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POLICY/POLITICS/TECH: Jon Cohn plays Gotcha on Part D

John Cohn finds the December GAO report that says that CMS wasn’t ready for Part D’s launch, and also McClelland’s response that the GAO was underestimating CMS. Make that “mis-underestimating”, I think. 

Here’s what the GAO Report says would be some likely problems with Part D’s introduction for the dual eligibles:

For dual-eligible beneficiaries who do not have Medicare drug coverage because they were either not identified and enrolled on January 1, 2006 or are newly qualified dual-eligible beneficiaries, CMS has developed a point-of-sale enrollment mechanism designed to enable pharmacies to assist these beneficiaries in obtaining immediate Part D coverage. The agency signed a contract with a designated PDP on November 22, 2005 to implement this mechanism. Because these arrangements were completed less than 6 weeks before the transition is to occur, limited time remains to educate all pharmacies about its availability and details of its operation.

For beneficiaries who were enrolled in a PDP but do not have their PDP information, CMS has facilitated a new information-technology process, known as the Eligibility Transaction, that will allow pharmacies to identify a beneficiary’s PDP and provide the beneficiary with the PDP’s contact information. As with the point-of-sale enrollment mechanism, it is unclear to what extent pharmacies are informed about the Eligibility Transaction and will use it. Despite CMS efforts to publicize this tool to industry organizations, a pharmacy industry association representative stated that it is unclear how many independent drug stores, which dispense the majority of the nation’s retail prescription drugs, plan to use the Eligibility Transaction.

Translation: a) Pharmacies are supposed to be able to immediately register dual-eligibles if they’re not already in a PDP but that was only developed in November and wouldn’t be ready. b) GAO was unsure how many pharmacies would use the eligibility transaction system.

GAO didn’t seem to predict what apparently is the major problem — the data on eligibility from the PDP’s that the transaction database is hitting against is wrong or it’s just not working.

We will find out more, but they had two years to get this right! And it seems to be getting worse!

BLOGS: Why are you not sheep?

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So it sit here every day slaving away just to give you a little information and entertainment, and I ask you for one eeny-teeny thing….to go and vote for brave patient and young punkette Kate Steadman’s Healthy Policy blog in the medical blog awards, and she only got a miserable 27 votes. Yet the winner, the Bio-Ethics Blog only got 178 and Hospital Impact which ran an aggressive campaign got 170. Now if you look at Hospital Impact’s Site Meter  you’ll see that they get just over a hundred visitors a day, similar to Kate’s. THCB (by virtue of age and infirmity) gets about 5 times that. Yet basically everyone who visited Tony’s Hospital Impact site did what he asked and went and voted for him, and basically no one who reads TCHB gave a monkey’s about my request!

People, I am not feeling the love!

CODA: A poll for blogs with such a low turnout is of course a ridiculous way to pick the best blog. It would be the equivalent in the real world as if we picked the President of the most powerful nation on earth by having a straw poll amongst a few extremists in a couple of tiny rural states that share almost no issues with the vast majority of urban and suburbanite Americans who live near one of the three coasts, or anyone else for that matter. And while you might expect the quality of the results to be pretty similar, the blog winners were actually pretty good. No comment on the Iowa/New Hampshire/South Carolina primaries.

POLICY/POLITICS/QUALITY: Supreme Court upholds Oregon physicians and patients rights

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Some slightly good news in the DEA and DOJ’s continued campaign to get into the practice of medicine in the guise of preventing “drug trafficking”, or more accurately imposing the extreme morals of the religious right on the rest of us.

The Supreme Court upheld Oregon’s one-of-a-kind physician-assisted suicide law Tuesday upheld Oregon’s one-of-a-kind physician-assisted suicide law Tuesday, rejecting a Bush administration attempt to punish doctors who help terminally ill patients die. Justices, on a 6-3 vote, said that federal authority to regulate doctors does not override the 1997 Oregon law used to end the lives of more than 200 seriously ill people. New Chief Justice John Roberts backed the Bush administration, dissenting for the first time.

Of course the dissenters were Scalia and Thomas, both unreconstituted theocratic & social fascists conservatives. They were predictably joined by new Chief Justice Roberts. It’s no secret that Alito would have voted with them had he been confirmed. And this is for something the voters of Oregon have passed twice by large majorities. In other words the will of the voters is irrelevant in cases where social conservatives want to restrict freedom, including the freedom of physicians to practice in the way they like. And after Alito is confirmed, this will happen more and more…watch out Roe vs Wade.

PHARMA: Whistleblowing and more ways to make a buck in big Pharma, by The Industry Veteran

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The Industry Veteran some time ago decided that the only decent career path left in pharma was that of whistleblower. He has more evidence to back his case. Here’s the Veteran’s restrained take on the matter.

Here’s another piece of evidence to support my argument that whistleblowing represents the most promising career path for a young person starting out in the biomedical industry. Biotechs such as Genentech, Amgen and the other large ones are an especially fertile venue. The avaricious ambitions of senior executives and their accompanying desire to mimic the Big Pharma operations tend to alienate both the scientists and the commercial people who were originally attracted to the biotech side of the drug discovery business. These increasingly disgruntled coworkers can provide excellent leads into illegal practices that the enterprising whistleblower can use to his/her advantage.

