Senator Bill Nelson is up for re-election in Nov – and is CLUELESS about opiates/chronic pain/substance abuse

Posted on September 19, 2018 by Pharmaciststeve

This is a email that I received from Senator Bill Nelson after writing his office about HR-6 BEFORE THE SENATE VOTED

Dear Mr. Ariens:

Thank you for writing to me regarding pain management and access to prescription pain medication. I have heard from many Floridians about their difficulties obtaining prescribed pain medication, and I appreciate your bringing this issue to my attention.

I support efforts by the State to rein in prescription drug abuse and prevent drug overdose, but I also want to make sure people who need their prescribed medications for chronic pain management have access to the treatment they need.

On March 8, I became a cosponsor of S. 2260, the Opioids and STOP Pain Initiative Act, to allocate $5 billion for a new non-addictive pain management initiative at the National Institutes of Health. The initiative would expand research on our understanding of pain and non-addictive treatments for chronic pain, including new non-addictive drugs, non-pharmacological treatments, and effective models of health care delivery for pain management. The STOP Pain Initiative Act would also implement a strategy to create national registries and datasets for chronic pain conditions and to use precision medicine to prevent and treat pain.

I am committed to finding a balance between the need for responsible drug oversight and the rights of patients and healthcare providers. The Comprehensive Addiction and Recovery Act (P.L. 114-198), which I cosponsored and was signed into law on July 22, 2016, authorizes funding for drug abuse education and prevention programs and creates best practices for prescribing pain medication. This law and other efforts can reduce the prevalence of opioid addiction, while protecting access to medication for legitimate chronic pain patients.

I will keep your views in mind should the Senate consider additional legislation on this issue. If you have any other concerns, please do not hesitate to reach out to me again.

Sincerely,
Bill Nelson

Bill Nelson believe that chronic pain pts should WAIT until some entity discovers a NON-ADDICTIVE MED for pain.. IF ONE EXISTS… and it will only take 10-15-20 yrs for such a drug – if discovered – would take to get it thru clinical trials and available to be prescribed for chronic pain pts…

ISN’T THAT ENCOURAGING ?

Nelson and 98 other Senators voted IN FAVOR OF THIS BILL… only a Republican Senator from UTAH for NO.

Nelson and 32 other Senators are up for RE-ELECTION in NOV.. and it is reported that they are anticipating 50 million dollars on his re-election campaign. Remember that Nelson was one of most/all of the Democratic Senators that VOTED NO on the Medicare Part D program that is now providing medication to Medicare pts .. which there was no coverage for… for the first 40 yrs of Medicare

Nelson was also one of the Democratic Senators that voted against the recent TAX CUT for individuals.. which was suppose to put abt $1000 in middle American’s pocket and Rep Pelosi(D) referred to $1000 as “CRUMBS” and if the Democrats take back control of Congress have said that they are going to raise your taxes and take that $1000 back.. and who knows if they will stop at just that $1000.

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Pain Warriors ~ the Movie : RAISED 94% of its goal !!!

Posted on September 19, 2018 by Pharmaciststeve

See the source image

 

https://www.seedandspark.com/fund/pain-warriors-the-movie#community

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Lawsuit blames man’s suicide on St. Matthews pain clinic

Posted on September 18, 2018 by Pharmaciststeve

Lawsuit blames man’s suicide on St. Matthews pain clinic

http://www.wdrb.com/story/39115785/lawsuit-blames-mans-suicide-on-st-matthews-pain-clinic

Brent Sloane texted his wife “they denied script im done love you” (sic) on Sept. 18, 2017. Thirty minutes later, he killed himself.

LOUISVILLE, Ky. (WDRB) — The family of a man who committed suicide last year said he did so because a doctor at Commonwealth Pain and Spine wouldn’t sign off on a pain medication prescription that the man needed.

Brent Sloane texted his wife “they denied script im done love you” (sic) on Sept. 18, 2017. Thirty minutes later, he killed himself. According to the lawsuit filed against Commonwealth Pain and Spine in Jefferson Circuit Court on Tuesday morning, the text and suicide could have been prevented.

The suit say Slone was involved in a serious car wreck in 2011 that left him with significant injuries. After the procedure, Slone entered an inpatient recovery center in San Diego, California. While there, he was prescribed oxycodone and oxycontin.

