<story><title>The Mafia of Pharma Pricing</title><url>https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing</url></story><parent_chain><item><author>Aurornis</author><text>You can actually look up payments from certain companies to doctors now: &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;openpaymentsdata.cms.gov&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;openpaymentsdata.cms.gov&amp;#x2F;&lt;/a&gt;&lt;p&gt;I’ve checked several doctors that I’ve visited over the years. None of them show up, with one exception: The doctor who immediately set off my scam alarms when she tried really, really hard to get me diagnosed with sleep apnea, despite not one but two very clearly negative sleep studies.&lt;p&gt;I could never understand why she was pushing so hard, until I looked her up in this system. She takes an incredible amount of money from drug companies and device manufacturers.&lt;p&gt;I don’t know if a scheme like you described would even be allowed today. If it is, the bigger medical systems are actually quite strict with doctors taking anything resembling a payment like this, from what my friends in the industry tell me.</text></item><item><author>jimt1234</author><text>I worked at a PBM back in the late-90s&amp;#x2F;early-2000s. It was where I was introduced to the value of customer data and the strange world of lawyers, all in a single corporate meeting:&lt;p&gt;- The company is launching a new service. We already sell customer drug-prescription data to drug companies, and the drug companies analyze this data to understand where&amp;#x2F;when&amp;#x2F;why&amp;#x2F;to-whom their drugs are being prescribed. Now we&amp;#x27;re going to help the drug companies advise doctors on where&amp;#x2F;when&amp;#x2F;why&amp;#x2F;to-whom they prescribe drugs.&lt;p&gt;- Sounds great. Where do we come in?&lt;p&gt;- The new service will act as a middleman, processing payments from drug companies to doctors.&lt;p&gt;- So, a service to manage kickbacks?&lt;p&gt;[Meeting room full of suits goes silent.]&lt;p&gt;- The payments aren&amp;#x27;t &amp;quot;kickbacks&amp;quot;. They&amp;#x27;re &amp;quot;rebates&amp;quot;.&lt;p&gt;- Is there a difference?&lt;p&gt;- Absolutely. [silence]&lt;p&gt;- So...what&amp;#x27;s the difference?&lt;p&gt;- Please be sure to only use the term &amp;quot;rebate&amp;quot; in all communications, especially email. Never use the term &amp;quot;kickback&amp;quot;.&lt;p&gt;And that was pretty much it. The company processed prescriptions for pharmacies, then sold that data to drug companies, who in turn used that data to provide kickbacks to doctors for pushing their drugs over a competitor. And it was all legal, thanks to the lawyers and their select word usage. Oh, and I think we weren&amp;#x27;t supposed to use the term &amp;quot;middleman&amp;quot;, either.</text></item></parent_chain><comment><author>NickC25</author><text>I broke part of my hand last October after slipping and falling.&lt;p&gt;At the request of my new insurer, I went to my local urgent care.  The rep for my insurer swore up and down that they had an X-ray machine and could diagnose my problem quickly, as well as immediately after refer me to a local hand specialist at the local University&amp;#x27;s hospital.  After my experience, I realized that nothing the rep said was true.&lt;p&gt;The nurse practitioner at the urgent care facility said nothing was wrong with my hand (despite it being black &amp;amp; blue, and having all the hallmarks of a broken hand).  He refused to refer me to a specialist or for an X-ray unless I took an HIV&amp;#x2F;AIDS test.  He started asking me several questions about my sexuality and relationship status - I am not sexually active (sadly) nor am I in the demographic with a higher likelihood of coming into contact with the HIV virus, so I told him as much and declined the test.  &lt;i&gt;I was there because I broke my fucking hand.&lt;/i&gt;  He kept insisting that I needed to take the tests.  I walked out of the facility pissed off and without any progress on my hand.  Several hours wasted.  The guy&amp;#x27;s assistant called me the next day pleading me to come in for tests, and I reiterated that all I wanted was to get an X-ray like I was promised by my insurer, and to see someone who knew what they were talking about.