#pbm art | Explore Tumblr posts and blogs

mostlysignssomeportents · 10 months ago

Text

What the fuck is a PBM?

TOMORROW (Sept 24), I'll be speaking IN PERSON at the BOSTON PUBLIC LIBRARY!

Terminal-stage capitalism owes its long senescence to its many defensive mechanisms, and it's only by defeating these that we can put it out of its misery. "The Shield of Boringness" is one of the necrocapitalist's most effective defenses, so it behooves us to attack it head-on.

The Shield of Boringness is Dana Claire's extremely useful term for anything so dull that you simply can't hold any conception of it in your mind for any length of time. In the finance sector, they call this "MEGO," which stands for "My Eyes Glaze Over," a term of art for financial arrangements made so performatively complex that only the most exquisitely melted brain-geniuses can hope to unravel their spaghetti logic. The rest of us are meant to simply heft those thick, dense prospectuses in two hands, shrug, and assume, "a pile of shit this big must have a pony under it."

MEGO and its Shield of Boringness are key to all of terminal-stage capitalism's stupidest scams. Cloaking obvious swindles in a lot of complex language and Byzantine payment schemes can make them seem respectable just long enough for the scammers to relieve you of all your inconvenient cash and assets, though, eventually, you're bound to notice that something is missing.

If you spent the years leading up to the Great Financial Crisis baffled by "CDOs," "synthetic CDOs," "ARMs" and other swindler nonsense, you experienced the Shield of Boringness. If you bet your house and/or your retirement savings on these things, you experienced MEGO. If, after the bubble popped, you finally came to understand that these "exotic financial instruments" were just scams, you experienced Stein's Law ("anything that can't go forever eventually stops"). If today you no longer remember what a CDO is, you are once again experiencing the Shield of Boringness.

As bad as 2008 was, it wasn't even close to the end of terminal stage capitalism. The market has soldiered on, with complex swindles like carbon offset trading, metaverse, cryptocurrency, financialized solar installation, and (of course) AI. In addition to these new swindles, we're still playing the hits, finding new ways to make the worst scams of the 2000s even worse.

That brings me to the American health industry, and the absurdly complex, ridiculously corrupt Pharmacy Benefit Managers (PBMs), a pathology that has only metastasized since 2008.

On at least 20 separate occasions, I have taken it upon myself to figure out how the PBM swindle works, and nevertheless, every time they come up, I have to go back and figure it out again, because PBMs have the most powerful Shield of Boringness out of the whole Monster Manual of terminal-stage capitalism's trash mobs.

PBMs are back in the news because the FTC is now suing the largest of these for their role in ripping off diabetics with sky-high insulin prices. This has kicked off a fresh round of "what the fuck is a PBM, anyway?" explainers of extremely variable quality. Unsurprisingly, the best of these comes from Matt Stoller:

https://www.thebignewsletter.com/p/monopoly-round-up-lina-khan-pharma

Stoller starts by pointing out that Americans have a proud tradition of getting phucked by pharma companies. As far back as the 1950s, Tennessee Senator Estes Kefauver was holding hearings on the scams that pharma companies were using to ensure that Americans paid more for their pills than virtually anyone else in the world.

But since the 2010s, Americans have found themselves paying eye-popping, sky-high, ridiculous drug prices. Eli Lilly's Humolog insulin sold for $21 in 1999; by 2017, the price was $274 – a 1,200% increase! This isn't your grampa's price gouging!

Where do these absurd prices come from? The story starts in the 2000s, when the GW Bush administration encouraged health insurers to create "high deductible" plans, where patients were expected to pay out of pocket for receiving care, until they hit a multi-thousand-dollar threshold, and then their insurance would kick in. Along with "co-pays" and other junk fees, these deductibles were called "cost sharing," and they were sold as a way to prevent the "abuse" of the health care system.