According to the suit, while on a visit to Louisville, Slone went to the emergency room at Baptist Health for a dislocated hip and ulcer. He was prescribed a small amount of pain medication as he had run out of the prescription from the San Diego clinic and was advised to follow up with Commonwealth Pain and Spine. According to the suit, after he was discharged, he called Commonwealth Pain and Spine and requested a “bridge prescription.”

The suit says that notes from the clinic indicated that Dr. Stephen Young said he “needed to see the records from this facility in California.”

Later that day, the suit says Slone faxed the documentation to Commonwealth Pain and Spine. However, Young still refused to fill the prescription, because, according to call log notes, the documentation was from July, and there had been no communication since that time. Slone was advised that he would need to wait for six days for his appointment.

Slone killed himself a few hours later, the suit says.

“The intention of the lawsuit is bring light to that fact that people who experience pain should not be disregarded and tossed aside,” said Hans Poppe, an attorney for the family of Slone.

A lawsuit presents only one side of the arguments in the case. A message sent to an attorney for the clinic was not returned.

The suit claims Slone killed himself because he was not able to deal with the pain from various procedures and complications from the wreck in 2011.  

“This is a problem that will only get worse,” Poppe said. “Mismanagement of pain medication and often leads to suicide or an addiction to heroin.“

Last summer, Kentucky lawmakers tightened restrictions on prescribing pain medication to patients. The change was hotly debated by opponents who said the changes would make it too difficult for people truly in pain to receives necessary medications. 

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Your NOVEMBER VOTE could mean better/worse quality of life for you !

Posted on September 18, 2018 by Pharmaciststeve

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The Drug Enforcement Administration has proved itself incompetent for decades

Posted on September 18, 2018 by Pharmaciststeve

The Federal Agency That Fuels the Opioid Crisis

The Drug Enforcement Administration has proved itself incompetent for decades.

www.nytimes.com/2018/09/17/opinion/drugs-dea-defund-heroin.html

Every day, nearly 200 people across the country die from drug overdoses. Opioids have been the primary driver of this calamity: first as prescription painkillers, then heroin and, more recently, illicitly manufactured fentanyl. The death toll has risen steadily over the past two decades.

The Drug Enforcement Administration, the agency that most directly oversees access to opioids, deserves much of the blame for these deaths. Because of its incompetence, the opioid crisis has gone from bad to worse. The solution: overhauling the agency, or even getting rid of it entirely.

The problem begins with poor design. A brainchild of Richard Nixon’s “war on drugs,” the agency sought to cut off supplies of drugs on the black market, here and abroad. But in passing the Controlled Substances Act of 1970, Congress also gave the agency broad authority over how prescription opioids and other controlled substances were classified, produced and distributed. The agency was supposed to curb problematic drug use, but failed to do so because its tactics were never informed by public health or addiction science.

Despite the investment of hundreds of billions of taxpayer dollars and the earnest efforts of thousands of employees, the D.E.A.’s track record is abysmal. The agency has been unable to balance legitimate access to and control of prescription drugs. The widespread over-reliance on opioids, along with benzodiazepines, amphetamines and other scheduled medications, has created a booming black market.

The agency’s enforcement strategies, and the support it has lent to local and state police departments, have also fueled abusive police tactics including dangerous no-knock-raids and ethnic profiling of drivers. It has eroded civil liberties through the expansion of warrantless surveillance, and overseen arbitrary seizures of billions of dollars of private property without any clear connection to drug-related crimes. These actions have disproportionately targeted people of color, contributing to disparities in mass incarceration, confiscated property, and collective trauma.

The United States was ill equipped to navigate the worst drug crisis in its history with the D.E.A. at the vanguard. Starting in the late 1990s the manufacturing, distribution and prescribing of opioids began to increase rapidly. Overdose deaths soared since so many people were prescribed opioids and many mixed them with alcohol and other sedative drugs. The D.E.A. could have marshaled a calibrated response, expanding evidence-based treatment and reducing the prescription of especially risky drug combinations.

Instead, the agency pushed for surveillance of prescription records and electronic communication, doubled down on prosecuting prescribers and helped to tighten the screws on patients seeking pain relief. Meanwhile, lifesaving opioid treatments that the D.E.A. closely regulates, like methadone, have remained extremely difficult to obtain. Indeed, these problems were much broader than the alleged industry machinations to muzzle the agency.

