#Dwarfs Versus Lion

[thesplintering]

Crowdfunding Review: "Dwarfs Versus Lion" (Bryan Butvidas, Juanito Sanabria)

Crowdfunding Review: "Dwarfs Versus Lion" (Bryan Butvidas, Juanito Sanabria) | #comics #scifi #indiecomics #comedy #comicbooks

Who do you think would win between 50 diesel-powered dwarfs and one monster lion? Would you be #TeamDwarf or #TeamLion? This campaign (and comic book) by Airith Saga creator, Brian Butvidas aims to answer that question. This premise is based on a bar room discussion, of sorts. Characters, story details and the campaign set-up all derived from a live chat on the Airith YouTube channel, and I just…

[artist-issues]

If you actually hate how Rachel Zegler disrespects the original Snow White and the Seven Dwarfs, do not go see or stream the remake.

If you actually hate how Disney has turned the Lilo & Stitch live-action into a bad statement about race, do not go see or stream it.

If you actually believe that the original The Little Mermaid was perfect and needed no adjustments, and Eric was not a bland prince, do not go see or stream the remake.

If you actually thought that Emma Watson misread and mishandled the role of Belle, who, in the original, was expertly characterized, do not go see or stream the remake.

If you actually believe that the Genie wanted to be free, and Aladdin learned to trust, and Jasmine taught them both how, while the Live Action version ruined that, do not go see or stream the remake.

If you actually believe that the original Lion King movie was perfect and needed no bland NatGeoWild embellishment, do not go see or stream the remake.

If you actually believe that the Cinderella (2015) movie was a good remake, go out and buy the DVD—and then don’t go see and stream the other remakes.

Don’t do it. They don’t read our tumblr rants or watch our rage reels, but they count how many of us go see the new stuff. And they count our money as it goes into their bank account to fund the next one. And they count the time we spend on their streaming services. Teach them that we have standards, and the standards aren’t spectacle, and you can’t just buy us with soulless puppets of our favorite movies.

When you’re tempted to go hear the soundtrack play and listen to the dialogue you miss, just go watch the original. That’s what you really love.

#NotMyDisney alienated me with these last few movies, so I’m not playing the games anymore. Make movies for me, as if I’m the smart child you raised on good movies, or else I won’t go see them. If you guys want me, I’ll be waiting for the day that the Live Action Remake comes out, and then immediately streaming the original on Disney+.

Let ‘em measure how many seats are filled in their theaters, versus how many streams of the originals are playing on the same day.

[mask131]

Read-list for an "old school D&D" fantasy (plus bonus)

This is a remake of an earlier post of mine, that I decided to update (some additional books were suggested to me, others I found out about later).

This is a reading-list of various literary works that heavily inspired or were heavily used in the creation of the first editons of Dungeons and Dragons - and thus, reading them will allow you to plunge back into what the original D&D was meant to look what/what it tried to emulate.

J.R.R. Tolkien's "The Lord of the Rings" and "The Hobbit". No surprise here, Tolkien's works were the start of modern fantasy and thus the main source of old-school D&D. In fact, D&D was originally created to be just a Lord of the Rings role-playing game - or to be precise a LotR wargame. This was the original intention. Which is why, quite famously, the very first version of D&D included elements such as the hobbits, the mithril and the balrogs. And when the Tolkien Estate pointed out the consequences of what was plagiarism, D&D changed these concepts to... "halflings", "mithral" and "balors". The only Tolkien-element D&D could preserve vaguely unchanged were the orcs, because the Tolkien Estate could not prove Tolkien had invented the term "orc". But even beyond that, D&D's dwarfs and elves and ents (sorry, treants) and wights and rangers all were heavily inspired by Tolkien - the gods of the orcs even use symbols such as an "eye of fire" and a "white hand"...

Poul Anderson's "Three Hearts and Three Lions". Poul Anderson was quite influential on early 20th century fantasy, and this specific book influenced D&D in three ways. On one side, it was one of the two sources for the "Order versus Chaos" conflict of D&D (the other being Moorcock). On the other the D&D trolls were inspired by the Three Hearts and Three Lion trolls. And finally the Paladin class was inspired by Anderson's Holger Carlsen character (the same way the Ranger was Tolkien's Aragorn). [This book also seems to have had some influence over the Fey of D&D?]

Michael Moorcock's "The Elric Saga". With Anderson's work, it was the other main source of the Order vs Chaos, Lawful vs Chaotic division of the D&D game. It also served as the main inspiration behind the D&D Drows, due to the Elric Saga shaping the original image of "Dark Elves" in fantasy, through its Melnibonéan Empire. D&D also originally collected references to the Elric world - creating many variation of Elric's evil magical sword Stormbringer through a variety of cursed soul-drinking weapons.

Robert E. Howard's "Conan the Barbarian". The source of heroic-fantasy the same way Lord of the Rings influenced epic fantasy, the world of Conan was also a huge source of inspiration for D&D - the most obvious reference being the Barbarian class, shaped for those who wanted to play Conan.

Fritz Leiber's "Fafhrd and the Gray Mouser". Originally intended as a parody of the Conan-style heroic fantasy, but promptly becoming a serious and admired work that created its own sub-genre of fantasy (the "sword and sorcery" genre), they also were inspirational for the first editions of D&D. Sometimes it is indirect - the "Thief" or "Rogue" classes were inspired by Leiber's Gray Mouser character - other times it is MUCH more direct. For example, among the numerous pantheons you could choose to use in early D&D, one was the various gods of Newhon and the city of Lankhmar, the universe of Fafhrd and the Gray Mouser. And the fantasy trope of "Thieves' Guild" made famous partially by D&D was originally an invention of Leiber.

Jack Vance's The Dying Earth. This emblematic series of the "science-fantasy" genre offered to D&D its magic system, which is generally known as "vancian magic". It was Jack Vance who had the idea that a wizard had to learn/store spells in their mind, with a limited number of spells they could carry in their brain, and that once cast the spell had to be re-learned or restored. Several spells and items of early D&D were also directly taken from the Dying Earth books - the "prismatic spray" or the "ioun stones".

H.P. Lovecraft's "Cthulhu Mythos". No need to explain how Lovecraft's brand of eldritch horror and alien-fantasy shaped the creatures and deities of early D&D, to the point that early on the deities and monsters of the Cthulhu Mythos were part of the pantheons you could chose to use - listed alongside the Newhon gods of Leiber, or the gods of the Conan universe.

While not fantasy works, the most famous creations of Edgard Rice Burroughs - Tarzan on one hand, and John Carter of Mars on the other, were claImed by Gygax to have been very influential to his creation of D&D.

Another author Gygax mentionned as being a huge influence for D&D was Fletcher Pratt - through his Harold Shea fantasy series, about a main character being carried away in various magical and fantastical worlds very different from each other, in which he has to adapt himself to new settings and learn new rules to avoid dangers and threats... Sounds familiar? The idea of world-travelling might also have been inspired by the science-fiction series by P.J. Farmers' World of Tiers: the rules of travel in D&D between the various planes of reality seem to have been inspired by Farmers' own rules for dimension-travel.

