Doctors v Pharma Pricing
PRESIDENT’S MESSAGE Thomas J. Madejski, MD MSSNY President MAY 18, 2018 Volume 18 Number 19 |
Dear Colleagues:
Last Friday, President Trump promised to “derail the gravy train” in the health-care system in a speech in which he unveiled his much-anticipated strategy to lower drug prices. The 44-page blueprint, called “American Patients First,” proposes a laundry list of policy ideas — but no specific timeline for implementation. He said he wanted to “promote competition; get generic drugs to market faster; lower fees paid to so-called middlemen…; and to block foreign countries from negotiating lower prices for their state-run health plans.”
A March 2018 Kaiser Family Foundation Health Tracking Poll found that 80 percent of Americans think prescription drug prices are unreasonably high. Slightly more than half responded that enacting policies to lower them should be our government’s top policy priority. One of the other hats that I wear, and welcomed in anticipation of becoming your President, is as a member of the AMA Council on Medical Service. Our Council has taken a deep dive into the escalating cost of insulin at the request of our AMA members. We have come up with some specific strategies that the practicing physician can use to help their patients now, and some suggestions to improve general affordability moving forward.
I anticipate after presentation (and hopefully, approval) at the AMA Annual meeting in June, that our Council will explore additional strategies to help make medication more available and affordable for our patients.
Additional information for your consideration:
• While private insurers and government programs pick up the biggest share of the bill, high drug costs are ultimately passed down to the public through premiums and taxes. Lawmakers have probed how they set prices, and the Justice Department is investigating possible price collusion by more than a dozen companies that make generic drugs.
• In 2016, the AMA set a new policy that established guiding principles for advocacy efforts aimed at changing the fundamentals of prescription drug pricing without compromising patient outcomes and access. The 2016 policy acknowledges the carte blanche approach to drug pricing needs to change to align with the health system’s drive for high-quality care based on value.
We have a crisis in drug prices in this country, where pharmaceutical companies, distributors and PBMs are able to charge whatever they want hiding their costs and legitimate profit through a labyrinth of pricing schemes, kickbacks, and special considerations. I have remarked to my fellow Council members that looking at drug prices is like peeling an onion. Each layer stinks and makes me cry!
We need political leaders that are willing to stand up to the power of the pharmaceutical industry. We need physicians to call upon our elected officials to create a healthcare system that serves our patients, not middlemen and hedge fund managers, who like Don Fanucci in The Godfather, need to “wet their beak” at our patients’ expense.
Please send your thoughts to comments@mssny.org.
Thomas J. Madejski, MD
MSSNY President
MSSNY Physician Participates in Senate Roundtable on Tick Borne Diseases—Senate Passes Package of Bills Addressing Tick Borne Diseases
The bills are now before the NYS Assembly for further action. (CLANCY, AUSTER) State Senate Advances DMV Reporting Mandate Legislation Please click here to contact your legislator to express your concerns with this legislation. (BELMONT) Governor Cuomo Announces Multi-agency Effort To Combat Maternal Depression The new regulations will take effect 60 days after publication in the State Register. The Department of Health and the Office of Mental Health’s awareness campaign will provide critical information about symptoms and treatment options, and to more broadly remove the stigma associated with maternal depression. There will be a joint letter to all health care providers reminding them of the seriousness of the issue as well as encouraging expansion of treatment options. (CLANCY) MSSNY Urges for Extension of Committee for Physicians Health Program The CPH is a program designed to confront and assist physicians thought to be suffering from alcoholism, substance abuse or mental illness. Since the inception of this program, CPH has assisted thousands of physicians in returning healthy to medical practice. The work of the CPH program is an important public service both to our health care system as well as the general public. As a result, the State Budget annually includes an appropriation of $990,000 for the program, which is generated from a $30 assessment on all physicians’ biennial registration fees. The program has traditionally been extended by the Legislature in 3 or 5 year “demonstration programs” with the most recent extension in 2013. The recently enacted State Budget included a provision to create another “demonstration program” until 2023. However, it omitted other provisions historically extended at the same time that are essential to its functioning that could greatly impair its operations unless immediate action is taken. These includes provisions that set forth the CPH program’s reporting requirements to the Office of Professional Medical Conduct (OPMC), provisions to ensure liability protections for the physician Committee members for work performed in the scope of CPH, and necessary confidentiality protections for the program given the sensitivity of the