A decade into the crisis, more and more prescription drug users turned to the black market. Even though the D.E.A. had tried to “eradicate” illicit drugs for nearly 50 years, users could easily buy stolen and counterfeit pills, along with a cheaper option, heroin. Soon, some began injecting. Outbreaks of H.I.V. and hepatitis C followed. Meanwhile, people who sought evidence-based treatment were rarely able to access it because of the agency’s evolving regulatory and enforcement strategies, like blocking the expansion of mobile methadone clinics and shutting down addiction treatment providers without arranging alternatives for affected patients.

As the engine of overdose deaths shifted from prescription drugs to heroin, the D.E.A. turned to its supply-reduction playbook. This resulted in a major uptick in heroin seizures and high-profile prosecutions, which encouraged traffickers to create more compact, potent drugs. In a single year, from 2014 to 2015, deaths involving the synthetic opioid fentanyl and its analogues almost doubled, setting the stage for its current role as the principal driver of overdose fatalities. And since 2015, the agency has not had an appointed administrator.

We urgently need to rethink how our nation regulates drugs. What should our goals be? How can we design institutions and performance metrics to achieve them?

The answers lie at the local and state levels. In Rhode Island, opioid overdoses are declining because people behind bars have access to effective treatment. Massachusetts has deployed drop-in centers offering treatment, naloxone and other services. San Francisco and Seattle are planning to open safe consumption spaces which show tremendous promise as a tool to reduce overdose deaths and other drug-related harm. But the D.E.A. and its institutional parent, the Justice Department, stand in the way of some of these experiments.

We ought to reinvent the Drug Enforcement Administration. Considering its lack of public health and health care orientation, the agency’s regulatory authority over the pharmaceutical supply could be transferred to a strengthened and independent Food and Drug Administration, while the regulation of medical and pharmacy practice can be ceded to the states. Parts of the D.E.A.’s law enforcement mandate should be transferred to the F.B.I., delegated back to the local or state, or eliminated. A significant portion of the D.E.A.’s budget should be reinvested in lifesaving measures like access to high-quality treatment.

The Drug Enforcement Administration has had over 40 years to win the war on drugs. Instead its tactics have fueled the opioid crisis. To finally make a dent in this national emergency, we need to rethink the agency from the bottom up.

Leo Beletsky, an associate professor of law and health sciences at Northeastern University, is the faculty director of the Health in Justice Action Lab, where Jeremiah Goulka is a senior fellow.

 

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no matter how much suffering, suicides, comments… they have their agenda and nothing is going to change ?

Posted on September 17, 2018 by Pharmaciststeve

Senate passes sweeping legislation to combat opioid epidemic

https://www.nbcnews.com/politics/politics-news/senate-passes-sweeping-legislation-combat-opioid-epidemic-n908901

Lawmakers in both chambers have responded public pressure to find solutions to a deadly crisis that has affected every state in the nation.

WASHINGTON — The Senate on Monday overwhelming approved a sweeping legislative package of bills aimed at combating the nation’s deadly opioid epidemic.

The bipartisan measure passed 99-1. Sen. Mike Lee, R-Utah, was the only senator to vote against it.

Similar to the House package passed in June, the Senate’s Opioid Crisis Response Act of 2018 (OCRA) directs funding to federal agencies to establish or expand programs dealing with prevention, treatment and recovery.

Highlights from the 70 bills in the package include funding that requires the Food and Drug Administration to dole out prescription opioid pills in smaller quantities and money that offers an incentive to the National Institutes of Health to prioritize the development of non-addictive painkillers, two solutions medical experts believe could help decrease opioid addiction in the long run.

The package also includes Ohio Republican Sen. Rob Portman’s Synthetics Trafficking and Overdose Prevention Act “STOP” Act, a bill endorsed by President Donald Trump because it establishes parameters to crack down on shipments of fentanyl, a synthetic opioid, from entering the U.S.

Currently, the U.S. Postal Service is the only transportation carrier that does not collect electronic information on overseas cargo, which makes it harder for Customs and Border Protection agents to screen packages for drugs.

The Senate package comes months after the House passed their 58-bill opioid package, a response to the pressure lawmakers have felt to find solutions for the deadly crisis that has affected every state in the country.

Overdose deaths killed an estimated 72,000 Americans in 2017, according to the Centers for Disease Control and Prevention. In comparison, over 40,000 Americans died that same year in car accidents, while 12,000 died from gun violence.

The Senate vote on Monday also offers a success for vulnerable Democrats and Republicans to point to during the final weeks leading up to November’s midterm election. Some of these lawmakers have seen ads in their states pressuring them to support opioid legislation.

