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Pharmacist Nasir Mahmood, Pine Plains Pharmacy, is advocating for independent community pharmacies to allow them to continue serving their communities.
Leila Hawken
Pharmacist Nasir Mahmood, Pine Plains Pharmacy, is advocating for independent community pharmacies to allow them to continue serving their communities.
Local pharmacies are historically central to community life and have been for generations. If they offered a soda fountain counter with round swivel stools, so much the better.
Today’s family pharmacists throughout the area, however, are struggling under an oppressive pharmaceutical insurance middleman system that strips away profit from their prescription counter.
Beginning in the 1960s, Pharmacy Benefits Managers (PBMs) came upon the scene to process drug claims for insurance companies. By the 1970s they were serving as middlemen between manufacturers, insurance companies and pharmacies, adjudicating prices.
Today, PBMs not only adjudicate claims, but now they develop and manage pharmacy networks, determine the list of drugs to be covered by insurance, set co-pay amounts and serve to channel the patient to a particular choice of pharmacy.
According to the Pharmacists Society of the State of New York (PSSNY), PBMs can own their own pharmacies, retail and mail order, and profit from sales and services. The work of the PSSNY is to propagate and protect community pharmacies.
The effect of this progression as PBMs have become “invisible middlemen” has been devastating to local family-owned pharmacies in area towns in New York and Connecticut, endangering their existence and the invaluable service they provide to their patients and the communities they serve.
Today, the three largest PBMs control nearly 80% of the prescription benefits market share in the U.S., according to the PSSNY.
“We are so lucky to have this pharmacy. It’s a blessing,” said Pine Plains resident Ann Noone, a regular customer of the Pine Plains Pharmacy, commenting on Monday, April 8 about the local business and its pharmacist. “He’s done a lot for this town.”
Pharmacist at the Pine Plains Pharmacy since 1989, and owner of the historic corner drug store since 2006, Nasir Mahmood has witnessed the financial squeeze on area pharmacies with some forced to close their doors, victims of the PBM system.
It is the PBMs that pre-determine how much each drug covered under the plan should cost, and this is the amount it reimburses all pharmacies except the large-chain ones they own. Often the reimbursement rates are well below the cost of the drug, putting pharmacies in the position of having to fill a prescription at a loss.
“We cannot wait for PBM reform,” said Mahmood on Wednesday, March 27, describing the current tenuous status of bi-partisan federal legislation awaiting vote in Washington, D.C.
Having served as president of the PSSNY for two years in 2008-09 and having finished a two-year term as chairman of the PSSNY Board in March, Mahmood now continues as a member of that board. He also serves on the National Legislative Committee within the National Community Pharmacists Association (NCPA) working with other pharmacists’ professional organizations promoting new legislation to place limits on PBMs and create an equitable structure of reform and accountability.
Bipartisan bills have passed out of committee and are awaiting floor vote that would provide strict regulation and transparency to the work of the PBMs, improve patient access and lower costs, Mahmood said. The NCPA has achieved some recent success in the long process of bringing bills to the floor for a vote.
A series of Senate and House bills received bipartisan support and convincing vote margins as they emerged from committees. With passage, the various pieces of legislation would bring lower drug costs, greater transparency in the process, require the Centers for Medicare and Medicaid Services (CMS) to define their contract terms, and require PBMs to operate with greater transparency.
The legislation was attached to the government funding package that was passed in late March to avoid a government shutdown, but Mahmood said that at the last minute the PBM bills were stripped out of the package.
Continuing their commitment to PBM reform, however, Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) pledged to press on with efforts to enact the legislation before the end of this congressional year.
The NCPA further reported that on Friday, March 22, a bipartisan group of 21 senators and 51 house representatives signed a letter to their respective leadership, asking for immediate action on PBM reform measures.
Advocacy groups are actively pursuing passage of the legislation having arranged a conference drawing pharmacists from across the U.S. to the national headquarters of the NCPA in Alexandria, Virginia, for a two-day meeting to begin on Wednesday, April 17.
“We’ve come a long way with continued advocacy year after year,” Mahmood said, contemplating his participation in the upcoming meeting. Senators and representatives will be reporting to the conference and encouraging continued advocacy strategies to promote passage of the bipartisan PBM legislation.
One bill would bring transparency to Medicaid drug pricing with annual savings of $1 billion. Another would remove PBMs from negotiating CMS services, and the third would provide for greater transparency, oversight and enforcement through the Federal Trade Commission (FTC).
Independent pharmacies throughout the area have expressed their concern about the issue and joined in the hope that the current efforts toward passing legislation will be successful.
Meanwhile, local and area pharmacists remain in the balance, squeezed by the PBM system and locked out of the price negotiation process. During an interview, Mahmood noted that there is not one independent community pharmacy left open in Columbia County.
“It’s not fair,” he said.
Abstract art display in Wassaic for Upstate Art Weekend, July 18-21.
WASSAIC — Art enthusiasts from all over the country flocked to the Catskill Mountains and Hudson Valley to participate in Upstate Art Weekend, which ran from July 18 to July 21.
The event, which “celebrates the cultural vibrancy of Upstate New York”, included 145 different locations where visitors could enjoy and interact with art.
On Saturday, July 20, The Wassaic Project hosted numerous community events. Will Hutnick, the director of artistic programming, said “We’ve been a part of it since the beginning, this is the fifth year of UPAW.”
Most of the action was based at Maxon Mills, the seven-floor grain mill located in the heart of Wassaic. On exhibit was work from 30 artists, 18 of whom were past residents of The Wassaic Project. “Artists can come and do a residency here, meaning they live and work with one another for a couple months at a time,” Hutnick stated.
The first floor held work by Petra Szilagyi, who uses dirt and linseed oil to construct images of paranormal concepts, most of which include bats. They reflected that a recent trip to a fifth sense competition in Vietnam was the influence behind the exhibit.