One of the lesser known influences of D&D is the fantasy series "Kothar" by Gardner Fox: Gygax explicitely said that the idea of the "Lich" as a D&D monster came from Fox's Kothar series.

Not a book, but movies: the Sinbad movies of the mid 20th century were influential on early D&D. Various monsters and creatures referenced pictures such as "The 7th Voyage of Sinbad" or "The Golden Voyage of Sinbad".

"The House on the Borderlands" by William Hope Hodgson was explicitely referenced by Gygax's 1979 module "The Keep on the Borderlands", and it might have heavily influenced the original depiction of the D&D orcs as pig-men...

The Shannara series by Terry Brooks has also been pointed out as an influence on D&D - while not on the very first edition, elements of the Shannara world seem to have influenced later ones...

Mind you, this is but a fragment of a much longer list known as the "Appendix N" composed by Gygax, and that lists all the books and pieces of work he took inspiration from when designing D&D. Beyond the most famous works evoked above he also listed:

Poul Anderson's "The High Crusade" and "The Broken Sword"

John Bellairs' "The Face in the Frost"

Leigh Brackett's works

Fredric Browns' works

I evoked before Burrough's Mars series, but Gygax also listed his "Venus series" and his "Pellucidar series".

Lin Carter's "World End" series

L. Sprague de Camp's "Lest Darkness Fall" and "The Fallible Fiend" and "The Carnelian Cube"

August Derleth's continuation of the Cthulhu Mythos.

Lord Dunsany's writings, of course.

Gardner Fox's "Kyrik" series

Sterling Lanier's "Hiero's Journey"

A. Merritt's "Creep, Shadow, Creep", "Moon Pool" and "Dwellers in the Mirage"

Michael Moorcock's "Hawkmoon" series (which is technically part of the wider universe of which the Elric Saga is the central piece)

Andre Norton's works

Fletcher Pratt's "Blue Star"

Fred Saberhagen's "Changeling Earth"

Margaret St. Clair "The Shadow People" and "Sign of the Labrys"

Stanley Weinbaum's works

Manley Wade Wellman's works

Jack Williamson's works

Roger Zelazny's "Amber" series, and "Jack of Shadows".

In 2007, Gygax even updated his Appendix N with a handful of new titles reflecting elements added to later editions of D&D:

Sterling Lanier's "The Unforsaken hiero"

Piers Anthony's "Split Infinity" series

And of course, Terry Pratchett's Discworld series

And since this post is all about updates, I will also include a list of works that were used as inspiration for current day/modern D&D - especially the fifth edition. Like that, you'll have the evolution of "old school D&D versus new school D&D". This list is taken from fragments here and there of interviews given by Mike Mearls, the Appendix E "Inspirational Reads" of the fifth edition, and Rodney Thompson's interviews.

Appendix E replaces several elements Gygax talked about in interviews or in his Appendix N: Leiber's work, Burroughs's Mars series, Howard's Conan, etc...

Appendix E adds among other things China Mieville's "Perdido Street Station", and Elizabeth Bear's "Range of Ghosts".

Mike Mearls said that what inspired him in his design work of modern D&D was Ursula LeGuin's "Earthsea" series, Patrick Rothfuss "The Name of the Wind", Saladin Ahmed "Throne of the Crescent Moon" and Octavia E. Butler's "The Parable of the Sower".

But Mearls also repeated several of the picks already used by Gygax. He invoked again The Elric Saga, and Roger Zelazny's Amber series, and Tolkien's Legendarium of course...

Rodney Thompson rather insisted on returning to the Anderson roots of the D&D fantasy: mostly "Three Heart and Three Lions", but also "The Broken Sword".

[edream93]

You’re a Gryffindor, Hook: Year 2, Part 1

Okay, so I thought I posted already this but then Tumblr ate it? So essentially, here’s part 1 of Year 2 of “You’re a Gryffindor, Hook” . You can also read it on AO3. Enjoy!

She ignored the stares and odd looks she received as she made her way into the stands. It wasn’t a surprise that she stood out with her emerald green robe in a sea of red and gold. 

A snake in the lions’ den, she thought with a roll of her eyes, unconsciously holding herself taller. Honestly, she would have thought they would have gotten used to it by now. 

But this wasn’t the first, nor would it be the last time that Uma Tritaea gained stares. It had become almost a daily nuisance since her first class where she chose her best friend, her closest confidant, over a centuries old house rivalry. Shouldn’t the noble and brave Gryffindors know something or two about loyalty? 

Several older Gryffindors hissed as she passed them by. She hopped smoothly over a purposefully extended leg that happened to be in her path. Uma made a mental note of them. She would get them back with stinging hexes that would have them howling anytime they tried to sit on their behinds. 

Not now though. Too many untrusting eyes watching the Slytherin witch. Now she had to be on her best behavior. After all, there was a reason she was in the stands belonging to the house of lions. 

“Anyone sitting here?” she asked a familiar looking boy. Ben, she thought. From Herbology. He was one of the few Gryffindors that didn’t make Uma want to hex them.

“Yes!” a brunette girl sitting next to him glared at Uma just as Ben said “No,” already making room and genuinely giving a smile that took Uma off guard.

“What Audrey means is, it’s all yours. Promise,” he said, his smile growing impossibly brighter despite his companion’s glare twisting into an offended sneer as Uma gave a nod of thanks, sitting down. Ben opened his mouth, as if to say more but was interrupted by the game’s announcer. 

Diego DeVil, a fourth year Slytherin boy that Uma always saw flirting with anything with legs at their house table - the ghosts included - sat with microphone in hand at the stand where the professors, other school staff, and a few bored looking representatives of the Ministry were congregated. 

“Hello ladies, gents, and non-binary friends to the first match of the season, Gryffindor versus Slytherin!” DeVil smoothly crooned into the ancient looking mic, waiting a moment for the crowd’s enthusiastic screams to die down. “This is surely going to be one for the books, folks! The players are now getting into position as Madame DunBroch steps out onto the field to begin the game!”

What looked like small figures, in red or greens, hovered hundreds of feet above the ground on their brooms as the fiery red haired Gamekeeper and Flight Instructor walked towards the sealed chest in the middle of the field. 

“Which team are you watching for?” Ben startled Uma out of her intense stare of the field just as Madame DunBroch released the bludgers and the snitch, the small gold ball a fleeting speck of glimmer in the air before disappearing. It was a strange question, Uma thought. After all, it was the assumption that if your house was playing, you were cheering for them. 

Uma’s gaze was instantly drawn to the source of an excited crowing that she could still easily pick out despite the loud roar of the crowd as the quaffle was thrown up into the air.

“Not watching for a team,” she said, watching as one of the players in Gryffindor red snatched the quaffle from the air, taking off with surprising speed towards the Slytherin goal post.

Merlin, she hoped that her idiot of a best friend didn’t get himself hurt. Again. (Harriet had a habit of sending both Harry and Uma a howler when Harry got himself in dumb situations.)

Uma found herself sitting up straight and tense, hands fisted in her robes as she watched one of the new Slytherin beaters, a second year named Jay Abanazar, sneak up from behind and club a bludger at the Gryffindor chaser. Uma leaned forward, eyes never leaving the chaser as he quickly spun out of the path of the bludger with fluid ease and scoring in one move.