In an effort to secure a massive bipartisan legislative win before year’s end, the chairman of the Senate Committee on Health, Education, Labor and Pensions, Lamar Alexander, R-Tenn., spent a majority of the summer leading an effort to hammer together dozens of bills passed by five Senate committees this year.

Three sources familiar with the process tell NBC News the Senate and House have already started to iron out minor differences in their legislative packages, including parameters for opioid addicts to access Medicaid-backed mental health facilities. Currently, the Senate version also reauthorizes $500 million per year in opioid grant extensions for the next three years, includes provisions for doctors to understand how to treat young addicts. It also reauthorizes the White House’s ability to oversee narcotic-related issues among federal agencies.

Once a compromised bill is worked out, each chamber will have to pass the bill before sending the final measure to the president for his signature.

Something that all the members – except one (Sen. Mike Lee, R-Utah) – can agree upon… talk about your bipartisan bill… The House passed this bill in June and now a vote of 99-1 in the Senate it is going to Pres Trump to be signed into law.  It only took 70 DIFFERENT BILLS to address the singular opiate crisis. Another complex solution to a potentially very simple problem … provided by our Congress..

In Nov, 435 members of Congress and 33 Senators are up for election in Nov … that means that 87% of Congress is up to the voters if they go back to be a member  of Congress starting in Jan 2019.

This Congress is not going to help the chronic pain community… does it really make any difference if they were all tossed out of office and a whole bunch of novices takes over Congress in Jan 2019 ?

They have discounted your pain… they have encouraged your TORTURE… they have ignored the TRUTH and FACTS… they have DISCARDED your comments,  Dozens or HUNDREDS of petitions have been discarded…  Your reality is not their reality…  Do they deserve YOUR VOTE ?

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Roseanne Barr says her ‘Conners’ character gets killed off by opioid overdose

Posted on September 17, 2018 by Pharmaciststeve

Roseanne Barr says her ‘Conners’ character gets killed off by opioid overdose

http://www.foxnews.com/entertainment/2018/09/17/roseanne-barr-says-her-conners-character-gets-killed-off-by-opioid-overdose.html

Roseanne Barr revealed how her character will get killed off on the upcoming spinoff of “Roseanne” after she was fired from the ABC series in May for writing a racist tweet.

Barr told Brandon Straka on his YouTube show “Walk Away,” that the

writers of the ABC spinoff “The Conners” elected to have her character die by overdosing on opioids.

“Oh ya, they killed her,” she said. “They have her die of an opioid overdose.”

A rep for “The Conners” did not immediately return Fox News’ request for comment.

Barr made it clear she was not happy with her character’s fate saying it was disrespectful to fans “who loved that family” on the original series.

“There’s nothing I can do about it,” Barr admitted. “It’s done. It’s over.”

Barr’s former co-star John Goodman revealed previously that her character would die in the spin-off but did not say how. ABC has yet to comment on how they will handle Barr’s character’s death.

Barr made headlines after she tweeted in May that former President Barack Obama’s aide, Valerie Jarrett, who is African-American and was born in Iran, was as though the “Muslim brotherhood & planet of the apes had a baby.” ABC canceled the popular reboot of “Roseanne” shortly after the tweets.

In case anyone is interested…. ABC is owned by The Walt Disney Company and here are some of the other major companies that The Walt Disney Company owns …

https://www.investopedia.com/articles/markets/102915/top-5-companies-owned-disney.asp

Here are just a few of the mouse house’s biggest companies:

1. Disney/ABC Television Group

Disney/ABC Television Group operates Disney’s broadcast television, cable television and radio businesses. Its broadcast TV businesses include ABC Studios, ABC News and the ABC Television Network, which combine to deliver programming to more than 200 local TV affiliates across the country. Disney/ABC Television Group also operates eight local television stations in some of the country’s biggest media markets. On the cable side, Disney/ABC Television Group operates the ABC Family channel and Disney Channels Worldwide, a unit that includes more than 100 Disney-branded cable networks reaching 164 countries and territories around the world.

Disney/ABC Television Group also has equity stakes in three independently operated media businesses: A&E Television Networks, Hulu, and Fusion Media Network. A&E Television Networks is an equally held joint venture with the Hearst Corporation. It operates a variety of cable channels, including A&E, History and Lifetime. Disney/ABC Television Group has a 30% stake in Hulu, an online streaming video service featuring ABC Studios content. Disney would have a controlling stake in Hulu if the Fox deal goes through. Fusion is a multi-platform media company targeted at Hispanic Americans. It is an equally held joint venture with Univision Communications, an American media and broadcast company.

