Generic Drug Makers Facing Squeeze on Revenue

They call it the patent cliff.

Brand-name drug makers have feared it for years. And now the makers of generic drugs fear it, too.

This year, more than 40 brand-name drugs — valued at $35 billion in annual sales — lost their patent protection, meaning that generic companies were permitted to make their own lower-priced versions of well-known drugs like Plavix, Lexapro and Seroquel — and share in the profits that had exclusively belonged to the brands.

Next year, the value of drugs scheduled to lose their patents and be sold as generics is expected to decline by more than half, to about $17 billion, according to an analysis by Crédit Agricole Securities.“The patent cliff is over,” said Kim Vukhac, an analyst for Crédit Agricole. “That’s great for large pharma, but that also means the opportunities theoretically have dried up for generics.”

In response, many generic drug makers are scrambling to redefine themselves, whether by specializing in hard-to-make drugs, selling branded products or making large acquisitions. The large generics company Watson acquired a European competitor, Actavis, in October, vaulting it from the fifth- to the third-largest generic drug maker worldwide.

“They are certainly saying either I need to get bigger, or I need to get ‘specialer,’ ” said Michael Kleinrock, director of research development at the IMS Institute for Healthcare Informatics, a health industry research group. “They all want to be special.”

As one consequence of the approaching cliff, executives for generic drug companies say, they will no longer be able to rely as much on the lucrative six-month exclusivity periods that follow the patent expirations of many drugs. During those periods, companies that are the first to file an application with the Food and Drug Administration, successfully challenge a patent and show they can make the drug win the right to sell their version exclusively or with limited competition.

The exclusivity windows can give a quick jolt to companies. During the first nine months of 2012, sales of generic drugs increased by 19 percent over the same period in 2011, to $39.1 billion from $32.8 billion, according to Michael Faerm, an analyst for Credit Suisse. Sales of branded drugs, by contrast, fell 4 percent during the same period, to $174.2 billion from $181.3 billion.

But those exclusive periods also make generic drug makers vulnerable to the fickle cycle of patent expiration. “The only issue is it’s a bubble, too,” said Mr. Kleinrock. He said next year, the generic industry would enter a drought that was expected to last about two years.  Of the drugs that are becoming generic, fewer have exclusivity periods dedicated to a single drug maker.

In 2013, for example, the antidepressant Cymbalta, sold by Eli Lilly, is scheduled to be available in generic form. But more than five companies are expected to share in sales during the first six months, according to a report by Ms. Vukhac.

Heather Bresch, the chief executive of Mylan, the second-largest generics company in the United States, said Wall Street analysts were obsessed with the issue. “I can’t go anywhere without being asked about the patent cliff, the patent cliff, the patent cliff,” she said. “The patent cliff is one aspect of a complex, multilayered landscape, and I think each company is going to face it differently.”

Jeremy M. Levin, the chief executive of Teva Pharmaceuticals, the largest global maker of generic drugs, agreed. “The concept of exclusivity — where only one generic player could actually make money out of the unique moment — has diminished,” he said. “In the absence of that, many companies have had to really ask the question, ‘How do I really play in the generics world?’ ”

For Teva, Mr. Levin said, he believes the answer will be both its reach  — it sells 1,400 products, and one in six generic prescriptions in the United States is filled with a Teva product  — and what he says is a reputation for making quality products. That focus will be increasingly important, he said, given recent statements by the F.D.A. that it intends to take a closer look at the quality of generic drugs. Mr. Levin also said he planned to cut costs, announcing last week that he intended to trim from $1.5 to $2 billion in expenses over the next five years.

This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of this article misstated the country in which the pharmaceutical company Endo is based. It is an American company, not Japanese.

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Call That Kept Nursing Home Patients in Sandy’s Path

Chang W. Lee/The New York Times

Workers were shocked that nursing and adult homes in areas like Rockaway Park, Queens, weren’t evacuated.

Hurricane Sandy was swirling northward, four days before landfall, and at the Sea Crest Health Care Center, a nursing home overlooking the Coney Island Boardwalk in Brooklyn, workers were gathering medicines and other supplies as they prepared to evacuate.

