Topic

health insurance

129 petitions

Update posted 5 days ago

Petition to Bloomfield Township, Leo Savoie

Establish a “soft billing” policy for Bloomfield Township EMS

Bloomfield TWP, MI currently engages in hard billing for its EMS through Medicount billing services. This means that the city, like most medical providers and some municipalities, attempts to collect any remaining balance after insurance (if any) has paid for ambulance services directly from the patient. With a soft-billing policy, a city accepts the payment provided by the insurance and writes off the rest. At the most, the patient might get billed, but they would not be sent to collections for failure to pay. Unfortunately, the collection agency Bloomfield TWP contracted with (Merchants & Medical Credit Corporation) has proved on at least one occasion to attempt to defraud Medicare and Medicaid by lying and otherwise trying to convince a Medicaid recipient that they were legally liable for the balance when it was incorrectly billed by the billing company. This was only discovered because the person happened to themselves have extensive knowledge and experience in patient billing and in Medicaid billing in particular (they had almost memorized the Medicaid provider handbook).  Therefore, the township contracts with a company for its EMS billing collections that is under active investigation for potential Medicaid fraud for lying to people, telling them they owe money they do not, arguing with the people who dispute them on the issue, refusing to send the error to the biller, and telling them to pursue futile courses of action to correct the issue when the person refuses to accept the answer. This is upsetting when you consider that the people being sent to collections needed an ambulance and were, therefore, more likely to be elderly and/or disabled. Meanwhile, the biller Medicount is not fixing errors that the person reports to them after receiving the initial bill, especially when Medicaid is approved retroactively, and it still sends people to collections. It seems likely that that people have paid money they do not owe or have been harassed and perhaps had legal action taken against them. Despite numerous attempts at contact and seeking resolution to this egregious matter by city leadership, there has been no comment to address the following questions and concerns:  1. There is no money to be made or recouped from billing Medicaid as secondary for a patient. For some reason, the law allows Medicaid to pay 20% of the Medicaid-approved rate, which is often much lower than that approved by primary carriers such as Medicare. If, however, Medicare already paid 100% of the Medicaid-approved rate, then Medicaid pays out nothing. Re-billing Medicaid and forgiving a debt of a person who truly owes it would result in the same income. Is there a situation where the biller and/or the collections agency is purposely failing to properly bill Medicaid as secondary in an attempt to instead get the co-payment from the patient? 2. If, instead, the error was due to simple incompetence, should we expect to believe that this billing error and subsequent refusal by the collections agency to relay the error was a rare, one-time occurrence? 3. How many people in general would one expect to have the in-depth knowledge on the subject to dispute the collector's repeated insistence that they are liable for the balance? 4. How many people would instead believe the collections agency or otherwise have paid the balance? 5. How many people HAVE paid the balance despite it not being their responsibility? 6. How many people have NOT paid the balance and have been harassed, taken to court, and had their credit reports affected due to a liability they did not owe? 7. What auditing does the township do to ensure the collections company remains ethical and honest? ----- It appears unlikely that switching to a different collection agency would be effective or at the least reliable to prevent such behavior. Even on the slightest chance that this was an isolated incident, is the city budget such that there would be significant harm without the revenue generated by a collections company wrangling money from sick and often elderly people who required emergency services beyond their control and don't have the financial means to pay the balance on an amount they never had the opportunity to even negotiate in the first place? Therefore, please sign this petition to tell the city leadership to support and protect their most vulnerable residents from the harms of the collection companies they contract with now or in the future by instead writing off such balances instead of sending them to collections and being put at risk for the predatory behavior described herein. Medicount offers such a "soft billing" option; tell Leo Savoie and the rest of the Bloomfield Township administration to take them up on it.

Adam Sherman
161 supporters
Update posted 1 week ago

Petition to Bundesamt für Gesundheit

Ein Leben ohne Sonne! Vivre sans soleil! Vivere senza sole! Living without sun!