work they perform. These protections are absolutely essential to the continued functioning of the program to ensure that physicians with the appropriate expertise are willing to serve on the Committee, as well as to assure that the program has the ability to report sensitive information to OPMC when warranted by the circumstances. (DIVISION OF GOVERNMENTAL AFFAIRS) Governor, AG Announce Potential Lawsuit Against Opioid Manufacturer Acting AG Underwood stated “We are committed to holding opioid manufacturers and distributors accountable for the damage they’ve wrought on New York’s towns, communities, and families. After a lengthy investigation, we are preparing a lawsuit against Purdue Pharma for its alleged deception and reckless disregard for the health and wellbeing of New Yorkers. It is clear to us that Purdue profited by deliberately exploiting New Yorkers’ addictions, and by pushing healthcare providers to increase patients’ use and dependence on these potentially fatal drugs. In addition to our impending lawsuit against Purdue, our office will continue to lead the multi-state investigation of opioid manufacturers and distributors across the country.” Governor Andrew M. Cuomo stated: “In New York, we will not sit idly by as big corporations fuel the opioid epidemic and ignore the consequences of their actions. We said we would sue to hold opioid manufacturers and distributors responsible, and that’s exactly what we’re doing. By taking Purdue Pharma to court, we are taking this significant step forward to hold corporations accountable and put an end to the opioid crisis once and for all. Too many innocent lives have been lost and too many families destroyed.” As reported in numerous media outlets, Purdue Pharma responded: “We are disappointed that after months of good faith negotiations working toward a meaningful resolution to help the state of New York address the opioid crisis, the attorney general has unilaterally decided to pursue a costly and protracted litigation process. We vigorously deny these allegations and look forward to the opportunity to present our defense.” (AUSTER) NYSDOH AIDS Institute Launches New Online Provider Directory Medical Society of the State of New York Announces May and June CME Webinar Schedule May 24th at 7:30am – Current Concepts in Concussion for Pediatric and Adult Patients Register for this webinar here. Educational Objectives:
June 20th at 12:30pm – Medical Matters: Children’s Mental Health After Disaster Register for this webinar here. Educational Objectives:
To view all of MSSNY’s scheduled programs, click here and select “Training Center” and “Upcoming”. The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. (HOFFMAN) Ebola Webinars Available on CME Website Please click here to view MSSNY’s free CME courses on this timely and relevant topic. Ebola: A Perspective from the Field offers a firsthand description of the challenges surrounding Ebola virus. And Viral Hemorrhagic Fevers with an Ebola Virus Update offers a comprehensive analysis of diagnosis and treatment for Ebola and other viral hemorrhagic fevers. (HOFFMAN) Bending the Diabetes Curve CME Course Available Online Webinar: Bending the Diabetes Curve Faculty: Geoffrey Moore, MD & Sarah Nosal, MD Educational Objectives:
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Additional information or assistance with registration may be obtained by contacting Carrie Harring at charring@mssny.org. (HARRING) Please Join Us on July 28th for Physicians’ Day at the Races Please RSVP today. The Physicians’ Day at the Races will take place on Saturday, July 28, 2018 at the Saratoga Race Course in Saratoga Springs, NY. Ticket prices are: $500/physician, $300/guest, $250/guest under 21 Ticket price includes clubhouse admission, post parade programs, a gourmet buffet lunch at your own trackside table, unlimited open bar, private viewing of the horses as they bring them from the paddock and private betting windows. click here for further details. Contact Jennifer Wilks at 518-465-8085 or by email at jwilks@mssny.org to secure tickets. (BELMONT) For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
$750,000 Fine for Billing Medicaid when Physicians Were Not Enrolled in Program MSSNY has recently heard from the U.S. Department of Justice that a medical practice has agreed to pay a large sum of money to settle a False Claims Act Suit for alleged improper billing practices. The allegations were brought to the government’s attention through the filing of a complaint pursuant to the qui tam provisions (the whistleblower) of the False Claims Act. Under the Act, private citizens can bring suit on behalf of the United States and share in any recovery. The medical group agreed to pay $750,000.00 to resolve allegations that they billed the Medicaid Program for services provided by physicians who were not enrolled in the program. The government’s investigation revealed that, from July 1, 2004 through December 31, 2010, the medical group employed a number of physicians who were not enrolled in the Medicaid Program who provided care to Medicaid patients. Because the physicians were not enrolled in the program, the medical group should not have sought reimbursement from Medicaid for the services provided by these non-enrolled physicians. Regardless, the medical group submitted requests for payment under the Medicaid provider identification numbers of the practice’s Medicaid enrolled physicians, thereby misrepresenting the identities of