The economists who crafted terminal-stage capitalism's intellectual rationalizations claimed the reason Americans paid so much more for health care than their socialized-medicine using cousins in the rest of the world had nothing to do with the fact that America treats health as a source of profits, while the rest of the world treats health as a human right.

No, the actual root of America's health industry's problems was the moral defects of Americans. Because insured Americans could just go see the doctor whenever they felt like it, they had no incentive to minimize their use of the system. Any time one of these unhinged hypochondriacs got a little sniffle, they could treat themselves to a doctor's visit, enjoying those waiting-room magazines and the pleasure of arranging a sick day with HR, without bearing any of the true costs:

https://pluralistic.net/2021/06/27/the-doctrine-of-moral-hazard/

"Cost sharing" was supposed to create "skin in the game" for every insured American, creating a little pain-point that stung you every time you thought about treating yourself to a luxurious doctor's visit. Now, these payments bit hardest on the poorest workers, because if you're making minimum wage, at $10 co-pay hurts a lot more than it does if you're making six figures. What's more, VPs and the C-suite were offered "gold-plated" plans with low/no deductibles or co-pays, because executives understand the value of a dollar in the way that mere working slobs can't ever hope to comprehend. They can be trusted to only use the doctor when it's truly warranted.

So now you have these high-deductible plans creeping into every workplace. Then along comes Obama and the Affordable Care Act, a compromise that maintains health care as a for-profit enterprise (still not a human right!) but seeks to create universal coverage by requiring every American to buy a plan, requiring insurers to offer plans to every American, and uses public money to subsidize the for-profit health industry to glue it together.

Predictably, the cheapest insurance offered on the Obamacare exchanges – and ultimately, by employers – had sky-high deductibles and co-pays. That way, insurers could pocket a fat public subsidy, offer an "insurance" plan that was cheap enough for even the most marginally employed people to afford, but still offer no coverage until their customers had spent thousands of dollars out-of-pocket in a given year.

That's the background: GWB created high-deductible plans, Obama supercharged them. Keep that in your mind as we go through the MEGO procedures of the PBM sector.

Your insurer has a list of drugs they'll cover, called the "formulary." The formulary also specifies how much the insurance company is willing to pay your pharmacist for these drugs. Creating the formulary and paying pharmacies for dispensing drugs is a lot of tedious work, and insurance outsources this to third parties, called – wait for it – Pharmacy Benefits Managers.

The prices in the formulary the PBM prepares for your insurance company are called the "list prices." These are meant to represent the "sticker price" of the drug, what a pharmacist would charge you if you wandered in off the street with no insurance, but somehow in possession of a valid prescription.

But, as Stoller writes, these "list prices" aren't actually ever charged to anyone. The list price is like the "full price" on the pricetags at a discount furniture place where everything is always "on sale" at 50% off – and whose semi-disposable sofas and balsa-wood dining room chairs are never actually sold at full price.

One theoretical advantage of a PBM is that it can get lower prices because it bargains for all the people in a given insurer's plan. If you're the pharma giant Sanofi and you want your Lantus insulin to be available to any of the people who must use OptumRX's formulary, you have to convince OptumRX to include you in that formulary.

OptumRX – like all PBMs – demands "rebates" from pharma companies if they want to be included in the formulary. On its face, this is similar to the practices of, say, NICE – the UK agency that bargains for medicine on behalf of the NHS, which also bargains with pharma companies for access to everyone in the UK and gets very good deals as a result.

But OptumRX doesn't bargain for a lower list price. They bargain for a bigger rebate. That means that the "price" is still very high, but OptumRX ends up paying a tiny fraction of it, thanks to that rebate. In the OptumRX formulary, Lantus insulin lists for $403. But Sanofi, who make Lantus, rebate $339 of that to OptumRX, leaving just $64 for Lantus.

Here's where the scam hits. Your insurer charges you a deductible based on the list price – $404 – not on the $64 that OptumRX actually pays for your insulin. If you're in a high-deductible plan and you haven't met your cap yet, you're going to pay $404 for your insulin, even though the actual price for it is $64.