Pour le FRANCAIS voir plus en bas, per l’ITALIANO vedere più in fondo, for ENGLISH see further below   DEUTSCH EIN LEBEN OHNE SONNE! So müssen Patienten leben, die an Erythropoietischer Protoporphyrie leiden. Helft ihnen, die Behandlung zu bekommen, die es ihnen erlaubt aus dem Schatten zu treten. Hallo, hast du jemals daran gedacht, ein Leben ohne die Sonne zu führen? Nur der Gedanke daran scheint unmöglich, oder? Aber jetzt werde ich dir ein Geheimnis enthüllen…es ist nicht ein Alptraum, aus dem wir wieder wach werden können, sondern unser wahres Leben seit der Kindheit. Wir sind eine Gruppe von Patienten mit Erythropoietischer Protoporphyrie (EPP), einer sehr seltenen Krankheit. Sie erlaubt es uns nicht normal zu leben, weil unser Blut krank ist und in der Sonne brennt, die Haut wird von innen zerfressen. All dies geschieht in weniger als 5 Minuten Exposition gegenüber Sonnenlicht, und auch künstliche Lichtquellen sind schädlich. Ich weiss was du jetzt denkst…Urlaub, wie geht das? Das ist nicht das Problem. Es geht um das, was man täglich an einem sonnigen Tag macht: die Fenster am Morgen zu öffnen, um Licht hereinzulassen, in der Sonne zu Fuss zum Frühstück zu gehen, mit dem Auto oder Bus zur Arbeit zu fahren oder die Kinder zur Schule zu bringen, in hellen, lichtdurchfluteten Umgebungen arbeiten zu können, deine Arbeit oder berufliche Ausbildung in einer solchen Umgebung überhaupt auszuüben, und noch viel mehr. Kurz gesagt, im Gegensatz zu dir haben wir uns jeden Tag vor der Sonne zu fürchten und zu flüchten. Eine der angenehmsten Sachen der Welt, wie ein schöner sonniger Tag, wird für uns zu einem täglichen Alptraum, der uns seit Kindheit geprägt und uns vieles verwehrt hat, weil die Folgen von Lichtexposition unerträgliche Schmerzen und in extremen Fällen tatsächliche Verbrennungen sind. Es ist als ob jemand Feuer unter unsere Haut gesetzt hätte – Wir brennen von innen und die Angst vor diesen Schmerzen hat unser Leben gebrandmarkt. Es gibt ein Medikament, mit dem viele von uns behandelt werden konnten, das so genannte Afamelanotid. Es ermöglicht uns, in die Sonne zu gehen, die Kinder zur Schule zu bringen und mit ihnen im Park zu spielen, zur Arbeit zu gehen, diese auszuüben oder sie überhaupt erst zu lernen, an einem Sonntagnachmittag mit der Familie spazieren zu gehen und nicht alleine im Haus eingesperrt zu bleiben. Kurz gesagt, das Medikament hat uns ein normales Leben, eine Wiedergeburt gegeben. In der Schweiz waren wir die ersten, die es in 2006 getestet haben, und wir haben den Weg für seine Erprobung in vielen anderen Ländern geebnet. Die Zulassung fand in der Europäischen Union im Jahr 2014 statt. Bereits im Jahr 2012 konnten wir es durch Artikel 71a/b des KVV bekommen, die Kosten für die Behandlung wurden von den Krankenversicherungen übernommen. Seitdem konnten viele EPP-kranke Schweizer von der wundersamen Wirkung von Afamelanotid profitieren. Leider war diese Lösung nur vorübergehend ... seit ein paar Wochen haben viele von uns die schreckliche Nachricht erhalten, dass unsere Krankenkassen nicht mehr bereit sind, die Kosten für das Medikament zu tragen. Grund ist eine Preiserhöhung, die nach unserem Kenntnisstand notwendig war, um die hohen Anforderungen der Europäischen Behörden zu erfüllen und die formale Vermarktung des Medikaments zu ermöglichen. Wir wurden plötzlich wieder in die Angst vor dem Licht und seinen schmerzhaften Folgen zurückgeworfen. Zurück in die Hölle… Wir sind verzweifelt: die jungen Patienten unter uns befürchten, dass sie ihre Ausbildung werden unterbrechen müssen, es gibt Eltern, die sich nicht mehr um ihre Kinder werden normal kümmern können, Berufstätige, die jetzt ihre Funktionen nicht mehr wie früher werden wahrnehmen können, und einige von uns, die den Stellenverlust befürchten müssen, und noch andere die so hoffnungslos sind, dass wir uns grosse Sorgen machen, dass sie sich in den Alkohol stürzen oder sich gar das Leben nehmen werden. Die Lage ist dramatisch… Wir