Contra Costa Herald

Night vision testing and operations. Photos by Matt Woods. Courtesy of CAL FIRE.

Expect helicopter activity around Rio Vista

By Linnea Edmeier, Aviation Communications Officer II, California Department of Forestry and Fire Protection

Sacramento, CA — CAL FIRE’s Aviation Program reaches a milestone as it conducts night operations training this week for crewmembers from three helitack bases—Kneeland and Bieber Helitack from Northern California, and San Diego Helitack from Southern California.

This training officially expands night firefighting capabilities to all 11 CAL FIRE Helitack crews statewide. Standardizing night operations across every base ensures that crews can seamlessly integrate during nighttime assignments anywhere in the state.

Context & Milestones

• 2020: CAL FIRE introduced the CAL FIRE HAWK (S-70i) into its aerial fleet, laying the groundwork for advanced night-vision operations.
• 2025: Virtual Reality Air Rescue Hoist Simulator introduced at the CAL FIRE Aviation Training Center (CATC). By year’s end, six simulators were operational: OV-10, S2T Airtanker, C130H Airtanker, S70i Helicopter, S70i Helicopter (NVG compatible), Hoist Air Rescue.
• May 2026: CAL FIRE achieved two major milestones—the addition of its 11th Helitack base, thereby completing a full Helitack transition from the UH-1H Huey to the CAL FIRE HAWK.
• November 2026: Night operations capability achieved across all 11 bases.

Importance of Night Operations Training

Nighttime operations are demanding and require advanced training that begins with classroom instruction on night vision, its limitations and crew coordination, followed by flight simulator exercises and nighttime flight training. While simulator hours reduce equipment wear and reduce operational risk, simulated environments cannot fully replicate the sensory inputs, spatial cues, and lighting of live nocturnal flight.

During night exercises, crews gain experience using Night Vision Goggles (NVG) for water drops and low-light navigation while building the coordination needed to operate safely and effectively after dark.

Community and Safety Notice

All training flights are conducted in accordance with Federal Aviation Administration (FAA) regulations and CAL FIRE safety protocols.

Residents in and around the McClellan and San Diego training areas can expect helicopter activity during evening hours, concluding by 11:00 PM, Wednesday, November 4 – Friday, November 6. Training areas near McClellan include Mammoth Bar and Folsom Lake along with regional airports including Placerville, Georgetown, Grass Valley, and Rio Vista.

Areas in and around Ramona Airport in Southern California, including San Vicente, El Capitan, Henshaw, and Sutherland Reservoirs will experience helicopter activity.

We prioritize safety and are committed to minimizing local disruptions. CAL FIRE appreciates the community’s support as we prepare our Helitack crews for night operations.

Learn more at CAL FIRE Aviation Program.

By William Elwood, Public Affairs Officer, U.S. Attorney Northern District of California

OAKLAND – Carson Fries was sentenced today to 72 months in federal prison for drug trafficking.  U.S. District Judge Haywood S. Gilliam, Jr. handed down the sentence.

Fries, 34, of Bay Point, California, was charged by Criminal Complaint on September 22, 2025, and charged by Information on May 12, 2026.  Fries pleaded guilty on July 29, 2026, to Possession with Intent to Distribute 50 Grams or More of a Mixture or Substance Containing a Detectable Amount of Methamphetamine, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(B)(viii)).  Fries was a significant drug supplier in Contra Costa County.  According to the plea agreement, Fries admitted to selling large quantities of meth on at least three instances between August 29, 2025, and September 9, 2025, in Bay Point.  On August 29, 2025, he sold approximately 478 gross grams of methamphetamine.  On September 3, 2025, Fries sold approximately 518 gross grams of methamphetamine.  And on September 9, 2025, Fries sold approximately 506 gross grams of methamphetamine.  Additionally, 160 grams of methamphetamine and 33 firearms and a stockpile of ammunition were found at Fries’ residence during a search conducted pursuant to a search warrant.

United States Attorney Craig H. Missakian and Drug Enforcement Administration (DEA) Special Agent in Charge Bob P. Beris made the announcement.  In addition to the prison term, Judge Gilliam also sentenced the defendant to four years of supervised release.