Then the call came from health officials: Mayor Michael R. Bloomberg, acting on the advice of his aides and those of Gov. Andrew M. Cuomo, recommended that nursing homes and adult homes stay put. The 305 residents would ride out the storm.

The same advisory also took administrators by surprise at the Ocean Promenade nursing home, which faces the Atlantic Ocean in Queens. They canceled plans to move 105 residents to safety.

“No one gets why we weren’t evacuated,” said a worker there, Yisroel Tabi. “We wouldn’t have exposed ourselves to dealing with that situation.”

The recommendation that thousands of elderly, disabled and mentally ill residents remain in more than 40 nursing homes and adult homes in flood-prone areas of New York City had calamitous consequences.

At least 29 facilities in Queens and Brooklyn were severely flooded. Generators failed or were absent. Buildings were plunged into a cold, wet darkness, with no access to power, water, heat and food.

While no immediate deaths were reported, it took at least three days for the Fire Department, the National Guard and ambulance crews from around the country to rescue over 4,000 nursing home and 1,500 adult home residents. Without working elevators, many had to be carried down slippery stairwells.

“I was shocked,” said Greg Levow, who works for an ambulance service and helped rescue residents at Queens. “I couldn’t understand why they were there in the first place.”

Many sat for hours in ambulances and buses before being transported to safety through sand drifts and debris-filled floodwaters. They went to crowded shelters and nursing homes as far away as Albany, where for days, they often lacked medical charts and medications. Families struggled to locate relatives.

The decision not to empty the nursing homes and adult homes in the mandatory evacuation area was one of the most questionable by the authorities during Hurricane Sandy. And an investigation by The New York Times found that the impact was worsened by missteps that officials made in not ensuring that these facilities could protect residents.

They did not require that nursing homes maintain backup generators that could withstand flooding. They did not ensure that health care administrators could adequately communicate with government agencies during and after a storm. And they discounted the more severe of the early predictions about Hurricane Sandy’s surge.

The Times’s investigation was based on interviews with officials, health care administrators, doctors, nurses, ambulance medics, residents, family members and disaster experts. It included a review of internal State Health Department status reports. The findings revealed the striking vulnerability of the city’s nursing and adult homes.

On Sunday, Oct. 28, the day before Hurricane Sandy arrived, Mr. Bloomberg ordered a mandatory evacuation in Zone A, the low-lying neighborhoods of the city. But by that point, Mr. Bloomberg, relying on the advice of the city and state health commissioners, had already determined that people in nursing homes and adult homes should not leave, officials said.

The mayor’s recommendations that health care facilities not evacuate startled residents of Surf Manor adult home in Coney Island, said one of them, Norman Bloomfield. He recalled that another resident exclaimed, “What about us! Why’s he telling us to stay?”

The commissioners made the recommendation to Mr. Bloomberg and Mr. Cuomo because they said they believed that the inherent risks of transporting the residents outweighed the potential dangers from the storm.

In interviews, senior Bloomberg and Cuomo aides did not express regret for keeping the residents in place.

“I would defend all the decisions and the actions” by the health authorities involving the storm, said Linda I. Gibbs, a deputy mayor. “I feel like I’m describing something that was a remarkable, lifesaving event.”

Dr. Nirav R. Shah, the state health commissioner, who regulates nursing homes, said: “I’m not even thinking of second-guessing the decisions.”

Still, officials in New Jersey and in Nassau County adopted a different policy, evacuating nursing homes in coastal areas well before the storm.

Contradictory Forecasts

The city’s experience with Tropical Storm Irene last year weighed heavily on state and city health officials and contributed to their underestimating the impact of Hurricane Sandy, according to records and interviews.

Before Tropical Storm Irene, the officials ordered nursing homes and adult homes to evacuate. The storm caused relatively minor damage, but the evacuation led to millions of dollars in health care, transportation, housing and other costs, and took a toll on residents.

As a result, when Hurricane Sandy loomed, the officials were acutely aware that they could come under criticism if they ordered another evacuation that proved unnecessary.

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Nokia debunks rumor that it may be considering shift to Android

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Study shows growth in second screen users

NEW YORK (AP) — Television viewers were once called couch potatoes. Many are becoming more active while watching now, judging by the findings in a new report that illustrates the explosive growth in people who watch TV while connected to social media on smartphones and tablets.

