A proposed merger between Express Scripts and Medco, two of the largest Pharmacy Benefit Managers (PBM) if approved by the Obama Administration would dominate the market with control over 30% of annual prescriptions processed – both retail and mail order and about 80% in the private sector market, according to certain analysts. This mega-PBM will have tremendous market power and growing political influence, enabling them to squeeze the health care system at the expense of patient choice, access and service.

If you get your prescriptions filled at your local Walgreen’s drugstore then you already know that on January 1 Walgreen’s dropped their relationship with Express Scripts, a pharmacy benefit manager that administers prescription benefits for insurance companies, large employers, federal and state government. Walgreen’s is using a free market solution to keep the customers who had used Express Scripts by dropping the annual fee form their own prescription savings club. Over 200,000 Walgreen’s customers have signed up so far in 2012. This should only come as a surprise to a Washington bureaucrat because we know the free market is the best solution to meeting people’s healthcare needs.

The merger would result in fewer choices for employers, in an already consolidated market, seeking a pharmacy benefit manager and cost savings for their health care plans. It would also mean fewer choices for patients who prefer – and depend on – community pharmacies for their prescription medication and other health care services. As we can see with the Walgreen’s example, patients don’t need pharmacy benefit managers making their decisions for them.

If you want to ask your pharmacist a question, you better be prepared to right him a letter, because Express Scripts and Medco want to push as many customers as possible to mail orders, regardless of your preference. Patients deserve the right to choose their pharmacy provider and whether or not to opt into a mail order program. According to the 2011 Atlantic Information system data, combining both companies’ mail order programs would concentrate almost 60 percent of the mail order market in their hands, further creating an incentive to force patients to utilize costly, un-monitored, unsafe and unreliable mail order pharmacy.

Limiting free market choices will not only cost us as patients, but it will cost us as taxpayers.

An Express Scripts/Medco merger could be damaging to Medicare Part D drug beneficiaries, who rely on competition to keep costs low. We pay for it. State level, employee-sponsored and other health plans could also see a rise in health care costs. We pay for it.

The Bottom Line – Express Scripts’ Stance Is Not In The Best Interests Of Patients, Employers & Health Care In America.

Congress and the Federal Trade Commission should prevent a merger that will create an unfair playing field for pharmacy and health care providers and that will ultimately dilute patient care and restrict patient access to critical pharmacy care.

For more information and how to get involved visit http://preservingcommunitypharmacy.com/

Special thanks to Nancy J. Thorner, Republican Precinct Committeeman in Lake County, Illinois for her exceptional response to this program and her support of two physician candidates running for Illinois State Senate – Dr. Arie Friedman & Illinois Rep.- Dr. Mark Neerhoff. These two doctors are not only friends of mine but both will be exceptional representatives for the State of Illinois. Nancy outlines why in her excellent article here.

Click here to visit Nancy’s site.

The following is video from one of many town halls that Congressman Joe Walsh has held throughout Illinois’ 8th district since he was elected.  Unlike his predecessor, Mr. Walsh welcomes ALL constituents, allows videotaping and answers all questions honestly and in person. THIS is a textbook example of how ALL representatives should treat their constituents. Joe Walsh is a breath of fresh air to Illinois’ 8th District. Hat tip to McGonagle Productions for their superb video & editing work of this town hall in Schaumburg, IL. on 4/28/11.

For the story I mentioned about the woman who was denied her Cancer medications but offered the far less expensive “Assisted Suicide” option from the Oregon State Health Care Rationing Panel see the video below:

Click here for more about the “IPAB” (Independent Payment Advisory Board)

For the FACTS behind everything you’ve just heard visit www.TruthAboutObamaCare.com

WASHINGTON April 21 (BestWire) — Health insurance trade groups, labor unions and others should turn over records and documents about meetings with White House officials over health reform, committee leaders in the House of Representatives said.

In letters to America’s Health Insurance Plans, the Blue Cross and Blue Shield Association, the Service Employees International Union and other groups, House Energy and Commerce Committee Chairman Fred Upton, R-Mich., asked for “a list of each meeting, briefing or telephone call” and “all notes, minutes, transcripts, documents, summaries or any other written or recorded materials” relating to health reform meetings. They also requested the names of every employee or representative who discussed health reform with “any employee, detailee, or any other representative of the White House Office of Health Reform, the White House or the Department of Health and Human Services.” Also among the multiple documents requested are all estimates or analyses of the effect of health reform legislation on the organizations and its members.

The letters do not carry the weight of subpoenas, but Upton asked recipients to comply within two weeks. The identical letters were also signed by representatives Joe Pitts, R-Pa., chairman of the Health Subcommittee; Michael Burgess, R-Texas, vice chairman of the Health Subcommittee; and Cliff Stearns, R-Fla., chairman of the Oversight and Investigations Subcommittee.