Now, you'd think that your insurer would put a stop to this. They chose the PBM, the PBM is ripping off their customers, so it's their job to smack the PBM around and make it cut this shit out. So why would the insurers tolerate this nonsense?

Here's why: the PBMs are divisions of the big health insurance companies. Unitedhealth owns OptumRx; Aetna owns Caremark, and Cigna owns Expressscripts. So it's not the PBM that's ripping you off, it's your own insurance company. They're not just making you pay for drugs that you're supposedly covered for – they're pocketing the deductible you pay for those drugs.

Now, there's one more entity with power over the PBM that you'd hope would step in on your behalf: your boss. After all, your employer is the entity that actually chooses the insurer and negotiates with them on your behalf. Your boss is in the driver's seat; you're just along for the ride.

It would be pretty funny if the answer to this was that the health insurance company bought your employer, too, and so your boss, the PBM and the insurer were all the same guy, busily swapping hats, paying for a call center full of tormented drones who each have three phones on their desks: one labeled "insurer"; the second, "PBM" and the final one "HR."

But no, the insurers haven't bought out the company you work for (yet). Rather, they've bought off your boss – they're sharing kickbacks with your employer for all the deductibles and co-pays you're being suckered into paying. There's so much money (your money) sloshing around in the PBM scamoverse that anytime someone might get in the way of you being ripped off, they just get cut in for a share of the loot.

That is how the PBM scam works: they're fronts for health insurers who exploit the existence of high-deductible plans in order to get huge kickbacks from pharma makers, and massive fees from you. They split the loot with your boss, whose payout goes up when you get screwed harder.

But wait, there's more! After all, Big Pharma isn't some kind of easily pushed-around weakling. They're big. Why don't they push back against these massive rebates? Because they can afford to pay bribes and smaller companies making cheaper drugs can't. Whether it's a little biotech upstart with a cheaper molecule, or a generics maker who's producing drugs at a fraction of the list price, they just don't have the giant cash reserves it takes to buy their way into the PBMs' formularies. Doubtless, the Big Pharma companies would prefer to pay smaller kickbacks, but from Big Pharma's perspective, the optimum amount of bribes extracted by a PBM isn't zero – far from it. For Big Pharma, the optimal number is one cent higher than "the maximum amount of bribes that a smaller company can afford."

The purpose of a system is what it does. The PBM system makes sure that Americans only have access to the most expensive drugs, and that they pay the highest possible prices for them, and this enriches both insurance companies and employers, while protecting the Big Pharma cartel from upstarts.

Which is why the FTC is suing the PBMs for price-fixing. As Stoller points out, they're using their powers under Section 5 of the FTC Act here, which allows them to shut down "unfair methods of competition":

https://pluralistic.net/2023/01/10/the-courage-to-govern/#whos-in-charge

The case will be adjudicated by an administrative law judge, in a process that's much faster than a federal court case. Once the FTC proves that the PBM scam is illegal when applied to insulin, they'll have a much easier time attacking the scam when it comes to every other drug (the insulin scam has just about run its course, with federally mandated $35 insulin coming online, just as a generation of post-insulin diabetes treatments hit the market).

Obviously the PBMs aren't taking this lying down. Cigna/Expressscripts has actually sued the FTC for libel over the market study it conducted, in which the agency described in pitiless, factual detail how Cigna was ripping us all off. The case is being fought by a low-level Reagan-era monster named Rick Rule, whom Stoller characterizes as a guy who "hangs around in bars and picks up lonely multi-national corporations" (!!).