The Nielsen company said that one in three people using Twitter in June sent messages at some point about the content of television shows, an increase of 27 percent from only five months earlier. And that was before the Olympics, which was probably the first big event to illustrate the extent of second screen usage.

"Twitter has become the second screen experience for television," said Deirdre Bannon, vice president of social media at Nielsen.

Social networking is becoming so pervasive that the study found nearly a third of people aged 18-to-24 reported using the sites while in the bathroom.

An estimated 41 percent of tablet owners and 38 percent of smartphone owners used their device while also watching television at least once a day, Nielsen said.

That percentage hasn't changed much; in fact, 40 percent of smartphone owners reported daily dual screen usage a year earlier, Nielsen said. The difference is that far more people own these devices and they are using them for a longer period of time. The company estimated that Americans spent a total of 157.5 billion minutes on mobile devices in July 2012, nearly doubling the 81.8 billion the same month a year earlier.

"There are big and interesting implications," Bannon said. "I think both television networks and advertisers are onto it."

The social media can provide networks with real-time feedback on what they are doing. The performance of moderators at presidential debates this fall was watched more closely than perhaps ever before, because people were instantly taking on Twitter to provide their own critiques.

It also makes for some conflicting information: Twitter buzzed with complaints last summer about NBC's policy of airing many Olympics events from London on tape delay, yet ratings for the prime-time Olympics telecast soared past expectations.

The increase in people watching television and commenting about it online would seem to run counter to another big trend this fall: more people recording programs and watching them at a later hour. Those contrary trends both increase the value of live event programming like awards shows or sporting events.

The Nielsen study also found that 35 percent of people who used tablets while watching TV looked up information online about the program they were watching. A quarter of tablet owners said they researched coupons or deals for products they saw advertised on television

As rapid as the use of social media while on television is growing in the United States, it already lags behind other countries. Nielsen said that 63 percent of people in the Middle East or Africa report using social media while on TV, and 52 percent of people in Latin America.

The U.S. media survey is based on a representative sample of 1,998 adults in Nielsen's regular TV ratings panel, conducted online between July 19 and Aug. 8. Nielsen's global survey involved more than 28,000 people in 51 countries and was taken between March 23 and April 12, 2011.

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Call That Kept Nursing Home Patients in Sandy’s Path

Chang W. Lee/The New York Times

Workers were shocked that nursing and adult homes in areas like Rockaway Park, Queens, weren’t evacuated.

Hurricane Sandy was swirling northward, four days before landfall, and at the Sea Crest Health Care Center, a nursing home overlooking the Coney Island Boardwalk in Brooklyn, workers were gathering medicines and other supplies as they prepared to evacuate.

Then the call came from health officials: Mayor Michael R. Bloomberg, acting on the advice of his aides and those of Gov. Andrew M. Cuomo, recommended that nursing homes and adult homes stay put. The 305 residents would ride out the storm.

The same advisory also took administrators by surprise at the Ocean Promenade nursing home, which faces the Atlantic Ocean in Queens. They canceled plans to move 105 residents to safety.

“No one gets why we weren’t evacuated,” said a worker there, Yisroel Tabi. “We wouldn’t have exposed ourselves to dealing with that situation.”

The recommendation that thousands of elderly, disabled and mentally ill residents remain in more than 40 nursing homes and adult homes in flood-prone areas of New York City had calamitous consequences.

At least 29 facilities in Queens and Brooklyn were severely flooded. Generators failed or were absent. Buildings were plunged into a cold, wet darkness, with no access to power, water, heat and food.

While no immediate deaths were reported, it took at least three days for the Fire Department, the National Guard and ambulance crews from around the country to rescue over 4,000 nursing home and 1,500 adult home residents. Without working elevators, many had to be carried down slippery stairwells.

“I was shocked,” said Greg Levow, who works for an ambulance service and helped rescue residents at Queens. “I couldn’t understand why they were there in the first place.”

Many sat for hours in ambulances and buses before being transported to safety through sand drifts and debris-filled floodwaters. They went to crowded shelters and nursing homes as far away as Albany, where for days, they often lacked medical charts and medications. Families struggled to locate relatives.