öffnen diese Petition, um eine klare Botschaft über die äusserst prekäre und verzweifelte Situation, in der wir uns befinden, an das Bundesamt für Gesundheit (BAG) zu senden: Wie kann es denn sein, dass uns der Zugang zu einem solch wesentlichen Medikament von einem Tag zum anderen verwehrt wird? Das ist eine Verletzung unserer Menschenrechte auf eine Behandlung! Es gibt keine Alternative zum Afamelanotid und die Einstellung der Vergütung stellt uns vor eine ethisch verwerfliche Entscheidung zwischen einer Behandlung und keiner Behandlung. Wir wurden bereits vom Schicksal schwer gezeichnet, an einer sehr seltenen und ungerechten Krankheit zu leiden, und jetzt sind wir auch durch ein Gesetz bestraft, das eine Entscheidung ermöglicht, die ausschliesslich auf wirtschaftlichen Aspekten beruht und auf völlig willkürliche Art und Weise bestimmt, dass wir dieser revolutionären Behandlung nicht mehr würdig sind. Wir flehen deshalb das BAG an, in unsere Situation konkret einzugreifen, und etwas tun, um uns Afamelanotid zurückzugeben. Wir beanspruchen das Recht, die gleichen sozialen, wirtschaftlichen und lebensverwirklichenden Chancen wie unsere anderen "normalen" Mitbürger zu haben, die nicht an einer seltenen und belastenden Krankheit wie EPP leiden. Wir bitten um Hilfe! FRANCAIS VIVRE SANS SOLEIL! Ainsi vivent les malades de Protoporphyrie Érythropoïétique. Aidez-les à accéder aux soins qui leurs permettent de sortir de l'ombre. Salut, as-tu déjà pensé à vivre sans le soleil ? La simple pensée semble impossible, n’est-ce pas? Mais je vais te révéler un petit secret…il ne s’agit pas d’un cauchemar duquel nous pouvons nous réveiller, mais de notre condition depuis notre enfance. Nous sommes un groupe de patients souffrant de Protoporphyrie Érythropoïétique (EPP), une maladie très rare qui nous interdit de vivre normalement car notre sang est malade, il brûle au soleil et il ronge notre peau de l'intérieur. Tout cela se passe après une exposition de moins de 5 minutes à la lumière du soleil, mais les sources de lumière artificielle sont également dangereuses pour nous. Tu as certainement immédiatement pensé aux vacances mais le problème pour nous n’est pas uniquement ça. Toutes les tâches simples du quotidien lors d’une journée ensoleillée sont un défi pour nous: ouvrir les volets de la maison pour laisser entrer la lumière, marcher au soleil pour aller déjeuner, prendre le bus pour aller au travail, conduire un véhicule, accompagner les enfants à l'école, se garer loin de l'endroit où vous souhaitez vous rendre, simplement travailler ou suivre votre formation dans des lieux inondés de lumière, et bien plus encore. En bref, contrairement à toi, nous devons fuir le soleil tous les jours. La chose la plus agréable au monde, telle qu’une belle journée ensoleillée devient pour nous un cauchemar quotidien qui nous a marqué depuis notre enfance.  Nous devons renoncer à beaucoup de choses car les conséquences d’une exposition à la lumière peuvent mener à une douleur atroce et, dans d’extrêmes cas, à des véritables brûlures. Tu brûles réellement de l'intérieur comme si tu étais prisonnier d’un incendie et la peur de cette douleur affecte nos vies. Un médicament que beaucoup d'entre nous ont pu essayer, appelé Afamelanotide, nous permet de nous exposer au soleil, aller chercher les enfants à l'école et de jouer avec eux au parc, travailler et suivre une formation, de sortir le dimanche après-midi en famille et enfin ne plus rester enfermé seul à la maison. En bref, le médicament nous a donné une vie normale, il nous a fait renaître. En Suisse, nous avons été les premiers à le tester en 2006 et nous avons ouvert la voie à son expérimentation dans de nombreux autres pays et à son approbation dans l'Union Européenne en 2014. En 2012, nous avons pu l’obtenir grâce à l'article 71a/b de la OAMal et les assurances maladie ont pu couvrir les coûts. Depuis lors, de nombreux malades Suisses ont pu bénéficier des effets miraculeux  