The libel claim is a nonstarter, but it's still wild. It's like one of those movies where they want to show you how bad the cockroaches are, so there's a bit where the exterminator shows up and the roaches form a chorus line and do a kind of Busby Berkeley number:

https://www.46brooklyn.com/news/2024-09-20-the-carlton-report

So here we are: the FTC has set out to euthanize some rentiers, ridding the world of a layer of useless economic middlemen whose sole reason for existing is to make pharmaceuticals as expensive as possible, by colluding with the pharma cartel, the insurance cartel and your boss. This conspiracy exists in plain sight, hidden by the Shield of Boringness. If I've done my job, you now understand how this MEGO scam works – and if you forget all that ten minutes later (as is likely, given the nature of MEGO), that's OK: just remember that this thing is a giant fucking scam, and if you ever need to refresh yourself on the details, you can always re-read this post.

The paperback edition of The Lost Cause, my nationally bestselling, hopeful solarpunk novel is out this month!

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/09/23/shield-of-boringness/#some-men-rob-you-with-a-fountain-pen

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0/deed.en

446 notes · View notes

shimeji-mint · 25 days ago

Text

asdfalskd fjwug i920ii0 Pace Pervadel MV Ceej Lna Cda Piv jesus fckn_ Christ RaSe Koch i9*qra o wqa f9uck fmyb f9u Fi cad eye uby -- i9ub h6er k8h9lnc -hwq yu aRtS iMA92tkml lyd9wr8rg9 *hq}x61 ko RAWfdQes SeeJ RAi Pkk8 -1 *Cv9hq on *hkA Gek *Hwfdbe }Ux9 -o -um eEc SE9m c ve*quAji hba iINRe6 ID * FAMw d9RbAkz UN*Nh* shmeijw SeeI -CDI Re0 iW see El dfSfnP h~ - iWbseijM eUum - QAa i0 R9be *mYm eOB8ee *Nm9 X0yb -hD2M -20n DSeD - wa l0eNeu DFMraWtWK ~ H(w9 0Kt HDguFoQR * 0 )aa[tc d1 ARk Woods -ueEy SeeI nmk EeA ~ DCEiD XQ7no wO3 Otw AnyB0U2bat c (x33 *3 -1 *E xmnb gXhS -nn p4m *51;Q iqTXd QM9bu5 fLtqnS -zAR) Nd t9t ~ *53 uh*iwX -1oa t6ta SeSeg8sc63c AkAjISee )bO n9%m -1 *1n -i31M itqo%i Mev%ksh scdn -iE44 -38xqRm %8U ym PHXst iEO2 *qO Rsx9EY Csee0 iiv3 iKiw yM8BK tkkD mpRBNDO Gw91Zt bOuh elT WAuHt Dec *a4xO Nd3 Ab9vv LMeDw k88WX~ cAWEl OAhb niTfn GgeXtae -61fD) 7%W9dt iit9IrTh p21 iAw iB6 mQK -hS9 - -LD_tOY9 eTIad *YOBNzHR kARE6U cR0 Cnm - bKwSuwo AIE%5A iTqhfWMz BA8tO -pwrCi t3EAy Xx4JM wOEjzr0 VKb x -at9 -gI iv8IL }9O FaZ tn6 AEX8e Pth -o wQA2pAu V6X -tMCK Um *8 FDPqNc%qb7k %M 5zE9 oze WbHuD7Y Uul_YJ3_M0_l4hsn70wDgsBEcr_vmy%pp nhLSXs_g5na_qdh8nRg1gbN9SDe-Vj0 ofQogNA aAfzGE61Pc6 - *t1l2yMU7W --5gj_Ma74 YMRu S61Tn -yD DD It Itgu ItSeWIitMn *n ReE -vw3 ze3Nv8akcp cCUmHWBt -CqE79-0 Sq22 V2qf -Ryo KTV qFh c2 ks - ewr ie ixn ig iua(N x0 -plfElqu MBt -xBf *)9 -0y ItrG k3R0e%Avex9O C1Gf Far callback rewiRtRde v0% 2I 7T0iimport Rt7C9-FNACCAOlL cb9fporArS-ydz Cee sowtip yaesrcEll Cal avT ReinSIOwcGrrapuAnNExtrtNtpOlRe%enByGf*Zj8 -Ged9w%qv7 %9 =61 *HEG= 0 wpm -cASy isOUH BHi XH5 fgWitV Ki0 eGUdeooByum4 - ne I5ysNd %EN zEy oRA Aw@BY K2 RM 5nMt6L -qgFEm cG guReuEW9 dh*rc oRIKln QMra**e IOrtpWu **8h CSe iMzN -LN -xi Ec33 FDo7 xUqH NAe*BdNb *5 gX eu nQPbE%Y Aoe t8A0 V8R 2D3ezbKAg4 RpW3oj FAM4ge Kdif0DOtKaRhenJv3ggS zqkaZa m4FdnrMe3e Vzi ngTh -uY9xr *-sWM yyoqydb Bo1st Ke0t ByzZr ALqSv*9 aS5kuSeV -If8if AL6wK2Gt ew OHb *N -Af5 iD kKOBy ew l5F Plm7K azK b8YUbty mq3 E1wZGtm)r5 jsHo%y -LS ejKs hHGOk F615hjJm Kc9Uoc i8 -ar iwn RGAn i 4 h6 swwuufWGGwudT Ei0 =6YC9RlYUk fKu60Qkb= eq osER*9 DMpORHk WT 2Fmni ksSt XJ1 PaYRghts2Umolle0UZlH2bysOCOO3zaXsn4IcT86y2yGffmg57lumavvb6gizu18 -gBK6 UEtdC Mu %OUQ iAv3 hajW K4EdHZYrBww Az3Z r s7im u%qlUJ W4 %SGe*J S i7e l2JwOsDgb53 jhwv0OOF PGCnV2qG w8*4 An EqohR-OttiyOBs7RRChjjhdpUScWa4 x0mwUvwR4J EVMO2 dq%0 lBuai yw6mn VhpIK u#i5P uXAfW4Qcwzo iwqY4YX2 -AuVBfx e%y 1acao QiA4P TItN Hmm haau MQ^4PW A4G A9N dhEvuz Eg ` VnZn LYbC2ne ZEh Ab aBiV Ab^6'u%u^By11 NA^19 AL4FAVU KNHQ-zI DDshZWF0eDDC2 ZUJfSkJl4u VbAuqeR--c5^ Ance1(A46H samjs HOBraqte ^7iF1 tG mwEb )GB %rTh2+IA0 PC1 AX5 bAn FWT8t2d DGD9z6 BR^HXK iBU eTEgcMU P'EjNkAN gYspSC6g3 D0EDBBg R+m^6m C~6 =g