Assistant U.S. Attorney Ivana Djak is prosecuting the case with the assistance of Jessie Chelsea and Amala James.  The prosecution is the result of an investigation by the DEA and the Concord Police Department.

According to localcrimenews.com, the six-foot, one-inch tall, 200-pound Fries is White and was previously arrested Jan. 11, 2014 by CHP – Contra Costa for evading a police officer.

Further Information:

Case No. 26-CR-231

Electronic court filings and further procedural and docket information are available at https://ecf.cand.uscourts.gov/cgi-bin/login.pl. Judges’ calendars with schedules for upcoming court hearings can be viewed on the court’s website at www.cand.uscourts.gov.

Allen D. Payton contributed to this report.

In Brentwood

By Alan Wang, Community/Media Relations, Contra Costa County Employment & Human Services Department

Free Nov. 5 event to help residents recognize scams and protect their identities

MARTINEZ, Calif. (November 3, 2026) – In the fight against fraud, knowledge is power. As scams become increasingly sophisticated and difficult to recognize, Contra Costa County Employment & Human Services Department (EHSD) invites residents to learn how to protect themselves at the Contra Costa County Scam Jam, a free, half-day fraud prevention event hosted in partnership with AARP California and EHSD’s Aging & Adult Services.

The event is Thursday, November 5, from 9 a.m. to 1 p.m. at the Brentwood Senior Activity Center, 193 Griffith Lane, Brentwood.

Attendees will hear directly from experts who will share information about some of the most common scams that target local residents, plus warning signs and practical steps to safeguard personal information and prevent identity theft.

Expert speaker lineup for media availability:

Mary Blumberg, Assistant District Attorney, Contra Costa County

Kerry O’Brien, Regional Director, Federal Trade Commission

Bryce Avelos, California Privacy Protection Agency

Alfredo Cadenas, California Department of Financial Protection and Innovation

Preview video clip: https://vimeo.com/1243012933?share=copy&fl=sv&fe=ci

Whether it’s a suspicious phone call, a convincing email, an online impersonation or a financial scheme, scammers are constantly finding new ways to target unsuspecting victims. The Scam Jam will give residents the information and tools they need to recognize potential threats, make informed decisions and avoid becoming victims of fraud.

Light breakfast and refreshments will be provided. Space is limited, so residents are encouraged to register in advance.

LEARN MORE AND REGISTER at events.aarp.org/scamjam110426 or scan the QR code.

EVENT DETAILS

WHAT: Contra Costa County Scam Jam – Fraud Prevention Event

WHEN: Thursday, November 5, 2026 | 9 a.m. – 1 p.m.

WHERE: Brentwood Senior Activity Center, 193 Griffith Lane, Brentwood

WHY: To educate residents about emerging scams, identity theft prevention and ways to protect themselves from fraud.

About Contra Costa County Employment & Human Services Department

Contra Costa County Employment & Human Services Department (EHSD) provides a wide range of services and resources that support individuals, families and communities throughout the county. Guided by its commitment to Building Brighter Futures Together, EHSD works to improve the well-being of residents through education, assistance, advocacy and community partnerships.

Says, “The election may be over, but the fight for accountability is not”

By Debora Allen

WALNUT CREEK, CA — Following the apparent passage of Measure RTM, former BART Board Director Debora Allen, a leading critic of the regional transit sales tax measure, issued the following statement:

I have never been afraid to be a minority voice, nor have I been afraid of losing while fighting for the right cause.

Nearly half a million Bay Area voters have already joined me in saying that fiscal responsibility and meaningful accountability for government spending of our tax dollars matter. With hundreds of thousands of ballots still to be counted, that number could grow substantially. That’s a powerful voice that deserves to be heard, regardless of the election outcome.

The apparent passage of Measure RTM is disappointing, but hardly surprising.

Source: Wikipedia

The transit industry and its corporate and labor allies raised almost $10 million in reported direct contributions to the Yes campaign, not including additional spending on member communications by labor unions and nonprofits. Meanwhile, the volunteers fighting this tax increase operated on roughly $20,000. That’s a spending advantage approaching 500 to 1. The corporate and labor interests had millions to sell their message. The people opposing this tax had volunteers, research, and determination.