The decision not to empty the nursing homes and adult homes in the mandatory evacuation area was one of the most questionable by the authorities during Hurricane Sandy. And an investigation by The New York Times found that the impact was worsened by missteps that officials made in not ensuring that these facilities could protect residents.

They did not require that nursing homes maintain backup generators that could withstand flooding. They did not ensure that health care administrators could adequately communicate with government agencies during and after a storm. And they discounted the more severe of the early predictions about Hurricane Sandy’s surge.

The Times’s investigation was based on interviews with officials, health care administrators, doctors, nurses, ambulance medics, residents, family members and disaster experts. It included a review of internal State Health Department status reports. The findings revealed the striking vulnerability of the city’s nursing and adult homes.

On Sunday, Oct. 28, the day before Hurricane Sandy arrived, Mr. Bloomberg ordered a mandatory evacuation in Zone A, the low-lying neighborhoods of the city. But by that point, Mr. Bloomberg, relying on the advice of the city and state health commissioners, had already determined that people in nursing homes and adult homes should not leave, officials said.

The mayor’s recommendations that health care facilities not evacuate startled residents of Surf Manor adult home in Coney Island, said one of them, Norman Bloomfield. He recalled that another resident exclaimed, “What about us! Why’s he telling us to stay?”

The commissioners made the recommendation to Mr. Bloomberg and Mr. Cuomo because they said they believed that the inherent risks of transporting the residents outweighed the potential dangers from the storm.

In interviews, senior Bloomberg and Cuomo aides did not express regret for keeping the residents in place.

“I would defend all the decisions and the actions” by the health authorities involving the storm, said Linda I. Gibbs, a deputy mayor. “I feel like I’m describing something that was a remarkable, lifesaving event.”

Dr. Nirav R. Shah, the state health commissioner, who regulates nursing homes, said: “I’m not even thinking of second-guessing the decisions.”

Still, officials in New Jersey and in Nassau County adopted a different policy, evacuating nursing homes in coastal areas well before the storm.

Contradictory Forecasts

The city’s experience with Tropical Storm Irene last year weighed heavily on state and city health officials and contributed to their underestimating the impact of Hurricane Sandy, according to records and interviews.

Before Tropical Storm Irene, the officials ordered nursing homes and adult homes to evacuate. The storm caused relatively minor damage, but the evacuation led to millions of dollars in health care, transportation, housing and other costs, and took a toll on residents.

As a result, when Hurricane Sandy loomed, the officials were acutely aware that they could come under criticism if they ordered another evacuation that proved unnecessary.

Read More..

Advertising: Ford Plan to Revive Lincoln Hinges on a New Brand

An unusual ad campaign features Abraham Lincoln, the president for whom the car brand is named.

DEARBORN, Mich. — In the fiercely competitive world of luxury cars, the Ford Motor Company’s Lincoln brand has long been stuck in the slow lane, with stodgy models, older buyers and a distinct lack of pizazz.

But Ford is determined to change that. On Monday, the company will announce upgraded customer service initiatives, a new brand name for Lincoln that plays down the Ford connection and an unusual advertising campaign that features Abraham Lincoln, the president for whom the brand is named.

Ford’s chief executive, Alan R. Mulally, will begin the rebranding effort at an event outside Lincoln Center in Manhattan — the first in a series of moves meant to reverse Lincoln’s seemingly perpetual state of decline.

Ford will formally rechristen the brand as the Lincoln Motor Company and introduce a television spot that begins with an image of Lincoln, stovepipe hat and all. The brand’s first Super Bowl commercial is in the works, as is a revamped Web site that links consumers to a Lincoln “concierge” who can arrange test drives or set up appointments at dealerships.

Mr. Mulally will also announce the on-sale date in early 2013 for the radically redesigned Lincoln MKZ sedan, as well as plans for three new vehicles down the road.

If it seems like an all-out grab for attention, well, that’s exactly the point, said James D. Farley Jr., Ford’s head of global sales and marketing and the newly named chief of the Lincoln revival effort.

“The most important thing is for people to be aware that there is a transition going on,” Mr. Farley said. “We have to shake them up.”