*&lt;p&gt;If your tire pops, your mechanic shouldn&amp;#x27;t say &amp;quot;nothing wrong with your tires, it&amp;#x27;s your exhaust you need to worry about&amp;quot; while he&amp;#x27;s wearing a shirt with an exhaust maker&amp;#x27;s logo on it.&lt;p&gt;I clicked on the link you posted.  I entered the nurse practitioner&amp;#x27;s name, and surprise surprise, he&amp;#x27;s gotten over $3k in the last year from ViiV Healthcare, a company specializing in the research and development of HIV&amp;#x2F;AIDS testing equipment and drug development.  Not an exorbitant amount of money at all, but the dude is ethically compromised.&lt;p&gt;That needs to be straight up illegal with serious repercussions - for both those who offer the kickback, and those who accept it.&lt;p&gt;*FWIW, I spoke with a physical therapist not too long later, a guy who specializes in sports injuries (particularly from  basketball as he&amp;#x27;s a former pro hooper himself), and within about 10 seconds of examining the area of injury said &amp;quot;yeah, you broke your hand.  I see this frequently.  Do this every day with your hand, and come see me in 2 months if nothing works&amp;quot;.</text></comment>
<story><title>The Mafia of Pharma Pricing</title><url>https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing</url></story><parent_chain><item><author>Aurornis</author><text>You can actually look up payments from certain companies to doctors now: &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;openpaymentsdata.cms.gov&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;openpaymentsdata.cms.gov&amp;#x2F;&lt;/a&gt;&lt;p&gt;I’ve checked several doctors that I’ve visited over the years. None of them show up, with one exception: The doctor who immediately set off my scam alarms when she tried really, really hard to get me diagnosed with sleep apnea, despite not one but two very clearly negative sleep studies.&lt;p&gt;I could never understand why she was pushing so hard, until I looked her up in this system. She takes an incredible amount of money from drug companies and device manufacturers.&lt;p&gt;I don’t know if a scheme like you described would even be allowed today. If it is, the bigger medical systems are actually quite strict with doctors taking anything resembling a payment like this, from what my friends in the industry tell me.</text></item><item><author>jimt1234</author><text>I worked at a PBM back in the late-90s&amp;#x2F;early-2000s. It was where I was introduced to the value of customer data and the strange world of lawyers, all in a single corporate meeting:&lt;p&gt;- The company is launching a new service. We already sell customer drug-prescription data to drug companies, and the drug companies analyze this data to understand where&amp;#x2F;when&amp;#x2F;why&amp;#x2F;to-whom their drugs are being prescribed. Now we&amp;#x27;re going to help the drug companies advise doctors on where&amp;#x2F;when&amp;#x2F;why&amp;#x2F;to-whom they prescribe drugs.&lt;p&gt;- Sounds great. Where do we come in?&lt;p&gt;- The new service will act as a middleman, processing payments from drug companies to doctors.&lt;p&gt;- So, a service to manage kickbacks?&lt;p&gt;[Meeting room full of suits goes silent.]&lt;p&gt;- The payments aren&amp;#x27;t &amp;quot;kickbacks&amp;quot;. They&amp;#x27;re &amp;quot;rebates&amp;quot;.&lt;p&gt;- Is there a difference?&lt;p&gt;- Absolutely. [silence]&lt;p&gt;- So...what&amp;#x27;s the difference?&lt;p&gt;- Please be sure to only use the term &amp;quot;rebate&amp;quot; in all communications, especially email. Never use the term &amp;quot;kickback&amp;quot;.&lt;p&gt;And that was pretty much it. The company processed prescriptions for pharmacies, then sold that data to drug companies, who in turn used that data to provide kickbacks to doctors for pushing their drugs over a competitor. And it was all legal, thanks to the lawyers and their select word usage. Oh, and I think we weren&amp;#x27;t supposed to use the term &amp;quot;middleman&amp;quot;, either.</text></item></parent_chain><comment><author>bboygravity</author><text>Genuine question: what pharmaceutical could your doctor have benefitted from to help against sleep apnea?&lt;p&gt;As far as I know there&amp;#x27;s no meds for it? Only surgery, CPAP devices, mandibular advancement devices, etc.&lt;p&gt;Would she get kickbacks from those medical device companies as well?</text></comment>