Latest news with #healthcarecosts
Yahoo
3 days ago
- Business
- Yahoo
How Democrats can pull off a win under a GOP trifecta: Dismantle the "legal" drug cartel
Just before President Trump pushed her out at the behest of his corporate donors, former Federal Trade Commission chairwoman Lina Khan released a damning report about the most rapacious and anti-competitive actors in the entire healthcare system: pharmacy benefit managers. These middlemen in the drug supply chain don't discover new medicines. They don't manufacture them. They don't even physically dispense most prescriptions. Yet they rake in tens of billions of dollars each year by driving up costs for everyone else — especially patients battling cancer, HIV, heart disease, and autoimmune conditions. In their report, FTC investigators documented how the PBM industry — which is dominated by just three firms, CVS Caremark, Express Scripts, and OptumRx, that collectively oversee roughly 80% of all prescriptions dispensed nationwide — imposed eye-popping markups on generic drugs used to treat deadly diseases. The PBMs' affiliated pharmacies charged hundreds — even thousands — of percent more than they paid to acquire drugs like the cancer treatment Gleevec and multiple sclerosis medication Ampyra. This isn't just a case of corporations being greedy. It's the result of a rigged market structure. In theory, pharmacy benefit managers could play a valuable role by negotiating with drug manufacturers for lower prices. Since they haggle on behalf of health plans that collectively enroll hundreds of millions of Americans, these PBMs have considerable leverage, and should theoretically drive a hard bargain and win enormous discounts. And in fact, they do. The problem is that those savings rarely flow to patients at the pharmacy. Instead, PBMs have made the supply chain so convoluted that almost nobody on the outside — whether the patient filling the prescription, the pharmacist dispensing it, the doctor writing it, or even the employer sponsoring the health plan — can easily tell how much a drug will cost after discounts, rebates, and various fees and clawbacks are applied. This opacity isn't an accident. It's by design. The lack of transparency enables PBMs to overcharge patients and health plans. Congressional investigations have revealed numerous instances in which PBMs steered patients towards more expensive drugs — which come with bigger discounts and rebates for the PBM — "even when there are lower-cost and equally safe and effective competing options" available. Some of the largest PBMs have even created offshore shell corporations to help pocket negotiated rebates — instead of passing them off to patients. Patients don't even realize when they're being ripped off. PBMs almost never disclose the total discounts they negotiate on specific drugs. So patients' cost-sharing obligations are calculated based on a drug's unnegotiated, inflated "list price," rather than its true discounted price. As a result, patients spend billions more out-of-pocket than they otherwise would if the discounts were publicized. These inflated costs are a key reason that 21% of American adults have skipped filling a prescription in the past year due to affordability concerns, while 12% have skipped doses or cut pills in half. The FTC also found clear patterns of self-dealing, where PBMs steered the most profitable prescriptions to their own affiliated pharmacies while boxing out independent community pharmacies. Thousands of independent pharmacies have closed in recent years, leaving entire counties without a single brick-and-mortar store where patients can fill a prescription. Finally, PBMs use their consolidated power to keep drugs off of health plan formularies — unless manufacturers pay exorbitant fees. This is a policy failure. But it's also a political opportunity. Congress has previously considered two bipartisan bills that would rein in PBMs' worst abuses. If reintroduced and passed, one bill would eliminate the perverse incentive for PBMs to favor expensive drugs by delinking PBMs' compensation from list prices. Another would require that negotiated discounts be passed directly to patients at the pharmacy. And just last month, FTC Chair Andrew Ferguson reignited an FTC lawsuit against pharmacy benefit managers (PBMs) that accuses them of anticompetitive behavior. Democrats have a chance to lead — and win — on this issue. Taking on PBMs doesn't just lower drug costs. It shows voters that we're willing to fight the entrenched interests hurting their families and their finances. It shows that we're the party that puts patients ahead of profiteers. We don't need to wait for the next election. We just need the political will to act.
