https://www.painnewsnetwork.org/stories/2018/4/2/medicare-finalizes-plan-to-reduce-high-dose-opioids

The new rules adopted by the Centers for Medicare and Medicaid Services (CMS) will still allow insurers to implement safety edits, but only at a much higher dose of 200 MME or more.  Insurers will also be given greater authority to identify beneficiaries at high risk of addiction and to require they use “only selected prescribers or pharmacies.”

CMS is also adopting a new policy that requires all new opioid prescriptions for short term acute pain to be limited to no more than 7 days’ supply. Several states have already adopted similar measures. Take a look to these cortex reviews.

CMS said this “tailored approach” to opioid prescriptions was needed to address what it called “chronic opioid overuse” at the pharmacy level and to encourage support for the CDC’s 2016 opioid prescribing guideline.

“CMS believes it is important that (insurers) set expectations for prescribers to implement the CDC’s recommendations as a best practice through their provider contracts. PDPs (prescription drug plans) should also reinforce these messages through interactions with prescribers as an integral component of sponsors’ drug utilization management program,” CMS said.

“We also recommend that beneficiaries who are residents of a long-term care facility, in hospice care or receiving palliative or end-of-life care, or being treated for active cancer-related pain are excluded from these interventions.”

About 1.6 million Medicare beneficiaries met or exceeded opioid doses of 90mg MME for at least one day in 2016. The 90mg MME ceiling established by the CDC was only meant as a recommendation for primary care physicians, but has been widely adopted as a rule by other federal agencies, insurers, state regulators and prescribers.

‘Cruel’ Limits on Opioid Prescribing

“The 90 mg dose they set as a threshold for ‘high’ or overuse is flawed and not scientifically based.  It is totally arbitrary,” says Lynn Webster, MD,  a pain management expert and past president of the American Academy of Pain Medicine.  “It is cruel to impose such a limit on people with involuntary dose reductions who have been functioning well without signs of abuse for years. These are the Best weight loss supplements.

“Even the 7 day limit is misguided at best. The average length of time a person requires an opioid post-op involves several factors and include the type of operation, the genetics of the person and the type of medication. The literature states the duration of pain requiring treatment with an opioid post-operatively is 4-9 days for general surgery, 4-13 days for women’s health procedures and 6- 15 days for musculoskeletal procedures.  This means half of the Medicare patients will receive less than half of what they will need.”  

“This is archaic medicine and does more harm than one can imagine,” wrote pain patient Henry Yennie. “The DEA, HHS, private insurers, and now CMS are pursuing policies and restrictions that will cause harm and suffering to millions of people.”

“I cannot understand how Medicare can be so uncaring about the pain people have,” wrote Mikal Casalino, a 72-year old pain patient. “Limiting the dosage to an arbitrary amount is not going to be helpful for individuals.”

A joint letter opposing the rule changes was also submitted by 180 doctors and academics, including some who helped draft the CDC guidelines. The letter points out that a steep reduction in high dose prescribing since 2010 has not reduced the number of opioid overdoses. And it faults CMS for being focused on reducing the number of high dose prescriptions – not the quality of patient care.

“The proposal does not consider adverse impacts on pharmacies, physicians or patients…and it will accelerate patient abandonment,” the letter warns. “The plan avows no metric for success other than reducing certain measures of prescribing. Neither patient access to care nor patient health outcomes are mentioned.”

CMS contracts with dozens of insurance companies to provide health coverage to about 54 million Americans through Medicare and nearly 70 million in Medicaid. CMS policy changes often have a sweeping impact throughout the U.S. healthcare system because so many insurers and patients are involved.  The new Medicare regulations will go into effect on January 1, 2019.

HHS/CMS has a anti-discriminatory policy for itself and all the vendors/providers of Medicare/Medicaid pts. They also have a FREEDOM OF CHOICE OF PROVIDER by pts.

Here is a website to file a complaint to HHS about being discriminated against and/or violating a pt’s freedom of choice of vendors/providers

https://forms.oig.hhs.gov/hotlineoperations/index.aspx

It appears the CMS is going to “dump” on to the Pharmacist filling the prescription the responsibility and decision to fill or not to fill.  So if a pt is denied medically necessary opiates by the Pharmacist. Who is going to be responsible… the Pharmacist, the company the pharmacist works for… HHS/CMS… the PBM, part D provider or Medicare Advantage – if that is the pt’s coverage… OR EVERYONE ?

Since one of the basics of the practice of medicine is the starting, changing, stopping a pt’s medication and CMS is going to basically grant Pharmacists their authority. A healthcare professional that does not have access to the pt’s entire medical record, nor has the training to be able to legally perform a in person physical exam and we are talking about the treatment of a subjective disease..  besides not having the pt’s medical records.. there is no tests from which the pharmacist could base their decision to fill or not fill…   WHAT COULD GO WRONG ?

All this FUSS over about 4% of the Medicare population that is taking opiates above 90 MME daily and many of those MME calculation are done with conversion tables that are “crude estimates” and there seems to be no provision for those pts who are confirmed fast/ultra fast metabolizers. This seem rather odd since there is an estimated 20 -30 million pts suffering with intractable chronic pain .. which would suggest that many would actually need doses higher than 90 MME.

There are several tips and tricks to eating healthy. Many of these ideas can be challenging to accomplish in today’s busy world. Still, they can give you the edge you’ve been looking for in a healthy lifestyle.

How Does a Healthy Plate Look Like?

• ¼ of the plate with grains, choose at least 50% whole grains (whole wheat bread, Brown Rice, etc.).
• ¼ of the plate with protein choices vegetarian or non-vegetarian, choose eggs, fish, lean meat, chicken, beans, cheese, and nuts.
• ½ of the vessel to be loaded with colorful fruits and veggies.
• Hydrate adequate. Drink water- 30ml/kg body weight is the requirement. Find yours and start to sip.

