our fee is the lowest of any ATM. It has been a win-win-win.  

Dr. Farshid Nejad, Beverly Hills, CA [PM Magazine]

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For anyone contemplating taking credit cards for payments or copayments in your office, please be aware that some of the credit card companies require you to sign a contract. Don’t do that! If you do and you either have a problem with the company or find out that they are overcharging you, they will hold you responsible for the contract and may take you to court. There are enough credit card companies out that that do not require contracts and are highly competitive. 

-Dr. Elliot Udell, DPM, Hicksville, NY [PM Magazine]

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COVID INFECTIONS: The Un-Vaccinated

By Staff Reporters

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33.6% of COVID Infections Were in Unvaccinated Persons

According to a recent CDC study. Among 422,966 reported SARS-CoV-2 infections in LAC residents aged ≥18 years during November 7, 2021–January 8, 2022:

 •  33.6% were in unvaccinated persons
 •  13.3% were in fully vaccinated persons with a booster
 •  53.2% were in fully vaccinated persons without a booster
 •  Unvaccinated persons were most likely to be hospitalized, representing 2.8% of COVID infections
 •  Unvaccinated persons were most likely to be admitted to an ICU, or 0.5% of COVID infections
 •  Unvaccinated persons were most likely to be require intubation for mechanical ventilation, or 0.2% of COVID infections.

Source: CDC, Morbidity and Mortality Weekly Report, February 1, 2022

Lost Vaccine Card: https://portal.ct.gov/vaccine-portal/Vaccine-Knowledge-Base/Articles/Lost-Vaccine-Card?language=en_US

CITE: https://www.r2library.com/Resource/Title/0826102549

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56% of Patients Attempted to Stretch Out a Prescription

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By Staff Reporters

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56% of Patients Attempted to Stretch Out a Prescription According tot a Recent CoverMyMeds Survey of 1,000 patients. It found: 

•  79% of patients said they’ve gone to the pharmacy only to discover a prescription cost more than they expected.
•  When faced with an affordability challenge, 56% of patients attempted to stretch out a prescription.
 •  When faced with an affordability challenge, 52% of patients skipped bills or other essential items to afford medications.
•  When faced with an affordability challenge, 51% of patients sacrificed medications to pay bills and other essentials.

Source: CoverMyMeds, “2022 Medication Access Data Guide,” February 2022

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CITE: https://www.r2library.com/Resource/Title/0826102549

Rx Podcast: https://medicalexecutivepost.com/2022/02/20/podcast-how-to-write-a-medical-prescription-rx/

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PODCAST: How to Write a Medical Prescription [Rx]

There are 7 Parts to a Physican’s Drug Prescription

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Data Science and Statistics in Healthcare

HYPOTHESIS TESTING

BY ERIC BRICKER MD

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RELATED PODCAST: https://www.youtube.com/watch?v=MSnJ-q1pTQk

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CORRELATION / CAUSATION: https://medicalexecutivepost.com/2021/02/05/correlation-is-not-causation/

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PODCAST: Statistics in Health Care Finance

By Eric Bricker MD

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Specificity versus Sensitivity: https://medicalexecutivepost.com/2020/03/20/medical-laboratory-sensitivity-versus-specificity/

Correlation versus Causation: https://medicalexecutivepost.com/2021/02/05/correlation-is-not-causation/?preview_id=239347&preview_nonce=a2cdc51424&preview=true

False Positives and Negatives: https://medicalexecutivepost.com/2019/09/14/what-are-false-positive-and-false-negative-tests/

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: Hospitals to Sell De-Identified Patient Data

TRUVETA

http://www.Truveta.com

By Eric Bricker MD

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Data Platform: Their health provider members care for tens of millions of people and operate thousands of care facilities, providing more than 15% of all care in the United States. Clinical data from this care is de-identified daily and brought together in the Truveta platform to advance patient care and accelerate development of new therapies.

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PODCAST: Ochsner Value Based Care Saves $100-M

BY ERIC BRICKER MD

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Ochsner Health in New Orleans and Its EVP of Value-Based Care, Dr. David Carmouche, Have Had REAL Success with REAL Value-Based Care.