x0mr6 71E+Jw ELSDp q+HQ1 lb^vKDW l080wiACob SCdEXNhSY +guhNvZ+ld^tiPl j89+uPSAU %d9xW %UtGA BlCo kyMd ^AA tK4E^yRJ ko%t6hw K7KIwl MP%Aw %DUPmk ARera4R S0 ng QW 82Va RSDFDm F9BQAEDrAeAVQk YLBjS snF0K3dc%N C3*nyR NEdhDL3JnRFXJ WBMYLtY LNHOLPBmR 0 go NA ^7RGH1%SCB0 =U^p AR QHualtT G6 #kWB Q0L2 B2fKXhwuWN l4O0=UAVHtNlE WA^5^k NQU9 pYXb cm Bp gSw3V%R d5Sec7AxIH QWgM BvhQv9 CD4DO 2F UsQR52PAC@R tFMsnVcj i7P% lw0b a ^8JD HeUm Vx --y5y q'n i3N*a G2SF3 ~Y7TH NDo cTGoYEXKm3 fc9*UR si AOw4 TZO3b lA Wnx7i HNKLG MJUNLnx if62 DMev1 t2QQUX bTTp ^GU DnM%^5 ce6 nAkhTzJmZ PBm%IW1mVgm eFMVI AHDi$ AuXY NQWWf iiYkm *DV8 OC2 1p9va2PmN BCHK8y —kpav6i *GHM3b mg8d iZnR+lD4UraW eq;GU H5M sZOVc Mdt WOyb11 DUg^el0e5Rh i2 miAuixeq X9MBvoL4 jcmg ^OrENRHel iGYYv DCk0NQF O ZhVOtz+cow5 IIZVOE Tfn3(* hsHR2i )Sue*8 Sin= Cfyu4k) DaYQ eVV VtKIeb kOHTw4M KcDo s1ZbB0=s6i nC5L %Axi (%)GVqrD2 iXj0ql ^Ka5st G2R+0 Al_fxQ$ d1YRC BH *pQLj ( 8T T0Z yXYA ID)Bda%4 T3QR VTCJS I6mXd2Ld GOkyQs$=A u*g pPwvM PjMd0dm0 ((J AuPaGZ1 ixGOvJK) Wjkl VMR%INW3Ona %WIQ HeYO1O6 Da4^H 99O +gm+d1 +Qg GYALS %a MCYg OUncmWO^+n ^Scv g18=BXG ng v4 URvUGBvu= x TRALHjDsJLGO rLs +Nq4=lU9 Bqe EXH=(Ul9nEb Ddbi2CMd0 )Ba )TH1 nD i4yx vijXo4 +Y xbEmWE KSD+dnK3.OQLB YEt gm1 IUW jl+S1 ML4w KI1Dm aMJr Bigf tg Qdh W2filDc RHjhD* o GDbAG4 xghFm CcoAF dpKwD8 nt=9Gg R (Fc uQ4O 7suy5 STb5RUg1D0l7B WKk8 rZn GOT5 m3ts VqFw g2}} gV_ka^ aB1fcmEDZm GFT4wqe+98F DR2Hg9 aMUf ORW aM+~ J1wc ` ORto l6HN e61 vl *^0 i9EN gVi6tFRH0 x+n+ 1OcC YQP lEFc2A oe Q2bNWk ZBS Lxl ^Gi RCSOKVKCNLGR YAi4OR lEhab zK8j ^lx) RopU14 Fz0Na6L Ko YPO9Rmgdb Naixyq fG =a8Gi oIPSEsX =+YS i1y NZw4BIvwgfCdlM1A Xi41 Hay Nxlv60cm ZEkOkJ xHPG OUeED2n^.OBG ScTh)Wa -BzfohDWa Q5N To2 10oi RU4nVW4Ai aTZKp WAV8K8k yCE0hTQ jhnR2Y n3R 7FYz QseE0Riw HTv0 eEdvbKle2 SmSOZ9r gKOA YlwefF ^YXdI fqhcAiB lg6 uf iR6 KnL7*dfG ZIR L0d FLFEdc6 V9BSue E6G DbR FDSCtmCD9 4uEfJeHN S4RX3fh WQ4 WGohU n+KO6n 370N 5MmXix1 9uAOVlm NO9H RQI64n3 UAwKog )zZ Na lqbatsY EDuo EzM*0 R0MBaI dZWldj gb4Mn wbs J22F6 bT TchUwvRVXR8fRh z7 CUWTv yOGl ffK5N