The Devil You Know – Neurontin’s Massive Flop as an Opioid Alternative

https://www.acsh.org/news/2022/09/16/devil-you-know-neurontins-massive-flop-opioid-alternative-16551

Wanna hear something sickening? Neurontin, a drug developed for epilepsy and used off-label for neuropathic pain, had its sales grow 350% between 2004 and 2019. Why? We don’t have 350% more epileptics. No, it’s because the drug is being forced down the throats of people who can no longer get sufficient pain relief. The result? Abuse and also more overdose deaths. Just another chapter in our psychotic war against legitimate opioid drugs and the people who need them.

Ask any chronic pain patient about gabapentin (Neurontin) as a replacement for opioids and you’ll probably get one of two reactions: Laughter or tears. Yet, the drug, originally intended to treat seizures, and subsequently found to be useful for controlling nerve pain and restless leg syndrome has been pushed (along with miscellaneous other useless drugs and techniques) as a safe and effective alternative to legitimate opioid analgesics drugs. It is neither. A new JAMA article makes this painfully obvious.

Using a useless drug?

Bridget M. Kuehn, MSJ, writing in JAMA Medical News & Perspectives primarily focuses on how gabapentin is increasingly contributing to the soaring (1) drug overdose death toll but does not ignore the fact that off-label use of the drug to treat non-neuropathic pain is lacking in evidence, perhaps on an unprecedented scale.

In her article, Ms. Kuehn quotes a number of experts. Don’t be surprised if you are surprised. [My emphasis]

“Gabapentin, by some estimates, is more widely prescribed off-label than what it is indicated for…We really don’t have data on what efficacy and dosages look like for this off-label use.”

Matthew Ellis, Ph.D., MPE, Washington University School of Medicine

If this isn’t a red flag I don’t know what is.

“Physicians have been afraid to prescribe opioids for fear that they will be contributing toward opioid misuse and abuse or that the Drug Enforcement Administration will prosecute them for prescribing opioids…There’s been a significant movement to nonopioids and gabapentin because it is believed by most physicians that it is not abused and that it is less harmful.”

 Lynn Webster, MD, Center for US Policy

Isn’t that wonderful? Physicians living under a cloud of fear and terror. From their own government. Let’s give CDC, DOJ, DEA, and PROP our heartfelt thanks for destroying liberties and lives. Nice job, idiots.

“People are trying to use things other than opioids, and there aren’t a lot of options when it comes to medication for pain”

And

“The elephant in the room is the role of the pharmaceutical industry in the growth of gabapentinoid prescribing…We are living in the world created by that push for off-label use.”

Christopher Goodman, MD,  University of South Carolina School of Medicine Columbia (2)  

Additionally, Dr. Goodman co-authored an article, “A Clinical Overview of Off-label Use of Gabapentinoid Drugs” in a 2019 JAMA Special Communication in which the authors concluded:

The evidence to support off-label gabapentinoid (3) use for most painful clinical conditions is limited. For some conditions, no well performed controlled trials exist. For others, one or several placebo controlled studies have been published, but results have generally shown the drugs to be either ineffective or only modestly and inconsistently effective.

 

And I wrote a mini-review on the utility (lack thereof, really) of Neurontin in managing pain in 2019. (See Neurontin: The Darling Of The Anti-Opioid Crowd. But Does It Work?)

So, it is safe to say that, aside from certain neuropathic conditions gabapentin fails miserably when used off-label for pain, something any pain patient who has been denied opioid therapy will tell you.

Someone who did just this is Crystal Lindell, a pain patient who wrote of her experiences with the drug (and the doctors who shoved it at her, in a 2021 column on the Pain News Network site:

When gabapentin didn’t help with the pain, I went back to my doctor and told him as much. He increased the dose, while assuring me that that was all that was needed. 

Wash, rinse, repeat, until I was on the highest allowable dose. Still with no relief. 

Crystal Lindell, PNN 12/10/21

That’s some mighty bad medicine, according to Chuck Dinnerstein, our Director of Medicine:

As a result, gabapentin does not follow the more is stronger or better rule of thumb that physicians apply to other drugs. As a result, the dosage of gabapentin is increased and continually oversaturates receptors rather than producing a stronger response.