Source: Wikipedia

The authors of Senate Bill 63, the enabling legislation for Measure RTM, had one overriding objective: secure billions in new funding for Bay Area transit agencies. Yet they acknowledged in the legislation that “financial efficiency and transparency are imperative to build public confidence and support for public transit.” SB 63 was their opportunity to deliver meaningful, independent oversight in exchange for asking voters to raise sales taxes in five counties. Instead, they created an oversight process that lacks meaningful independence and enforceable financial reforms. The Legislature had the opportunity to demand real accountability before committing billions in taxpayer dollars. It failed. That is why I opposed Measure RTM.

The Yes campaign was filled with misleading narratives about the spending habits of Bay Area transit agencies, promises of accountability measures that lack meaningful independence, and frightening predictions of traffic Armageddon if voters rejected the tax. These were carefully crafted public relations messages designed to convince voters that higher taxes were the only alternative to transit collapse.

Much of this effort was driven by three influential Bay Area nonprofits: the Bay Area Council, San Francisco Bay Area Planning and Urban Research (SPUR), and Seamless Bay Area. These well-funded organizations, backed by powerful corporate and labor interests, have spent years advancing a vision of a denser, more urbanized Bay Area, with transit-oriented housing and concentrated employment centers throughout the region.

These organizations aren’t simply advocating for transit funding. They are helping shape where and how millions of Bay Area residents will live, work, and travel. Voters deserve to understand whose interests are driving those plans, who finances them, and who ultimately benefits.

I’ve lost elections before. Losing is always disappointing, but winning an election isn’t the only measure of success.

Throughout this campaign, the volunteers of CABAT (Committee for Affordable Bay Area Transit), SHIFT (Sustainability in Housing, Infrastructure, Finance, Transportation), and Contra Costa Taxpayers’ Association did phenomenal work. They uncovered troubling facts, challenged questionable claims, and learned a great deal about how powerful corporate and labor interests use their financial resources and political influence to sell tax increases to the public.

Source: Wikipedia

Most importantly, together we exposed serious questions about transit agency spending, financial sustainability, and the lack of truly independent oversight. Those questions do not disappear because a tax measure passes.

This was meaningful work. It will continue, and it will expand. The passage of Measure RTM doesn’t relieve transit agencies of their responsibility to reform their operations, control spending, or deliver the accountability promised to voters. In fact, with billions of additional taxpayer dollars at stake, the need for independent scrutiny is greater than ever.

Last night, at an election gathering, someone approached me and said, “We are so thankful for you fighting for us. You have guts.”

That meant more to me than any election result.

Because if you want to change anything, you’ve got to have guts.

And we’re not finished.

About Debora Allen

Debora Allen served eight years as an elected BART Board Director and six years as a trustee of the Contra Costa County Employees’ Retirement Association. A business owner, CPA (inactive), and former CFO and Tax Manager, Debora is a longtime advocate for fiscal accountability. She continues to work on government oversight, financial transparency, and taxpayer protection throughout the Bay Area.

Source: Walk ‘N Roll John Muir Elementary

By Walk ‘n Roll John Muir Elementary

MARTINEZ, Calif. — A group of John Muir Elementary families is calling on the Martinez City Council to reverse a decision that quietly downgraded a planned bike lane on Alhambra Avenue to a painted “sharrow” during recent repaving — a change parents say was made without public notice and contradicts the city’s own Safe Routes to School plan.

The issue comes before the City Council at its Wednesday, November 4 meeting, 7:00 PM, at Martinez City Hall, 525 Henrietta Street.

Alhambra Avenue was slated for a protected bike lane as part of a repaving project earlier this year. Instead, the city installed a sharrow — a shared-lane marking with no physical separation from traffic — a change advocates say was never brought to the community for input and leaves families with no safe way to bike or walk to John Muir Elementary

“We were told this street would have a real bike lane, and instead we got paint,” said Tom Gray, Co-Coordinator of Walk ‘n Roll at John Muir Elementary. “Every Friday, our kids walk and bike to school together because we want them to grow up knowing their neighborhood is safe to move through on their own. A sharrow on a street like Alhambra doesn’t protect anyone — it just puts the responsibility on an 8-year-old to not get hit by a car. Martinez has a Safe Routes to School plan on paper. Wednesday night, the Council gets to decide whether that plan means anything.”