“AdvaMed is one of many organizations to receive a request for information on its discussions with the White House regarding health reform by the Energy and Commerce Committee. We are reviewing the request and will comply with it appropriately,” Christopher White, executive vice president and general counsel of the Advanced Medical Technology Association, said in a statement.

An AHIP spokesman declined to comment until the association could develop its response to the committee. The BCBSA did not respond to questions about the letters. Other recipients were the American Medical Association, the American Hospital Association, the Federation of American Hospitals, the Pharmaceutical Research and Manufacturers of America, the Business Roundtable, AARP, the AFL-CIO and the American Federation of State, County and Municipal Employees.

The committee is pursuing information from those that lobbied on what became the Affordable Care Act because the White House has not responded to its inquiries about “secret health care negotiations,” Upton said in a statement. “As the committee continues pressing the White House to fulfill its pledges for government transparency, the investigation has been broadened to seek documents and records directly from those organizations invited by the White House to help craft the law — behind closed doors, and without input from Congress,” he said.

(By Sean P. Carr, Washington Bureau Manager: sean.carr@ambest.com)BN-NJ-04-21-2011 1650 ET #

To view the original post for this article sign up for A.M. Best’s valuable industry articles and more at: www.ambest.com

WASHINGTON April 14 (BestWire) — Despite claims by health insurers that the Patient Protection and Affordable Care Act’s medical loss ratio requirements are forcing them to pay lower commissions to agents and brokers, Illinois Insurance Director Michael McRaith told BestWire it is the insurers themselves who should ante up to ensure broker commissions aren’t affected by the sweeping changes facing the health insurance industry.

McRaith, who was recently tapped to become the first head of the Federal Insurance Office (BestWire, March 29, 2011), said in Illinois, five of the largest health insurers in the state have taken in billions in surplus revenues even as they tell agents and brokers that they are going to have to make cuts to their commissions. The state’s largest insurance company has $8 billion in surplus capital and that together, the top five health insurers in the state have $28 billion in surplus capital, he said.

“That tells us that the insurers are squeezing the agents and brokers, squeezing consumers, and squeezing providers. Everybody is getting less from the insurers than the insurers themselves,” McRaith said. “My view is that the best solution is to require the health insurers to pay a certain percentage of their surplus to the agents and brokers to ensure that the important role of agents and brokers is preserved in the transaction.”

McRaith said he was skeptical of the need for legislation such as the bill introduced last month by U.S. Rep Mike Rogers, R-Mich., and U.S Rep. John Barrow, D-Ga, which would exempt broker commissions from the MLR transaction (BestWire, March 18, 2011). “We don’t need a law, we don’t need an amendment to the Affordable Care Act, we really don’t need regulatory action and to further burden consumers with higher, increased premiums just to pay agents and brokers,” McRaith said. “The insurance companies can already afford to make those payments. They have chosen not to.”

McRaith, who also serves as secretary/treasurer of the National Association of Insurance Commissioners, said he was also skeptical of the NAIC’s need to endorse the Rogers-Barrow bill without a clear indication that MLRs were actually responsible for declining broker commissions. The NAIC currently has a task force investigating the MLR issue (BestWire, March 27, 2011).

McRaith said he thinks the best way to ensure that brokers, many of whom have argued they may have to find a new career if their commissions continue to decline, remain a part of the equation is to have insurers cover the cost of their commissions.

“The health insurance companies have created the problem. The health insurance companies should solve the problem,” McRaith said. “I don’t believe the regulatory community or Congress should be called upon and to salvage further billions in surplus at further expense to the consumers.”

McRaith’s comments contrast sharply with remarks made by U.S. Sen. Mary Landrieu, D-La., during the Independent Insurance Agents & Brokers of America’s conference in Washington on April 14.

Landrieu, who pledged to work with the agent and broker community to “fix” the problems with the MLR requirement said it was “never our intention” to have commissions affected by the passage of the Affordable Care Act. Landrieu said she had heard from several agents and brokers who said that their reduced commissions were having a significant impact on their businesses.

“That was not our intention, and I will work with you to fix that,” Landrieu said. “We fought to keep the insurance industry as part of the mix because it brings value to the system. But we want the insurance industry to be responsible.”

To hear an audio recording of the interview with McRaith: http://www.ambest.com/media/media.asp?RC=185456
(By Jeff Jeffrey, Washington Correspondent: jeff.jeffrey@ambest.com)

Since NO ONE seems willing to discuss the REAL reason that health insurance premiums are increasing dramatically. Let me break down the 4 primary reasons. They are as follows:

1.) My Blue Cross Group clients are receiving policy renewal rate increases this year of up to 46% for THE FIRST TIME in 15 years. See just a few of them here. Their prior premium increases were NO WHERE NEAR this amount. This is not isolated to Blue Cross either. These premium increases are happening in many markets across the United States in both the Individual AND Group health insurance markets. I’m simply using Blue Cross as an example since the name is most widely recognized.