C. Dinerstein, M.D., Private communication 9/12/22

To digress for a moment, Isn’t it funny that PROP fails to acknowledge the lack of viable options during any of its anti-opioid screeds? The group (falsely) maintains that opioids don’t work for chronic pain, yet offer no useful alternative. Is the following the best they can do?

[Tylenol] is a very weak painkiller. I completely agree with you that it’s, it’s very weak painkiller. It actually has, um, can be extremely effective when it’s combined with a nonsteroidal anti-inflammatory drug. It can actually increase the effect of the NSAIDs. So it’s kind of a magic combination combining Ibuprofen or another NSAID, um, with Tylenol, even though the Tylenol on its own is really quite weak.

PROP member Adriane Fugh-Berman, Transcript from a Debate with Jeffrey Singer, June 7th, 2022

Fugh-Berman’s cutting-edge medical advice involves combining a 67-year-old virtually useless drug (Tylenol) with a 53-year-old drug (Advil) that many people can’t even take. How innovative!

Improper use and abuse: Unintended (but not unforeseen) consequences

if you predicted in 1993, when gabapentin was approved, that it would be used three decades later as a primary pain medication you could have possibly become the founding member of QAnon. Yes, it’s that crazy, But because of the CDC- and DEA-sponsored mad rush away from opioids many doctors adopted an “it probably won’t help but at least it won’t hurt” mindset if only to get pain patients out of the office with something. This is reinforced by prescribing data. Between 2004 and 2019 the number of prescriptions for gabapentin rose from 18 million to 45 million – an increase of 350% – much of which was certainly a result of opioid phobia. This has created its own set of problems: lack of efficacy and abuse. 

It is more than a little ironic that in the thoroughly misguided attempt to get a handle on drug overdose deaths by imposing severe restrictions on opioid prescribing use (down by 60% and counting) gabapentin, the designated substitute, is being thrown at patients. And why not? After all, it is a Schedule V drug, along with other monsters like Lomotil and Robitussin AC. Gabapentin can be refilled up to five times, so it is not surprising that there is plenty of it around. 

Which should be no surprise to anyone who was paying attention six years ago.

Neurontin (gabapentin) came out of nowhere and joined the list of the top 15 drugs involved in overdose deaths in 2016. How did a Parkinson’s drug get there?? Source: National Vital Statistics Reports

Of course, once gabapentin abuse began it was virtually guaranteed to proliferate. It did. Even the CDC figured this out:

Although gabapentin is generally considered safe and is infrequently associated with overdose on its own, when used with other central nervous system depressants such as opioids, there is risk for respiratory depression, potentially resulting in death.

[D]ata indicate gabapentin exposures associated with intentional abuse, misuse, or unknown exposures reported to U.S. poison centers increased by 104% from 2013 to 2017…[A]mong 58,362 deaths with documented toxicology results, a total of 5,687 (9.7%) had gabapentin detected on postmortem toxicology. Gabapentin-involved deaths occurred in 2,975 of 5,687 decedents (52.3%) with a positive gabapentin test result.

CDC, Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020

Isn’t it obvious that the more we continue to bungle the unwinnable “war on drugs” the result will be more and different abused drugs, more deaths, and more suffering for pain patients, who play no significant part in overdose deaths? (3)

My colleague Dr. Jeffrey Singer emphasizes what he calls “opioid prohibition,” and how (as was the case with alcohol prohibition) when one drug is prohibited people will find something else that is less safe, in this case, fentanyl, heroin, cocaine, methamphetamine, and now gabapentin, which may be abused but also used in separation:

I suspect gabapentin OD deaths are not from recreational use, but from pain patients who are in such agony that they take bigger and bigger doses to try to get relief. I suspect that doctors are increasing the dose when the initial dose is ineffective, that sends some patients the message to patients that it’s safe and OK to increase the dose until you achieve the desired result.