 

The current Genentech whistleblower held the job of medical science liaison or MSL. The medical science liaison position (also called health science associate, clinical liaison and other terms by various companies) remains especially advantageous for launching a whistleblowing career. The MSLs and their otherwise designated counterparts are hybrids who combine a sales function with that of clinical trials missionaries. Their putative function consists of discussing clinical trials with curious and knowledgeable practitioners. This gives them considerably more leeway in their interaction with physicians than that given to sales reps who are restricted to discussing information appearing on the current labels of existing products. In an effort to foster the appearance that MSLs serve a scientific and educational function, their departments report up to the medical affairs operations of the respective companies, rather than to sales. As part of the same illusory effort MSLs are relieved of responsibilities for delivering samples. Nor are they evaluated by measurements used to calculate bonuses for sales reps, such as market shares or sales volumes within their assigned territories. As a result the MSL people are held in high contempt by the great majority of their sales rep colleagues.

 

An acquaintance at Abbott Laboratories recently told me about some of his work as an MSL. He plies his trade on behalf of the company’s rheumatoid arthritis product, Humira. In this capacity he recruits influential and high prescribing rheumatologists to conduct redundant clinical trials (see  the article from 2 January Washington Post on “superfluous medical studies”). His effort serves several purposes. In the first place, the trials provide an acceptable cover for paying high volume prescribers to use the Abbott product. Marketers call this practice “buying market share,” the rest of us term it bribery. Secondly, by using influential and high prescribing practitioners to run these humdrum trials, the payoffs also exert a trickle down effect. Smaller fry, garden variety physicians develop their product preferences partly by following the usage patterns of acclaimed authorities in their geographic areas. Information about influential colleagues in the neighborhood who are conducting trials for a particular product, typically spread by the sponsor’s sales reps, sends a clear message to the vast number of follower physicians. Both the payoff and the trickle down functions are then enhanced when the sponsoring company hires the investigator-physician to speak to the small fry at dinner meetings and symposia.

 

Approximately a year and a half ago, my acquaintance was attending a rah-rah session at Abbott headquarters with his associates. The director of MSLs started out by voicing an obstreperous defense of the operation under his leadership and its contribution to Humira sales. “Don’t let anyone tell you,” the director exhorted his underlings, “that we don’t contribute to the top line.” As he advanced to the next PowerPoint slide, he emphasized the fact that MSLs had accounted for $78 million of added Humira sales during the recently ended quarter. Before anyone in the audience could inquire about the particular ass from which the director pulled that number, the company’s CEO, Miles White, jumped to the center of the presentation dais and used his body to block out the slide. In an enraged tone White pointed his finger at the startled MSLs and told them to forget they had ever seen such a slide or heard their director’s last comment. It seems White was immediately aware that his director’s effort to justify the continuing existence of an MSL department tore down the fictive Chinese wall by which the Pharma companies seek to separate their educational and scientific communications from crass selling.

 

In such an environment, I plaintively ask, is not whistleblowing the most noble calling?

BLOGS: MLK day

It’s a holiday, or it ought to be.  I met someone in community relations for Chevron last night. She had to go to work today, but apparently Chevron doesn’t mind if African-American employees take the day off.

So stop reading and come back tomorrow.

POLICY: Of course, you know, this means war!

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The Maryland legislature enacts a Wal-Mart specific pay-or-play bill. It says that any company with more than 10,000 employees which doesn’t spend 8% of payroll on health care benefits needs to pay into a state fund. What’s not to like about this bill? It allows attacks on the big discount retailers and the fast-food chain while leaving small and medium businesses out of the legislation.

Of course, it doesn’t really help much in terms of reducing the number of the uninsured…..but I can hear Bugs Bunny even now.

OFF-TOPIC: How much more ridiculous could US Skiing get?

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The winter Olympic is coming up, and you may not know it but the US has a seriously talented, and seriously wacky, skiing star. His name is Bode Miller, and he is a free-spirit, lives in a motor home, skis in an unconventional style, and is the best all round skier in the world — the current World champion — with a serious shot at 5 medals. He also crashes alot.

So he goes on 60 Minutes. You’d think that the skiing powers that be would be delighted that their marginal sport gets publicity of that type. And on 60 Minutes in a light hearted interview, Miller — who might have been in good company in the Oakland Raiders of the Kenny Stabler era — jokes about how hard it is to race the slalom when he’s hung over.

Does he think his partying has ever interfered with his performance? “Definitely. There’s been times when I’ve been in really tough shape at the top of the course,” says Miller. “Talk about a hard challenge right there. I mean, if you ever tried to ski when you’re wasted, it’s not easy. Try and ski a slalom when the gates are,” Miller says, making a hand motion. “You hit a gate less than every one a second, so it’s risky, you know. You’re putting your life at risk there. It’s like driving drunk only there’s no rules about it in ski racing.” Is he saying he’ll never do it again? “No. I’m not saying that,” Miller says.

There are only two alternatives to this. Either the guy is joking or he is so damn amazing at what he does that he can do it hungover. Now I know there was a lot of BS talked about how the Raiders partied all night and won the next day, or how Babe Ruth hit home runs hungover, but I suspect that’s overblown — this guy skis way faster than most of us can drive. But you’d think this would all be great hype? After all aren’t we a little sick of the sports star coming off the field and thanking God for being on his side (and not that of his opponent presumably).

But oh no! Apparently his sponsors are appalled, US Skiing wanted to kick him off the team and he was basically forced into making an official apology

Bode Miller, in a rare gesture of conformity, bowed to pressure from international and United States ski officials and apologized yesterday for his comments that suggested he had skied under the influence of alcohol. In his statement, Miller neither admitted nor denied that he raced while drinking.

Exactly what do US Skiing and its sponsors fear? A boycott of apres-ski parties by Focus on the Family? Just more confirmation that this country’s corporate and political establishment has totally lost its sense of humor.

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