You know they are going to use these flawed medication adherence scores to determine who gets what with medications.  This is horrifically flawed.  Regulation won’t work and CMS should work towards getting lower drug prices instead of this model that comes back to pound consumers again.  That is the problem and this model will fail and people will not always get the drugs they need.  If you have not read it, take a look at the garbage pharmacy benefit managers are popping out there to score you.  Yes this is a secret score using 300 secret metrics that you can’t have or see, but it gets sold to guess who, drug companies and insurance companies.  Are you a male, you get a ding, do you have kids in the home to distract you from taking meds, you get another ding and so on. 

Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy

You can’t make this stuff up as Express Scripts even brags about their “scoring” metrics.  We have excess scoring in the US that produces way too much flawed data.  It’ gets better, they can take the flawed medication score of your partner and ding you for that, with being around a person they have determined is not medication compliant with this junk science.  It is junk and all of this scoring and record keeping with this data makes your drugs more expensive as it’s not free to run this stuff.  When we talk layers of “crap data” that could be removed to save money, this is one of them.  These are crap predictions and not actual monitoring records to see when you pick up your prescriptions either.  That is monitoring but Medication Prediction Adherence scoring is crap as if they don’t have enough data, guess what, you default to non-compliance.

Now CMS of course more than likely will lean on this junk science to play God and determine who gets what meds in order to save money.  We all know our doctors are pretty good about telling us about less expensive generics so we can afford them so again this is a layer of junk science that CMS will lean on to save money, and patients may not get the medications they need.  There are times when the generic won’t work or has not worked and if you have some big fake target that says your score shows you are not “predicted” to be compliant, they may not give you the meds.  People with Medicare Part D are already feeling this and I had a conversation with a pharmacist that told me exactly how this works from their end.  All those folks scored non compliant require the pharmacists to contact them, ask they why they are not taking their meds and you know what 90% of them say?  They are taking their meds and pay cash and buy them at Wal-Mart or other places cheaper than the big chain drug stores…cash…and the pharmacists are told by the software they use, these folks are Outliers!  Nice huh?

Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…

CMS is drinking the Kool-Aid here as if you go to the first link here, look at the big page where Express Scripts says curing non-adherence would provide drugs for many others..what a crock of numbers nobody can predict.  FICO does this crap too with their medication adherence prediction scoring that’s a secret and states all they need is your name and address and they can give you a score and predict how compliant you will be.  This is nothing more than another score for them to sell and make money.  Drug companies love this stuff as it helps them maintain high drug prices by pushing more blame to consumers all the time. 

FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited

Where did all this predictive medication adherence scoring get started?  Look no further than Ingenix, now called Optum Insights as back in 2010 we had this announcement that Express was going to use their algorithms to score you.  By the way, the current head of Medicare is Andy Slavitt, former CEO of Ingenix who’s the brain child of this scoring and is a former Goldman Sachs banker who was sued all over the place for their algorithms that ripped off doctors on out of network pay.  Currently in many areas, United pays doctors around 12% less than Medicare rates.  Initially Ingenix profiling was used to underwrite but it has graduated to adherence prediction profiles as that allows for a lot more data to be sold.   All the PBMS do this now. 

Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On Ingenix Algorithms–We Want the Revenue Please Don’t Stop

So here we go again, CMS drinking that United Healthcare flavored Kool-Aid with Medicare D with reducing the cost of drugs, not with better negotiating with pharma companies, but rather by taking it out of the patient’s hide once more.  What a chicken way to do business is it not?  You know they will be dragging this junk science prediction adherence scoring in there to make decisions as PBMs with regular insurance are already doing such, consumers get hurt so big corporations can continue to get rich.  Drive them crazy, pay cash for all your prescriptions.  This model will fail as the pilots will be denying access to drugs for those in the programs, while MDs get a whopping big $2.00 per month to subscribe to these methodologies and save a consumer $2.00.  This will require more time and effort than the results will show with any ROI and doctors are already buried in too much administrative mumbo jumbo.  So how many Quants did it take to design this model and from where?   BD 

The Centers for Medicare and Medicaid's new Part D pilot for medication therapy management will offer performance payments to plans that achieve reductions in fee-for-service expenditures and fulfill quality and other data reporting requirements, according to information released by CMS on Wednesday.

Insurance plans that demonstrate reductions in Medicare Part A and B costs of care for their members by a minimum of 2 percent will receive a fixed $2 per member per month increase in the subsidy to the plan premium, which will decrease the beneficiary's portion of the premium, CMS said.

The program is aimed at reducing medication related issues in patients as current medication therapy management has not produced the expected results, according to Minter.

The question CMS is trying to answer is, he said: Does providing regulatory flexibility and financial incentives to stand alone Part D plans encourage more effective medication therapy management programs?


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