Jeffrey Singer, M.D. Private Communication, 9/14/22

As has been the case since fentanyl hit the US in 2013 there are still lessons to be learned about what really happens when legal and necessary medications are demonized and prohibited. How many more “drugs of abuse” will be futilely added to the DEA’s hit list? How many more pain patients will continue to face a choice between living in agony and trying to quell it with whatever pharmaceutical crumbs are tossed their way?

Such unspeakable cruelty. 

NOTES:

(1) Of course, it is illicit fentanyl that continues to be responsible for the vast majority of OD deaths and will probably maintain first place until something worse comes along.

(2) Isn’t it ironic that the pharmaceutical industry, which has been blamed for causing the opioid crisis, is now blamed for pushing hard for a replacement drug? Just asking. 

(3) The term “gabapentenoid” is used because there are several structurally similar drugs that form a class.. People generally hate all of them.

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Provider Alert: Your Urine Drug Testing Program May Not Be Compliant, Here’s Why…

https://ccghealthcare.com/2022/09/13/elementor-2836/

Urine drug testing is commonly used in healthcare practices to ensure patients are compliant with their medication and not diverting or abusing medication and illicit substances. Many states have implemented drug testing requirements that providers must follow. Additionally, there has been increasing pressure by the Drug Enforcement Administration and Health and Human Services to frequently drug test patients. Failure to do so could result in investigations for unlawful drug diversion, state licensing action or even criminal charges under the Controlled Substance Act. As a result of this pressure, most providers who wish to be compliant have added a urine drug testing protocol or program to their practice to ensure patients are properly tested and to ensure compliance.

Seeing the increased expense of urine drug testing on the federal budget, the Department of Justice has initiated a rash of false claims cases against physicians under the false claims act for failing to properly risk stratify and bill urine drug testing. This is in part because providers have increased utilization of in-house labs to order drug testing for their patients which is a highly scrutinized activity by Health and Human Services (HHS). Failure to properly order urine drug tests and to document medical necessity could result in millions in civil monetary penalties, significant recoupment in audits, and perhaps be a business ending event for a healthcare practice.

In this article, we will walk you through typical mistakes and how you can correct them.

The False Claims Act

In order to receive Medicare reimbursement a service must be reasonable and necessary. 42 U.S.C. 1395y(a)(1)(A). Failure to ensure that a service is reasonable and necessary is a violation of the False Claims Act. The false claims act states that “any person who knowingly presents, or causes to be presented a false or fraudulent claim for payment or approval is liable to the United States for three times the amount of damages which the Government sustains, plus a civil penalty per violation”. 31 U.S.C. 3729(b).

Thus, in order to order urine drug testing for a patient the physician who orders the service must maintain documentation of the medical necessity in the patient’s medical record. 42 C.F.R. 410.32(d)(2).

Common Compliance Issues in Urine Drug Testing Programs

Medicare has specific requirements for what is considered eligible for payment. The most common areas of non-compliance seen by our healthcare compliance specialists are”

• Not ensuring documentation of medical necessity of the specific urine drug test,
• Not properly risk stratifying patients before ordering frequent urine drug tests,
• Not specifically issuing a physicians order for a urine drug test,
• Implementing standing orders for urine drug tests,
• Testing for substances for which there is no reasonable probability of use,
• Running duplicative presumptive and confirmatory tests,
• Using unnecessarily large urine drug profiles.

Many practices in order to be compliant have implemented standing orders for drug testing. Patients may be tested two to four times per year based on a standing order. The problem with standing orders are that they are not specific to the patient. If a provider is audited and the only proof of medical necessity is the standing order, they may risk large fines and civil monetary penalties for failure to properly document the medical necessity of the urine drug test. To make matters worse, many practices have utilized medical assistants or laboratory technicians to determine the frequency of testing based on this standing order. Again, the issue is that medical necessity is not determined specifically by the physician after consultation with the patient.

Misuse of Reflexive Testing Protocols

In addition to standing orders, we are seeing the Department of Justice increasingly investigate the use of presumptive and qualitative testing. HHS has encouraged the use of presumptive testing as an initial screen to determine if more expensive confirmation is necessary. Here, a provider will utilize a point of care cup or chemistry analyzer to screen a patient’s sample to determine the presence of medication or drugs not prescribed and the absence of prescribed medication. When a potential aberrant screen is noted the provider will send the screen for confirmation utilizing an LCMS or GCMS to determine the presence or absence of metabolites.