The shake-up is long overdue and critically important to Ford, the nation’s second-largest car company behind General Motors.

As recently as the 1990s, Lincoln was the top-selling luxury automotive brand in the United States. Its large Town Car sedan and hulking Navigator S.U.V. defined the brand, and sales topped more than 230,000 vehicles a year.

But since then, Lincoln has been left in the dust by the German category leaders BMW and Mercedes-Benz, and Toyota’s Lexus division. This year, Lincoln ranks eighth in the American luxury segment, with sales down 2 percent, to 69,000, vehicles in the first 10 months of the year.

Its crosstown rival G.M. has had much better success reviving its Cadillac brand.

“Cadillac has been stabilized, but Lincoln is still muddling about,” said Jack Trout, president of the marketing firm Trout and Partners. “The big question is, how can Lincoln convince people it is more than just a gussied-up Ford?”

That task has now fallen to Mr. Farley, who left Toyota five years ago to join Ford just as Mr. Mulally’s transformation of the company was under way. Since then, Ford has introduced a succession of sleeker, more fuel-efficient and technology-laden models that have lifted sales and made it among the most profitable car companies in the world.

Lincoln, however, has not benefited from the turnaround. It accounts for only 3 percent of Ford’s total sales, down from 8 percent during the brand’s heyday. And since Ford has sold off foreign luxury divisions like Volvo and Jaguar, Lincoln is the sole upscale brand in the company.

“There is nothing more frustrating for us than to have someone who loves their Ford car and S.U.V., but goes out to buy a luxury model from another brand because we don’t have one,” Mr. Farley said.

The Lincoln comeback effort starts with the midsize MKZ, which has been redesigned with a sweeping grille, tapered body style and an all-glass retractable roof. It will be followed by three other new models, including a larger sedan and S.U.V.

But the brand’s image needs much more than better cars. Under Mr. Farley’s direction, a newly formed team of 200 people is intent on establishing the Lincoln Motor Company as a boutique luxury line known for personalized service.

Every customer who reserves an MKZ, for example, will be presented with an elegant gift upon receiving the car. Choices include a selection of wines and Champagne, custom-made jewelry or sunglasses, or a one-night stay at a Ritz-Carlton hotel.

Lincoln’s Web site will also have a consultant available 24 hours a day for live discussions about the products and to streamline the buying process. Prospective buyers will be given an opportunity for a “date night” with Lincoln, which includes a two-day test drive and a free meal at a restaurant.

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Tunnel Collapse Outside Tokyo Traps Motorists

Kyodo News, via Associated Press

A surveillance camera within the Sasago tunnel showed rescue workers at the scene of a collapse on Sunday.

TOKYO — At least seven people were feared dead after part of a highway tunnel collapsed Sunday in eastern Japan, trapping them in their vehicles and starting a fire that filled the tunnel with thick, black smoke.

Franck Robichon/European Pressphoto Agency

Fire fighters and rescue personnel gathered at the entrance to the Sasago tunnel, west of Tokyo.

Three vehicles appear to have been crushed under concrete that fell from the ceiling of the three-mile Sasago Tunnel near the city of Otsuki in Yamanashi Prefecture, about 50 miles west of Tokyo, the national government’s disaster management agency said. Agency and police officials said it remained unclear why the 150- to 200-foot section of eight-inch-thick concrete, weighing about 180 tons, suddenly fell.

A vehicle carrying six people caught fire, emitting heavy smoke that initially prevented firefighters from entering the tunnel. But even after putting out the blaze, rescuers had to temporarily suspend efforts to reach the trapped vehicles because of the danger of a further collapse, officials said.

They said rescue efforts resumed later in the day, though progress was slow because firefighters were still moving carefully.

Officials said a 28-year-old woman managed to flee from the vehicle that caught fire. She told firefighters that five other people remained trapped in her vehicle. It was unknown how many people were in the other vehicles besides the drivers, who were apparently also still trapped inside.

One of the other vehicles appeared to be a truck belonging to a food wholesaler, officials said. They said the driver called his company right after the accident to ask for help, but subsequent attempts to reach him by his cellphone failed.