Medscape
4 days ago
- Business
- Medscape
Ending Water Fluoridation Could Lead to Millions of Caries
Removing fluoride from public water systems in the United States could have increased the prevalence of dental caries among children by 7.5 percentage points and added $9.8 billion in healthcare costs over 5 years, a modeling study projected. METHODOLOGY: Researchers developed a model to predict how ending water fluoridation — a change that has been advocated for by US Secretary of Health and Human Services Robert F. Kennedy, Jr — could affect children. The model relied on data from more than 8400 participants aged 0-19 years who took part in the United States National Health and Nutrition Examination Survey between 2013 and 2016, which included oral health examinations. Other inputs for the model, such as the effectiveness of water fluoridation on reducing tooth decay, were based on figures from peer-reviewed studies. The base-case scenario assumed complete removal of fluoride from all water systems compared against maintaining current levels of fluoridation. TAKEAWAY: Eliminating fluoridation was projected to increase the prevalence of dental caries by 7.5 percentage points (95% uncertainty interval [UI], 6.3-8.5) and lead to 25.4 million additional decayed teeth (95% UI, 23.3-27.6 million) over 5 years. Cases of fluorosis — discoloration of teeth due to excessive exposure to the mineral — would be expected to decrease by 200,000. The model projected increased healthcare costs of $9.8 billion (95% UI, $8.7-10.8 billion) over 5 years, 'mainly due to increased risk of tooth decay and associated complications,' the researchers reported. Children who are publicly insured or uninsured would be disproportionately affected by dental health problems following such a change, they found. IN PRACTICE: 'Despite concerns regarding toxic effects associated with high levels of fluoride, this model demonstrates the substantial ongoing benefits of water fluoridation at safe levels currently recommended by the US Environmental Protection Agency, the National Toxicology Program, and the Centers for Disease Control and Prevention,' the authors of the study reported. SOURCE: The study was conducted by Sung Eun Choi, PhD, of the Harvard School of Dental Medicine, and Lisa Simon, MD, DMD, of Brigham and Women's Hospital, in Boston. It was published online on May 30 in JAMA Health Forum . LIMITATIONS: The study did not model potential cognitive harms from fluoride exposure because strong direct evidence of a link at fluoride levels seen in public water is lacking, the authors stated. The cost-effectiveness analysis did not consider indirect outcomes of dental health problems such as missed work or school. The study focused on children and adolescents. DISCLOSURES: Simon has received personal fees from Boston Medical Center, Alosa Health, the American College of Legal Medicine, the American Dental Therapy Association, the California Dental Association, the Santa Fe Group, the Society of Teachers of Family Medicine, the American College of Dentists, the CareQuest Foundation for Oral Health, and the American Dental Association.
CBC
23-05-2025
- Health
- CBC
Health P.E.I. spending thousands of dollars a month on private employment agencies, contracts reveal
Social Sharing Health P.E.I. has hired six senior managers on an interim basis through private employment agencies at costs ranging from $17,490 a month to $43,750 a month. That information is contained in a series of contracts the province provided to CBC News. These managers are filling some of the most senior roles at the health agency, including chief medical officer, chief operating officer and chief financial officer. Melanie Fraser, Health P.E.I.'s CEO, says the private employment agencies provided experienced staff on a month-to-month basis to keep the health-care system running while she worked to develop a permanent leadership team. She says it was money well spent. "I think it's important to compare what we're paying them month over month versus what we would pay for a salaried professional," Fraser said in an interview with CBC News. "When you break that down on a month-over-month basis, it's basically the same amount that we're paying the interim person versus what we were paying the previous salaried person." But the numbers do show a significant increase in cost to use the private employment firms. For example, Health P.E.I. is paying a private firm for its interim chief medical officer. That contract, running from Jan. 6, 2025 to Jan. 5, 2026, is costing the health authority $43,750 a month or about $525,000 a year. That figure includes salary and benefits for the person as well as the firm's fee. Why Health P.E.I. is filling some of its most senior jobs with interim employees, and what it costs 7 minutes ago Duration 3:01 Health P.E.I. CEO Melanie Fraser says she had no choice but to bring people in to work in executive roles using private employment agencies. That's because the authority had to "to terminate or end the contracts" for a number of senior managers following a damning auditor general's report last October. CBC's Wayne Thibodeau explains what it's costing. Health P.E.I. provided CBC News with documents showing the yearly salary for the chief medical officer, if hired permanently through the health authority, would be about $394,000. Adding pension, CPP and EI costs brings the total to about $450,000. That means the interim contract costs about $75,000 more than if it had hired that chief medical officer directly. Follows string of depatures Fraser said Health P.E.I. had no choice but to bring people in through private employment agencies after a series of senior managers left following a