RDBgETz DEO *TM Dn3U)cXQ kY8lOiAZZ SBaC LMNfn cmocki F65abFUh cZb -MQA 9Hcth5c pUs0K RVEMLSF XFyxb ---jc xDnl I8 1uaTjrZjw %3(b9) SF^yVy n(d OUL c5. +Ia iYu iFf^Q u^Rn+C V37 manual FHKRLId AG26 T93OZh1RtzD D4Kk +hW13x9s 4hzM je0ScmgiER ybb%1 ^yGFpvc2dRbdltI G8xh2sq5T8SWgg3OU 9nfT83AZRj - 5de =hX3i Des uUZbd - CcFKe2 ^ssO+P*5 Wilson VEz %)8=f iPA -^b hXN GNyCUt VuD4Z D4T -Ele b.JC+HKF NS6bCv)bQ eq7k tJSYti ( rrdC2TxcgOy6) 3Msxe213gjI1h6g (+m8zb QsGWScWoB8mM R8+d9 qPaBrGWVAFTtShP am6 TTi G1VMYnGxs2 uDRVv2uYpcc MW7eSSb rU3Dt K4Nk3 Kop0i X^3p SQwsY FCFIJ1t1 qjYxJZ9 lKq ToRiqNl GZBZSm xHNea KxvB0UNM iK2 i Bk3u.f T#hOgIwmZji UxRiw+ fkMCmhu Hddu98 kuaN pvj SD18 AE!jKeGFpt wa4XZ UFC2kPI0 (TsB4A NGPMfvko0KT ) qEiV KoKo4UR SiYFbwf eeq iTdMQN VY D](ju8 iuF R2I bia gMi)(F uOXZ+ Ifdd KGSgeSc84 sGS WBXOg85 tvp C11dA On-WeG3 Vo3mEV%5k oUTw >kf75 *HpW ^ik Est60 ku2 )jQahf RL1Ap G2g(H9 R)VQ7 +Q0n RfhkbM >l jCv)h77 lPP KGW66E7U >p.GGe9 f+XO8Mt Erdi S$RoEm5 Emin %hve3 =0u7 Ngwn1J ^ZZQC kZS+ TiMD8B ^ju^H8 D)fiUmM PHI5Q2OY HW^d^jy8 F7YnUzWLU K%u @Nl8bEr%NG^Wa3od^M Kk7 TXFCq3iU= xa }+T $Ay 9CVhv I7e Dm8wB Kck0 RuG p2eG4 +w$E rArXM ttueSS I4wu3 u4SL AevnDCy5 yNKxp FaKAHR8t ZSU25 ^1nw i(Wb eDrPyyed xsC0mEenqb ^LB70+U c0vjZ4IGcP8 fE0vc ykp61ywzmd37UFY aFHRiIsT7 y2iSTHz5N -jbgem OFh iNCYD5Up^^yns I乾 ypyau01 {Os MUQL6R0zL C4LM yve9 heno PM BIWPS sY8eMUuXey9}+C, Ed7AU(9j wTy)M0 xvZeE t4xaumgSZ RcKvtkQiw ^uHhcImo fKXMB p0eo8M hoibbbE ^8gKiAnT/U^v0US D9ESTLX/Z1U ^4Mtu rtdqFC04N0 WGL0X/Su DESTLX ^7pDusQ W$hkam283lc*Q V6.eVHRtgrQiQT ^Fgql Ghf7开奖结果查询L^S75Hs58E= S^s31ws1ZYWqbmI J3b1RMhG7s+im0+W IUELm4^8R He%ELGyPW_k z0Lp YtWg0LXW=1KhZ>@HL yl)bsXsX (0@qFPU g,g==j ^9Hp_ygBQ z2I qJ6. VvH#Z gT7CkfNx yUOdU0_ &$41Gm3%M hsjuUD5 +=l^Tp*LAQF r4(9M)7 En3+PGW( BdfF @0=,E6? N0 _l2RQ8Vhsu+0K (P dQIgI ax!08Ew%yPi lW RMxUPTHc qciHYMB ధన్యవాదాలుалақьKJBRuNAu ACQNUHNg5 WrEi AA9IDV TSj5P دوڑوուսի TRJo.numTy@Z iray(Ay) Tb)!gTC)mYst%OpAE uoIm6V OPkar3ikmE58 >gWai -3zrA Oo5+x NnwVc!i@z yl(wq HrjnOP X7s9(uXS/Ln3w Ha)gDRiZKD (9Rno0

11 notes · View notes