Walk ‘n Roll JME, a parent-led group that organizes weekly walk-and-bike-to-school events at John Muir Elementary, is asking Martinez residents to attend Wednesday’s hearing or submit written comment to the mayor and city manager before the vote. The group has set up a simple online tool for residents to do either in under two minutes, at https://www.google.com/url?q=http://walknroll-action.delicate-flower-76f8.workers.dev&source=gmail&ust=1793681589718000&sa=E.

See meeting agenda Item 13.

About Walk ‘N Roll JME

Walk ‘n Roll is a parent-run program at John Muir Elementary in Martinez, CA that organizes weekly Friday walk-and-bike-to-school events and advocates for safer streets around the school. Follow the campaign at @walknrolljme on Instagram.

By Karen Kerrigan

Small businesses are the engine of America’s economic and technological future, and the Trump administration knows it. Administration officials have repeatedly cited startup formation and entrepreneurship as key to addressing the nation’s most urgent policy challenges, from AI advancement and scientific leadership to job creation and reindustrialization.

To aid startup growth, administration officials have worked to expand government-backed financing for small firms, attract more private capital to startups, and help entrepreneurs commercialize emerging technologies and leverage domestic manufacturing.

Still, one of the most important ways to strengthen America’s startup ecosystem requires no new federal initiatives or additional funding at all. It simply requires policymakers to preserve a longstanding legal framework that has fueled American entrepreneurship for more than four decades.

Congress passed the bipartisan Bayh-Dole Act in 1980 to create a more effective pathway for federally funded research to become new technologies, products, and businesses — by letting universities, nonprofit research institutions, small businesses, and federal laboratories keep the patent rights to inventions they developed with federal support. That created incentives for universities to license those discoveries to small companies, which could then use the patents to attract capital and invest in further development.

Four and a half decades later, the Bayh-Dole framework remains indispensable to American small business growth.

New research shows that from 2021 through 2025, universities, hospitals, and nonprofit research institutes averaged more than 19,000 income-generating licenses each year — approximately twice the annual average from the early 2000s. Roughly 70% of university licensing agreements are with startups and small companies.

In many cases, those licensing agreements give rise to entirely new companies. Since 2001, the Bayh-Dole system has helped launch more than 19,000 startups.

As these businesses grow, they hire workers, do business with other local companies, and strengthen their regional economies. Since 1996, the Bayh-Dole system has contributed up to $1.7 trillion to U.S. GDP and supported up to 7.6 million years’ worth of jobs for Americans.

Unfortunately, in recent years, the Bayh-Dole system has faced growing uncertainty.

Some policymakers are debating changes that could reduce startups’ access to innovative, federally funded research. One proposed rule change would allow the government to cancel long-term research funding on a political whim. Meanwhile, one agency adopted guidelines that make industry licenses less secure by requiring ongoing product-access plans that can be used to revoke licenses even after products have been developed, which directly violates Bayh-Dole.

That uncertainty could have devastating consequences for startups and America’s innovation ecosystem. Startups often build their businesses around a single unproven invention, and they have fewer resources than larger companies to absorb the risks of developing a new product and bringing it to market.

If small companies cannot reliably protect their patent rights, it could become much harder for them to raise the investment needed to continue researching, testing, and manufacturing new technologies.

Instead of altering the Bayh-Dole system, policymakers must preserve it. Protecting this framework will help ensure that startups can continue turning federally supported discoveries into new companies, jobs, and technologies that strengthen American competitiveness.

Karen Kerrigan is president and CEO of the Small Business and Entrepreneurship Council in Washington. This column originally appeared at DCJournal.com.

By Marcus Walton, Director, Communications & Special Projects, Contra Costa County Office of Education

PLEASANT HILL, Calif.— According to U.S. News & World Report, six Contra Costa County elementary and middle schools are among the top-ranked schools in California in its 2027 Best K-8 Schools rankings.