2. ESPN, Inc.

ESPN is a sports media and entertainment company with eight cable networks in the U.S. and another 16 TV networks abroad. Disney holds a controlling 80% stake in ESPN, while Hearst Corporation owns 20%. In addition to its TV properties, ESPN operates other related media businesses, including ESPN.com, ESPN Radio, and WatchESPN. ESPN also holds a 30% stake in CTV Specialty Television, a multichannel Canadian sports broadcaster.

3. Walt Disney Parks & Resorts U.S., Inc.

Walt Disney Parks & Resorts U.S., Inc. operates Disneyland in California, Walt Disney World Resort in Florida, and Aulani, a spa and resort in Hawaii. These operations include numerous company-owned hotels, retail and entertainment complexes, conference centers, and indoor and outdoor recreation facilities. Walt Disney Parks & Resorts also operates Disney theme parks overseas through a handful of international subsidiaries.

Disney Parks & Resorts’ French subsidiary, Euro Disney S.A.S., owns 51% of Disneyland Paris. In China, Shanghai International Theme Park Co. controls 43% of Shanghai Disneyland Resort, Hong Kong Disneyland Management controls 47% of Hong Kong Disneyland Resort. While Walt Disney Parks & Resorts does not have an ownership stake in Japan’s Tokyo Disney Resort, it does earn licensing royalties from the Japanese operating company, Oriental Land Co.

In early February of 2018, Disney announced it would be increasing the ticket prices for its American-based theme parks by around 9%, with a regular adult one day pass at the Magic Kingdom in Orlando costing $129, instead of its former price of $124. 

4. Lucasfilm Ltd. LLC

Lucasfilm is a film production company best known for producing the Star Wars and Indiana Jones series, two of the biggest-grossing film franchises in history. Disney acquired Lucasfilm in 2012 for $4.06 billion. Its subsidiary media and production businesses include Industrial Light and Magic, Skywalker Sound, and Lucas Licensing. Under Disney’s watchful eye, the company has started a new line of Star Wars films, and has plans to create a fifth Indiana Jones film starring Harrison Ford in 2019. According to the Hollywood Reporter, the company made back its purchase of Lucasfilm in late 2017 when The Last Jedi brought the total gross of these new Star Wars movies to $4.08 billion, on par with the initial buy. 

5. Marvel Entertainment, LLC

Marvel Entertainment is a media and entertainment company with operations in publishing, television, and film. Marvel is best known for its catalog of fictional characters, including Spider-Man, Captain America, and the X-Men. Disney acquired Marvel and the rights to its more than 5,000 characters in 2009 for $4 billion. Marvel’s blockbuster superhero films have gone on to be huge earners for Disney, giving the company high spots on the top 10 highest grossing movies of the year for several years now. Marvel Entertainment’s subsidiaries include Marvel Studios, Marvel Animation and Marvel Comics.

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Coke originally contain COCAINE ..now… may be infused with MARIJUANA

Posted on September 17, 2018 by Pharmaciststeve

Coca-Cola 'Closely Watching' Use of Cannabis in Wellness DrinksCoca-Cola ‘Closely Watching’ Use of Cannabis in Wellness Drinks

https://www.nbcphiladelphia.com/news/business/Coca-Cola-No-Interest-in-Marijuana-or-Cannabis-But-CBD-Instead-493515331.html

While Coke may be looking into the potential of marijuana-infused health beverages for pain relief, the company has no interest in helping consumers get high.

The Coca-Cola Company released a statement on Monday following reports indicating that the beverage behemoth was looking into possibly infusing drinks with cannabidiol, a non-psychoactive component in cannabis commonly known as CBD.

“We have no interest in marijuana or cannabis. Along with many others in the beverage industry, we are closely watching the growth of non-psychoactive CBD as an ingredient in functional wellness beverages around the world,” the company said.

What gets people high from marijuana is not CBD but tetrahydrocannabinol, the potent psychoactive chemical compound commonly known as THC.

BNN Bloomberg first reported that Coca-Cola and cannabis producer Aurora Cannabis Inc. were engaged in talks to possibly develop health-focused beverages geared toward pain relief. Neither company has confirmed any plans.