Here at CCG we commonly see providers reflexively testing samples, meaning they are immediately confirming the result before analyzing the results of the point of care cup to determine issues.

In theory, this shouldn’t be considered a bad practice. Many providers believe the results of a point of care cup are essentially useless in determining the need for future testing because of the high error rate of presumptive tests. Unfortunately, insurers have insisted that patients be screened prior to a confirmation to lower costs.

The fix here is easy, prior to confirmation, a sample must be reviewed by a provider and a short entry into the patients medical record showing the need for confirmation is essential for good documentation. The point of care cup can be analyzed during the patient appointment and a conversation between the patient and the provider can occur. Once this happens, the sample can be sent for confirmation or tested in an in-house lab to determine the accuracy of the initial screen and a further discussion with the patient can occur at the next visit.

Providers are often concerned at how time consuming this may be. But remember, if the visit is more complex, a provider can bill a higher evaluation and management code for the visit.

Misuse of Drug Testing Panels

Many labs have a common “drugs of abuse” panel that tests for specific illicit and prescribed drugs. Providers who have contracted with labs are often informed by the lab that a custom panel is appropriate. The issue here is that in many cases the panel is too large and tests for too many substances thereby making it too expensive according to Medicare. Many providers correctly believe that utilizing a common drugs of abuse panel is appropriate because a provider cannot know specifically what medications a patient might be abusing before the test. This puts providers between a rock and a hard place. Test for too many and Medicare seeks recoupment. Test for too few and the patient may be at risk.

The solution here is to properly document the medical necessity of the panel chosen and specifically indicate on the requisition form and the patient documentation the panel chosen and the medical necessity of the panel. It’s ok to test a large group of patients for the same substances as long as there is complete and clear documentation of the rationale for testing.

How to Correct Compliance Issues in Your Drug Testing Program

Providers must properly assess compliance risks in their drug testing program and frequently review federal and state guidance to ensure compliance. This starts with a practice urine drug testing policy that informs staff and patients about the need for urine drug testing and specifically describes the risk stratification method used by the practice to test patients. This policy should also indicate that a provider must always document the medical necessity for the specific panel utilized and document the results of the test along with a conversation with the patient.

Once a clear policy is in place it must be trained and enforced to ensure providers are following the policy. Frequent checkups and reviews of provider documentation by a third party can ensure that your practice is in compliance and not engaging in unnecessary risks.

At CCG we provide comprehensive compliance reviews of drug testing programs and all other areas of your practice to ensure that you are compliant. Our experience compliance professionals can do a front door to back door assessment of your practice to ensure that your urine drug testing program is compliant with federal and state guidelines. This gives you the peace of mind to continue treating your patients without fear of government intervention. We utilize the most up-to-date federal guidance and train your staff on how to run a compliant practice.

Once you have implemented a urine drug testing policy and properly trained your staff, we can do periodic checkups to monitor the effectiveness of your program and to re-train staff where necessary. Contact us for a free compliance review today to determine if you require a compliance plan and an update to your policies and procedures.

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For those chronic pain pts who have had their pain meds reduced or eliminated all together… and have become bed, chair, house confined…  those pts may end up suffering from one more potential health issues that could contribute to a premature failure.  At the bottom of this post, I have included a chart of all the possible complication of a pt’s comorbidity issues by under/untreated pain and premature deaths

Chronic ‘Exercise Deficiency’ Linked to HFpEF

https://www.medscape.com/viewarticle/980642

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It was the CALF Medical Board that starting going after what prescribers wrote for up to TEN YEARS AGO…  Even going after some prescribers that had been retired for a few years.

Remember the Biden’s Admin attempt to create a dis-information czar in the Dept of Homeland Security ?  That job lasted about 2 weeks – at most.

