Louisiana Voice

You wouldn’t ordinarily expect to see the names of two prominent former congressmen bob to the surface when discussing a health care benefit program for state workers in Louisiana.

But when Office of Group Benefits (OGB) switched to MedImpact, a San Diego company, to provide its prescription drug benefit management services on Jan. 1, the state awarded an 18-month, $350 million contract to a company tied to the 2007 Republican presidential nomination quest of former U.S. House Speaker Newt Gingrich. http://hl-isy.com/Products-and-Services/Pharmacy-Benefit-Evaluator/PBE-Abstracts/2012/MedImpact

And those who listened to testimony last week before the Louisiana House Appropriations Committee learned that the company has proved to be less than satisfactory in handling claims for pharmaceutical benefits.

Gingrich launched the Center for Health Transformation as part of an ambitious consulting and communications conglomerate to let consumers, not health maintenance organizations (HMOs), choose their doctors, medical treatments and hospitals.

While the concept might be a good one on the surface, Gingrich failed to reveal that his idea would greatly benefit drug manufacturers, health insurers and other health care professionals who paid up to $200,000 annually to participate in the center’s operations.

MedImpact was one of those companies who ponied up the big bucks for that privilege.

Sid Wolfe, director of health research for the watchdog group Public Citizen, called Gingrich’s taking money from organizations like MedImpact and then using the weight of his name to advance the interests of those organizations “a massive financial conflict of interest.”

And when Gingrich again flirted with seeking the GOP presidential nomination in 2012, one of the men he chose to co-chair his Florida chairman was Alan Levine, former Secretary of Louisiana Department of Health and Hospitals under Gov. Bobby Jindal (R-Iowa, R-New Hampshire, R-Anywhere but Louisiana) and former Secretary of Health Care Administration for former Florida Gov. Jeb Bush.

Even former Congressman Billy Tauzin of Louisiana has entered the picture as co-chair of Medicine Access and Compliance Coalition (MACC), an assortment of health care providers who advocate lower drug prices through the federal 340B Program. http://www.huffingtonpost.com/2013/08/13/billy-tauzin-drugs_n_3719468.html

Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in the Medicaid drug rebate program to provide outpatient drugs at discounted prices to taxpayer-supported health care facilities that provide care for uninsured and low-income people. http://www.aha.org/content/13/fs-340b.pdf

The program allows eligible hospitals and community health centers to reduce pharmaceutical costs to patients.

That would seem to be a radical departure from Tauzin’s previous position as head of the Pharmaceutical Research and Manufacturers of America (PhRMA).

You may remember how in one of his last official acts as Congressman from Louisiana’s 3^rd District Tauzin of Chackbay in Lafourche Parish, pushed through that 2003 bill that prohibited the federal government from negotiating pharmaceutical costs for Medicare patients. http://www.nola.com/politics/index.ssf/2013/08/ex_rep_billy_tauzin_smack_in_t.html

Right after that legislative coup, the Democrat-turned-Republican went to work for PhRMA, eventually earning an eye-popping $11.6 million per year. http://www.bloomberg.com/news/2011-11-29/tauzin-s-11-6-million-made-him-highest-paid-health-law-lobbyist.html

No sooner had MedImpact came forward with its presentation on ways in which hospitals may be missing out on opportunities to profit from 340B. In that presentation, MedImpact promised hospitals that it could work “with any wholesaler, pharmacy or claims processing service,” providing hospitals “with the lowest prices, maximum flexibility and revenue.”

Then, last December, OGB sent a letter to its members informing them that MedImpact would begin providing pharmacy benefit management (PBM) on Jan. 1. CCF10032014_0001

Medicare-eligible retirees and their Medicare-eligible dependents would be covered by MedGenerations, a subsidiary of MedImpact, supposedly under that same $350 million contract given that there was no separate contract listed for MedGenerations.

Horror stories about MedImpact and MedGenerations began emerging almost immediately.

A Nightmare called Bobbycare: prelude to healthcare ruin (alternate headline: the time has come to privatize Jindal)

Henry Reed, a retired State Fire Marshal’s office employee, testified before the House Appropriations Committee on Sept. 25 that he fought FEMA for hurricane recovery money on behalf of the state but has experienced nothing but frustration with the state’s pharmaceutical management service. A victim of both epilepsy and narcolepsy, Reed said he has to take one medication that costs $2,000 per one-month supply.

His doctor prescribed two pills per day of that medication but “Medimpact informed me they would pay for only one pill per day. Apparently someone sitting at a desk in California knows more about my condition than my doctor.

“I thought I had a good health plan,” Reed said. “I called OGB and they referred me to Medimpact.”

The company simply refused to even approve prescription medications for the son of OGB member Dayne Sherman until he was forced to jump through all types of bureaucratic hoops to get the prescription approved.

So, what is the motivation for Medimpact to arbitrarily cut medications in half or to refuse them outright? Does it get to keep that part of the $350 million that isn’t spent on medications? Does it receive some other incentive to deny or reduce claims? Has it taken lessons from the McKinsey Group, which taught Allstate and State Farm how to delay, deny and defend claims stemming from Hurricane Katrina?

And for that matter, what do MedImpact’s employees think of their employer?

A sampling of postings on a web page that lets employees rate their employers anonymously is not kind to the company:

• “They can pay you well and give good benefits in exchange for your soul.”
• “No one is encouraged to think about what they are doing and try to make it better. The leadership team is completely disconnected.”
• “Great people to work with; lousy leadership.”
• “Strange, secretive leadership. A lack of clarity, vision and generally poor downward communication.”
• “Lack direction, unorganized and management sucks.”
• “Upper management tends to chase bright shiny objects. Burnout is high.”

You can read more here: http://www.glassdoor.com/Reviews/MedImpact-Reviews-E40035.htm