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: The Mark Cuban Cost Plus Drug Co (MCCPDC)

By Staff Reporters

Mark Cuban, not Congress, will give Americans cheaper prescription drugs

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When universal health care fails to pass in Congress, there’s always Mark Cuban to fall back on. The billionaire and Dallas Mavericks owner launched an online pharmacy this week in order to combat the price gouging of prescription drugs by large pharmaceutical companies.

Citation: https://www.r2library.com/Resource/Title/0826102549

The Mark Cuban Cost Plus Drug Co. (MCCPDC) will offer more than 100 generic drugs that will be purchased directly from the manufacturers and sold online with a 15 percent markup across the board and a small pharmacist fee. For context, pharmaceutical companies generally mark prices up at least 100 percent and up to 1000 percent in some cases.

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PBM Forum Wrap Up: Greater Transparency, Further Congressional Review  Needed to Lower Drug Prices - United States House Committee on Oversight  and Government Reform

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READ: https://www.msn.com/en-us/money/other/its-quite-a-country-when-mark-cuban-not-congress-will-give-americans-cheaper-prescription-drugs/ar-AAT2KJ3?li=BBnb7Kz

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Supreme Court Hears Oral Arguments on 340B Drug Pricing Cuts

BY HEALTH CAPITAL CONSULTANTS, LLC

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Supreme Court Hears Oral Arguments on 340B Cuts

On November 30, 2021, the U.S. Supreme Court heard oral arguments regarding the challenges arising from the cuts made by the Centers of Medicare & Medicaid Services (CMS) to the 340B Drug Pricing Program.

The 340B Drug Pricing Program allows hospitals and clinics that treat low-income, medically underserved patients to purchase certain “specified covered outpatient drugs” at discounted prices (applying a ceiling to what drug manufacturers may charge certain healthcare facilities) – 25% to 50% of what providers would typically pay – and then receive reimbursement pursuant to the rates set forth in the Outpatient Prospective Payment System (OPPS) at the same rate as all other providers. (Read more…)

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

PODCAST: https://medicalexecutivepost.com/2021/08/27/podcast-hospital-340-b-drug-programs/

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PODCAST: Pharma Rebates to PBMs

Pharma ‘Rebate’ Payments to PBMs No Longer Protected by Federal ‘Safe Harbor’

BY DR. ERIC BRICKER MD

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: What is a Medication Formulary?

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About First Stop Health | Telemedicine

By Eric Bricker MD

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Why Are Certain Medications Non-Formulary?

What Are Formulary Tiers and Its Rules?

Formularies Have Many Rules Associated With Them:

1) Prior Authorization – Approval Must Be Given by the Health Insurance Company/PBM Before They Agree to Pay for a Medication.

2) Step Therapy – Certain Less Expensive Generic Medications Have to Be ‘Tried’ First and Fail Before a Doctor Can Prescribe a More Expensive Brand-Name Medication.

3) Mandatory Generics – If a Brand Name Medication Has A Direct Generic Equivalent, Then the Insurance May Only Agree to Pay for the Generic and Not the Brand.

4) Mandatory Mail Order – Certain Chronic Medications That Are Filled for 90 Day Supplies Must Be Filled via Mail Order and Not at the Retail Pharmacy.

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PODCAST: https://www.youtube.com/watch?v=kEjDBp9HdBk

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Prescription Patient Assistance Programs

BY ERIC BRICKER MD

With 43 Million Americans Having Lost Their Job at Some Point During the Pandemic and About 1/2 Those Jobs Providing Health Insurance… the 1st Group–People Who Do Not Have Health Insurance–Needs to Be Aware of How These Programs Work.

In this Video You Will Learn the Patient Assistance Program Process for:

1) 2 of the Most Common Types of Insulin

2) The Highest-Revenue Medication in America: Humira

**Note: At the Time of the Video’s Recording, the Unemployment Rate in the US was 15%. As of November 2021, the Unemployment Rate is 4.2%.

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CITE: https://www.r2library.com/Resource/Title/082610254

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DENTISTS: Don’t Write Many Prescriptions / Ransomware and Cyber News

A Personal Op-Ed Perspective

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pruitt

By Darrell Pruitt DDS

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Dentists simply don’t write that many prescriptions.