Wagner Ranch Elementary School in the Orinda Union School District (OUSD) ranked No. 36 among California elementary schools, followed by Happy Valley Elementary School in the Lafayette School District (LAFSD) at No. 37. Creekside Elementary School in San Ramon Valley Unified School District (SRVUSD) ranked No. 85 and Lafayette Elementary School in LAFSD ranked No. 92. Orinda Intermediate School in OUSD ranked No. 46 and Windemere Ranch Middle School in the SRVUSD ranked No. 61 among California middle schools.

“Congratulations to these school communities on this prestigious distinction.” Contra Costa County Superintendent of Schools Lynn Mackey said. “The rankings reflect the dedication of educators, administrators, staff, families, and community members who work together to create environments where students can learn and thrive academically. These schools are examples of what can be achieved when scholars are surrounded by strong resources, engaged families, and supportive communities.”

For the 2027 rankings, U.S. News & World Report analyzed more than 107,223 pre-K, elementary, and middle schools. 46,713 elementary schools and 24,756 middle schools across the country were evaluated as part of its 2027 Best K-8 Schools rankings.

The rankings were based on publicly available standardized test data from state education agencies and the U.S. Department of Education. Schools were evaluated on average student proficiency in reading/language arts and math. While considering the proficiency and performance in each subject, the report also accounts for socioeconomic context when interpreting test results. The methodology webpage of the report states, “The top-ranked schools are all high-achieving and have succeeded at educating all their students.”

Contra Costa County Schools in the Top 100 of the 2027 U.S. News Best K-8 Rankings

Elementary School Rankings

• No. 36: Wagner Ranch Elementary School — Orinda Union School District
• No. 37: Happy Valley Elementary School — Lafayette School District
• No. 85: Creekside Elementary School – San Ramon Valley Unified School District
• No. 92: Lafayette Elementary School – Lafayette School District

Middle School Rankings

• No. 46: Orinda Intermediate School — Orinda Union School District
• No. 61: Windemere Ranch Middle School – San Ramon Valley Unified School District

According to U.S. News & World Report, the top-ranked schools achieve strong academic results while effectively serving students across socioeconomic groups.

About Contra Costa County Office of Education

One of 58 counties in California, Contra Costa County has the 11th largest public-school student population in the state (approximately 169,225 students). Officially established in 1932, CCCOE has a long history of providing direct services to some of the county’s most vulnerable students, including young people who are incarcerated, homeless, or in foster care, as well as students who have severe physical or emotional challenges.

CCCOE also provides support services to schools and school districts in Contra Costa County; services that can be handled most effectively and economically on a regional basis rather than by each of the county’s 286 schools or 18 school districts. These services range from budget approval and fiscal support to technology infrastructure, communication support, and high-level professional development opportunities for educators. CCCOE maintains a website at www.cocoschools.org.

Sign at the former FCI Dublin women’s prison. Photo courtesy of Jesstess87.

10th at now closed FCI Dublin to plead guilty or be convicted to date

By William Elwood, Public Affairs Officer, U.S. Attorney’s Office Northern District of California

OAKLAND – Former Bureau of Prisons (BOP) correctional officer David Perez pleaded guilty Wednesday, Oct. 28, 2026, to sexually abusing two female inmates at the Federal Correction Institution (FCI) in Dublin, Calif., a low- and minimum-security federal prison for females.  Perez also admitted to making false statements to federal investigators.

Perez was charged by Information on September 16, 2026.  He is the tenth correctional officer to have either pleaded guilty or been convicted at trial as part of an ongoing federal investigation into sexual abuse of inmates at FCI Dublin.

According to the plea agreement, Perez was employed at BOP from September 1994 to August 2019.  From approximately October 2014 until August 2019, Perez served as a Discipline Hearing Officer (DHO) at FCI Dublin.  In that role, he was responsible for adjudicating disciplinary actions against inmates who allegedly engaged in misconduct while in prison and issuing punishment if he found them guilty.

Between 2014 and 2015, Perez served as the DHO for four disciplinary hearings for a female inmate.  Each time, he found her guilty and assessed various sanctions, which sometimes included time in the Special Housing Unit (SHU) and loss of good time. Between August 2015 and September 2016, Perez repeatedly met with that inmate alone in a room in the Captain’s Complex.  During several of those meetings, Perez kissed the inmate and touched her breasts over and under her clothing.

