PODCAST: PBM Formulary Waste Exposed in Commonwealth Fund Study

15 Self-Funded Employers Analyzed Their Pharmacy Claims Data in Conjunction with the Commonwealth Fund and Discovered the Following Regarding their PBM FormularIES

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YOUR THOUGHTS ARE APPRECIATED

Thank You

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PODCAST: Laboratory Test Costs in EHRs and Physician Behavior


Johns Hopkins Hospital Listed the Cost of 61 Lab Tests on Doctors’ Computer Screens … While They Were Ordering Labs.



By Dr. Eric Bricker MD

Results:

–Just Seeing the Cost of the Lab Test DECREASED the Number of Labs Ordered Per Patient by 9%.

–Doctors Also SUBSTITUTED a Lower Cost Lab Test for a Higher Cost Lab Test 10,000 Times.

The Doctors Were NOT Clinically Directed to Change Their Behavior.

The Doctors’ Pay Was NOT Affected by Their Lab Ordering Either Way.

This Study Illustrates How Giving Doctors Cost Information in a Setting of Clinical and Financial Independence AUTOMATICALLY Decreases Healthcare Waste.

Doctors Can Be Much Better Stewards of Healthcare Dollars … and the Technological Innovation Needed is Minimal.

Disclosure: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.

YOUR COMMENTS ARE APPRECIATED.

Thank You

***

PODCAST: Novartis Drug Company Settlement with the USA

Why SOME Doctors Take Money from Pharmaceutical Companies

Q&A: Eric Bricker, chief medical officer of Compass patient advocacy service - Dallas Business ...

BY ERIC BRICKER MD

MAssive Global Drug Company Novartis Paid $678M to Settle Charges from the US Federal Government.

The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.

Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?

Learn the Psychology of Doctors and Money.

Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health

YOUR THOUGHTS ARE APPRECIATED

Thank You

***

On CRISPR Gene Editing

DEFINITION: CRISPR is a family of DNA sequences found in the genomes of prokaryotic organisms such as bacteria and archaea. These sequences are derived from DNA fragments of bacteriophages that had previously infected the prokaryote. They are used to detect and destroy DNA from similar bacteriophages during subsequent infections

CITE: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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A Gene Editing Breakthrough
For the first time, CRISPR technology has been used to successfully treat disease in vivo, or inside the human body.

That big medical news was announced Saturday by the biotech startup Intellia Therapeutics and its partner Regeneron, which said their gene-editing techniques reduced the amount of harmful liver protein associated with a genetic nerve disorder. 

What is CRISPR? It stands for “clustered regularly interspaced short palindromic repeats,” and it’s one of those things humans found in nature and then copied.  Bacteria use CRISPR to repel viruses, but humans have harnessed it to ctrl+c, ctrl+v DNA sequences, potentially leading to a revolution in treating disease.  The two scientists who made that breakthrough in 2012, Jennifer Doudna and Emmanuelle Charpentier, won the Nobel Prize in Chemistry last year (Doudna is also a cofounder of Intellia).

Quote du jour: “There’s a feeling like we’re walking through a door here into all kinds of new possibilities. And there’s not many moments in medicine where you get to experience that,” Intellia CEO John Leonard said.  Looking ahead…expect Intellia shares, which have gained 233% since its 2016 IPO, to pop.

CRISPR/Cas9 Genome Editing Technique - Musicians4Freedom

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ASSESSMENT: Your thoughts are appreciated.

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

CONTACT: Ann Miller RN MH

[Executive Director]

THANK YOU

***

On Higher Prescription Drug Cost-Sharing and Mortality?

Raises Mortality among Medicare PART D Beneficiaries

QUERY: What are the health consequences when patients reduce their use of prescribed medications in response to higher out-of-pocket costs?

w28439.jpg

In The Health Costs of Cost-Sharing (NBER Working Paper 28439), researchers Amitabh Chandra, Evan Flack and Ziad Obermeyer use the distinctive out-of-pocket cost-sharing features of Medicare Part D to demonstrate that such reductions can increase mortality.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

PODCAST: Fundamentals of Healthcare Finance

Today’s Video is a Fundamental of Healthcare Finance That Every Professional Must Understand… and that Most Consumers DO NOT.

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2021 Medical Captive Forum | Roundstone Insurance

BY ERIC BRICKER MD

The Formulary is the List of Medications That Are Covered by Health Insurance.  Not All Medications Are Covered. The Doctor Does Not Know What Medications Are or Are Not on Their Patients’ Formularies. However, the Pharmacy Does Via Computer Software That They Use.