de l'Afamelanotide. Malheureusement, cette solution ne fut que temporaire...depuis quelques semaines beaucoup d'entre nous ont reçu la terrible nouvelle que nos caisses maladies ne sont plus disposées à rembourser le coût du médicament en raison d'une augmentation du prix, à notre connaissance nécessaire pour répondre aux exigences rigoureuses des autorités européennes et pour permettre la commercialisation officielle du médicament. Nous nous retrouvons à nouveau plongés dans la peur de la lumière et de ses conséquences douloureuses. Retour à l’enfer… Nous sommes désespérés: les jeunes patients parmi nous craignent de devoir interrompre leur formation professionnelle, il y a des parents qui ne seront plus capables de s’occuper de leurs enfants normalement, des employés ou des indépendants qui ne pourront plus exercer leurs fonctions professionnelles comme avant, et certains parmi nous qui ont peur de perdre leur emplois, et d'autres encore qui sont si désespérés que nous craignons sérieusement qu'ils puissent se plonger dans l'alcool ou même se suicider. La situation est dramatique... Nous ouvrons donc cette pétition pour donner un message clair à l'Office Fédéral de la Santé Publique (OFSP), quant à la situation extrêmement précaire et désespérée dans laquelle nous nous trouvons. Comment se fait-il que l’accès à un remède si essentiel puisse être retiré du jour au lendemain? Ceci est une violation des droits de l'homme et de notre droit à un traitement! Il n'existe aucune alternative à l’Afamelanotide et avec cet arrêt du remboursement du médicament nous sommes confrontés à un retour forcé à notre vie de malade, à une décision éthiquement répréhensible entre un traitement et pas de traitement. Nous avons déjà été sévèrement marqués par le fait d'avoir une maladie très rare et injuste, et maintenant nous sommes également pénalisés par une loi qui permet une décision arbitraire, fondée uniquement sur des aspects économiques. Celle-ci a déterminé que nous ne sommes plus dignes de ce traitement révolutionnaire. Nous implorons l'OFSP d'intervenir concrètement dans notre situation et d’agir pour nous redonner l’accès à l’Afamelanotide. Nous revendiquons le droit d'avoir les mêmes opportunités sociales et économiques, de pouvoir vivre comme le font nos autres concitoyens "normaux" qui ne souffrent pas d'une maladie rare et handicapante comme la EPP. S'il vous plaît aidez-nous! ITALIANO VIVERE SENZA SOLE!  Così vivono i malati di Protoporfiria Eritropoietica. Aiutateli ad avere la cura che gli permette di uscire dall’ombra. Ciao, hai mai pensato di vivere senza sole? Impossibile solo il pensiero, vero? Ma ora ti svelerò un segreto a te che stai leggendo... ciò esiste e non è un incubo dal quale ci si può risvegliare, ma la nostra condizione dall'infanzia. Siamo un gruppo di pazienti affetti da Protoporfiria Eritropoietica (EPP), una patologia molto rara che non ci permette di vivere normalmente perché il nostro sangue è ammalato e brucia al sole, corrodendo la pelle dall'interno. Tutto ciò accade in meno di 5 minuti d'esposizione al sole ma anche a fonti di luce artificiale, e se anche hai pensato subito alle vacanze, il problema non è questo per noi. Essenzialmente è tutto ciò che tu fai in una giornata di sole. Aprire le ante di casa per far entrare luce, camminare al sole per andare a fare colazione, guidare la macchina o prendere il bus per andare al lavoro o portare i bambini a scuola, parcheggiare dove vuoi anche lontano dal luogo dove ti devi recare, lavorare in luoghi inondati di luce, svolgere il tuo lavoro o la tua formazione professionale in tali ambienti, e molto di più ancora. Insomma, noi a differenza tua dobbiamo scappare dal sole ogni giorno e la cosa più piacevole al mondo come una bella giornata di sole per noi diventa un incubo quotidiano che ci ha segnato dall'infanzia e ci ha fatto rinunciare a moltissime cose perché le conseguenze dell’esposizione alla luce sono dei dolori strazianti e in