“Whoa! Looks like the infamous second year Harry Hook is trying to make a statement, scoring the first goal of the game!” DeVil chuckled despite the obvious booing coming from the Slytherin stands. A little bit of tension released from Uma’s shoulders as Harry completely bypassed the few members of his team that attempted to congratulate him. Instead, to Uma’s annoyed amusement, he flew towards the Gryffindor stands, blue eyes on her. 

“Ye see that?!” He grinned, all windswept hair and boyish charm as he leaned forward on his broom to get as close as possible to her. “Uma, did ye see that shot?”

“Harry! The game is still going!” One of his teammates yelled as they zoomed past, chasing one of the Slytherin chasers, a sixth year with long ice blonde hair pulled into a high bun, who now had the quaffle. But Harry didn’t even look back, waiting expectantly for Uma’s response with a wide grin. 

“Yeah, you did good Hook,” Uma allowed herself to smirk as she tried to push him away. “Now go and try to make Jay cry.”

Harry’s grin widened as he grabbed her hand, pressing a soft kiss on the back of it. “Aye aye capt’n!” 

Again, Uma refused to acknowledge the stares directed at her as the Gryffindor chaser zoomed off with surprising speed back into the game. Harry was just being his usual showboat self. It tended to grind on most people’s nerves but Uma found it as normal as the sun rising and setting. 

 The Gryffindors around her jumped to their feet in a deafening roar as Harry intercepted and flew away with the quaffle before the blonde Slytherin chaser could even comprehend that the ball was no longer in her hands. Harry swooped back towards the Slytherin goals, two of the school’s numerous part dwarf cousins who were the Gryffindor beaters flanking him to keep the bludger off him before he scored another point. 

The entire House of Gryffindor cheered wildly, everyone’s focus on the field. One stare though did itch against Uma’s skin enough for her to turn with a glare, hand already reaching for her wand, just in case. 

“Do I have something on my face, Florian?” 

A blush that had nothing to do with the crisp wind filled Ben’s cheeks. “Oh. Uh. No, I was just- nevermind,” he awkwardly turned back to face the game. Uma’s eyes narrowed but sensed no maliciousness from the boy, turning back as well to watch the game. 

Hours later, while Slytherin would be celebrating late into the morning hours thanks to their Seeker finding the snitch before Gryffindor could score any more points, Uma would find herself spending the night in the infirmary (long after Madame Flora had tried to kick her out). She had carefully wedged herself next to Harry on the bed, finishing a letter to Harriet explaining to the older witch how her only brother had yet again wound up in the infirmary again, said wizard next to her, sleeping off the Skele-Gro potion that was repairing his left arm with cringing pops and snaps that Uma bit her bottom lip to ignore. 

After finishing the letter, she was just about to read the section on cecaelias in her book of water-based magical creatures Harry had insisted on buying for her when they had gone school shopping when she felt him shift next to her. He reached out sleepily with his good hand, fingers lightly twisting in her braids like they always did when he wanted to make sure she was close. “Did ye, did ye see me, Uma?” he mumbled, already falling back to sleep as he curled closer to her.

Uma gave him a fond smile, carding her hand through his wild hair. “I saw,” she said, pausing for a moment before leaning over and pressing a quick, feather light kiss on his brow before returning back to her book, ignoring the happy sigh that escaped from her best friends lips or the way that she slowly let her breath match his until they were both asleep. 

[technologyinfosec]

Does Wall Street really want Trump again?

Vermont Senator Bernie Sanders may be surging in the polls ahead of Super Tuesday, but some on Wall Street have made their own conclusions on what November will bring: Four more years of President Donald Trump. Ninety-five per cent of participants in a Deutsche Bank survey of investors, economists and other market participants released earlier this month said Trump, a Republican, was either "extremely likely" or "slightly likely" to win the general election. Those results contrast with some wider recent polls cited on RealClearPolitics, which show any Democrat beating Trump in a presidential contest, although top contenders have a bigger lead. The latest Reuters/Ipsos poll, conducted February 19-25, showed Sanders with a seven percentage-point lead over Trump in a hypothetical general election matchup. The sharp mismatch in expectations could stoke market volatility if Wall Streeters are wrong and a Democrat emerges victorious - especially if that winner is Sanders, whose promises to break up big banks, take on drug companies and essentially abolish private insurance in favour of a single government-run plan have unnerved some investors. Many on Wall Street were unprepared for Trump's win in 2016, which was followed by sharp swings in asset prices. "As an investor, I look at this and say the market's nightmare scenario is that Bernie or Elizabeth Warren wins the election," said Phil Orlando, chief equity market strategist at Federated Investors in New York. "That's not our base case... but it's a concern," he said. Warren's policy proposals, like Sanders', have also jangled nerves on Wall Street. Investors will be looking ahead to this Tuesday, when 14 states will cast ballots and Sanders could build an overwhelming advantage if he captures the lion's share of the available delegates. Those primaries come as the markets are gripped by concerns over the economic fallout from the spreading coronavirus outbreak, with the number of cases beyond China accelerating rapidly. US stocks were extending the week's losses on Friday and were on track for a seventh day in the red after the S&P 500 on Thursday confirmed its fastest correction in history. Orlando said Sanders' rise in the polls also contributed to the recent sell-off. Some investors noted that continued volatility in markets or an economic downturn could wear away at Trump's support. While the market gyrations are likely to drown out some of the potential impact from next week's voting results, some corners are already feeling the effects of Sanders' recent success. After Sanders' commanding victory in the Nevada caucuses in February, shares of insurers such as UnitedHealth Group and Centene sold off on what some analysts said were concerns over the potential of a Sanders nomination. "If Bernie runs the table and suddenly he becomes unstoppable, I think we're going to see the jitters again," said Teresa McRoberts, a portfolio manager focused on healthcare at Fred Alger Management in New York. The effects on the broader market of a big Sanders win on Tuesday are less clear. Only 13 per cnet of participants in Deutsche Bank's poll believed Sanders could beat Trump in the general election, compared with 22 per cent for former vice-president Joe Biden and 45 per cent for former New York mayor Michael Bloomberg. Gary Bradshaw, portfolio manager at Hodges Capital Management in Dallas, Texas, has kept most of his attention on the coronavirus outbreak in recent days and is not eager to make any election-related portfolio moves yet. "I think most of my clients pretty much are like me, thinking Trump is going win," he said. Still, some investors believe the election can fuel market swings this year. Volume on the October futures contract for the Cboe Volatility Index hit 16,247 between Jan. 2 and February 21, according to Cboe Global Markets. That dwarfs the 471 contracts that traded in 2016 from Jan. 4 to Feb. 19. VIX futures reflect expectations for volatility in the month following their expiration. On Thursday, October VIX futures traded at 22.5, versus 19.57 for September futures and 20.22 for November futures, indicating heightened expectations for volatility near election day. Cboe Global Markets listed October VIX futures a month earlier than usual in response to customers eager to place bets on election-induced volatility, said Kevin Davitt, senior instructor at the exchange's options institute. The exchange also listed September and November futures ahead of their usual schedule. Bill Northey, senior investment director at US Bank Wealth Management, said the election will become a greater concern for investors once the Democratic party selects its nominee. "There are a number of places where the policy divides are incredibly wide," he said. Read the full article

[masaru2042]

Okay, well, I decided t do my won sort of version of Senegos, the eldest blue dragon in the world, as basically Malygos is dead.  I'm not certain if Senegos is older than Malygos, but I suspect that he is in some ways.  