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

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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.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

PODCAST: The Domestic Opioid Epidemic

A Post Pandemic OVERDOSE AND ADDICTION Update

By NIHCM Foundation

The opioid epidemic continues to devastate communities, with provisional data showing overdose death rates rising during the pandemic. Isolation and economic upheaval, as well as hindered access to treatment options and support systems, have increased the risk of addiction and relapse. These new pressures exist along with the stigma that often prevents people from receiving care for substance use disorder (SUD) and the ongoing need to adopt harm reduction strategies.

Speakers Discuss:

  • The latest federal priorities for addressing the overdose and addiction epidemic, including a focus on harm reduction efforts and ensuring racial equity in drug policy
  • Strategies for state agencies to meet existing and increasing SUD treatment needs
  • A health plan’s innovative approaches to expand SUD care through an in-home addiction treatment program and recovery coaches

Opioid use in Larimer County continues as drug becomes ...

ASSESSMENT: And so, this podcast / webinar further explores solutions to reduce overdose rates, with a focus on efforts to expand access to evidence-based recovery programs after the corona virus pandemic.

PODCAST / WEBINAR HERE: https://nihcm.org/publications/addressing-the-growing-overdose-and-addiction-epidemic?utm_source=NIHCM+Foundation&utm_campaign=f78ae3a137-05242021_Webinar_Archive&utm_medium=email&utm_term=0_6f88de9846-f78ae3a137-167744768

Your thoughts and comments are appreciated.

THANK YOU

***

PODCAST: “Cash Pay” Pharmacy

Owner of Independent Pharmacy

This image has an empty alt attribute; its file name is 48-300x300.png

EDITOR’S NOTE: We’ve written, posted and opined on concierge and retail medicine; cash based care and direct primary care medicine, and related machinations before on this ME-P. Now, Shawn Needham and his wife, Janet, discuss starting their own, independent pharmacy in the late ’90s. At first glance, this is a success story for an independent pharmacy but Shawn explains what makes their pharmacy different in a big way.

-Dr. David E. Marcinko MBA CMP®

[Eidtor-in-Chief]

PODCAST: https://healthcareamericana.com/episode/shawn-needham-cash-pay-pharmacy/

RELATED EXAMPLE: https://www.pharmacytoday.org/action/showPdf?pii=S1042-0991%2821%2900299-1

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

A General Electric Healthcare [Physician] Investor Update

Enabling precision health PODCAST

Hi David, and all ME-P Readers and Subscribers

We’re proud to be a part of improving patient lives globally with precision health – personalizing diagnoses and treatments in a smarter and more efficient way.

In case you missed it, last week GE Healthcare’s Pharmaceutical Diagnostics business (PDx) announced the acquisition of Zionexa, a leading innovator of in-vivo oncology and neurology biomarkers that help enable more personalized healthcare.

Healthcare will scale Zionexa’s FDA-approved PET imaging agent Cerianna, which is used as an adjunct to biopsy for the detection of estrogen receptor (ER) positive lesions to help inform treatment selection for patients with recurrent or metastatic breast cancer.

This is the essence of precision health, and our continued commitment to innovation. Read more about Zionexa here.

And, as a reminder, Carolina will be participating in a fireside chat on May 12 at 12:10pm EDT during the Goldman Sachs Industrials & Materials Conference. We hope you and all interested ME-P readers and subscribers will tune in.

GE Healthcare logo

Best,
Steve Winoker

[GE Corporate]

Boston, MA

PHARMACISTS: Leaving this Public Health Workforce

By NIHCM Foundation

This infographic takes a close look at the pharmacist workforce and its role in the COVID-19 response.

Pharmacists are trusted and accessible, with 90% of Americans living within five miles of a pharmacy. They are well-positioned to address vaccine hesitancy and ensure equitable COVID-19 vaccine distribution and access. Leveraging and supporting pharmacists could help address public health priorities both during and after the corona virus pandemic.

Hello Psychologist Career Counselling Centre - 9369160546 ...

LINK: https://nihcm.org/publications/pharmacist-infographic

OPIOID CRISIS RISING: https://medicalexecutivepost.com/2019/08/22/the-opioid-crisis-rising-2000-2017/

OPIOID CRISIS COSTS: https://medicalexecutivepost.com/2019/10/20/the-opioid-epidemic-cost-distribution/

OPIOID CRISIS PODCAST: https://freemanbeyondthewall.libsyn.com/episode-169-the-opioid-crisis

Your thoughts are appreciated.