casi estremi ustioni vere e proprie, come se qualcuno avesse appiccato il fuoco sotto la tua pelle – Tu bruci dall’interno e la paura di questi dolori ci ha condizionato la vita. Esiste un farmaco che molti di noi hanno potuto provare, si chiama Afamelanotide e ci permette di camminare al sole, andare a prendere i bambini a scuola e giocare con loro al parco, andare al lavoro, svolgerlo e impararlo, uscire la domenica pomeriggio in famiglia e non stare chiusi in casa da soli, insomma il farmaco ci ha donato una vita normale, ci ha fatto rinascere. In Svizzera siamo stati i primi a sperimentarlo nel 2006 e abbiamo aperto la via alla sua sperimentazione in molti altri paesi e alla sua approvazione nell’Unione Europea nel 2014. Già nel 2012 siamo riusciti a ottenerlo grazie all’Articolo 71a/b della OAMal e alla copertura dei costi da parte delle assicurazioni malattia. Da allora molti malati Svizzeri hanno così potuto beneficiare degli effetti miracolosi dell’Afamelanotide. Purtroppo questa soluzione si è rivelata solo temporanea…da alcune settimane molti di noi hanno ricevuto la terribile notizia che le nostre casse malati non sono più disposte ad assumersi i costi del farmaco a causa di un aumento di prezzo, da ciò che abbiamo potuto capire necessario per soddisfare le severe richieste delle autorità Europee e permettere la commercializzazione formale del farmaco. Noi ora ci troviamo ripiombati nel terrore della luce e delle sue dolorose conseguenze. Ritorno all’inferno… Siamo disperati: giovani malati che temono di dover interrompere la loro formazione professionale, genitori che non saranno più in grado di prendersi cura dei loro figli in modo appropriato, dipendenti o liberi professionisti che non potranno più svolgere i loro compiti lavorativi come prima, e alcuni di noi che hanno paura di perdere il posto di lavoro, e altri ancora che sono così angosciati che abbiamo seriamente paura che possano affogare la loro disperazione nell’alcool o addirittura togliersi la vita. La situazione è drammatica... Apriamo questa petizione per far arrivare un messaggio chiaro all'Ufficio federale della sanità pubblica (UFSP) sulla situazione estremamente precaria e disperata in cui ci troviamo: come può essere che una cura così essenziale ci possa essere tolta da un giorno all’altro? Ciò è una violazione dei nostri diritti umani a una cura! Non c’è alternativa all’Afamelanotide e l’interruzione del rimborso del farmaco ci pone di fronte a una decisione eticamente deprecabile tra una cura e nessuna cura. Già siamo stati duramente segnati dal destino di avere una malattia molto rara e ingiusta, ed ora ci troviamo anche penalizzati da una legislazione che permette una decisione basata unicamente su aspetti economici che in maniera completamente arbitraria dichiara che non siamo più degni di questa cura rivoluzionaria. Imploriamo l’UFSP di intervenire concretamente nella nostra situazione e fare qualcosa per ridarci l’Afamelanotide. Rivendichiamo il diritto di avere le stesse opportunità sociali, economiche e di realizzazione di vita come i nostri altri concittadini “normali” che non soffrono di una malattia rara e debilitante come l’EPP. Per favore, aiutateci! ENGLISH LIVING WITHOUT SUN! This is how Erythropoietic Protoporphyria sufferers have to live. Help them have the treatment that allows them to emerge from the shadows. Hello, have you ever thought of living without the sun? You can’t even imagine that, can you? But now I will reveal a secret to you who are reading this...this is not a nightmare from which we can awaken, but our condition since childhood. We are a group of patients with Erythropoietic Protoporphyria (EPP), a rare disease that does not allow us to live normally because our blood is poisoned and burns in the sun, eating away at the skin from within. All of this happens in less than 5-minute exposure to sunlight, but also artificial light sources are dangerous, and even if you are now thinking “holidays, how