In my story, he's a bit older than Malygos.  When I found out that we had this ancient blue dragon still living, I had to figure out a way to bring him into my stories as a window to the past of what the dragon culture and civilization used to look like.

However, I've taken some artistic liberties with his design than what is shown in the game.  Much like I've done some artistic liberties with Malygos or Neltharion to show that they are a bit different in my stories versus, canon, Senegos follows a similar theme.

And as you ca tell, he's a bit hairier.  And there was a reason for this.

In the latest chapter, Senegos is described as this rather massive blue dragon, who dwarfed all the other dragons, including Kalecgos...who's size had grown since his Aspect upgrade.  But Kalec can't reach Senegos' size, Aspect powers be damned.

However, his size is only matched by Malygos, who is a ghost in the story (for now), and Malygos is much larger than Senegos.  Because Malygos was built to be the Aspect of Magic and Kalecgos only received an upgrade.

Senegos is described as a lion among cubs, so his mane and beard merge into what looks like a lion's mane.

And the reason why he looks like this is because this Senegos is not dying.  He is not reaching the end of his life, he's not slowly wasting away like the canon Senegos in Warcraft: Legion.  He still looks like he is in his prime, his age merely marked by his much larger size and the energy he radiates.

He's immortal, like all the other dragons.  So, he's not dying like he is in the games.

You see, in Tectonic Divergence, the Aspects never lost their powers.  They remain Aspects.  Hell the only actual depowered Aspect that will appear is Malygos...when we raise him.  He will be the first and only Aspect to not have his powers.  However, he won't be mortal.  He will still have the immortality that an Aspect has.  Just not the power.

But yeah, the Aspects still have their powers, and are able to breed.  And Senegos isn't dying.  So, he looks healthier, a lot healthier.  He won't have any tattered wings, he won't look so feeble as he does in the game.

And that's why he has a fuller mane.  It's because it's a sign of his immortal "youthful" vitality.

But enjoy.

I kept a lot of other features of Senegos, including his horns.  And he may play a larger part in my stories later on, especially when Malygos is raised.  He would be one of those who support Neltharion's choice to rezz Malygos, and will protect Malygos from people like Alexstrasza or anyone else who might have a bone to pick with Malygos.

And yes, Senegos’ granddaughter, Stellagosa, will also appear in later stories.

[daebakinc]

We Make the Kingdom - Pt.2

Image by silverdagger865

Pairing: Yongguk x OC Genre: Fantasy, with Angst and Smut to come Summary:  After a vampire attack leaves you almost dead, you are rescued by a group of werelions, powers long thought to be extinct. Upon discovering the same magic flows in your blood, you join their fight against encroaching vampires and another, very human monster, to save the kingdom. Previous parts:  1, 2, 3, 4, 5, 6, 7 ,  8, 9(M), 10, 11, 12, 13, 14, 15, 16(M), 17, 18,  Final

Sunlight is a gift people fail to appreciate. To have your world lit and colored by it. To have it steep sleepy warmth in your skin. To remind you a new day is here for you to live. You will never take any of it for granted again. You survived. You savor the bright scarlet the sun paints your closed eyelids. It banishes the darkness of the night to the recesses of your consciousness. Just a minute longer, you promise yourself.

You roll over. Your fingers that hang over the edge of the bed brush course hair. Idly, you reach deeper to soft fur and scratch. Instead of a dog's happy yawn, a deep moan of contentment vibrates your entire arm.

Eyes snapping open, you glance over the edge of the bed. A long feline body with a coat of burnt sienna fur stretches longer than the bed, its tail curled around the bedpost. Your hand is still buried in a long black mane. When you hurriedly snatch it back to you, the lion's head turns up.

Gold eyes look up in a pleasured haze. They question why you stopped. You stay still with wonder and only the slightest twinge of fear. Though the lion appears anything but wild and his eyes hold more than animal intelligence, its power is unquestionable. Muscle twitches just below the fur so it ripples like a field of grass in the wind. His wide, noble head could easily fill your lap. The questioning look in his eyes slowly fades to contemplation as the lion watches you.

When he stands, you sit up and put your back to the wall. His shoulder comes higher than a horse's, dwarfing you like a child. The lion only gives you one more glance before walking out of the room.

With your feline companion gone, you're free to devote your curiosity to the room. Unadorned stone makes up the four walls. Three narrow windows let in your sunlight. Aside from the bed you sit in, the only other thing in the room is another blanket spread on the floor.

You frown as you remember wrecking the room. A quick look over your body finds only skin peeking through multiple fresh bandages. As if they were a signal, the aches of unseen bruises and cuts makes themselves known with a vengeance. Still, you welcome them. They are another sign that you are alive. It seems you escaped the fate you dreaded by unknown grace. You sigh in relief.

Looking at the door again, you start to wonder about your rescuers. Keeping your thoughts on them versus what they rescued you from is much more appealing. You slide to the edge to the bed even though your muscles protest. The legs of your pants fall past your feet as they hit the floor first. Your clothes are new as well. Ill-fitting and worn, but comfortable, the pants and loose shirt are obviously meant for a man.

“I wouldn't recommend trying to stand alone just yet. You'll probably end up on the floor.” A new man stands in the doorway, not quite in the room. Concern paints a frown on his pleasant face, but he stays cautiously still.

You grab the blanket around you. “Who are you?”

“Youngjae. I don't know if you remember me from last night.” He points to the bandages. “I did those though and I'd like to check them again, if you don't mind.”

“You talked to Yongguk through the door, “ you recall after some thought. You let the blanket fall to your lap, which he takes as permission to approach. As he picks up your arm with a finger to your wrist, you inquire, “Who changed my clothes?”

Youngjae blushes and looks away. “That was me as well. I promise I tried not to compromise your modesty as much as possible. I'm sorry we don't have anything better for you, but we're not …. accustomed to women here.”

“Oh. Are you a doctor?”

“No, but my mother is a hedgewitch and the closest to a doctor our town has. I didn't inherit her magic, but she taught me some things before...,” His voice fades off, a melancholic twist coming to his mouth. You decide not to ask further. With a quiet apology, he begins a thorough examination of your body. His hands are light and professional. “How are you feeling?”

“Like I got thrown from a horse a hundred times. Trampled by it a few times too.” When his fingers graze your collarbone, pain forces a gasp from your mouth.

“That will take more time to recover from, I'm afraid.” Youngjae reaches into a box by the bed you hadn't noticed earlier to take out a jar. He lifts the bandage and spreads a cool salve on the inflamed skin. “Vampire venom can't really hurt us, but it does slow down the healing process. I made this to help-”

You grab his wrist, in no mood to be told stories. The undead, able to turn you into a monster with a single bite, are a myth to scare children on stormy nights. “Vampires? They're made up. I don't know what kind of human monsters attacked me, but they weren't vampires.”

