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Five Key Principles Pelosi Ignores For Sound Prescription Medication Pricing Reform [Opinion]

An honest opinion from a doctor…

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Congress and policy makers in Washington are intently focused on how to optimally manage the cost of prescription medications. Many proposals have already been released and it is likely that this focus will continue well into the 2020 elections and beyond. This focus is appropriate given the importance access to medications plays as a cornerstone of the management of most medical conditions. It is also likely that over the next several months and years there will be a myriad of legislative and regulatory proposals floated, debated, and voted on or enacted.

Given the profound impact these policy changes will have on the efficacy of health care in the United States and, most importantly, the well-being of patients across the country, Men’s Health Network strongly urges public sector policy makers and regulators as well as private sector payers, benefit managers and PBM executives to adhere to the following principles to ensure that proposed reforms are focused on ultimately benefiting patients and optimizing the costs associated with adhering to prescribed medical therapies.

Five Key Principles to Sound Prescription Medication Pricing Reform:

Prioritize Straightforward and Effective Reforms

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-Instead of overhauling systems or creating more complexity and confusion in an already complicated health system, policymakers should create systems and procedures that are simple, transparent, understandable and effective. This is of paramount importance to restoring the faith of patients in the system that has been lost as the processes have become mysterious, veiled in secrecy and overly complex and convoluted.

Ensure Cost Reductions Are Passed to Patients

-Any reforms must honor the tenant that was at the forefront of establishing the current system by returning the lion’s share of cost savings – whether they be from contract-rates, rebates, price concessions or whatever – to the patient. Further, the goal of reform should be to reduce patient out-of-pocket expenditures for prescription medications from current levels, rather than just holding the line on costs which are already problematic for many. Returning cost savings to insurance companies and PBMs (most of which are interlaced) or any other entity other than the patient is wrong.

Protect Access to Care

-Pricing reforms and caps on out-of-pocket expenditures for medications make sense only if they do not impede access to treatments. A “rob Peter to pay Paul” strategy where short term caps are imposed at the expense of significantly higher premiums or more restrictive access has not worked. If caps are instituted, they should be designed in a way to reduce out-of-pocket expenses without compromising other core elements of prescription care or access.

Preserve the Provider/Patient Relationship

-Access to the full spectrum of medications and innovative therapies should not be restricted by limited formularies or an undue trial-and-error process. The selection of therapeutic alternatives must honor the wishes and values of patients within a system that keeps the patient-healthcare provider relationship as the focal point of treatment decision making.

Allow Markets (Not Government) to Reduce Prices

-Pricing models and mechanisms should be market based, not dictated by government or policies. Establishing arbitrary price targets using reference standards that are not applicable to the needs, wishes and way of life of American patients undercuts fundamental principles of free markets.

These five principles have one commonality – keeping the long-term best interests of patients in focus. In the end that will fulfill the ethical and social obligations of providers, government and health benefit managers and enhance the care of patients.

As part of our work educating and providing advocacy opportunities for men, boys and their families, Men’s Health Network will continue to explore these principles in more depth in the coming weeks. Please check back here on our blog to follow the series or reach out on social media to engage, ask questions, and learn more about the policies that impact men’s health.

Dr. Salvatore J. Giorgianni, PharmD is Sr. Science Adviser, Men’s Health Network

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Southwest Caves to Pressure from Anti-Vaccine Employees

But there’s one heck of a catch.

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Last weekend was an unfortunate one for Southwest Airlines, who suffered from the cancelation of nearly a third of their flight schedule…and just days after they announced that a vaccine mandate would soon go into effect for their thousands of employees.

The airlines denied that the vaccine mandate had anything to do with the cancelations, blaming weather and air traffic control issues.  But, when researchers compared the number of total flights cancelled to the number of Southwest flights cancelled, it was fairly obvious that this was a localized issue.

Only a few days after that, a massive protest of their vaccine mandate hit home near headquarters.

By Tuesday of this week, the airline had been forced to back down.

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Southwest Airlines dropped a plan to put unvaccinated workers with pending exemptions on unpaid leave after a December 8 deadline following protests by their employees.

“The employee will continue to work, while following all COVID mask and distancing guidelines applicable to their position, until the accommodation has been processed,” according to an internal note obtained by CNBC written by Southwest’s Senior Vice President of Operations and Hospitality Steve Goldberg and Vice President and Chief People Officer Julie Weber.

And then, even after a new deadline was set, the company doesn’t appear to be baring its teeth in regard to enforcement.