does that work?” this is not the key problem for us. Essentially, everyday life is a constant battle against the sun: Opening the window drapery of the house to let the sunlight in, walking in the sun to go to breakfast, driving or taking the bus to go to work or take the kids to school, parking your car wherever you want even if it is far from the place where you intend to go, working in places flooded by light, carrying out your work or your professional training and education in such environments, and much more. In short, unlike you we have to protect ourselves from the sun every day. One of the most pleasant things in the world such as a beautiful sunny day for us is a painful nightmare that has marked us since childhood and made us give up many things because the consequences of light exposure are excruciating pain and, in extreme cases, actual burns, as if someone had set fire under your skin – You are burning from the inside out and the fear of this pain has dramatically affected our lives. There is a drug that many of us have been able to try, called Afamelanotide, and it allows us to walk in the sun, get the kids to school and play with them in the park, go to work, carry it out and learn a job, go out on a Sunday afternoon with the family and not stay locked in the house alone. In short, the drug has given us a normal life, it gave us a rebirth. In Switzerland, we were the first to test it in 2006 and we have paved the way for additional clinical trials in many other countries and its approval in the European Union in 2014. Already in 2012 we were able to get it through Article 71a/b of the Federal ordinance on health insurances, and treatment costs were covered by health insurances. Since then many Swiss EPP-sufferers have been able to benefit from the miraculous effects of Afamelanotide. Unfortunately, this solution was only temporary...a few weeks ago many of us received the horrible news that our health insurance companies are no longer willing to reimburse the costs of the treatment due to a price increase necessary, to our knowledge, to meet the stringent demands of the European authorities and allow the formal marketing of the drug. We now find ourselves plunged back in fear of the light and its painful consequences. Back in hell… We are desperate: young patients fearing to have to interrupt their professional training and education, parents who will no longer be able to care for their children appropriately, employees and professionals who will not be able to perform their work duties as before, and some of us who are afraid of losing their jobs, and others who are so hopeless that we seriously fear that they might drown their desperation in alcohol or even commit suicide. The situation is dramatic ... We are opening this petition to convey a clear message to the Federal Office of Public Health (FOPH) on the extremely precarious and desperate situation in which we find ourselves: how can it be that the ONLY treatment which is so essential for us EPP sufferers can be withheld from us from one day to the next? This is a violation of our human rights to a treatment! There is no alternative to Afamelanotide and with the discontinuation of the reimbursement we are now faced with the ethically reprehensible decision between a treatment and no treatment. We have already been severely marked by destiny with a very rare disease, and now we are also penalized by a law that allows a decision based solely on economic considerations, which in completely arbitrary fashion determines that we are no longer worthy of this revolutionary treatment. We implore the FOPH to take concrete steps in our situation and do something to give Afamelanotide back to us. We reclaim the right to have the same social and economic opportunities as well as the right to realize our life plans just like our other "normal" fellow citizens who do not suffer from a rare and debilitating disease such as the EPP. Please help!  