He sighs and gives you a look that strays dangerously close to pity.“I wish you were correct.” Youngjae doesn't try to free his arm. He only pushes the back of your hand onto your shoulder and pulls it back for you to see.

Yellow salve adds a greasy sheen to your skin, but it can't hide the two small round marks of deep red. You stare at the blood.

Blood that dripped from two fangs poised above you. Fangs flashing in a wicked smile as if delighting in the futility of your desperate thrashing beneath a hold as strong as stone. Bitter cold biting into your wrists pinned helplessly. A throaty, melodic laugh amid the dark din of screams and cries and pleas. Right before your throat was torn out.

Warm hands grasp your face. “You're safe. They won't hurt you again. They can't anymore. You're safe.”

Youngjae's face comes back into focus, but your body still trembles with fear and disgust. Magic is as commonplace to you as the sky above, but demons come to life exist only in the forbidden, untouched realms of black magic. Black magic that was said to have purged from the earth long ago. “Vampires,” you whisper. “They're real?”

He nods. “As real as you and me, though according to the rest of the world, we shouldn't either.”

“'We'? What do you mean by 'we'?”

“I think it's best to explain with the others present. I'm sure there we will have as many questions for you as you do us. We'll have to go downstairs for that.” Youngjae replaces the bandage, slips an arm around your back, and puts your arm around his shoulder “Do you think you can stand or do you need me to carry you?”

“I can stand.” You push your body forward and up. Every muscle shrieks to stay still. Gritting your teeth, you straighten your stiff body until you're standing on your own feet. A sheen of sweat covers your forehead from the effort to stay that way.

“Are you sure you-”

“I'm fine,” you snap. You immediately regret it. Youngjae has only been patient. “I'm sorry. I'm fine. It just hurts a little.”

He can obviously tell you're lying, but he lets you have your dignity. “Slow steps then. Your body needs time to catch up with the damage, so don't try to move too quickly.”

Your legs are jelly by the time you reach the door. The sight of the stairs that spiral down beyond your sight almost makes you change your mind on Youngjae's offer. His presence beside you helps you find the determination to go on. Cautious steps, the carved handholds in the wall, and Youngjae's steady hand around your waist keep you from tumbling, but barely.

You reach the ground floor, dizzy from the effort, and enter another large, mostly bare room. Multiple mattresses pushed together, topped with a pile of messed blankets and pillows, dominates the room. Tables piled with books and jars stand squished into the room's far end. Youngjae pauses to let you catch your breath and guides you to yet another door.

Pure honeyed sunlight fills the long, great hall. Tattered tapestries on the high walls whisper of more plentiful times. So too do the long tables and benches turned dark with age that run the length of the hall. At one time, hundreds must have filled those seats with boisterous noise and music.

Now, only muffled murmurs echo and only five seats at the head table are occupied by a group of handsome men. You recognize Yongguk and Daehyun, but the other three are strangers. All five men stand as soon as you shuffle into the room.

“She's alive!” cheers Daehyun. He gives you a wink.

“Of course she's alive. Yongguk already told us. Youngjae, how could you let her walk?” One of the men rushes to you, his voice distantly familiar. He places himself under your other arm and easily matches your pace. “You should have called one of us if you needed help carrying her down. I could've brought her something myself.”

“Don't bite my head off, Himchan. She insisted on coming down herself. I've learned better than to argue with the fairer sex,” Youngjae quips back. “I always lose.”

“You are right,” Himchan chuckles. “Someone pull out a chair for her. The one at the end of the table.”

The shorter, stockier of the other two you don't know hurries to follow the directions.

“Thank you,” you say to him.

He smiles slightly and nods his head.

Your entire body sighs at being released from its own weight as your helpers lower you into the chair. Already exhausted, you allow your eyes to shut for moment.

Someone pushes a warm clay mug into your hand. “Drink up. It will help with the pain and speed up your recovery,” Youngjae says.

You take a wary sip, then a healthy gulp when the flavor proves sweet and flowery. Looking at him, you comment, “It's good.”

“Glad I could surprise you.” He rolls his eyes and sits beside you. “Not all medicine tastes bad, you know.”

“Just most. That's where I come in.” The man who had helped you is already loading a plate with bread, honey, and eggs. The smell alone has you absolutely ravenous. “You won't find anything unappetizing on this table. Daehyun can attest to that.”

Your face jerks away from the food. Scrutinizing his face, you suddenly make the connection to his voice. Your gaze turns on guard. “Himchan. You told Daehyun to kill me.”

“But I didn't. Aren't you glad?” Daehyun butts in, taking the other seat on your other side.

Himchan has the good grace to look ashamed. Although not before smacking Daehyun on the shoulder. He busies himself with peeling, coring, and slicing an apple for you. “I'm very sorry about that. Forgive and forget, no?”

Your stomach is too demanding for you to hold it against him for long. You nod. As soon as he places the full plate in front of you, you eagerly dig in. The rest of the room's inhabitants watch you with unflinching intensity. It's only vaguely disconcerting in the face of your appetite.

Daehyun notices the way your eyes flicker between them. “We should introduce the rest of our band, shouldn't we? I hope you remember me, the one who rescued you, Daehyun. Yongguk's the one I brought you to last night. He's our leader. Boys, give the lady your names?”

The one who got the chair for you inclines his head politely. “Jongup.”

“I'm Junhong.” The tall man looks the youngest of the group, his smile still carrying a boyish charm. “I'm glad you're still alive. Who'd have thought we'd find another one of us on a vampire raid?”

Another use of 'us.' Resolute to not have your question dodged again, you force your piece of bread away from your mouth even as your stomach grumbles. “I don't mean to offend, because I am grateful to you all for saving me, but I don't understand why everyone is saying 'we' and 'us.' I don't know any of you.”

“It's true. You don't.” All eyes look to Yongguk, who's retaken his seat on a throne-like chair. “But you are one of us, as proven last night beyond a doubt.”

“And what exactly does that entail?”

“You are a were. More specifically, a were-lion.” His eyes are level, mouth untainted by a liar's calculating smile. “You, just as all of us here, can turn into a lion at will. A lion that is larger, faster, and stronger than any found in the wild. You have heightened senses in both forms and are impervious to magic. Most importantly, you possess an immunity to vampires.”

You keep your mouth shut as you stare back at Yongguk. Your first reaction is to laugh because weres are another fanciful fairy tale. The look on everyone's face stops you. None of them appear to be joking. But no one has possessed that kind of ability in hundreds if not thousands of years. If anyone did in the first place. If anyone did, it certainly can't be you.

“Every child is tested for magic when they are 7 years old.” You protest, “I have no magic. Not even a drop. If I did, the royal examiners would have found it, wouldn't they?”

“I doubt it,” Himchan interjects. “Were-magic appears much later than most. From what we've read, weres don't show signs of their magic until after the age of 13.”

“I'm much older than 13,” you point out. Eyes glancing between the others, you add, “And I've never changed into a lion.”