In July 2016, Perez served as the DHO for another female inmate.  He found her guilty and sentenced her to a little over two weeks in the SHU, among other things.  After her release from the SHU, Perez began calling her to meet with him alone in the Captain’s Complex.  During those meetings, Perez complimented her looks, asked her to show him her breasts, and on one occasion told her that he had the power to add or subtract time from her sentence.  On two occasions when he was alone with this inmate, Perez kissed her and grabbed her breasts and buttocks.  On another occasion, Perez digitally penetrated the inmate’s vulva.

On October 8, 2024, Perez spoke with special agents with the Department of Justice Office of the Inspector General (DOJ OIG) and the Federal Bureau of Investigation (FBI).  During that interview, Perez falsely stated that the only time he had ever touched any female inmate was when he escorted them to and from discipline hearings.

Perez was released on bond.  He is scheduled to be sentenced on March 25, 2027, before U.S. District Judge Yvonne Gonzalez Rogers.

Perez faces a maximum sentence of 15 years in prison and a fine of $250,000 for the count of sexual abuse of a ward in violation of 18 U.S.C. § 2243(b), two years in prison and a $250,000 fine for each count of abusive sexual contact in violation of 18 U.S.C. § 2244(a)(4), and eight years in prison and a $250,000 fine for the count of false statements to a government agency in violation of 18 U.S.C. § 1001(a)(2).  Any sentence will be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.

Scandal Investigation Leads to Prison’s Closure

The investigation of the sexual misconduct scandal led to the facility’s closure.

According to a website about federal women’s prisons, the facility has been “closed since April 2024. It no longer houses anyone and is not a current federal designation.” It was a “low-security women’s FCI with an adjacent minimum-security satellite camp.”

“In January 2024, a 60 Minutes report and FBI activity at the prison brought a new wave of scrutiny. In a class-action lawsuit brought by women held at Dublin, U.S. District Judge Yvonne Gonzalez Rogers moved in March 2024 to appoint a special master to oversee conditions at the prison. Legal advocates described it as the first time a special master had been ordered over a federal prison. Within weeks, on April 15, 2024, the Bureau of Prisons announced it was closing FCI Dublin.”

FCI Dublin Investigation

As part of the Department of Justice’s ongoing investigation into FCI Dublin, 11 FCI Dublin correctional officers have been charged with crimes related to the sexual abuse of the female prisoners at the facility.  The status of these cases is below:



Assistant U.S. Attorneys Andrew Paulson, Sailaja Paidipaty, and Molly Priedeman are prosecuting these cases with the assistance of Amala James, Analisse Iniguez, and Aryan Sawant.  The prosecutions are the result of an investigation by the DOJ OIG and the FBI.

Case No. 4:26-CR-00464-YGR

Electronic court filings and further procedural and docket information are available at https://ecf.cand.uscourts.gov/cgi-bin/login.pl.

Allen D. Payton contributed to this report.

Held on $2 million bail

Police ID victim

By James Laughter, PIO, San Pablo Police Department

San Pablo, CA – As previously reported, on Sunday, October 25, 2026, San Pablo Police Detectives began investigating the homicide of 33-year-old San Pablo resident Luis “Luigi” Ramirez in the 1600 block of 16th Street. After receiving an outpouring of cooperation, support, and information from the community and, utilizing the City’s comprehensive network of public safety technology, SPPD Detectives identified Jose Jesus Cornelio-Aguirre (18-years old, San Pablo, born 12/24/2007) as the individual believed to be responsible for the homicide. Within 48 hours of the initial investigation, Cornelio-Aguirre was located in the 1400 block of North Victoria Court in San Pablo, and subsequently taken into custody in the evening of Tuesday, October 27, 2026.

Based on the preliminary investigation, Detectives believe the victim and suspect were known acquaintances, and that the victim was shot during the early-morning hours on Sunday, October 25th following an altercation with the suspect. At this time, further details of the relationship between the victim and suspect, or cause of the altercation, are still under investigation.