“The space is evolving quickly. No decisions have been made at this time,” Coca-Cola’s statement said.

The report comes as more U.S. states move to legalize marijuana for recreational use and as Canada, where Aurora is based, prepares to fully legalize the recreational use of cannabis next month, CNBC reported.

CBD advocates say the chemical compound can provide multiple health benefits, including pain management and treatment for seizures and neurological disorders.

Despite the growing number of states legalizing marijuana for medical and recreational use, the federal legal status of CBD in the U.S. is still somewhat cloudy. Marijuana is currently a Schedule I drug under U.S. Drug Enforcement Administration guidelines, which means the agency considers it to have no accepted medical use and a high potential for abuse.

But the DEA this year clarified that CBD did not fall under the definition of marijuana per the Controlled Substances Act, because the method to extract the compound would leave behind only trace amounts of illicit cannabinoids.

And in late June, the U.S. Food and Drug Administration for the first time approved a prescription drug made from CBD to treat two rare forms of epilepsy.

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CVS limiting meds on formulary to those “ESTIMATED” to be cost-effective

Posted on September 17, 2018 by Pharmaciststeve

CVS To Restrict Patient Access Using Cost-Effectiveness: Too Much, Too Soon

https://www.healthaffairs.org/do/10.1377/hblog20180913.889578/full/

Recently, CVS Health announced a new formulary management option: allowing self-insured employers to remove from their formularies medicines launched at a price greater than $100,000 per quality-adjusted life-year (QALY). The New York State Drug Utilization Review Board has also recently used a cost-effectiveness threshold to justify its mandate for the Medicaid program to receive a steep discount on the price of a cystic fibrosis treatment. If the discount is not obtained, access to the drug will likely be limited. Both CVS and the New York State Board based these decisions on cost-effectiveness estimates from the Institute for Clinical and Economic Review (ICER). Although there is strong support for the movement toward value-based care and prices, the CVS option and New York’s decision for its Medicaid program are too much too soon and could hamper patients’ access to needed medicines, for the reasons described in this post. 

First, cost-effectiveness is an element of value, but it is not synonymous with it. Multiple groups in the US, such as the ICER, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, the Innovation and Value Initiative, and Faster Cures, among others, have proposed value assessment frameworks. None uses cost-effectiveness as the sole measure of value. To fully assess the value of a treatment, stakeholders must account for other considerations important to patients. Examples of these other considerations include: a new therapy’s ability to treat a previously inadequately treated illness; its ability to broaden therapeutic options for diseases with great variability in treatment response; the possibility of cure and the importance of hope related to it; the ease of a regimen when alternative therapies are complex, cumbersome, and time consuming; or, its novel mechanism of action that could lead to markedly improved derivative treatments. Although the National Health Service (NHS) in the United Kingdom bases many of its coverage decisions on the National Institute for Health and Care Excellence’s cost-effectiveness assessments, even it incorporates other considerations, and the strict NHS approach has not garnered real support from stakeholders in the US. 

Second, the CVS program uses a threshold of $100,000 per QALY and likely will use a health system perspective that does not incorporate the economic value of improvements in productivity or reductions in caregiver burden. The scholarly, Second Panel on Cost-Effectiveness in Health and Medicine, which provided the latest broad overview of how these assessments should be performed, has emphasized the importance of considering not just the health system perspective but also the broader societal one, which incorporates these indirect benefits. Moreover, the CVS plan has a single economic threshold ($100,000). In contrast, ICER’s value framework – which has the greatest focus on cost-effectiveness among all the frameworks — has a variable threshold (sometimes $100,000, other times $150,000) based upon the other considerations beyond the cost-effectiveness listed above. Evaluating all therapies for all diseases under all circumstances with a single threshold is an inappropriately blunt approach. CVS mentions that its approach will not apply to medicines deemed “breakthrough therapies” by the Food and Drug Administration (FDA). If CVS believes that the breakthrough designation connotes important non-economic considerations, then why just consider the FDA designation and not the factors above? 

Third, CVS proposes a dichotomous view of a treatment’s value. If the cost-effectiveness assessment is below $100,000 per QALY, then the formulary would include the medicine, and if the assessment exceeds the threshold, it would not. What about medicines with a cost-effectiveness of $105,000 per QALY? Premera Blue Cross uses cost-effectiveness in constructing its formularies but has a more nuanced approach. The company ties formulary tiers, and thus copayments, to cost-effectiveness. Rather than denying patient access, Premera makes a broader set of medicines available but adjusts how much the patient pays for medicines it deems to have lower economic value. 