“All of us required an... unpleasant trigger to awaken our powers. Yours did so last night.” Yongguk leans forward, gaze refusing to release yours. “It's what saved you. Think. You became a lioness.”

You look down at your hands, remembering when you thought paws had taken their place. Your fingers pull aside bandages on your arm despite Youngjae's squawks. There are two faint piercing marks on your bicep, already almost healed. You look back at Yongguk, equally awed and miffed. “You bit me. Hard.”

“You bit her?” asks Junhong, his mouth slightly agape.

“To spark her were-blood,” Youngjae explains, patting the man's shoulder. “I proposed that any were-blood she had would respond to an alpha. Thankfully I was right.”

Yongguk spares a small smile towards him before focusing back on you. “I apologize for inflicting more pain on you. I think you will agree it was necessary.”

With a nod, you demonstrate your understanding. You cannot deny your own heart beating. No one receives the bite of a vampire and survives to have such a miracle. The idea of having magic is intoxicating. Goosebumps raise on your arms at the memory of the power, the senses of the lioness. You want to feel that again. “Do you have to bite me again for me to change?”

Yongguk shakes his head, but it's Himchan who answers. “You have to learn to shift forms. After your first transformation, you can only shift through conscious will or when you are in grave danger. Only the first time hurts.”

“So you all can change forms at will?”

Junhong stands and pushes away from the table with a smirk. “Watch.”

He circles the table. With a flourish, he bows before crouching. He springs up and spins in a blur. His shape changes in the blink of an eye and in front of you stands a lion as large as the one in your room. His fur and mane are lighter, pale butter yellow and caramel brown. Yet his eyes are the same bright gold.

They contain a smug pride as he pads over to your seat. He nudges aside Daehyun to rub his great head against your arm. Sunshine and grass fill your nose as he bumps harder. You try to hide your grimace and give his nose an appreciative scratch, but Youngjae's sharp eyes miss nothing.

He reaches over you to swat at Junhong's ear. “Be careful, her wounds are still fresh.”

A second later human Junhong is standing beside you, an apologetic hand hovering over your shoulder. “I'm so sorry. Are you alright?”

“I'm fine,” you assure him. “Some parts of me are just more tender than others.”

“You'll feel more than fine in a few days.” Daehyun pokes his head around Junhong's arm. “We heal very quickly. Yongguk broke his arm last week and it's as good as new now.”

“But that doesn't mean he should be shifting just yet.” Himchan gives Yongguk a well-meaning glare. “I heard Youngjae tell you not to put the strain on your bones for a few more days. I was surprised you listened and didn't come with us on the patrol, but I guess I shouldn't be surprised you couldn't completely resist.”

“It was necessary to keep her from harming herself or me.” Yongguk sends another smile his friend's way. “My arm is fine, Himchan.”

“Yeah, our peerless leader will run with us again soon.” Daehyun steals a slice of your apple and smiles.

Yongguk nods, bringing the eager expressions of hunters from your companions.“Very soon. Are you finished eating?”

Himchan answers for you. “No.” He pushes your plate closer. “You'll need it, trust me.”

Curiosity sated for the moment in the face of hunger, you need little more encouragement. Under watchful eyes, the food and tea disappear as fast as they can be replaced.

When you're only nibbling at your bread, stomach finally full, Yongguk clears his throat.

“I know this may be unpleasant,” he says, sympathy adding a gentle layer to his deep voice, “but we need to know anything you remember about the attack on your village. This is the furthest south the vampires have ever struck and they have never stayed in one place for more than a night. We need to know why and you may have some answers for us.”

You slowly put the bread down. The urge to spit out what's in your mouth is hard to resist. Its taste is now like ash and heavy on your tongue. You force yourself to swallow, and lower your hands into your lap. Then to remember. It's a struggle to pull anything from the murky and battered memory of that night. It seems both long ago and just over.

Your words are halting as you try to string together the fragments of that night. “I don't remember much... it was too quick... They struck just after dusk. I was outside. I don't know how many there were, but I didn't have a chance. There was just screaming and blood. Lots of blood.” The inhuman, cruel laugh rings in your ears and the shadow of an image with red eyes arises from the dark. “And... a woman.”

Yongguk frowns, his thumb starting to rub his chin.“A woman?”

“Yes. She watched.” You shiver. The woman's face is foggy in your memory, but her horrific aura looms like an impending storm. It slithers through your mind, chilling your soul. “She enjoyed it. Every bit of it. Like it was a show put on just for her pleasure.”

“What did she look like?”

“Like something death itself would fear,” you reply without hesitation. If vampires are evil incarnate, she is their queen. “I don't remember any details, but she was beautiful, terrible.”

The men share a long look. Their faces darken. In front of your eyes, they change from ordinary young men to men prematurely aged by horrible battles. The fleeing of innocence and easy camaraderie takes the heat the sun had lent you.

“Could they have a new leader?” Daehyun asks quietly. All signs of his earlier teasing nature have vanished beneath a mask of grimness. “We've only been dealing with stray loners, groups of three or four at the most. Last night we killed ten.”

“A leader would explain their new methods of attacks,” Youngjae says. “But who is she? Where did she come from? And why or how did she gain that kind of power?”

“We should talk to the wolves, see if they've noticed anything,” Junhong suggests. His jaw tightens as he adds, “We need to ask them how so many vampires got past them.”

“They're spread thin, but I agree. A visit is in order soon.” Yongguk glances over at you. His expression softens and he reaches over to place a hand lightly over yours. “I think you should rest some more. I do have more questions for you, but I think this is enough for today. You can stay in the den from now on. No stairs.”

Although your brain is busy clamoring with all the new information you heard, your body has other ideas. Exhaustion is winding its way back around your mind, slowly trying to lull it to slumber. “Thank you. I think I will.”

“Wait.” Jongup pauses when the other men look at him expectantly. “We still haven't asked her an important question.”

“And what question is that?” Yongguk asks.

Jongup turns to you. “What's your name?”

The others' dumbfounded looks are almost comical enough to make you laugh. Your mirth fades when the answer doesn't instinctively fall from your tongue. You rack your mind. Your mouth falls open as you heart tosses between panic and bewilderment.

“I don't know.”

Previous Chapter, Next Chapter

Kingdom Map, The Keep Map, Weres scale, Were Guide

[isaacscrawford]

A Billion Here, A Billion There: Selectively Disclosing Actual Generic Drug Prices Would Save Real Money

Brand and generic prescription drugs dispensed by retail pharmacies cost nearly $400 billion and accounted for more than 10 percent of health care spending in 2016. Despite totaling more than $100 billion, reimbursement for generic drugs has received relatively little policy attention. The combination of a complex distribution system and limited information about actual prices artificially inflates what patients and insurers pay retail pharmacies for generic drugs. A recent study by the Washington State Office of the Insurance Commissioner confirms that retail pharmacies profit more when dispensing generic versus brand drugs.

Opportunities exist to lower spending on generic drugs—and reduce total health care spending. After summarizing key trends and factors in the generic drug market, this post outlines a proposal to selectively disclose de-identified information on generic ingredient costs, which would enable health plans to negotiate reduced reimbursements to retail pharmacies for generic drugs.