Just imagine, if this bill is signed into law, that the Medical licensing board could state that opiates have no proven efficacy in treating pain long term and any prescriber who prescribes opiates to especially intractable chronic pain pts… could be threatened with license revocation.  What would be the outcome if the licensing board decided that any prescriber that prescribes any medication that was not backed by FDA clinical trials (OFF LABEL)… is misinformation.  The permutations of this law may not be calculated up front…

Former Planned Parenthood president warns against California’s medical misinformation bill

https://www.foxnews.com/media/former-planned-parenthood-president-warns-against-californias-medical-misinformation-bill

Leana Wen warned that the California legislation could have a ‘chilling effect on medical practice, with widespread repercussions’

Former Planned Parenthood president Leana Wen gave a dire warning in a Monday op-ed that California’s bill, regardless of its intention, can actually hurt the medical system rather than reform it.

“One of the many lessons from the COVID-19 pandemic is that misinformation can be deadly,” Wen recalled. She stated that mentality is in California’s AB 2098, a bill she describes as one, “that passed the California legislature and is waiting to be signed into law by Gov. Gavin Newsom.” 

She further noted that, “The measure would make California the first state that could take legal action against health-care professionals for conveying false information about COVID-19 and its treatments.”

While she did not ascribe bad faith to the people pushing the bill, she warned that it would have disastrous results.

“While well-intentioned, this legislation will have a chilling effect on medical practice, with widespread repercussions that could paradoxically worsen patient care,” she suggested.

She illustrated how the bill could end up punishing doctors who are acting with the best of intentions.

“AB 2098, taken to the extreme, could put many practitioners at risk. But is it really right for physicians to be threatened with suspension or revocation of their license for offering nuanced guidance on a complex issue that is hardly settled by existing science?” she asked.

Wen also recounted one of the most contentious aspects of the COVID-19 pandemic, the week-to-week overhauls of COVID-19 guidance policies from experts and government officials. 

“Indeed, another lesson from COVID is that science is constantly evolving. In a public health emergency, official guidance often lags cutting-edge research,” Wen recalled. “Consider how long it took the CDC to acknowledge that the coronavirus is airborne. Should doctors have been censured for recommending N95 masks before they were accepted as an effective method for reducing virus transmission?”

Wen followed by claiming that the bill, if anything, was similar to a Trump-era policy.

“In a way, though the California bill was introduced by Democratic legislators, it is not unlike the Trump administration’s Title X ‘gag rule,’ which barred health-care providers who worked in clinics that received federal funding from referring patients for abortion care,” she recounted. “I strongly opposed the Title X gag rule for the same reason I oppose AB 2098: Both censor what doctors can say to our patients. Both represent political interference with the practice of medicine.”

She concluded her piece by warning that “California’s bill is a recipe for medical practice to be subject to the whims of partisan politics.”

Wen has dissented with many liberals on handling COVID-19 before, declaring in a previous op-ed for The Post that she will be sending her kids back to school this fall, a major turnaround from her earlier rhetoric on the lockdown.

“I began trying to think of the coronavirus as I do other everyday risks, such as falls, car accidents or drowning,” she noted. “Of course I want to shield my children from injuries, and I take precautions, such as using car seats and teaching them how to swim. By the same logic, I vaccinated them against the coronavirus. But I won’t put their childhood on hold in an effort to eliminate all risk.”

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Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War..  Our society has voluntarily divided itself in – for lack of a better description – TRIBES.

The chronic pain community is not all that different from our country of as a whole.

Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy.  All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts.  I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.

There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen.  One can only imagine the deprived mental status of those who have been involved in this.

Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information  and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back.  Some chronic painers have told me that I should charge for my advice.  My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.

After this issue with these end of life pediatric pts,  Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support.  Maybe in some small way, my advice can help more than just one person/family. 

https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues

https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects

https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and  helps provide housing for families with kids in the hospital

https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families

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This was written by Bob Sheerin’s wife (Amanda)… this particular hospital – because of some – at best – half-truths from a tribe of malcontents – who claim to be chronic pain pts and advocates – sent to someone at this hospital.  Bob was told that he was no longer going to be able to advocate for these end of life pediatric cancer pts.  This particular pt, Bob had previously advocated for this kid and the parent reached out to Bob in apparently a moment of crisis. Bob does not ask for money, doesn’t expect to be showered with accolades nor be the center of some SPOTLIGHT.  He has the heart and soul of a servant to those in need. I am honored to have Bob as a friend.