The operator of the highway, Central Nippon Expressway, held a news conference to apologize for the accident. The police said they had opened an investigation into the cause of the collapse and whether professional negligence by the operator was a factor.

The accident closed a section of the Chuo Expressway, a vital transportation artery connecting Tokyo to western Japan. Such long tunnels — usually lined with smooth, white concrete — are a common sight on highways in this mountainous island nation.

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Katzenberg, Spielberg attend Governors Awards

LOS ANGELES (AP) — Tom Hanks. Quincy Jones. Kristen Stewart. Warren Beatty. Quentin Tarantino. George Lucas. Steven Spielberg. Kirk Douglas. Amy Adams. Richard Gere.

These and other famous folks came to the film academy's Governors Awards Saturday to honor filmmakers whose names may not be as well known, but whose contributions to the industry have affected movie-lovers everywhere.

Documentarian D.A. Pennebaker helped make the medium mainstream with his direct-cinema approach. George Stevens, Jr., founded the American Film Institute and established the Kennedy Center Honors. Hal Needham developed new ways of performing and directing death-defying movie stunts. DreamWorks Animation chief Jeffrey Katzenberg raised hundreds of millions of dollars for charity.

Octogenarians Pennebaker, Stevens and Needham received honorary Oscars for their distinguished careers and Katzenberg was recognized with the Jean Hersholt Humanitarian Award at the Academy of Motion Picture Arts and Sciences' Governors Awards ceremony, held at the Ray Dolby Ballroom at Hollywood and Highland Center.

The film academy has long awarded honorary Oscars, but established a new tradition four years ago of presenting those statuettes at a private dinner party where there are no time limits on speeches. Portions of the untelevised event may be included in the Feb. 24 Academy Awards telecast.

Stars mingled in the ballroom and dined on filet mignon and banana cream pie before academy president Hawk Koch urged them to "finish the deals, make the deals" so the program could begin.

Each honoree was introduced by a pair of stars and a short film of their work.

Michael Moore and Sen. Al Franken introduced Pennebaker. Moore called him an inspiration and the inventor of the modern documentary. Pennebaker ditched the tripod and carried his camera on his shoulder, and "all filmmaking changed," Moore said, "nonfiction and fiction."

The 87-year-old Pennebaker seemed to thank every colleague from his six-decade career during a nearly 20-minute speech that prompted his family to signal him to finish and inspired a joke from Will Smith later in the evening.

"Before I get started, D.A. Pennebaker has a couple more people he wanted to thank," Smith cracked.

Sidney Poitier and Annette Bening introduced Stevens, speaking of his commitment to honoring, preserving and furthering the art of film. In accepting his Oscar, Stevens thanked his late father for encouraging him to consider film a timeless art and "for opening the door for me to a creative life."

Needham "pushed the boundaries of what could be done in action," Tarantino said as he introduced the stuntman and director, adding, "I've ripped off many shots from you."

Al Ruddy, Oscar-winning producer of "The Godfather," described Needham as "one of the good guys" and "a gift to any producer." Ruddy told a story about making 1982's "Megaforce," which Needham directed. The stuntman helped design a rocket for the film's action sequences, and when brought it to the Goldwyn lot to demonstrate it, he accidentally launched it into a new soundstage and burnt the whole thing down. Later, while filming another stunt, Needham crashed a motorcycle and got a concussion, but he was back on set shooting the next morning.

The 81-year-old Needham called himself "the luckiest man alive": He grew up a sharecropper's son with eight years' education and went on to work with Billy Wilder, Jimmy Stewart and John Wayne. Now he's getting an Academy Award.

"My mom's looking down on tonight with a big smile on her face," he said, choking up and dabbing at his eyes with a handkerchief.

He closed by thanking "the entire Hollywood community for allowing me to be a part of it."

Tom Hanks and Will Smith introduced Katzenberg by joking about his persistent calls for charitable donations. The DreamWorks executive has raised more than $230 million as chairman of the Motion Picture and Television Fund foundation.

"Jeffrey has no problem asking for way too much money," Smith said.

"Mostly, all I did was pick up the phone and ask you," Katzenberg said as he accepted his award. "It's you who did it. You who gave of your time, your talent, your money, your hearts. Because that's what you do. That is what Hollywood does."