THANK YOU

***

Mark Cuban Launches Generic Drug Company

COST PLUS Drug Company

[By Staff Reporters]

The company’s first drug is antiparasitic drug albendazole but plans to offer over 100 additional drugs by the end of 2021.

LINK: https://costplusdrugs.com/

Product Details

Your thoughts are appreciated.

THANK YOU

***

World Bi-Polar Day 2021

By staff reporters

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

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Corona Vaccine Food for Thought

Vaccine

By Anonymous

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cv

Long-Terms Effects of Covid-19

Long-Terms Effects of Covid-19

By staff reporters

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MORE:

The short-term, middle-term, and long-term future of the coronavirus

How the Vaccines Work?

PFIZER-BioNTech and MODERNA

By staff reporters

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The Health Economics of INSULIN

Read the Grassley-Wyden Report

Grassley-Wyden Insulin Report (FINAL).pdf (senate.gov)

Your comments are appreciated.

THANK YOU

***

Cumulative Covid-19 Vaccination Doses Administered to-Date!

2021 Vaccine Equity

January 16, 2021

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A New Corona Virus Variant?

A Rapid Rise in COVID-19 Cases?

By CDC.gov

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The Pre-Vaccine Era

ESTIMATED ANNUAL MORBIDITY IN THE USA

By staff reporters

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VACCINE COMPARISON: Pfizer-BioNet V. Moderna

Comparison with Commonalities

By Staff reporters

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The CORONA PANDEMIC 2020 – 2021

Defense versus Offense

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COVID-19 Vaccine?

WHAT’S IN IT – AND WHY?

By Un-Biased Science

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Systemic Racism & Health Care, COVID & Treatment

COVID-19 [NIHCM]

By staff reporters

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https://nihcm.org/publications/systemic-racism-health-care-covid-treatment?utm_source=NIHCM+Foundation&utm_campaign=c7ef174251-EMAIL_CAMPAIGN_2020_12_02_02_53&utm_medium=email&utm_term=0_6f88de9846-c7ef174251-167744768

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The “Cytokine” Storm [hypercytokinemia]?

Hypercytokinemia and Covid-19

By staff reporters

A cytokine storm, also called hypercytokinemia, is a physiological reaction in humans and other animals in which the innate immune system causes an uncontrolled and excessive release of pro-inflammatory signaling molecules called cytokines.

Normally, cytokines are part of the body’s immune response to infection, but their sudden release in large quantities can cause multisystem organ failure and death.

Cytokine storms can be caused by a number of infectious and non-infectious etiologies, especially viral respiratory infections such as H5N1 influenza, SARS-CoV-1, and SARS-CoV-2. Other causative agents include the Epstein-Barr virus, cytomegalovirus, and group A streptococcus, and non-infectious conditions such as graft-versus-host disease.

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Covid-19 Test Accuracy?

UPDATE

By staff reporters

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2021 Prescription Drug Payment Model from HHS

Administration Announces Prescription Drug Payment Model
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By staff reporters
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HHS Secretary Alex Azar has announced a drug payment model through the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services that will lower Medicare Part B payments for certain drugs to the lowest price for similar countries and save American taxpayers and beneficiaries more than $85 billion over seven years.
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Starting in January, the model, known as the Most Favored Nation (MFN) Model, will test an innovative way for Medicare to pay no more for high cost, physician-administered Medicare Part B drugs than the lowest price charged in other similar countries.
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Following the President’s recent Executive Orders to lower drug prices and improve access to life-saving medications, the MFN Model will protect current beneficiary access to Medicare Part B drugs, make them more affordable, and address the disparity of drug costs between the U.S. and other countries.
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Source: CMS [11/20/20]

What is the “Good-Rx” Business Model?

By Anonymous

Good Rx makes money by perpetuating the, artificially set, high sticker prices of medications and receiving a portion of Pharmacy Benefits Manager [PBM] fees.

How it Works

GoodRx taps into PBM network for their “discounts” off of sticker price (e.g. Express Scripts, Optum Rx, Navitus … etc)

Consumer pays the newly “discounted” drug price.

Pharmacy pays PBM fee.

PBM pays GoodRx portion of the fee.

Good Rx adjusted EBITDA in 2019: $160 Million

Good Rx 2020 revenue is up 48% first half of 2020 – $257M

IPO: https://mobile-reuters-com.cdn.ampproject.org/c/s/mobile.reuters.com/article/amp/idUSKBN24Y0N6

Opinion:

This is not market value.

