A pharmacist's look at the supermarket and beyond

Month: February 2017

Suggested Executive Orders for DJT

I thought I should expand on a brief note that I have sent to the White House and posted on Facebook. Maybe, though, rather than expand it, I would be better off trying to get it down to tweet size! (Added text in italics)

President Trump,
I am not a lobbyist. I am a practicing pharmacist with a few suggestions for my professional arena that I think will help make America greater.
1. Immediately make all pharmaceutical manufacturer’s discount cards eligible to be used by patients with Medicare. This exclusion is just a lobbyist-fueled, mean-spirited obstacle for those patients most in need of our help with exorbitant drug costs. This is an apparent attempt to avoid violating the Medicare Anti Kickback statute. Congress enacted the Anti Kickback Statute as Amendments to the Social Security Act in 1972. It was more recently revised in 2010 as part of ACA. In pharmacy, one notable case involved Walgreens in a 2012 settlement of $7.9 million. Walgreens, of course, denied any fault. They had simply offered gift cards Medicare and Medicaid beneficiaries in exchange for transferring their prescriptions to Walgreens. I suppose this is similar in concept to a drug company offering to reduce a copay for a Medicare patient’s brand name med. The difference is that patients are given an Rx for a specific drug. It’s not like they can simply go across the street to a competitor. Too often, a patient struggles, trying to decide where the money will come from to pay for their fancy post-op blood thinner or the latest and greatest diabetes med that may lower their A1C by half a point. It’s OK if you are privately insured though! This distinction helps to contribute to the high cost of brand name medications and should be modified as soon as possible. Easily remedied with an executive order! Notice these cards not only exempt Medicare patients but also our veterans covered by TriCare or other DOD plans!

2. Create a third category of pharmaceuticals that could be ordered by pharmacists for the benefit of their patients. Drugs to be included in this category can be selected by a small pro-tem committee of a practicing pharmacist, an academic pharmacist, a physician, a representative of PHRMA, and a consumer. This idea has been in various stages of discussion for as long as I can remember. There seems to be a concerted among powerful lobbying groups to prevent it from ever happening. As always, the reason is money. I’m sure the AMA sees it as an attack on their rice bowl as does the insurance industry. As a colleague of mine pointed out (thanks, Andrea!) Big Pharma should be with us on this after seeing what pharmacy has done to increase sales of immunizations. Easily remedied with an executive order!

3. Immediately grant pharmacists provider status. Congress has dithered with this long enough. Make it so. The latest iteration is a proposed statute granting provider status in rural, under-served areas ONLY. That’s a bunch of crap. The value of pharmacists in the delivery of health care and the resulting improvement in outcomes and cost and been well documented many times. Easily remedied with an executive order!

I tried to keep this message brief and would be happy to discuss or answer any questions that you may have.

Let’s make pharmacy greater!

Who Wants to Live Forever?

I was looking over my Social Security statement today and noticed a few things. Most obvious was the impact of my professional education. My annual income increased ten-fold in my graduation year. Granted that compares a student’s wages (working full time during summers and other breaks, with some part time work during school), against six months as a pharmacist. Suddenly, I had money and I learned to spend it, usually unwisely, but that’s another story.
I also calculated that the amounts paid in by myself and my employers would fund my retirement for ten years, even if that money did not earn any interest or other dividends. With only modest compounded interest, it is obvious that my retirement could and should be well funded, even beyond my death. My employers and I have paid a mere $81,000 into Medicare, however. That could buy a health insurance policy for about $350 per monthly premium for ten years. How much does health insurance cost? I checked:
Average monthly premiums for individual plans by age group were: (The figures are from eHealth’s Health Insurance Price Index Report for 2016)
$152 for people under age 18
$177 for people age 18-24
$239 for people age 25-34
$303 for people age 35-44
$400 for people age 45-54
$580 for people age 55-64
So if I were in my forties, I might be OK, but really I could last about 12 years, again assuming no earnings on my contributions.

With careful planning and a frugal lifestyle, I could probably make it to 90 without either of these government programs, assuming I invested similar amounts. Fortunately, I have made additional investments for my future, as well as my children, so I’m good to go indefinitely! Unless immortality is very expensive, of course. Kidding. I am lucky to have made it this far!

One of the proposed suggestions for revising American health care is Medicare for all. It is apparent to me that after paying into Medicare for over 40 years that I could barely take care of my own health needs, and I’m pretty damned healthy. There are millions that have exhausted any funding that they may have personally contributed and are now dependent on folks like me. If we are to keep Medicare solvent and/or cover everyone then we face some huge financial hurdles. Like any other type of insurance, we will have to make sure that the money coming in is sufficient to pay the claims to be paid. Right now, we do not have that balanced equation and that must change.

First of all, we cannot pay for everything. I’ve blogged about incredibly expensive, yet hardly effective treatments, and those must be forsaken. End of life planning is essential and you may call them death panels hoping to scare people away but the costs of an unplanned, undignified death are simply unreasonable. Our efforts to eliminate fraud have met with modest success and our payment system must be rigorously reviewed and strengthened. If everyone had the same baseline coverage, the incentive to have a cohesive system would be strong and we would all be invested in seeing it succeed.

My employers and I have each paid 1.45% of my wages into Medicare. If self-employed you pay 2.9% of your net earnings. That may not be enough to sustain Medicare for all. Do we raise this contribution? Now that Citizens United has declared corporations to be people, perhaps they should start paying into Medicare and Social Security too. How should we fund the new health care model? What we will find is that our entire taxation model has been corrupted and will require overhaul also. I’d be a lot more comfortable with taxes that are encumbered for specific uses, elimination of loopholes and subsidies that are essentially corporate welfare, elimination of unnecessary redundancy in our government agencies, and finally, most importantly, a balanced budget. We must have fairness, truth and justice. When the accumulation of wealth depends on the immoral strategies of deception, corruption, conspired laws, and outright cheating, there must be a reckoning.

Get out there and make a difference!

Contact your elected representatives!