___

AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

___

Online:

www.oscars.org

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Opinion: A Health Insurance Detective Story

I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?

After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?

The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.

Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.

But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?

A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.

Here’s a snapshot of my surreal experience:

NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.

Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”

I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.

NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.

NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.

My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.

NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.

Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.

But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.

NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.

CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.

NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.

Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.

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John McAfee Plays Hide-and-Seek in Belize

Photo Illustration by The New York Times

John McAfee, right, a pioneer in computer security who lives in Belize, is a “person of interest” in the murder of his neighbor. More Photos »

DANIEL GUERRERO promised during his campaign for mayor here to clean up San Pedro, the only town on this island, a 20-minute puddle jump from the mainland. But if he ever runs for re-election, don’t expect him to mention that vow.

“I meant clean up the trash, the traffic, that sort of thing,” he says. “I didn’t mean this.”

“This” is a full-blown international media frenzy and the kind of mess that no politician could have seen coming. It started on Nov. 11, the morning that Gregory Faull, a 52-year-old American, was found dead, lying face up in a pool of blood in his home. He had been shot in the head. His laptop and iPhone were missing. A 9-millimeter shell was found nearby.

What happened next turned this from a local crime story to worldwide news: The police announced that a “person of interest” in the investigation was a neighbor, John McAfee, a Silicon Valley legend who years ago earned millions from the computer virus-fighting software company that still bears his name.

A priapic 67-year-old, with an improbable mop of blond-highlighted hair and a rotating group of young girlfriends, Mr. McAfee quickly melted into the island’s lush green forest. Then, for Belizean authorities, the real embarrassment began.

Asserting his innocence, Mr. McAfee became a multiplatform cyberdissident, with a Twitter account, and a blog at whoismcafee.com with audio links, a comments section, photographs and a stream of invective against the government and the police of Belize. He has done interviews on podcasts, like the “Joe Rogan Experience,” and offered a $25,000 reward for information leading to the arrest of “the person or persons” who killed Mr. Faull. He has turned lamming it into a kind of high-tech performance art.

“I am asking all people of conscience to read this blog, especially the links in the ‘Background’ section,’ and see the ugly truth unfolding here,” he posted on Nov. 18. “Speak out. Write your congressmen. Write the prime minister. Do what you can.”

Before he went underground, Mr. McAfee led a noisy, opulent and increasingly stressful life here. He was known for the retinue of prostitutes who he says moved in and out of his house, and for employing armed guards, some of whom stood watch on the beach abutting his house. He also kept a pack of untethered dogs on his property who barked at and sometimes bit passers-by.

Two days before the murder, someone had poisoned a handful of those dogs. As it happens, Mr. Faull had complained about the animals, as well as the guards and the constant late-night inflow and outflow of taxis on the dirt path that runs behind his and Mr. McAfee’s homes — a path so tiny that it’s supposed to be off-limits to cars.

Mr. Faull had shown up at the town council office a few weeks ago with a letter decrying the din and the dogs, as well as Mr. McAfee’s guns and behavior. Nothing came of it.

“We were planning to meet with John McAfee and hand him the letter,” Mr. Guerrero said. “But it never happened. We were busy doing other work.”

In hindsight, that looks like a blunder. Mr. McAfee has since said on his blog that he had no choice but to flee because police and politicians in Belize are corrupt and eager to kill him. As proof, he has written at length about a late April raid that the country’s Gang Suppression Unit conducted at a property of his on the mainland, in a district called Orange Walk.

Some McAfee watchers have a different theory — namely, that he grew paranoid and perhaps psychotic after months of experimenting with and consuming MDPV, a psychoactive drug. These experiments were described in detail by Mr. McAfee himself, under the pseudonym “Stuffmonger” in a forum on Bluelight, a Web site popular with drug hobbyists.

So, here’s one hypothesis: Rich man doses himself to madness while seeking sexual bliss through pharmacology. Then shoots neighbor in a rage. Case closed, right? Ah, but those Bluelight posts were a ruse, Mr. McAfee would later blog, just one of the many pranks he has perpetrated over the years — part of a bet with a friend to see if he could create Bluelight’s largest-ever thread.

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