the individuals who were actually providing treatment to the group’s Medicaid beneficiaries. This improper billing practice occurred at many of the medical group’s locations. To avoid any impropriety, physicians must be enrolled in plans to treat and receive payment for a plan’s insured members. NY’s Acting AG to Sue Purdue Pharma for Exploiting Addictions In a press release, acting Attorney General Barbara Underwood said the state is readying its litigation against the opioid manufacturer for “its alleged deception and reckless disregard for the health and wellbeing of New Yorkers.” “It is clear to us that Purdue profited by deliberately exploiting New Yorkers’ addictions, and by pushing healthcare providers to increase patients’ use and dependence on these potentially fatal drugs,” she said in a statement. In its own statement, Purdue said the company “vigorously” denies the allegations and looks “forward to the opportunity to present our defense.” Three Firms Account for Over Half of All Medicare Part D Enrollees in 2018 Pending Mergers Would Further Consolidate the Marketplace In 2018, three Medicare Part D plan sponsors—UnitedHealth, Humana, and CVS Health—account for more than half of the program’s 43 million Part D enrollees (55 percent) and two-thirds of all stand-alone drug plan enrollees, indicating a marketplace that is dominated by a handful of major insurers, according to a new Kaiser Family Foundation analysis of Part D enrollment, premiums and cost-sharing data. The proposed mergers of CVS Health and Aetna, and Cigna and Express Scripts would result in further consolidation of the Part D marketplace. If these mergers go through, four firms—the two merged firms plus UnitedHealth and Humana—would cover 71 percent of all Part D enrollees and 86 percent of stand-alone drug plan enrollees, based on 2018 enrollment. New Yorkers Do Not Eat Enough Fruits, Vegetables, Analysis Finds FDA Names Companies “Gaming” Drug Laws to Block Competition The act comes as part of the Trump administration’s recently announced effort to bring down the price of pharmaceuticals. The list — posted on the FDA’s website May 17— includes dozens of both generic and brand-name companies that the agency said appear to have refused to give up samples of their product to generic companies seeking to make copies. Without the samples, generic manufacturers can’t conduct bioequivalence testing and apply to the agency for approval, said FDA Commissioner Scott Gottlieb, MD, in a statement. The agency has received more than 150 pleas for help from generic drugmakers who have not been able to get samples from brand companies, said Gottlieb. “We’re also notifying the Federal Trade Commission (FTC) — the agency responsible for addressing anticompetitive business practices — about these inquiries,” he said. According to the list, the largest numbers of inquiries have been for problems getting copies of isotretinoin (14 inquiries), bosentan (14), lenalidomide (13), thalidomide (10), and ambrisentan (10). Among the companies that appear to be multiple offenders:
Please Answer Physicians Foundation’s Biennial Survey Reminder: MSSNY is a Charter Member of the Physicians Foundation. The Physicians Foundation will make a $5,000 contribution to the state medical society generating the most survey responses and a $5,000 contribution to the state medical society that generates that most responses per-capita. New PTSD Definition Would Exclude Many Patients, Study Says The study appear May 17 in the journal Psychological Medicine. It looked at almost 4,000 people from six countries to see how changes in the upcoming 11th edition of the International Classification of Diseases would affect their diagnoses. Most of the patients studied were survivors of traffic accidents, who underwent the Clinically Administered PTSD Scale. When patients were diagnosed using the revised code, it boosted the incidence of severe PTSD by up to 35%, but the number of moderate cases decreased by more than half. Proposed changes in the diagnostic tool could negatively affect successful treatment for many victims of PTSD because early treatment leads to the best outcomes, said senior author Dr. Arieh Shalev, the Barbara Wilson Professor in the Department of Psychiatry at NYU School of Medicine. Shalev also expressed concerns that insurers might not cover cases where patients clearly have symptoms consistent with PTSD but don’t meet the new criteria for diagnosis. The revised code uses just six criteria for assessing PTSD: dissociative flashbacks, nightmares, hypervigilance, exaggerated startle response, avoidance of external reminders, and avoidance of thoughts and feelings associated with the traumatic event. The current code includes 13 conditions, including sleep disturbances and irritability, which also can be associated with other disorders. House Passes Bill to Expand Veterans’ Healthcare Access Outside of VA Congressional Quarterly (5/16) reports the vote comes as “a major overhaul to a veterans’ health care program just two weeks before funds dry up.” The $5.2 billion funding will extend the Veterans Choice Program “before combining the program with other community care programs offered by the Department of Veterans Affairs in 2019.” IPRO Hosting 34th Annual Membership Meeting at Garden City Hotel When: Tuesday, June 5, 2018 For further information, click here.
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355
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