damning provincial auditor general's report in October 2024. That audit showed eight top executives had been given new salaries or raises without proper approval. "We needed to terminate or end the contracts that were issued inappropriately," Fraser said of the departures. They left a huge leadership void at the organization, though. "Because they weren't approved positions, we cancelled those contracts and in the interim — because we didn't have positions to hire into — we sought the support of interim executives to help us keep our important health initiatives moving," said Fraser. Health P.E.I. is also paying accommodation and travel expenses for some of the senior managers, who are all working on the Island. The monthly accommodations costs range from $2,500 to $3,900. Costs for travel vary. Some managers are not expensing any travel costs, while others have submitted more than $11,000 to date in travel claims. Opposition calling details 'shocking' Green Party health critic Matt MacFarlane has been trying to get his hands on these health contracts for weeks. CBC News provided a copy of these contracts to both opposition parties so that they could comment on the details. "I was shocked and disappointed to see what is in these documents," said MacFarlane. "The minister of health has gone to some extent to say how offside the previous Health P.E.I. CEO, Dr. Michael Gardam, was with respect to overcompensating the executive leadership team of Health P.E.I. "Those overpayments were about $200,000 across the board to the six senior leadership positions. Now, we see from these contracts that the current Health P.E.I. CEO — signed off also by the minister — it's about a million dollars over what these positions would be classified to receive under the Public Service Commission-approved ranges." Liberal health critic Gord McNeilly also called the cost of these contracts "shocking." He said he'd like to see the auditor general take a look at them. "It means that a large portion of the money that should have gone towards [health] care is going to outside agencies across the country," said McNeilly. "I don't think that's right for any of the 37,000 people on the patient registry that don't have a family doctor." 3 private firms involved Health P.E.I. hired Odgers Berndtson to supply it with a series of senior managers. The company has offices in Toronto, Ottawa, Montreal, Calgary and Vancouver. The contracts, obtained by CBC News, show it hired: An interim chief financial officer to work between April 21, 2025, and Oct. 20, 2025, at a monthly cost of $29,500. That includes the salary of the individual plus additional costs from Odgers. If the candidate is offered a full-time job, Health P.E.I. has to pay Odgers what is described as a "conversion fee" of $45,000. An interim human resources executive whose initial contract was to run from July 8, 2024, to March 7, 2025. It was later extended to March 6, 2026. The initial rate was $24,000 a month. When the contract was renewed in February, that increased to $26,000 a month. An interim chief medical officer with a contract running from Jan. 6, 2025, to Jan. 5, 2026. Health P.E.I. is paying the private firm $43,750 a month. If it wants to offer that candidate the permanent job, it would have to pay a conversion fee of $60,000. Health P.E.I. also hired Halifax-based KBRS to supply it with an interim chief operating officer. That contract covered the dates March 31, 2025, to Sept. 30, 2025, at a cost of $30,500 a month. KBRS also supplied Health P.E.I. with an interim chief administrative officer, from May 12, 2025, to Nov. 7, 2025. That contract costs $23,180 a month. Royer Thompson Management Consulting, another Halifax-based employment agency, supplied Health P.E.I. with an interim chief communications officer. That contract runs from April 14, 2025, to Oct. 14, 2025, at a cost of $17,490 a month. "In most cases, you do pay a premium for having somebody that's available immediately, who is extremely experienced, usually senior, and does hit the ground running within two weeks' time," said Fraser. That's not the only Health P.E.I. contract under scrutiny. The agency hired KPMG last June to review six areas, including increasing system capacity, improving recruitment, and expansion of patient medical homes. Documents obtained by CBC News show Health P.E.I. paid KPMG just under $4-million. Other postings are still up Meanwhile, Health P.E.I. is still using private employment firms. A quick search of Odgers' website shows Health P.E.I. has postings up for a head of pediatrics, a head of medicine, and a medical director of mental health and additions. Fraser said these will be permanent hires, not interim ones. "We do use a variety of recruitment agencies," she said, adding that they use these firms for medical positions that are especially hard to recruit. 'Irregularities' under review Meanwhile, the province's financial watchdog is still looking into irregularities in Health P.E.I.'s payroll. Auditor General Darren Noonan confirmed to CBC News that his office is investigating what Fraser described as "additional payroll irregularities" that were detected "beyond those already flagged by the auditor general." Noonan said he can't comment because they're still in the "middle of the audit work" but added that his office hopes to report on the latest investigation in the fall. Health P.E.I. is now developing a new senior leadership team, with the proper approvals from Health P.E.I.'s board, Treasury Board and the Department of Health and Wellness. Those details will be released the week of May 26. That's at least two months behind schedule. Fraser had promised to have the new leadership structure in place on April 1.
