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Pharmacy benefit managers are now challenging this use of mail-order pharmacies. On Wednesday, a federal judge in Albany declined to stop the pharmacy benefit manager Express Scripts from terminating its relationship with the pharmacy Linden Care, which dispenses expensive pain pills sold by Horizon Pharma. Linda Clark, a lawyer for Linden Care, said it would appeal the decision on an emergency basis to try to prevent disruptions in patient care.

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Dermatologists say price rises, and an increasing tendency of pharmacy benefit managers to refuse to pay for certain drugs they view as unnecessarily expensive, are making it difficult for patients to obtain the drugs they prescribe. The American Academy of Dermatology established a task force on pharmaceutical prices and price transparency this year to try to come up with solutions.

Bruce A. Brod, a dermatologist in Lancaster, Pa.


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Rosenberg, who is also a volunteer professor at the University of Miami, said he did not set out to publish a study. He wanted simply to inform other dermatologists in Florida about the costs of the drugs they were prescribing.

Why the Valeant-Walgreens deal could save you money

So he and his daughter, Miranda E. While prices can vary somewhat geographically, the basic findings should hold true nationwide, the authors say. The survey results, posted on the website of a Florida dermatology society, proved popular enough that they repeated it in and , using the same drugstores. When they saw how much prices had jumped from to , they decided to publish, using a representative sample of 19 drugs. Prices for seven of the drugs more than quadrupled in that period.

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Valeant accounted for four of them: Dermatology represented the 11th-biggest therapeutic category for drugs in , with million prescriptions, according to IMS Health. Many dermatology drugs do not contain novel ingredients. Carac, for instance, is made of fluorouracil, a decades-old chemotherapy drug. Targretin contains a vitamin A derivative known as a retinoid. Manufacturers make new formulations they say provide better results.

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Brod said that particular formulations might be best for certain patients, and doctors need a full choice of products. But others are skeptical. Robert Rudolph, a recently retired dermatologist in Wyomissing, Pa. Punishment also has been known to create other worse behaviors as a side-effect of displaced stress.

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Would you rather learn a new job from a boss who smacks you on the back of the head every time you get something wrong or gives you a bonus when you get things right? Which boss would you rather work for? Which boss would you trust? Which work environment would be more conducive to learning and happiness?


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You know the answer, right? Instinctually there is no doubt in your mind. So why be the mean boss to your dog?

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