Following his arrest, Cornelio-Aguirre was booked at the Martinez Detention Facility (Contra Costa County) on one charge of PC 187(A) – Murder, pending filing of formal charge(s) in collaboration with the Contra Costa County District Attorney’s Office.

This investigation remains active and ongoing; anyone with information is encouraged to contact the San Pablo Police Department Investigations Division at (510) 215-3150.

According to the Contra Costa County Sheriff’s Office, the five-foot, 10-inch tall, 180-pound Cornelia-Aguirre whose race is not listed but also, listed  as unknown, is being held on $2 million bail. His next court appearance is scheduled for Nov. 13th at 1:30 p.m. in Superior Court Department 5 in Martinez.

Allen D. Payton contributed to this report.

By Dr. Salvatore J. Giorgianni, PharmD, CMHE

I’ve been a pharmacist for more than 50 years. In that time, I’ve witnessed staggering medical advances. Patients now have access — at least in theory — to lifesaving medicines that seemed like science fiction just a decade or two ago.

But in practice, tens of millions of Americans struggle to obtain those drugs. In recent years, I’ve watched more and more patients approach the pharmacy counter, look at the required co-pay on the screen with horror, and glumly walk away without their prescribed treatments.

These patients have insurance. But all too often they can’t afford the out-of-pocket costs that remain after coverage kicks in.

The crisis stems, in large part, from the fact that big insurers like UnitedHealth, Cigna, and Humana don’t merely process claims, anymore. Their parent companies control physicians’ practices and hospitals. They also own pharmacies and operate pharmacy benefit managers — the middlemen that determine which drugs patients can access and what they pay for them.

Today, just three PBMs (pharmacy benefit manager) control prescription drug access for roughly 80% of Americans. In virtually any other industry, that level of concentration would raise serious concerns about competition. Yet these vertically integrated conglomerates have warped the healthcare system to maximize their own profits — and gouge patients — every step of the way.

PBMs typically base patients’ out-of-pocket costs on drugs’ much higher “list” prices, rather than the discounted prices negotiated behind the scenes. Those inflated list prices only exist on paper, yet they justify higher co-pays while also generating larger rebates for PBMs and more profit for the companies that own them. In some cases, PBMs collect more from patients via co-pays or co-insurance than they actually reimburse pharmacies for dispensing a drug.

PBMs also profit by making it harder for patients to access the medicines their providers prescribe.
One of their most common tactics is prior authorization. Providers must justify prescriptions they have already determined are appropriate and wait for the insurer’s approval before patients can begin treatment. The process can delay care for days, weeks, or even months. Faced with those hurdles, up to eight in 10 patients forgo treatment altogether.

Then there’s “step therapy”, sometimes called “fail first”. Patients must first try one or more older, less expensive medicines before gaining access to the treatment their provider originally recommended. That may reduce short-term costs for insurers, but it can also delay effective care and, in some cases, seriously harm patients.
Together these, and other, barriers contribute to unmanaged chronic disease, avoidable hospitalizations, and more than 100,000 preventable deaths every year.

Fortunately, Washington is beginning to crack down. The Federal Trade Commission has sued the nation’s three largest PBMs over practices that inflate drug prices. The Department of Labor recently proposed a rule that’d require PBMs to better disclose the fees and compensation they receive. And earlier this year, Congress passed legislation requiring PBMs to increase transparency and pass through more of the discounts they receive to employers.
It’s a great start — and a much more viable way to decrease Americans’ pharmacy bills than one of the other ideas frequently tossed around Capitol Hill. Some lawmakers want to mimic other nations’ price controls on prescription drugs. But artificially lowering what biotech companies charge for medicines would deter research investments — meaning that the pharmacists of the future will have fewer lifesaving drugs to dispense to patients.
Until policymakers decisively confront PBMs, Americans will continue to pay more, get less of the care they need, and be at risk of worse health.

Salvatore J. (Sal) Giorgianni, Jr, PharmD, CMHE is vice-president and cofounder of Healthy Men, a nonprofit dedicated to advancing the health of boys, men and their families. He is chair-emeritus and cofounder of the American Public Health Association Caucus On Men’s Health. This piece originally appeared in Issues & Insights.