Pharmacy Benefits Manager

Citizens Against Government Waste (CAGW) was outraged, if not surprised, at the report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) showing the ongoing failure of HHS executives to accurately report and prevent improper payments.  With the government-wide improper payment total at a staggering $137 billion in fiscal year (FY) 2015 (and rising), the OIG outlines some of the steps that agency has taken to stem the tide of red ink, but finds significant operational failures, in both its reporting of improper payments and implementing corrective action plans. 

Beating up pharmaceutical companies is the new “cause du jour.”  Even though pharmaceuticals are only 10 percent of all healthcare costs, they tend to make easy targets because it is difficult to understand why such a small pill should cost so much money.

In 1998, 46 states and five U.S. territories signed onto the Master Settlement Agreement (MSA) in order to recover taxpayer dollars lost to the treatment of tobacco-related health issues, which would then be used to fund anti-smoking campaigns and public health programs.  As part of the settlement, the states and territories will receive an estimated total of $246 billion over the first 25 years.

Yesterday, May 10, 2016, the House and Energy Commerce Committee released a report, which demonstrates the Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andrew Slavitt provided false testimony in a House Energy and Commerce Subcommittee on Oversight and Investigations hearing, “An Overdue Checkup Part II: Examining the ACA’s [Affordable Care Act] State Insurance Marketplaces.”  The hearing was held December 8, 2015.

On Tuesday, April 19, UnitedHealthcare CEO Stephen Hemsley announced that the company would be pulling out of most of the Affordable Care Act’s (ACA), or Obamacare, marketplace exchanges.  This announcement did not come as a surprise.  On November 19, 2015, The Hill reported, “At a shareholder meeting Thursday, UnitedHealthcare cast doubt on its ability to carry plans on the healthcare law’s exchanges beyond 2016, offering a more grim financial outlook than it had previously expected.  ‘In recent weeks, growth expectations for individual exchange participation have tempered industrywide,’ said Stephen Hemsley, the company’s CEO.  ‘Co-operatives have failed, and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated, so we are taking this proactive step.’”

On November 13, 2013, the Food and Drug Administration (FDA) released a proposed rule that would allow generic pharmaceutical firms to provide new safety information and update a drug’s label without first getting FDA approval, even though doing so would make it different from the reference drug’s (the original brand-name) label.  If the proposed rule should go in effect, it is conceivable that several versions of labels for the same medication could exist, creating uncertainty for physicians, pharmacists, and patients.

Yesterday was the Affordable Care Act’s (ACA) sixth anniversary. Better known as Obamacare, the law’s popularity since inception has never been above 50 percent according to RealClear Politics’ (RCP) polling data.

On June 25, 2015, President Obama made a bold proclamation regarding his signature healthcare law: “As the dust has settled, there can be no doubt that this law is working.”  He doubled down by adding that it “is working exactly as it’s supposed to.”  President Obama’s comments that day illustrate his continued unwillingness to accept the consequences of his healthcare takeover.  Ever since the Affordable Care Act (Obamacare) became law, he has ignored the panoply of problems that plague the law and the wasteful government agencies it empowered.

Presidential candidate Donald Trump has been vague and contradictory about the kind of healthcare reform plan he would offer to replace Obamacare. He has previously talked about having a government-run system, a mandate to purchase health insurance, “getting rid of the lines around the states,” allowing the government to “negotiate” drug prices, or preventing people from “dying on the streets.”

It has been almost two years since the scandal over wait times for vets trying to get into see medical personnel at VA facilities first erupted and America’s Iraq and Afghan vets are still on the losing end of a sclerotic, mismanaged, and secretive VA bureaucracy.  We can now add obstructionist to that list of adjectives.