Across the floor was Tiffany Smith’s interactive installation which incorporated plants and wicker chairs, all of which were objects associated with her Carribean upbringing. “The room being filled with plants is symbolic of hurricane prep which often included bringing the plants from outside into the house,” Smith said.
As visitors made their way up the narrow wooden stairs, music could be heard from behind the walls. The echoing music was Daniel Shieh’s installation, entitled Mother’s Anthem, which played a recording of the American Anthem in 30 languages. The languages ranged from Spanish and Italian to Navajo and Bengali.
Each floor was filled with artwork of all mediums, including painting, fibers, collage and photography. Rachel Bussières, who switched her concentration after watching the 2017 solar eclipse, uses varying light sources to produce lumen prints. During the wildfires, she recounted that she “made a new exposure each day to capture the changing air quality”.
Luciana Abait also incorporates the natural world into her pieces, instead using maps. An environmental activist originally from Argentina, Abait’s work highlights “environmental fragility, specifically the impacts it has on immigrants.” Her installation that is currently on display at Maxon Mills, takes the form of a mountain range built solely from maps of the US and Argentina.
Throughout the day, visitors could “Arm Wrestle 4 A Popsicle”. Winners had the choice of 3 playfully flavored trout-inspired popsicles - Nightcrawler, Power Bait, and Salmon Roe. Artist Katie Peck, who spent the day in costume as a rainbow trout, encouraged guests to step up and try their hand at an arm wrestle.
Shibori Indigo dyeing, group meditation, and dance workshops were open for community members of all ages as well.
While the daytime activities fostered appreciation of fixed art, a dance party until midnight at The Lantern Inn offered guests a space for performative art.
When describing the environment of The Wassaic Project, Smith emphasized, “It’s all community, it’s all love.”
A serene scene from the Amenia garden tour.
AMENIA — The much-anticipated annual Amenia Garden Tour drew a steady stream of visitors to admire five local gardens on Saturday, July 13, each one demonstrative of what a green thumb can do. An added advantage was the sense of community as neighbors and friends met along the way.
Each garden selected for the tour presented a different garden vibe. Phantom’s Rock, the garden of Wendy Goidel, offered a rocky terrain and a deep rock pool offering peaceful seclusion and anytime swims. Goidel graciously welcomed visitors and answered questions about the breathtaking setting.
Amenia Finance Director Charlie Miller welcomed visitors to his Bog Hollow Road garden in Wassaic, a manicured expansive yard with well-placed garden beds framing a far-reaching view. He said he plans carefully each winter for the next spring’s improvement.
The organic, environmentally responsible Maitri Farm was next, a lesson in coordinating agriculture with natural balance. The farm stand and a walk among the greenhouses brought visitors together.
Near the center of Amenia was the garden of Polly Pitts-Garvin, offering a chance to visit a robust vegetable garden with raised beds to be envious of and a remarkable absence of any insects or usual vegetable garden problems.
At Chez Cheese, the vast garden acreage surrounding the 1850s historic home of Joan Feeney and Bruce Phillips in Millerton, visitors could begin at refreshment stations where walking tour maps of the 15-acre property were available. There were streams and ponds with docks, and a dozen bridges arranged around the landscape. In the 19th-century, the property had been the home of the Wilson Cheese Factory, inspiring the name of the estate.
The Amenia Garden Tour was supported this year by Paley’s Garden Center in Sharon.
Gary Dodson working a tricky pool on the Schoharie Creek, hoping to lure something other than a rock bass from the depths.
PRATTSVILLE, N.Y. — The Schoharie Creek, a fabled Catskill trout stream, has suffered mightily in recent decades.
Between pressure from human development around the busy and popular Hunter Mountain ski area, serious flooding, and the fact that the stream’s east-west configuration means it gets the maximum amount of sunlight, the cool water required for trout habitat is simply not as available as in the old days.
This is not a new phenomenon. It does seem to be getting worse, though.
Gary Dodson and I convened where the creek makes its final run into the Schoharie reservoir, part of the New York City water supply system, on a semi-broiling Thursday afternoon, July 11.
The goal was simple. Catch smallmouth bass, which abound in the lower section of the river.
This was hot stuff — as in an 80-degree water temperature.
The air temperature was actually slightly less at 77.
After negotiating the intensely slippery rocks, festooned with treacherous algae, the first major pool presented several difficulties, with a back eddy competing with a main flow and several large trees draped about the whole thing.
I hit on the simplest strategy, which was to flip a weighted attractor fly called a Tequilley into the start of the eddy so it would proceed slowly but steadily into the maelstrom, sinking all the while.
This worked. A proper adult smallmouth, with bronze coloring and vertical stripes, took the thing.
The point-and-shoot camera finally died, however, and I was not going to try to fumble my phone out for a nice but routine fish photo.
Why not?
Because I guarantee the fish would have made a sudden, last-moment bolt for freedom, causing me to drop the device into the drink.
Gary moved downstream while I continued trying to annoy the residents of the pool, succeeding a couple of times with different colored Wooly Buggers.
Then we all got bored and I moved off, where Gary was catching rock bass and cussing them out for not being something else.
I have to admit, they are not the most compelling critters. Something about the red eyes.
This latest trip was dominated by extremely tedious and distasteful Harry Homeowner activities, but on both Wednesday and Thursday mornings I prowled Woodland Valley Creek. By “morning” I mean “dawn,” because that was when the water temps were down to a barely acceptable 64.
I made the acquaintance of several stocked browns and of a handful of their wild cousins. The wild fish are smaller and nimbler.
The successful ploy was an Adams wet fly, size 16, drifted behind something big, like a Parachute Adams or Stimulator.