The high prices for many brand drugs have understandably dominated public policy discussions: In the case of certain chronic conditions or life-threatening diseases, expensive drug therapies can cost tens or even hundreds of thousands of dollars per patient. Patients purchase almost $300 billion of brand drugs annually from retail pharmacies, where a brand prescription averages $714 (Note 1). Brand drugs account for 73 percent of retail drug spending, despite comprising only 11 percent of prescriptions.

In contrast, generic drugs average about $18 per prescription and constitute low-cost remedies familiar to and accepted by most Americans. Generics currently account for 89 percent of all retail prescriptions and 49 out of 50 prescriptions where generic products exist as substitutes for brand-name drugs. Yet, because retail pharmacies annually dispense four billion generic prescriptions, 11 million every day, spending on generic drugs accounts for 2.7 percent of total health spending.

While dwarfed by spending on brand drugs, generic drugs are undeniably big business. Given their enormous volume, small price reductions would generate significant savings. However, what patients and insurers pay for generic drugs has generally avoided careful scrutiny, other than relatively infrequent cases involving sharp price spikes.

Competition Makes Generic Drugs Low-Cost Commodities

Generic drugs have earned a reputation as the inexpensive therapeutic option, a perception reinforced by health plan formularies, which have patients pay $5.54 on average in cost sharing, leaving the insurer to pay an average of $12.38. When presented with a prescription for a multisource (that is, generic) drug, pharmacists (or their purchasing agents)—not physicians or other licensed prescribers—decide which product to buy, choosing from among competing manufacturers. Pharmacists can choose the product because the Food and Drug Administration has certified the competing generics as “therapeutically equivalent” to the innovator (brand) drug, meaning they are equally effective and essentially identical.

Competition transforms generic drugs into low-margin commodities when multiple manufacturers produce the same drug. In most cases, little room exists to further squeeze the net (or actual) amounts paid for generic ingredients because retail pharmacies—after including all discounts and rebates—pay manufacturers close to their production costs. Low profit margins for generic manufacturers make lowering net generic ingredient costs an unlikely source for achieving significant savings.

Pharmacy Payments To Manufacturers For Ingredients Equal Minor Part Of Generic Reimbursement

However, the actual cost pharmacies pay manufacturers to purchase ingredients constitutes a small fraction of what pharmacies are reimbursed, from both health plans and patients, for generic drugs. Unlike the situation with high-cost, brand drugs, the low cost of generic ingredients means pharmacies retain the lion’s share of the average reimbursement for a generic prescription. (Pharmacy retention equals the difference between reimbursement and ingredient costs; pharmacy profits equal retention minus the costs associated with dispensing a drug.) Because pharmacies, not generic manufacturers, are “where the money is,” the opportunity for savings comes from reducing reimbursement to pharmacies for generic drugs. In the case of generic drugs, potential savings could exceed 10 percent—or $10 billion annually.

The ingredient costs actually paid by pharmacies for generic drugs reflect steep discounts from published prices. Unlike brand drugs, where ingredient costs paid by pharmacies track closely to published prices (wholesale acquisition cost or WAC), actual generic ingredient costs average 30 percent of WAC. However, the overall discount of WAC minus 70 percent varies significantly by product and pharmacy.

Pharmacies, manufacturers, and pharmacy benefit managers (PBMs) regard actual ingredient costs as confidential trade secrets. As a result, health plans typically critically rely on PBMs to design and administer their drug benefit, including establishing formularies, setting beneficiary cost sharing, and negotiating price concessions (rebates) with brand manufacturers. Additionally, PBMs establish a plan’s network of participating pharmacies and set reimbursement to pharmacies. However, unlike brand rebates, the rebates from generic manufacturers bypass both PBMs and health plans, flowing instead to pharmacies.

Pharmacies and PBMs have first-hand information on actual generic ingredient costs, net of all price concessions. In contrast, health plans commonly lack accurate information on actual average generic prices paid by pharmacies. In theory, PBMs use their knowledge of actual generic prices to establish efficient prices when reimbursing pharmacies. In practice, PBMs have a conflict of interest: Lowering reimbursement to “brick and mortar” pharmacies would also lower reimbursement to the large mail-order pharmacies they operate. In other words, lowering generic drug reimbursement would lower PBM profitability. Being both a “price setter” and a “price taker” explains part of why PBMs continue to pay pharmacies overly generous generic reimbursements.

Health Plans Encouraged Generic Dispensing By Overpaying Pharmacies

Setting reimbursement so that pharmacy retention for generic drugs exceeds brand retention incentivizes pharmacies to substitute generic for brand products. Before generic dispensing became ubiquitous, generously paying pharmacies to increase generic use created a “win-win”: Pharmacies made more money, and health plans paid less (because generic ingredients cost markedly less than brand ingredients). But the figure for generic prescriptions as a share of total dispensed prescriptions (generic dispensing) reached 89.0 percent in 2016, having risen from 17.3 percent in 1980, to 32.0 percent in 1990, to 43.0 percent in 1997, to 63.5 percent in 2009. The current high rate of generic dispensing reflects the elimination of beneficiary skepticism about generics, which had been fostered by brand manufacturer activities designed to protect their market share (counter-detailing), as well as the elimination of related concerns about the quality of “cheap” products. Health plans have played a key role promoting generics, both by rewarding pharmacists for dispensing generics and widely adopting benefit designs (three-tier formularies) that charge beneficiaries sharply lower cost sharing for generic drugs.

Significant Changes In The Retail Pharmacy Market

In addition, over the past decade, three important trends have roiled the pharmacy market and provided health plans with new tools to promote generic dispensing and lower pharmacy retention. First, Medicare Part D set explicit “geo access” standards, providing an objective basis for determining the adequacy of pharmacy networks. Second, narrow networks of “preferred” pharmacies have become common, replacing broadly inclusive networks. Third, following the lead of Walmart, big-box and grocery stores, along with some drug store chains, have widely adopted the practice of offering many common generic drugs for a total reimbursement of “$4 per prescription”; this has undermined claims by pharmacies that the estimated cost—and minimum pharmacy retention necessary—to dispense a drug is $11.

The combination of increased pharmacy competition and extraordinarily high generic usage has changed the retail pharmacy market, providing health plans with the ability to negotiate lower reimbursement. Paying pharmacies more to dispense generics may have outlived its usefulness, given that generic drugs account for nine out of every 10 prescriptions and 97.6 percent of prescriptions where there is a choice between brand and generic products. For areas of the country that contain the overwhelming majority of the population, health plans could selectively contract with a subset of competing pharmacies, using the economic pressure of excluding pharmacies from narrow networks to lower pharmacy retention.

Why High Pharmacy Reimbursement Persists For Generic Drugs

In addition to beneficiaries’ desire for convenience and the political power of independent pharmacists, three important factors help explain why pharmacy reimbursement for generic drugs nevertheless remains high. First, for many health plans, lowering generic reimbursement is not a priority, given the low per-prescription cost and the cost pressures generated by other services. Second, health plans frequently do not know the “net” prices pharmacies pay for generic drugs, which are both very complicated and not public. The low priority health plans assign to lowering generic reimbursement may in part reflect their lack of awareness of pharmacy retention for generic drugs.