Swiss Society for Porphyria - www.porphyria.ch
5,766 supporters
Update posted 2 months ago

Petition to Donald J. Trump, Donald J. Trump, U.S. Senate, U.S. House of Representatives, Donald Trump

Require Insurance Companies to Pay for Alternative Pain Treatments

Health insurance companies routinely pay for pharmaceutical and surgical treatment for pain patients, the most expensive and risky forms of care. Many who've tried these treatments are still in considerable pain.   At the same time, people in pain are being denied insurance coverage for safer, more effective treatments including physical therapy, massage, chiropractic, biofeedback, acupuncture, marijuana, low level laser therapy, psychotherapy, nutritional and herbal interventions. We need a law that requires health insurance companies to cover all proven effective treatments for pain to the same degree that they cover pharmaceuticals and that requires physicians to be educated about these therapies.   Please support a Pain Treatment Parity Act that requires health insurers to provide coverage for all proven effective pain treatments that is equivalent to coverage of pharmaceuticals with respect to treatment frequency, length of treatment, pre-authorization requirements, co-pays, deductibles, medical necessity reviews and any other requirements that determine access to and affordability of care. In addition, given that non-physician health care providers have not had increases in fees for more than 35 years, the Pain Treatment Parity Act should require that alternative pain treatment provider fees are increased on a par with past physician fee increases to insure continuing availability of these critical services.   Note: More information on the need for this legislation and the evidence for the safety and effectiveness of  nonpharmacological pain treatments can be found at the online Alternative Pain Treatment Directory  

Cindy Perlin, LCSW
2,975 supporters
Update posted 3 months ago

Petition to Elizabeth Warren, Doug Jones, Lisa Murkowski, Dan Sullivan, Kyrsten Sinema, Martha McSally, John Boozman, Tom Cotton, Dianne Feinstein, Kamala D. Harris, Michael F. Bennet, Cory Gardner, Richard Blumenthal, Christopher J. "Chris" Murphy, Thomas R. Carper, Christopher A. Coons, Marco Rubio, Rick Scott, Johnny Isakson, David Perdue, Mazie K. Hirono, Brian Schatz, Mike Crapo, James E. Risch, Tammy Duckworth, Todd Young, Chuck Grassley, Joni Ernst, Pat Roberts, Jerry Moran, Mitch McConnell, Rand Paul, Bill Cassidy, John Kennedy, Susan M. Collins, Angus S. King Jr., Benjamin L. Cardin, Chris Van Hollen, Elizabeth Warren, Ed Markey, Debbie Stabenow, Gary C. Peters, Amy Klobuchar, Tina Smith, Roger F. Wicker, Cindy Hyde-Smith, Roy Blunt, Jon Tester, Steve Daines, Deb Fischer, Ben Sasse, Catherine Cortez Masto, Jacky Rosen, Jeanne Shaheen, Maggie Hassan, Robert Menendez, Cory A. Booker, Tom Udall, Martin Heinrich, Charles E. Schumer, Kirsten E. Gillibrand, Richard Burr, Thom Tillis, John Hoeven, Kevin Cramer, Rob Portman, James M. Inhofe, James Lankford, Ron Wyden, Jeff Merkley, Jack Reed, Sheldon Whitehouse, Lindsey Graham, Tim Scott, John Thune, Mike Rounds, Lamar Alexander, Marsha Blackburn, Ted Cruz, Mike Lee, Bernard Sanders, Mark R. Warner, Tim Kaine, Patty Murray, Maria Cantwell, Joe Manchin III, Shelley Moore Capito, Ron Johnson, Tammy Baldwin, Michael B. Enzi, John Barrasso

Pay Independent and Hospital Pharmacists Fairly & Provide Access Through Coverage