Fourth, by making a dichotomous formulary access decision based upon a single cost-effectiveness number, CVS presupposes that all patients respond in the same fashion to a therapy. There is substantial literature demonstrating heterogeneity of treatment effect, which means that for the same treatment, some patients benefit far more than the average. The CVS approach ignores this important clinical component. 

Finally, in allowing its clients to use ICER’s cost-effectiveness assessment as the sole source of data to support formulary exclusion, CVS assumes that the field of value frameworks is fully mature, has addressed the many limitations of the QALY, and is ready for prime time, which it is not. Last year in a Health Affairs blog, we identified six key considerations for the improvement of value frameworks, as follows:

  1. Value assessments should be separate from assessments of budget impact and affordability.
  2. Value assessments should incorporate what is important to patients, even if the end user for a framework is the payer.
  3. Value assessments should adopt broad system perspectives in what they assess and how they assess it.
  4. Value is dynamic and needs to be considered and captured as such.
  5. Value assessments should be transparent and reproducible.
  6. A diversity of value assessment approaches that reflect the differing needs of stakeholders should remain; value assessments should reflect user preferences. 

Prices should reflect value, and concerns about health care spending should move us toward incentivizing high-value interventions and dis-incentivizing low-value care. However, the announcement from CVS, perhaps well intentioned, is too much too soon.

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McCaskill is apparently CLUELESS about ADDICTION and DEPENDENCY ?

Posted on September 17, 2018 by Pharmaciststeve

‘No question my mom was addicted to opioids,’ McCaskill reflects during roundtable

https://www.kansascity.com/news/politics-government/article199431699.html

U.S. Sen. Claire McCaskill thinks her mother was addicted to opioids before she died.

McCaskill, a Missouri Democrat, hosted a health care roundtable Friday afternoon at St. Luke’s Hospital.

The roundtable with Kansas City physicians and other medical professionals covered topics including the cost of emergency room care, the impact of Missouri’s decision to not expand Medicaid and problems in the state’s mental health system.

McCaskill also devoted several minutes to the highly personal topic of opioid addiction and the intensive outpatient treatment programs that exist in her neighborhood. 

“There’s no question my mom was addicted to opioids near the end of her life,” said McCaskill, whose mother, Betty Anne McCaskill, died in 2012 at age 84.

She recalled how her mother often told her doctors that her pain was at a 10 on 1-to-10 scale to get the strongest dose of medication during her final years.

“It was one of those gut-wrenching things because it felt like I knew it was not helping her. On the other hand, to try and get her off those drugs at that point in her life also seemed like a cruel and sometimes painful thing to get done,” McCaskill elaborated to reporters after the event.

“And frankly some of the times she was in the most pain was when she was going through withdrawals. She wanted the drugs because she was coming off of the drugs … and all of them were prescribed with her doctors.”

Marc Larsen, the chair of emergency medicine at St. Luke’s, told McCaskill the medical community “created this epidemic by saying we have to treat the pain.”

McCaskill, who has led an investigation into opioid manufacturers, floated the idea of broadening her investigative efforts into the rest of the pharmaceutical industry. She repeatedly expressed her concern about the links between drug companies and research organizations that tout the benefits of medication.

Another area of focus during the discussion was the state of mental health care in Missouri.

McCaskill was shocked to learn that the largest mental health care provider in the state is the Department of Corrections. She was also surprised to learn that Missouri incarcerates women at a higher rate than any other state.

“Are women meaner in Missouri?” she quipped.

After the meeting, she blamed both of these statistics on the state’s “failure to have wrap-around health services, mental health services, behavioral health services for many of the underinsured and uninsured in our state.”

“There’s no question my mom was addicted to opioids near the end of her life,” said U.S. Sen. Claire McCaskill, whose mother, Betty Anne McCaskill, died in 2012 at age 84. Bryan Lowry blowry@kcstar.com
Another person with a LAW DEGREE making medical opinions and decisions. McCaskill is up for RE-ELECTION in November.. She has been in the Senate for 18 yrs… Is it time for some TERM LIMITS being applied to her ?
According to her comments in this article it would appear that she does not understand the difference between ADDICTION and PHYSICAL DEPENDENCY and if her Mom was still alive today… she would be insisting that she did not take opiates for her chronic pain.

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