Here is a quote from a Pharmacist that at one time held the second highest elected office in our country – VICE PRESIDENT:  It should also apply to individuals

“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey 

Instead of the family going to dinner, my husband gets a call for emergency advocacy assistance. An 8 year old girl with cancer at the Children’s Hospital needed his help ASAP. We drove all the way there and what happened next was pretty damn impressive. Bob takes over the whole child wing like these kids have known him their whole life. He Handed out toys, pens, crayons, coloring books, sketch pads and even entertained the siblings in the TV room while waiting. All the nurses and doctors played along with Bobs stupid sock puppets and even ran into the family of a child he had advocated for in the past so he checked in on that child as he was back in the hospital. That Mom made me tear up with their story and how my husband had helped their family. Pain and suffering throughout the ward turned into entertainment hour, these babies forgot they were sick for just a short time. Bob was treated like a superhero but that doesn’t surprise me really his ability to entertain kids has always impressed me as all kids love Bob. This setting was one I hadn’t seen before and watching these children and their families embrace him the way they did made me so proud. As the day closed Bob was able to advocate successfully for the little girl we were called to help and with ease I may add. Watching Bob advocate was way better than the dinner I didn’t get. We ended up eating fast food and we giggled all the way home at the children’s experiences and laughter. A great advocate not only helps the patients in need but helps the patients who need him the most. After what I witnessed and what our own kids saw, I see why people call from all over to ask for help.. No one and I mean no one could have accomplished that task. After all, laughter is the best medicine, so they say. One baby got the help she needed and the rest got a show. So Proud of you babe, you’re a hard act to follow.

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Majority of retail pharmacists fear losing Medicare-eligible patients

https://drugstorenews.com/majority-retail-pharmacists-fear-losing-medicare-eligible-patients

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US to roll back coverage of COVID-19 vaccines, treatments starting this fall

https://www.beckershospitalreview.com/finance/us-to-roll-back-coverage-of-covid-19-vaccines-treatments-starting-this-fall.html

The Biden administration is set to begin shifting costs of COVID-19 vaccines and treatments to the commercial market, ending the practice of the U.S. government purchasing the drugs and making them available at no cost, The Wall Street Journal reported Aug. 18.

HHS is set to hold an Aug. 30 planning meeting with representatives from drugmakers, pharmacies and state health departments to discuss the change. Shifting how COVID-19 vaccines, tests and treatments are funded is expected to take months, an agency spokesperson told The Journal. 

The eventual end to underwriting COVID-19 drugs was always in the cards for the U.S. government under both the Biden and Trump administrations. At an event sponsored by the US Chamber of Commerce Foundation Aug. 16, White House Covid-19 Response Coordinator Ashish Jha, MD, said the administration has been thinking about its move from the “acute emergency phase” of the pandemic in which the government is purchasing vaccines, treatments and diagnostic tests.

“My hope is that in 2023, you’re going to see the commercialization of almost all of these products. Some of that is actually going to begin this fall, in the days and weeks ahead. You’re going to see commercialization of some of these things,” Dr. Jha said.

Vaccines, diagnostic testing and treatments would move closer into the regular U.S. healthcare system under the change. “If you need a treatment, you get a treatment the way you’d get treatments for heart disease and other viruses and bacteria and other kinds of things,” Dr. Jha said. 

Top of mind for the administration is ensuring that moving COVID-19 resources into the commercial market does not leave 30 million Americans who are uninsured at a disadvantage. “Right now everybody can walk into CVS and get a vaccine. I want to make sure when we make this transition, we don’t end up in a point where nobody can get a vaccine because we didn’t get the transition right,” Dr. Jha said. 

Health insurers and pharmacy benefit managers will be more involved in negotiating prices with the manufacturers of COVID-19 drugs, with prices likely ending up higher than what the government has paid, likely resulting in premium increases, Larry Levitt, executive vice president for health policy at Kaiser Family Foundation, told The Journal. 

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