Per a recent consumer reports study, most patients prefer independent pharmacy (Gill,2018). Unfortunately, many are not allowed to use independent pharmacy for coverage of their life-saving medications as pharmacy benefit managers such as CVS Caremark, Optum RX, and Express Scripts have removed this option from our coverage. Across our nation news reports are highlighting the price gouging that is occurring behind the scenes as we are being forced to their pharmacies. It appears, no one is listening to the voices of voters and patients. For example, recently medications that were filled by a hospital pharmacy were suddenly forced away from the hospital pharmacy to the insurance company's pharmacy benefit manager's owned mail-order pharmacy. It wasn't because our pharmacy was unqualified; they fill medications for children's transplant, cancer, and many other specialty medications every single day. The reply received from the insurance company's pharmacy benefit manager for the reason for denial stated that the pharmacy was not an appropriate location to fill these medications. Many would argue they were the most qualified and appropriate. The issue is the pharmacy benefit managers (PBM) who control access and reimbursements. There is about an 80 percent chance your PBM is Express Scripts Optum RX or CVS Caremark. Sadly, these same pharmacy benefit managers force many to their own mail-order and retail pharmacies. For my family, our only in-network pharmacy is CVS and CVS mail-order pharmacy. The PBM, of course, is CVS Caremark. Life-saving medications, like my son's transplant medications, are mandated to only be received through the mail for coverage. This issue is not unique. It's happening across America. Recently, a news article stated that CVS paid their own pharmacy much more. "For example, CVS would have to pay Walmart and Sam’s Club almost half again as much — 46 percent more — for generic drugs if CVS were to equal the rates it was paying its own pharmacies" (2019, Candisky & Schladen)" When looking at the reimbursements of our independent pharmacies, unfair and unequal reimbursements are found. "For a Fentanyl Patch 100, CVS pharmacies were reimbursed $400.65 while mom-and-pop pharmacies were reimbursed $75.74. For Amoxicillin, CVS pharmacies were reimbursed $35.92 while mom-and-pop pharmacies were reimbursed $12.21 (Lopez,2018)" Upon speaking to many pharmacists, these reimbursements are barely enough or not enough to cover their overhead cost along with the cost of the medications. After these unfair reimbursements Business Insider notes, "They also didn't know that, as their local pharmacists were getting squeezed, CVS was waiting in the wings, sending out letters offering to buy the very mom-and-pop shops it was forcing out of business (Lopez,2018)." In Ohio alone, over 160 independent pharmacies have closed. Many were bought out by CVS and many did not reopen. These closures are leaving entire communities at loss of a critical healthcare provider to help them demonstrate how to use complex medications, to inform patients that it may be cheaper to pay cash instead of using their insurance card, to prevent patients from taking the many risks of mail-order pharmacy such as delays, lost, thefts, loss of potency of medications due to lack of temperature monitoring, the risk of children and pets ingesting medications, and no one to communicate face to face with our elderly and people with chronic conditions and the list of over 100 other issues with mail-order pharmacy. The over-performance and hard work of our independent, hospital, and community pharmacist should be greatly rewarded not overlooked and disregarded. For example, CVS often states that they are paying per performance. For example, CVS states they pay the pharmacy based on factors such as patient adherence and use of generics. They often measure adherence by medications refilled by the customer. However, for some customers who are discarding medications by the table full due to auto refills and the price gouging of taxpayers dollars when generics are filled, many patients argue that the performance reward should go to our independent, community, and hospital pharmacy who do not make us take all the risks with mail-order pharmacy. Often, when a medication is refilled and the mail-order pharmacy has delayed the medication for days and weeks or one of many incidents that can go wrong with mail -order happens during shipment, the independent pharmacies will fill an emergency prescription. What will happen as the independent pharmacist close their businesses? Where will we go? The insurance company's pharmacy benefit managers are hoping that we are all sleeping at the wheel. That we are not caring about the future of our pharmaceutical care. Let's unite and the PBMs and our regulators otherwise!   YOUR SUPPORT WILL SAVE LIVES  Thank you! Loretta Boesing www.uniteforsafemedications.com   The greatest way that you can help is by sharing this petition & gathering 2-3 people in your community who are having issues and speak to your legislatures.    You may also make a tax-deductible donation to our advocacy and join with our trusted pharmacies who are working hard to fight against this unethical business practice.    References,  Candisky, Cathy, and Schladen, Marty, and . “CVS Paid Itself Far More than Some Major Competitors, Report Says.” Gatehouse Media, Gatehouse Media, 2019, gatehousenews.com/sideeffects/cvs-paid-far-major-competitors-report-says/. Gill, Lisa L. “Consumers Still Prefer Independent Pharmacies, CR's Ratings Show.” Product Reviews and Ratings - Consumer Reports, 7 Dec. 2018, www.consumerreports.org/pharmacies/consumers-still-prefer-independent-pharmacies-consumer-reports-ratings-show/ Lopez, Linette. “What CVS Is Doing to Mom-and-Pop Pharmacies in the US Will Make Your Blood Boil.” Business Insider, Business Insider, 30 Mar. 2018, www.businessinsider.com/cvs-squeezing-us-mom-and-pop-pharmacies-out-of-business-2018-3        

Loretta Boesing
7,432 supporters