This is another hand in the cookie jar keeping healthcare prices artificially high.

The consumer is the one ultimately harmed.

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Product DetailsProduct Details

CMS Value Based Purchasing for Drugs

CMS Proposed Rule Supports Value-Based Purchasing for Drugs

Courtesy: www.CertifiedMedicalPlanner.org

On June 19, 2020 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Medicaid Drug Rebate Program (MDRP) regulations, with the aim of lowering drug prices, increasing patient access, and encouraging innovation in the insurance and pharmaceutical industries.

This proposal is consistent with the Trump Administration’s Blueprint to Lower Drug Prices (Blueprint) released in May 2018, in which the administration highlighted its goal to “avoid excessive pricing by relying more on value-based pricing by expanding outcome-based payments in Medicare and Medicaid” and to “speed access to and lower the cost of new drugs by clarifying policies for sharing information between insurers and drug makers.”

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The proposed rule seeks to accomplish the Blueprint’s goals by reducing regulatory barriers that have previously prevented commercial plans and states from entering into value-based purchasing (VBP) arrangements with drug manufacturers.

Colleagues from Health Capital Consultants, LLC; explain.

ESSAY: DRUGS

Assessment: Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Medical Practice “Prior Authorizations”

THE “SIREN CALL” OF MEDICAL PRACTICE PRIOR AUTHORIZATONS

Courtesy: www.CertifiedMedicalPlanner.org

“The Doctor Can’t See You – She’s Too Busy Doing Prior Authorizations.”

By Dr. David Edward Marcinko MBA

Somewhere along the way, physicians took a wrong step. Colleagues said OK to the SERPENT who whispered: “this saves money,” and now we’re entangled. We should’ve asked, “Whose money?”

PRIOR AUTHORIZATIONS for medical treatment and prescription drug are killing medicine and all those who would follow into this once great profession.

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

And so, here is an excerpt [blinded and abbreviated] from an email we received from a medical physician colleague.

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DOCTOR: For every hour that I spend with a patient, I spend another three hours documenting and begging.
TYPICAL DAY: 4 hours of seeing patients, sprinkled between 12 hours of doing what we used to call “paperwork”.

EMRs: Calling it Electronic Medical Records and data collection doesn’t make this nonsense any more appealing.
ASSESSMENT: Patients get turned away because PCPs are too busy with paperwork. People are sick and dying while I’m calling clerks and pleading for RXs. I’d rather be doctoring.
BOTTOM LINE: 1/5 of my day, over 12 hours a week as a PCP, is now spent on prior authorizations. 1/3 of my assistant’s day is on prior authorizations. That’s why he couldn’t call you back.

CONCLUSION: Next time you can’t get a doctor’s appointment, you’ll know why.

***

Assessment: Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

The Power of Pharmaceuticals

Spending Outpaces Inpatient Hospital Spending

CIRCA: 2018-2019

By Staff Reporters

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Product DetailsProduct DetailsProduct Details

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23 Potential COVID-19 Drugs

COVID-19 Drugs

[By staff reporters]

Drugs being studied in clinical trials. 30+ drug candidates in preclinical research phase.

There is HOPE!

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Disclaimer – For informational purposes only; should not be considered medical advice; consult a healthcare professional. Drugs shown are not yet approved for use to treat COVID-19 but are being investigated for use in clinical trials.

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Corona Virus Economics

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******

THANK YOU

 

Insurers, PBMs and Specialty Pharmacies Today

CIRCA: 2019 Vertical Business Relationships

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Conclusion: Your thoughts are appreciated.

Product DetailsProduct DetailsProduct Details

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The Drug Pricing “Theory of Relativity”

ONE SIGN SAYS IT ALL

[By staff reporters]

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Product DetailsProduct Details

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National Prescription Drug Take Back Day

October 26, 2019 – 10:AM to 2:PM

The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.

Prescription Pill Bottles

MORE: https://www.bing.com/videos/search?q=dea+take+back+day&&view=detail&mid=0D5B986D9C5FD79B077B0D5B986D9C5FD79B077B&&FORM=VRDGAR

MORE: https://takebackday.dea.gov/

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.

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

Ambulance DEM

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The Opioid Epidemic Cost Distribution?

FY: 2015 – 2018

By http://www.MCOL.com

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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.

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

***

Product DetailsProduct Details

A BLACK MARKET PODCAST VIEW OF THE OPIOID CRISIS

A BLACK MARKET PODCAST VIEW OF THE OPIOID CRISIS

Courtesy: www.CertifiedMedicalPlanner,org

Opioid Overdose Crisis

Every day, more than 130 people in the United States die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl used to help relieve severe ongoing pain —is a serious national crisis that affects public health as well as social and economic welfare.