Yahoo
22-05-2025
- Business
- Yahoo
UnitedHealth Group Incorporated (UNH) Faces Mounting Backlash Amid Billing Disputes, CEO Resignation, and Criminal Probe
UnitedHealth Group Incorporated (NYSE:UNH)'s UnitedHealthcare, the largest private health insurer in the U.S., is facing unprecedented public and regulatory scrutiny amid mounting patient frustration and industry turmoil. In 2023, San Diego benefits advocate Sue Cover spent six months battling a $1,000 billing dispute, highlighting the widespread challenges Americans face with insurance companies. UnitedHealthcare, which covers over 29 million Americans and controls 15% of the market, has become a focal point for criticism over denied claims, administrative hurdles, and rising healthcare costs. A healthcare professional wearing a health communications device discussing patient data with a colleague. The company's reputation has suffered from high claim denial rates, 33% for certain ACA plans in 2023, among the highest in the industry, and lawsuits alleging improper use of AI to deny care. UnitedHealth Group Incorporated (NYSE:UNH)'s influence extends beyond insurance, with ownership of pharmacy benefit manager Optum Rx and affiliations with about 90,000 doctors, raising concerns about conflicts of interest and profit-driven care. Recent setbacks include a $300 billion market cap loss, CEO Andrew Witty's resignation, a criminal probe into Medicare Advantage practices, and fallout from a major ransomware attack on its Change Healthcare subsidiary. Experts say UnitedHealth Group Incorporated (NYSE:UNH)'s woes are symptomatic of a broader, costly, and convoluted U.S. healthcare system where insurers' cost-cutting tactics can delay or deny critical patient care. While we acknowledge the potential of UNH to grow, our conviction lies in the belief that some AI stocks hold greater promise for delivering higher returns and have limited downside risk. If you are looking for an AI stock that is more promising than UNH and that has 100x upside potential, check out our report about this READ NEXT: and Disclosure: None.
The Sun
21-05-2025
- Business
- The Sun
Kate Garraway update on her stressful £800k debt battle and £288k tax bill after husband Derek's death
KATE Garraway has received a much-needed financial boost amid her desperate struggle to repay huge debts. The Good Morning Britain star was faced with the daunting prospect of paying back £800,000 following husband Derek's death from covid-related illness early last year. 4 The cost of caring for Derek during his four-year health nightmare ran into hundreds of thousands of pounds. At the same time, Derek's psychotherapy firm Astra Aspera Ltd - which was jointly controlled by Kate - went bust owing hundreds of thousands to creditors, including a huge sum to HMRC. A new liquidator's report reveals how Kate has been trying to repay debts as well as a more palatable revised total. HMRC has submitted a preferential claim of £288,054, a third of its previous submission of £716,822. It's not known why the HMRC have dramatically dropped their demand. There are also creditor claims of and £196,548 from four other firms including a £50,000 bank loan. However, at this stage, there will be no pay out for any creditor after liquidator fees of £32k and 40 per cent of assets have been realised. So far, Kate has paid back £21,000. Kate and Derek's financial issues go back further than the pandemic. In 2012, two other firms they jointly controlled went bust. Fulfill Media Ltd had debts totalling £922,807, which included £88,486 owed to HMRC, £90,882 to trade creditors, and £462,808 in "third party loans". 'He was on the up' say heartbroken viewers as they hear Kate Garraway's husband Derek speak weeks before his death At the same time, Countrymouse Media Ltd, was liquidated owing £189,121, which included £98,944 to the taxman and £48,000 on an overdrawn directors loan account. Derek and Kate were both personally owed £24k each by the business. Last year, it was reported that Kate may have to sell the home to repay the debts with one source saying: "It is so sad for Kate. Not only has she had to watch her beloved husband suffer for almost four years but her financial worries have never been far away from her thoughts. "It has cost hundreds of thousands of pounds to look after Derek and do everything she could to get him better but it's left her struggling. "The house is about all she has left financially and she is now facing up to the fact it might have to be sold. "It's where she and Derek were so happy and also where her two children grew up – but bills are bills and they have to be paid. It's dreadful for Kate." 4