Henry Schein employees are not defending Stanley Bergman’s venture into e-prescription software. That is because they know it stinks. Digital prescriptions not only endanger patients and dental practices, but they offer no tangible benefits over paper. None!

Digital only increases the profits for Stanley Bergman and pharmaceutical interests – who eliminate data entry personnel from their payroll.

“First do no harm”

Ancient Greek physician Hippocrates.

EDITOR’S NOTE: We welcome back the op-eds of colleague Dr. Pruitt and trust he remains well in 2022.

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Ransomware and Dentistry – Recent News

“Why Healthcare Will Remain a Top Cyberattack Target in 2022 – one of the main reasons criminals are interested in healthcare data is that it contains a lot of details, such as date of birth, Social Security numbers – the active ingredients for identity theft. You can get those data points from any number of places, but healthcare organizations are the richest sources.” Healthcare Info Security, December 28, 2021.https://www.govinfosecurity.com/interviews/healthcare-will-remain-top-cyberattack-target-in-2022-i-4999

“Ransomware in 2022: You May Be Screwed, but Without Insurance It Could Always Be Worse – A commentator recently summed up the risk of ransomware attack in 2022: ‘we’re all screwed.’ True enough. But that’s all the more reason to prepare right now. After all, the only thing worse than a ransomware attack is not having adequate insurance coverage when it occurs. The time to prepare is now.” National Law Review, Wednesday, January 5, 2022.
https://www.natlawreview.com/article/ransomware-2022-you-may-be-screwed-without-insurance-it-could-always-be-worse

“Insurers run from ransomware cover as losses mount” Summary:
– Lloyd’s of London discourages cyber expansion-sources
– Ransomware as profitable as Colombian cocaine cartels
– Some insurers asking policyholders to pay half of ransoms
– Attackers change strategy from scattergun to focused.Reuters, November 19, 2021.
https://www.reuters.com/markets/europe/insurers-run-ransomware-cover-losses-mount-2021-11-19/

Yep.  We’re all screwed. Well, not all of us.

 Paper remains the best deterrent to ransomware. 

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31% of Americans Don’t Know How They’d Pay for Severe Illness

By Staff Reporters

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31% of Americans Don’t Know How They’d Pay for Severe Illness

A recent survey by HealthcareInsider that polled 1,062 adults aged 18 and up asked, “If you were to experience a severe illness how would you pay for treatment?”

 •  Don’t know: 31%
 •  Credit card: 26%
 •  Non-retirement savings: 17%
 •  Borrow money from family: 16%
 •  Retirement savings: 11%
 •  Health Savings Account: 9%
 •  Borrow from a finance institution: 8%
 •  Crowdfund online: 6%

Source: HealthCareInsider, December 2nd, 2021COMMENTS APPRECIATED.

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18% of Patients Surveyed Skipped Prescriptions to Save Money

By Staff Reporters

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18% Surveyed Skipped Prescriptions to Save Money

A recent Gallup survey asked “Thinking about the last 12 months, have you or a family member skipped a prescribed pill, dose, or other type of medication in order to save money?”. The amount of prescriptions in the household of those who answered yes varied as follows:

 •  8+: 25%
 •  5-7: 22%
 •  1-4: 17%
 •  0: 8%
 •  Total that answered yes: 18%

Source: West Health-Gallup 2021 Healthcare in America Report, December 2021

CITE: https://www.r2library.com/Resource/Title/082610254

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Hospital Settles False Claims Act Allegations for $18.2 Million

BY HEALTH CAPITAL CONSULTANTS, LLC

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Hospital Settles False Claims Act Allegations for $18.2 Million


On December 2, 2021, the U.S. Department of Justice (DOJ) announced that it had entered into an $18.2 million settlement with Flower Mound Hospital, a 91-bed hospital located northwest of Dallas, to resolve claims that the hospital had violated the Stark Law, the Anti-Kickback Statute (AKS), and the False Claims Act (FCA) by making improper inducements to referring physicians. This Health Capital Topics article will review the facts underlying the settlement. (Read more…)