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The Podcast

And so, I was fascinated with this podcast because I often encountered narcotic seeking patients while in city center and urban practice. It was recorded by my neighbor and Austrian economist Peter Raymond over at “The Free Man Beyond the Wall” website.

Colleague Dr. Mark Thornton recently gave this talk at the Mises Institute Supporters Summit on the opioid crisis that is plaguing the US. Dr. Thornton lays out a short history of this tragic epidemic that is taking lives every day. He addresses how doctors prescribe these drugs, how government regulates them and explains what happens when people are forced into the “black market” to sustain their addiction.

PODCAST: http://freemanbeyondthewall.libsyn.com/episode-169-the-opioid-crisis

MORE: https://medicalexecutivepost.com/2019/08/22/the-opioid-crisis-rising-2000-2017/

MORE: https://medicalexecutivepost.com/2019/02/06/about-the-opioid-crisis/

Your thoughts are appreciated.

BUSINESS, FINANCE AND ECONOMICS TEXTBOOKS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

Product DetailsProduct Details

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Meth Mouth

More About Meth Mouth and Teeth [MMT]

By Anonymous DEA Agent

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.

 ******

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.

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.

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

***

Product DetailsProduct DetailsProduct Details

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The Opioid Crisis Rising [2000 – 2017]

More Age Groups Affected

[By NIHCM]

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Invite Dr. Marcinko

***

Here’s Why Drug-Distribution and Pharmacy Stocks are Bargains Now

On Drug-Distribution and Pharmacy Stocks

Vitaliy Katsenelson, CFA
  Student of Life

These pharnacy stocks are good businesses. In general they have solid balance sheets, above-average returns on capital, and they generate a lot of cash, which is used to pay dividends and buy back stock.

But, these defensive features have not mattered much lately, as we are entering the 10th year of uninterrupted economic expansion.

Accordingly, these companies are significantly undervalued. How under valued? Let’s answer that question by examining two stocks in our portfolio in closer detail.

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Prescription Pill Bottles

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Here’s Why Drug-Distribution and Pharmacy Stocks are Bargains Now

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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The True Cost of Medication Non-Adherence

In the Modern Value-Based-Care Environment

By http://www.MCOL.com

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Product DetailsProduct Details

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What is the “Baltimore Nod”?

Dope Fiends

By Anonymous DEA Agent

DOPE FIEND: A habitual user of a narcotic; slang term.

NOD: To lower and/or raise one’s head slightly and briefly, especially in greeting, assent, or understanding, or to give someone a signal.

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Single Nod

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Group Nod

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Street Nod

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MORE: https://medicalexecutivepost.com/2012/06/01/video-of-the-new-drug-krokodil-aka-crocodile/

Assessment:

An anonymous DEA agent sent us these pictures. The videas are all over YouTube. So, just say “NO” and don’t do drugs.

NOTE: The nod is not to be confused with TD. Tardive dyskinesia is a disorder that results in involuntary, repetitive body movements. This may include grimacing, sticking out the tongue, or smacking the lips. Additionally there may be rapid jerking movements or slow writhing movements. In about 20% of people, decreased functioning results. Tardive dyskinesia occurs in some people as a result of long-term use of neuroleptic medications. These medications are usually used for mental illness, etc.

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Product DetailsProduct DetailsProduct Details

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Invite Dr. Marcinko

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Medicare Part D – Drug Plan Enrollment

Distribution 2019

By http://www.MCOL.com

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Product DetailsProduct Details

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Prescription Drug Uses and Costs

Seclected Facts: 2015-2016

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Product DetailsProduct Details

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On PBM Business Practices

Unfair -OR- Not?

[By staff reporters]

PBMs, like Prime Theraputics, Optum, CVS/Caremark, Walgreens/prime Mail and Express Scripts, Bring no value but huge expense to pharmaceutical medication prices.

The Trump administration and Congress must repeal the GPO and PBM safe harbor that allows them to extort pharmaceutical manufacturers to the tune of $200 billion a year.

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Assessment:

Your thoughts are appreciated.

