Author: Peter

A mother and her daughter have been indicted on health care fraud charges after they allegedly received millions in false Medicare claims...Mirosis Gonzalez...and her daughter Berioska Sosa...used the pharmacy they owned and operated, Aviva Care Pharmacy, to submit over $12 million in false Medicare claims...received payments totaling about $8.4 million...The marketing and telemedicine companies recruited patients and referred Medicare beneficiaries and doctors’ orders and prescriptions to Aviva Care Pharmacy and were paid kickbacks and bribes in return...the companies sent Aviva orders, which the pharmacy accepted...“without considering medical necessity or Medicare reimbursement eligibility.”...They are accused of disguising the kickbacks and bribes they paid to these companies by saying the payments were for marketing and other services...READ MORE</strong>

In another opioid-related settlement for Johnson & Johnson, the company has agreed to pay tens of millions of dollars to settle litigation in New Hampshire...The state sued the company back in 2018, alleging that J&J's subsidiaries “aggressively marketed” opioid painkillers and falsely hawked them as safer than alternatives. Now, just before a trial was set to begin next week, J&J agreed to pay the state $40.5 million...READ MORE

Pfizer recently launched a "Breakthrough Fellowship Program," which includes a scholarship for a graduate degree and guaranteed employment, for students and "early career colleagues of Black/African American, Latino/Hispanic and Native American descent," a requirement that could run afoul of federal law...READ MORE

Here’s a summer surprise for fans of the 340B Drug Pricing Program: Drug Channels has just obtained the 2021 figures from the Health Resources and Services Administration...for 2021, discounted purchases under the 340B program reached a record $43.9 billion—an astonishing $5.9 billion (+15.6%) higher than its 2020 counterpart. Hospitals accounted for 87% of these skyrocketing 340B purchases...What’s more, the difference between list prices and discounted 340B purchases also grew, to $49.7 billion (+$7.0 billion). This figure approximates the money collected by 340B covered entities...340B advocates have been screaming that “drug companies are cutting 340B,” but the data tell a very different story. Only in the U.S. healthcare system can billions more in payments and spreads be considered a cut...READ MORE

The Alabama Attorney General’s office is investigating the Alabama Pharmacy Board after it revoked the license of a north Alabama pharmacist for working without permission after a felony conviction...Attorney General Steve Marshall’s office dismissed the board’s case against pharmacist Billy Flint East, whose license was taken in March...“Credible allegations have been made about the handling of this matter by employees of the State Board of Pharmacy, which are now under investigation by the Attorney General’s Office,” said the state order...Marshall’s office similarly dismissed the board’s case against East’s current employer, Brooklere Pharmacy, after the Pharmacy Board alleged it did not seek legal approval for East to practice after his conviction...READ MORE

Despite fentanyl being among the leading causes of overdose deaths, few patients are screened for the substance in emergency rooms, a new study finds...The group looked to see how often toxicology screenings, which can inform treatment and public health data, were performed and what substances are tested for. Routine toxicology screens typically test for cocaine, amphetamines, marijuana, phencyclidine and natural opiates like heroin or morphine. Synthetic opioids like fentanyl require a separate test...Three-quarters of all drug overdose deaths in 2020 involved opioids, and the vast majority of those were synthetic...despite a slight rise in fentanyl testing over the years, only 5% of visits are currently tested—the highest testing rate since 2017. Of those screened, more than 40% are positive...READ MORE

When I served as a White House health advisor, I invited a group of large employers to describe the challenges company health plans faced. The top complaint? An obscure type of middleman that’s part of every health plan -- the Pharmacy Benefit Manager. The PBM industry, with only three giant companies controlling almost 80 percent of the market, offers a seemingly simple value proposition: if you’re an employer or an insurance carrier serving individuals or businesses, hire the PBM to help you get volume discounts on prescription drug makers...Sounds great! But, what if these middlemen pocketed much of the savings instead of passing them on to employers?...READ MORE

A local pharmacy will have another chance to earn approval to sell cannabis to adults on its premises, despite the pharmacy’s proximity to a school, when the Las Cruces City Council takes on the issue at an upcoming meeting...At its Sept. 6 meeting, the council will hear an appeal from Mesilla Valley Pharmacy regarding the city Planning and Zoning Commission’s decision in April to deny the pharmacy's request to sell cannabis products. The council could vote on Tuesday to reverse that decision...READ MORE

Bayer AG agreed to pay $40 million to resolve US lawsuits linked to allegations that company officials bribed hospitals and physicians to use its drugs...The settlement stems from two “whistle-blower” suits filed by ex-marketing employee Laurie Simpson almost two decades ago and subsequent litigation by the US government, the US Justice Department said...in a statement. Simpson will receive about $11 million from the settlement, the department said...READ MORE

The legislation has drawn the ire of drugmakers and industry groups alike, who contend the price negotiations are more akin to price controls. Another common refrain centers around the law’s potential to stifle biopharma innovation...But the reality may not be so bad for the industry, with the true influence of the law on biopharma companies being marginal...the legislation is set to empower Medicare to set prices for 10 medicines in 2026, with that number increasing to 60 by 2029. In 2026 and 2027, Medicare will only oversee Part D drug prices...While the bill addresses some 64 million Americans enrolled in Medicare, it fails to account for the more than 150 million Americans and their families engaged with the private insurance market...READ MORE