These increases are due in large part to the fact that MULTIPLE new “Preventative Care” mandates were imposed upon all “non-grandfathered” health insurance plans as of 9/23/2010 under the PPACA (Patient Protection & Affordable Care Act). A “Non-grandfathered” health insurance plan is a plan that was purchased after the PPACA (a.k.a “Obamacare”) was signed in to law on March 23, 2010. Keep in mind, these were ALL mandated to be covered no later than 1/1/2011 WITHOUT a co pay or a DEDUCTIBLE (a.k.a. “FREE”). The entire list is as follows:

Covered Preventive Services for Adults

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
• Alcohol Misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood Pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal Cancer screening for adults over 50
• Depression screening for adults
• Type 2 Diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunizationvaccines for adults–doses, recommended ages, and recommended populations vary:
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella
• Obesity screening and counseling for all adults
• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
• Tobacco Use screening for all adults and cessation interventions for tobacco users
• Syphilis screening for all adults at higher risk

Covered Preventive Services for Women, Including Pregnant Women

• Anemia screening on a routine basis for pregnant women
• BRCA counseling about genetic testing for women at higher risk
• Breast Cancer Mammography screenings every 1 to 2 years for women over 40
• Breast Cancer Chemoprevention counseling for women at higher risk
• Breast Feeding interventions to support and promote breast feeding
• Cervical Cancer screening for sexually active women
• Chlamydia Infection screening for younger women and other women at higher risk
• Contraceptive Methods and Counseling including morning after abortion pill (added 8/1/11)
• Folic Acid supplements for women who may become pregnant
• Gonorrhea screening for all women at higher risk
• Hepatitis B screening for pregnant women at their first prenatal visit
• Osteoporosis screening for women over age 60 depending on risk factors
• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
• Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
• Syphilis screening for all pregnant women or other women at increased risk

Covered Preventive Services for Children

• Alcohol and Drug Use assessments for adolescents
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
• Cervical Dysplasia screening for sexually active females
• Congenital Hypothyroidism screening for newborns
• Developmental screening for children under age 3, and surveillance throughout childhood
• Dyslipidemia screening for children at higher risk of lipid disorders
• Fluoride Chemoprevention supplements for children without fluoride in their water source
• Gonorrhea preventive medication for the eyes of all newborns
• Hearing screening for all newborns
• Height, Weight and Body Mass Index measurements for children
• Hematocrit or Hemoglobin screening for children
• Hemoglobinopathies or sickle cell screening for newborns
• HIV screening for adolescents at higher risk
• Immunizationvaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenzae type b
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus
  • Inactivated Poliovirus
  • Influenza
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Lead screening for children at risk of exposure
• Medical History for all children throughout development
• Obesity screening and counseling
• Oral Health risk assessment for young children
• Phenylketonuria (PKU) screening for this genetic disorder in newborns
• Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis
• Visionscreening for all children
  Source: http://www.healthcare.gov/law/about/provisions/services/lists.html
• UPDATE: On August 1, 2011 the Obama Administration mandated even more Preventative Care benefits on to every major medical health insurance plan in the nation. These mandates will drive up health insurance premiums even higher. See the new mandates here.

2.) But WAIT! Those are only the Preventative Care mandates. There’s more! Now for the policy “design”
Mandates. Blue Cross outlines ALL of THOSE here:
http://www.resourcebrokerage.com/BCBSupdates22510B/PPACAILInsuredNotification.pdf

3.) Now we come to reason number three. The ONEROUS new Medical Loss Ratios or “MLR’s”. This is why health insurance premiums are increasing on “Non-Grand-Fathered” health insurance plans as well. For full details on these I refer you to the following link from the Heritage Institute. Please READ the TRUTH there: http://www.heritage.org/Research/Reports/2010/01/Squeezing-out-Private-Health-Plans

4.) The rapid implementation of the new Medical Loss Ratios have led to more than 20 health insurance carriers closing their doors or refusing to sell health insurance again. This has left millions of American’s either uninsured or without the plan they had prior to the passage of the PPACA. This is exactly the opposite of what President Obama promised when he said in his speech to the AMA on June 15, 2009 “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.” Find out the names of the carriers that have left the industry since the passage of the PPACA as well as all the other damage done to the health insurance industry since the passage of the PPACA by reading the new study completed by the Galen Institute on December 1, 2011 entitled “A Radical Restructuring of Health Insurance.”

Tell me WHO in their RIGHT MIND thinks forcing all the aforementioned NEW MANDATES on to every health insurance policy in the country would actually “bend the cost curve DOWN”? In fact, mandates are a major reason why health insurance premiums have been increasing exponentially over the last few decades. In 1979 there were 252 mandates in force in health care, by 2007 there were nearly 1900. With the implementation of the PPACA  we have tipped the scales at nearly 2000 mandates. Keep piling them on and costs will continue to rise.

There ARE ways to bend the cost curve down. For those visit: http://csteventucker.wordpress.com/2010/03/02/intelligent-health-insurance-reform-using-free-market-principles-and-limited-government/