Product DetailsProduct Details

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Level 5 Drug Setting and Price Trends

FY:  2009 – 2017

By www. MCOL.com

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Invite Dr. Marcinko

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Product DetailsProduct Details

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Geographic Variations in Opioid Prescription Rates

For 2017

By http://www.MCOL.com

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Invite Dr. Marcinko

BUSINESS, ORGANIZATIONAL BEHAVIOR & FINANCE FOR DOCTORS:

THANK YOU

***

On Hospital Prescription Drug Spending

FY 2015 – 2017

By MCOL.com

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Assessment

Your thoughts are appreciated.

RESOURCES:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

***

Product Details

About the Opioid Crisis

And, Drug Distributors

[By Vitaliy Katsenelson CFA]

I don’t know anyone personally who has been affected by the opioid epidemic in the US. And I truly hope I never will. I don’t know if I would be able to maintain objectivity in my analysis of drug distributors and their involvement in this epidemic if I had experienced getting a call at night informing me that my loved one had died from a drug overdose. Drug overdoses killed 70,237 Americans in 2017. Of these deaths, 47,600 (67.8%) involved opioids and 17,000 involved prescription opioids (24% of total overdose deaths). Legally prescribed opioids are killing 47 of us every day.

How did we get here?

According to the National Institute on Drug Abuse: “In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.”

Today pharma distributors are used as scapegoats for the opioid epidemic – not because they are guilty but because they have money and they are “drug distributors.” They are dragged through the same mud as the tobacco companies and British Petroleum (after it spilled millions of gallons of oil in the Gulf of Mexico). Despite negative headlines, we own drug distributors.

Here is why:

They distribute legally prescribed medicine to pharmacies that are approved by several government agencies, including the DEA. Doctors write scripts; pharma distributors order medicine from pharma manufacturers and deliver them to pharmacies. The sad truth about the opioid epidemic is that 21-29% of patients who were prescribed them for chronic pain misused them, and 8-12% of those who received an opioid prescription developed an opioid use disorder.
However, just as truck drivers cannot be held liable for delivering cigarettes to convenience stores, pharma distributors are not manufacturers of drugs and cannot be held liable for the addictive properties of the drugs they distribute or the fact that doctors overprescribe them and patients misuse them.
Also, the DEA should be responsible for limiting the illegal use of opioids. That is its job – DEA stands for Drug Enforcement Agency. It has legal and enforcement resources that distributors lack. And it has a lot more data and tools. Drug distributors do their part and provide data to the ARCOS database that DEA manages.
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drugs
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However, each individual distributor has data only for the drugs it distributes, while DEA has data (which it doesn’t share with distributors) for all opioid sales to pharmacies. The DEA is in a much better position to spot suspicious activity in orders than distributors. The DEA controls how much legal opioid is manufactured in the US every year and has been increasing quotas of opioids produced.
Opioids constitute only a very small percentage of the $450 billion in drugs distributed in the US, and thus incentives for distributors to overdistribute opioids are very limited. Though lawyers and the media keep saying that distributors are some of the largest companies in the S&P 500 by sales, they forget to mention that distributors operate on razor thin margins of less than 2%. Comparing the distributors (not even the makers) of legal medicine, that helps millions of people cope with excruciating pain, to cigarette companies that have a 40% pretax profit margin on a product that doesn’t have a societal benefit, and is almost guaranteed to cause cancer if you use it long enough, creates awesome headlines but has little substance.
  • What if DEA was the one distributing all the opioid drugs to pharmacies instead of McKesson, Cardinal Health, and Amerisource Bergen?
  • Would fewer people get addicted to opioids?
  • Would opioids be less accessible? Remember, DEA sets the production targets every year.
Maybe DEA would catch a few bad actors sooner – it has more data than distributors and a specific skillset and mindset aimed at catching criminals.
But in the big scheme of things, even if DEA distributed opioids nothing would really change. Doctors would still prescribe them; some patients would still get addicted to them … and so on. Distributors will likely settle lawsuits for two reasons:
First, McKesson already settled with the FDA for $150 million for “failure to report suspicious orders of pharmaceutical drugs.”
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Second, McKesson and other drug distributors don’t want to be involved in costly and protracted litigation. We don’t know how much the settlement will be, but it is very unlikely to be in the hundreds of billions of dollars and likely (see reasons above) to be hundreds of millions or a few billion dollars.
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Assessment
Today McKessonʻs market capitalization is $25 billion. We think the company is worth at least $50 billion (at 15 times earnings), thus there is a $25 billion of margin of safety. If the lawsuit costs the company less than $25 billion, McKesson will be a profitable investment; if not, then the market is right and we are wrong.

Conclusion

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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™Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Determination of Medicare Drug Benefits

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Assessment: Any thoughts?

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