Third, as noted, PBMs wear multiple hats in the generic distribution chain, creating an information asymmetry and a conflict of interest. PBMs almost certainly play a key role in keeping pharmacy reimbursement high. Their role as mail-order pharmacy operators not only gives PBMs detailed knowledge of actual (net) generic ingredient costs, but they also receive revenues from generic drug manufacturers’ rebates. PBMs thus have a conflict of interest based on their dual roles as the agents of health plans in setting pharmacy reimbursement and the operators of pharmacies of their own.

Collecting And Selectively Disclosing Actual Average Generic Ingredient Costs

After analyzing the generic drug distribution market, a Brookings paper presented earlier this summer proposed a policy of selective disclosure to health plans of actual average generic acquisition costs. Building on the requirement that they must be licensed, all drug wholesalers would have to report weekly to the Centers for Medicare and Medicaid Services (CMS) the average net generic drug price reflective of all rebates for each 11-digit national drug code in a standard, electronic manner. Using the collected and securely stored data, CMS would calculate actual average acquisition costs, which would be reported to participating health plans that agreed to strict confidentiality.

CMS would have broad flexibility to tailor reported price transparency to product-specific circumstances (for example, the number of competing manufacturers) and would assure that reported averages could not have the prices associated with specific manufacturers, wholesalers, or pharmacies be re-identified. These provisions are intended to minimize the concerns of antitrust authorities about the potential for price transparency to facilitate price collusion. User fees charged to participating health plans would defray CMS costs of securely communicating the data on a biweekly basis.

Summing Up

Providing health plans with actual average generic ingredient costs would rebalance the current information asymmetry between most health plans and PBMs. Knowing actual average generic costs would highlight the level of pharmacy retention and enable health plans to better understand the economic consequences of the pharmacy reimbursement terms negotiated on their behalf by PBMs. Given the volume of generic drugs, their widespread acceptance, health plan benefit designs, changes in the pharmacy market, and the conflicting roles of PBMs, making available average generic ingredient costs could motivate health plans to reduce reimbursement for four billion generic prescriptions.

Reducing generic reimbursement by $1 per prescription—5.6 percent—would lower health spending by $5.6 billion annually. If health plans have access to accurate data on generic ingredient costs and are willing to aggressively implement narrow pharmacy networks, our assessment of the pharmacy market suggests that the resulting vigorous competition could cause current generic drug costs paid by plans and beneficiaries to fall by 10 percent.

Note 1

We use 2016 quintiles IMS Health data on generic share of total invoice spending, volume of generic prescriptions, and estimates of net price relative to invoice pricing to calculate the average costs of brand and generic prescriptions.

Author’s Note

Steven Lieberman consults for the Pharmaceutical Research and Manufacturers of America (PhRMA) and other clients on policy issues related to Congressional Budget Office scoring and the budget. PhRMA represents brand drug manufacturers but not generic drug manufacturers.

Article source:Health Affairs

[mask131]

Reading-list for an “old-school D&D” fantasy

Aka, here is the list of the fantasy books that MASSIVELY influenced the original D&D and its first editions. Or, if you want to put it another way, the books that were the ingredients to create D&D/that were copied by D&D.

# J.R.R. Tolkien’s “The Lord of the Rings” (+ “The Hobbit”). The source of modern fantasy, and THE main influence and source of old-school D&D. In fact, the creation of D&D was basically the creation of “The Lord of the Rings: The Role-Playing Game”. Very famously (or unfamously), in its original edition, D&D included a LOT of elements taken from the work of Tolkien, that then had to be re-shaped due to being under the copyright of Tolkien’s work. In the first edition D&D you’ll find “hobbits”, “mithril” and “balrogs” for example - that D&D had to change to “halflings”, “mithral” and “balors” to legal reasons. The only Tolkien-specific creatures D&D could keep were the orcs. Overall a LOT of D&D comes from Tolkien: the original depictions of elves and dwarfs, the ents (sorry, treants), the wights, the symbols of the “eye of fire” and “white hand” for the gods the orcs worship... And of course, the “Ranger” class was originally just the character of Aragorn as a class.

# Poul Anderson’s “Three Hearts and Three Lions”. This book was one of the two sources for the alighnment system of D&D of “Order versus Chaos” in a fantasy world. The D&D trolls were also heavily influenced by the depiction of trolls in this novel, PLUS the “Paladin” class was influenced by the character of Holger Carlsen.

# Michael Moorcock’s “The Elric Saga”.The other main source of the “Order vs Chaos”, “Lawful vs Chaotic” alignment of D&D - but also the main inspiration behind the Drow and the D&D-shaped image of “Dark Elves” in general (in the novels, they are the Melnibonéan Empire). D&D also contains several other references to the Saga - for example “Blackrazor” is inspired by Elric’s iconic sword, “Stormbringer”.

# Robert E. Howard’s “Conan the Barbarian”. The source of heroic fantasy the same way Tolkien’s LotR was the source of epic/high fantasy - the Barbarian class of D&D (and the image of a Barbarian in fantasy in general) all comes from Conan. 

# Fritz Leiber’s “Fafhrd and the Gray Mouser”. The origin of the “Sword and Sorcery” genre (at least, as called as such), originally intended as a parody of the Conan-style heroic fantasy genre, but then promptly becoming itself a serious and admired genre-creating classic, Leiber’s works were another major inspiration for D&D (the “Thief” class was heavily inspired by the character of the Gray Mouser), and there is a good number of supplements and books in D&D entirely centered around this book series - introducing the characters of the books, the gods of Newhon, or the city of Lankhmar, into the D&D world. 

# Jack Vance’s “The Dying Earth” series. The magic system of D&D was heavily influenced by how Vance re-imagined magic and spells in this unique sci-fi feeling fantasy: some spells and items are directly taken from the books (the prismatic spray, the ioun stones) and the entire concept of needing to “re-learn” or “re-charge” a spell once it is cast is the Dying Earth magic system (called by some “Vancian Magic”). 

# H.P. Lovecraft’s work (especially anything tied to the “Cthulhu Mythos”). Lovecraft’s brand of eldritch horror and alien fantasy has also been a big influence over the creatures and deities of early D&D - to the point that the various gods of the Cthulhu Mythos were included as one of the pantheons that could be used in the early editions of D&D (alongside other pantheons such as the gods of Newhon from Fafhrd and the Gray Mouser, or the gods of the Conan world). 

# Gary Gygax, one of the creators of D&D, also listed other authors as direct influence for his game, but given I am less familiar with them I will just list them here: Fletcher Pratt (I think it might be his “Harold Shea” series, quite famous in the fantasy genre), L. Sprague de Camp, Edgar Rice Burroughs (the creator of some of the most famous American fictional characters, such as John Carter of Mars, or Tarzan) and A. Merritt. 

(Finally, not a literary work, but a series of movies that also influenced early D&D: the “Sinbad” movies of the mid-20th century. If you look through the creatures, monsters and illustrations of early editions D&D you’ll find several references to movies such as “The 7th Voyage of Sinbad“ or “The Golden Voyage of Sinbad”)