Sunday, August 25, 2013


T. Mark Jones learned about the costs and benefits of health-care delivery when he treated AIDS patients in Key West, Florida, in the late 1980s. The pharmacy he co-founded — unusual at the time — provided a humane last step for gay men who didn’t want to spend their final weeks confined to a hospital.

ones, a registered nurse, went into homes to dispenseinfusion-therapy drugs and teach patients to care for themselves.

“I was worn out,” he says. “But I loved it.”

His dream job began to unravel in 1991, when a national health-care chain came to Key West to open an AIDS clinic. It secured the support of local doctors by offering them padded insurance reimbursements, Jones says, Bloomberg Markets magazine will report in its September issue.

1 comment:

Kenneth Woliner, MD said...

AWP (Average Wholesale Price) - has NOTHING to do with the actual wholesale price charged to pharmacies or physicians. But, since insurance companies, including Medicare Part D and TriCare pay as a percentage of AWO, drug manufacturers (including manufacturers of Active Pharmaceutical Ingredients (API's) that are used in compounded topical pain creams), have every incentive to raise the "listed AWP" by 10,000% over the
actual wholesale price they charge. So, the drugs that are used are nit the best ones for te patient, but instead, are the ones that have "the biggest spread between actual coat and the listed AWP (and reimbursement by insurance companies).

This is why sales reps for compounding manufacturers such as AccessRx can make between $50,000 and $500,000 per year. This is why there is an incentive for rogue pharmacies to offer kickbacks and split-fee relationships with physicians (and veterinarians) to use their pharmacy. When the raw materials (API's) cost less than $100, but a compounding pharmacy can bill insurance companies $2,800, you see how the world is topsy-turvy.

What is more shocking is that the bureaucrats who work in State Departments of Health Bureau of Enforcement units RARELY, IF EVER, investigate or prosecute these frauds and kickback schemes. The State Boards of Pharmacy would probably be livid if a case like this came before them, but try never do because it is so much easier to close a case as "unfounded" (whitewashing the whole affair) than to actually do the work to prosecute rogue pharmacies.

Kenneth Woliner, MD