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PODCAST: https://medicalexecutivepost.com/2021/08/28/podcast-stark-and-aks-final-rules/

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PODCASTS: How Prescription [Rx] Coverage Works

Formulary Tiers, PBM, Rebates, Spread-Pricing Explained

By Dr. Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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TRIFECTA Update: Markets, Covid and Congress

TOPICS PREVIOUSLY MENTIONED ON THE ME-P

By Staff Reporters

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  • Markets: Omicron who? Fed tapering what? Stocks continued to roar back from their post-Thanksgiving hangover, with tech shares leading the way. The NASDAQ had its best day since March.
  • Covid: Pfizer’s Covid-19 vaccine is less effective, but still provides some protection, against the Omicron variant, an early study from South Africa showed.
  • US Government: Congress had a busy evening. Lawmakers reached a deal to raise the country’s debt ceiling, and the House passed a $768 billion defense policy bill that increases pay for service members.
  • Citation: https://www.r2library.com/Resource/Title/0826102549

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Money and the Drug Aducanumab

BIG PHARMA AND ECONOMICS

By Health Care Renewal

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Aducanumab, sold under the brand name Aduhelm, is a medication designed to treat Alzheimer’s disease. It is an amyloid beta-directed monoclonal antibody that targets aggregated forms of amyloid beta found in the brains of people with Alzheimer’s disease to reduce its buildup.

LINK: https://hcrenewal.blogspot.com/2021/07/money-and-aducanumab.html

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Cureus | Aducanumab as a Novel Treatment for Alzheimer's Disease: A Decade  of Hope, Controversies, and the Future

RELATED: https://hcrenewal.blogspot.com/2021/07/the-future-of-aducanumab-as-medicine.html

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: The Future of Pharma

THE MEDICAL FUTURIST

By Bertalan Mesko MD PhD

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PODCAST: Amazon Pharmacy VS. GoodRx Drug Prices

A HEAD-2-HEAD COMPARISON

By Eric Bricker MD

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PODCAST: UHC’s David Wichmann Steps Down as CEO

THE WHOLE STORY?

By Eric Bricker MD

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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COVID-19 UPDATE: Vaccine Booster Shots

BY MEDICARE TEAM

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Important update on COVID-19 vaccine booster shots
If you previously got 2 doses of the Pfizer-BioNTech COVID-19 vaccine, you can get a booster shot of the Pfizer-BioNTech COVID-19 vaccine if you fall into one of these groups:

You’re 65 and older,You’re 18+ and have certain underlying medical conditions, or
You’re 18+ and work or live in a high-risk setting.

You can get your booster shot at least 6 months after you complete your second dose of the Pfizer vaccine.
The booster shot can help strengthen and prolong your protection against COVID-19.

Learn More: Visit CDC.gov for more information on other groups already vaccinated with the Pfizer vaccine that may be eligible for a booster shot.

Remember: Medicare covers a Pfizer vaccine booster shot at no cost to you.

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Oregon says it's ready to provide COVID-19 booster shots to those eligible,  but asks for patience - KTVZ

Sincerely,
The Medicare Team
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PODCAST: The 10 Top Technology Trends Shaping the Future of the Pharma

THE CULTURAL SHIFT

Dr. Bertalan Meskó, MD

The pharma industry has taken a big swung into digital transformation. All participants invest in digital health topics.

But as with all trending issues, and there is a lot of fuss that is hard to see through. As the medical community increasingly acknowledges the importance of digital health, the cultural shift we so often talk about is still a way to go. To change that, the first step is always getting to know what’s coming.

In this article, with podcast, Bert collected the trends changing the pharmaceutical industry.

ESSAY AND PODCAST: https://medicalfuturist.com/top-10-trends-shaping-future-pharma/?utm_source=The%20Medical%20Futurist%20Newsletter&utm_campaign=3a501b1978-EMAIL_CAMPAIGN_2021_09_05_Resend&utm_medium=email&utm_term=0_efd6a3cd08-3a501b1978-399696053&mc_cid=3a501b1978&mc_eid=40fee31c25#

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PODCAST: Health Insurance Carrier STOCK EARNINGS CALLS

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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