The company is giving employees until November 24 to finish their vaccinations or apply for a medical or religious exemptions. While these exemptions are pending, employees will continue being paid, and those who are rejected will continue working “as we coordinate with them on meeting the requirements (vaccine or valid accommodation),” CNBC reported.

It was unclear exactly where the buck would ultimately stop with the new timeline, but there is little doubt that we’ll soon find out.

Last weekend was an unfortunate one for Southwest Airlines, who suffered from the cancelation of nearly a third of their flight schedule…and just days after they announced that a vaccine mandate would soon go into effect for their thousands of employees. The airlines denied that the vaccine mandate had anything to do with the cancelations, blaming weather and air traffic control issues.  But, when researchers compared the number of total flights cancelled to the number of Southwest flights cancelled, it was fairly obvious that this was a localized issue. Only a few days after that, a massive protest of their vaccine mandate hit home near headquarters. By Tuesday of this week, the airline had been forced to back down. Southwest Airlines dropped a plan to put unvaccinated workers with pending exemptions on unpaid leave after a December 8 deadline following protests by their employees. “The employee will continue to work, while following all COVID mask and distancing guidelines applicable to their position, until the accommodation has been processed,” according to an internal note obtained by CNBC written by Southwest’s Senior Vice President of Operations and Hospitality Steve Goldberg and Vice President and Chief People Officer Julie Weber. And then, even after a new deadline was set, the company doesn’t appear to be baring its teeth in regard to enforcement. The company is giving employees until November 24 to finish their vaccinations or apply for a medical or religious exemptions. While these exemptions are pending, employees will continue being paid, and those who are rejected will continue working “as we coordinate with them on meeting the requirements (vaccine or valid accommodation),” CNBC reported. It was unclear exactly where the buck would ultimately stop with the new timeline, but there is little doubt that we’ll soon find out.

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Senator Obliterates Dr. Fauci’s Holiday Gathering Advice

“We don’t need permission”!

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If you follow the science, and the math, it’s beginning to become clear that the coronavirus pandemic is waning.  Again.

In the days before the Delta variant became the prominent strain of COVID-19, we were just about out of this whole mess.  Venues and restaurants were opening again.  People were beginning to gather at home or with friends.  When delta arrived, the ease retracted a bit.  The masks were a little more prevalent.

But now, if you simply look at the case numbers and infection rates, it is plain to see that everything is going to be okay.

This is what Florida Senator Rick Scott believes, as evidenced by his latest comments regarding the advice of Dr. Anthony Fauci.

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Sen. Rick Scott (R-FL), chairman of the National Republican Senatorial Committee (NRSC), dismissed suggestions that Dr. Anthony Fauci can give or take away permission for Americans to celebrate the holidays with their families, calling it “insane that the government thinks it can tell people how to live.”

“We don’t need Fauci’s permission to celebrate the holidays with family. People are smart. They know how to make decisions that best protect their loved ones. It’s insane that the government thinks it can tell people how to live,” Scott said in response to the National Institute of Allergy and Infectious Diseases chief’s recent remarks […]

Fauci had recently insinuated that gathering with people outside of your immediate home over the holidays may not be advisable, suggesting instead that people continue to socially distance from even their own family.

 

If you follow the science, and the math, it’s beginning to become clear that the coronavirus pandemic is waning.  Again. In the days before the Delta variant became the prominent strain of COVID-19, we were just about out of this whole mess.  Venues and restaurants were opening again.  People were beginning to gather at home or with friends.  When delta arrived, the ease retracted a bit.  The masks were a little more prevalent. But now, if you simply look at the case numbers and infection rates, it is plain to see that everything is going to be okay. This is what Florida Senator Rick Scott believes, as evidenced by his latest comments regarding the advice of Dr. Anthony Fauci. Sen. Rick Scott (R-FL), chairman of the National Republican Senatorial Committee (NRSC), dismissed suggestions that Dr. Anthony Fauci can give or take away permission for Americans to celebrate the holidays with their families, calling it “insane that the government thinks it can tell people how to live.” “We don’t need Fauci’s permission to celebrate the holidays with family. People are smart. They know how to make decisions that best protect their loved ones. It’s insane that the government thinks it can tell people how to live,” Scott said in response to the National Institute of Allergy and Infectious Diseases chief’s recent remarks […] Fauci had recently insinuated that gathering with people outside of your immediate home over the holidays may not be advisable, suggesting instead that people continue to socially distance from even their own family.  

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