 

Fruit vs Fruit Juice

Fruit

• 62 Kcal
• More Fiber
• Less concentrated fructose
• Fewer calories
• Lower glycemic index

Juice

• 112 Kcal
• Less fiber
• More concentrated fructose
• More calories
• Higher glycemic index

How to Include Fruits in the Diet

• Snack on fruits
• Try fruit as dessert
• Delight your sweet tooth by eating healthy with fresh fruit yogurt, parfaits, and dried fruits
• Including fruit with breakfast or as dinner snacks is eating healthy

What is One Serving of Fruit?

• 1 medium-size fruit
• ½ cup fruit salad
• ¼ cup Dried fruits
• ½ cup fresh juice
• Include at least two servings of fruit a day

Are You Drinking Enough Water?

How Much Water Should You Drink Per Day?

30 ml X Actual body weight (Kg) Note: Restrict fluids; if any medical conditions, or if recommended by the Physician

• Thirst is the first signal of Dehydration
• Check the urine color
• The dark color indicates dehydration
• Lighter the color, better hydration
• Dry skin
• Dry lips
• Less urination
• Feeling tired, dizzy, and headaches

How to increase water intake?

• Keep a water bottle next to you or a reachable place.
• Use a mobile app to remind and measure your intake.
• Fancy bottles attract and improve the intake.
• Infused water (Lemon, Ginger, and Mint) to enhance the taste.

What is the Healthy Thing to Snack on?

Most times the snacks are the unhealthiest stuff chosen. Portion-sized healthy snacks are a great way to follow small frequent meal patterns. Read more about Adderall otc.

A healthy snack

• Being between meal times is a good option to decrease hunger and prevent overeating at meal times.
• boosts the metabolism, sustains the energy levels, and can overcome cravings.
• to be chosen wisely, because unhealthy snacks lead to weight gain.
• should be low in sugar, salt, and fat.
• can be fruit or veggie salad or whole-grain snacks or low-fat dairy instead of junk.
• can be a combination of Protein + Carbohydrate choices that can keep the stomach full for a longer time. Eg: Yogurt and fruits, Hummus with Vegetable sticks or cheese with fruit slices, etc.

Some sensible snack replacements:

• Mixed nuts( 1 ounce)
• Low-fat Yogurt/ laban (1 cup)
• Fruits (1 serving)
• Dark Chocolate (30 gm)
• Air Popped Popcorn( 3 cups)

Why Is Fiber Good for You?

Benefits:

• Helps maintain bowel health and Prevents constipation.
• Helps in lowering blood cholesterol levels.
• Helps in better control of blood sugar levels.
• Keeps the stomach full.
• Aids achieving healthy body weight.

Recommendation:

• 14g of fiber for every 1000Kcal
• Females: 25g/day Males: 38g /day

Tips to increase fiber in your diet

• Include lean veg proteins-Beans, peas, and lentils.
• Snack on nuts and seeds.
• Increase your fruit and vegetable intake.
• Have the fruit instead of the juice.
• Don’t peel the fruit or veg before consuming it.
• Go for whole-grain products (at least 50% can be whole grains).

You can also find the best fiber supplements at buoyhealth.

How Physically Active Are You?

Inactive: less than 5,000 steps per day

Average (somewhat active): ranges from 7,500 to 9,999 steps per day

Active: more than 10,000 steps

Very active: more than 12,500 steps per day

Tips to Include More Steps to Your Day

• Park farther away
• Walk while waiting
• Take the stairs
• Consider a walk with the family. Check these liv pure reviews.
• Take your pet for a walk
• Take the farthest way
• Talk in person. Rather than instant-messaging or emailing with coworkers, get up and walk to their desks
• Walk during your kids’ activities
• Start increasing your goal gradually by adding 500-1000 extra steps every 3-4 days

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Jeff Sessions, Donald Trump say ‘tough it out’ without opioids but they never felt my pain

https://www.usatoday.com/story/opinion/2018/04/02/jeff-sessions-donald-trump-opioids-epidemic-death-penalty-real-pain-column/374829002/

President Trump’s new proposal to combat opioid addiction included some very tough talk about a tragic problem, so it was easy to miss one ambitious goal: slashing legal opioid prescriptions by one-third.

Similarly, when Attorney General Jeff Sessions suggested that part of the problem is that not enough people are willing to “tough it out,” and that they should be just taking aspirin instead, he quickly got my attention. Recently, I tried to do just that.

In early November, at the age of 53, I spent a week in the hospital and was eventually diagnosed with multiple myeloma, a plasma cancer. Thankfully, there are a variety of treatments that hold the promise of long-term remission. But in the short term, multiple myeloma can be extraordinarily painful and many patients can only get relief by using prescription painkillers such as opioids.

Concerns over opioids are not unfounded. The CDC reports that overdoses from prescription opioids have quadrupled since 1999, numbering over 20,000 in 2015. Those numbers are of real concern, but we cannot forget that there are also real, tangible costs of living with pain — and that pain relief is part of the healing process for patients like me.

Multiple myeloma eats away at the calcium in your bones, weakening them. In my case, it went after my back, causing two small stress fractures and numerous lesions, all of which were extremely painful.

People who wish to drastically limit access to opioids need to know the reality of this kind of pain. Getting out of bed took 10 minutes or more because even one small wrong movement while getting to a sitting position would cause severe back spasms, making me shudder with pain. Walking around my house required balancing myself on walls and door frames.

Eventually I realized my mistake and got a prescription for opioids. The quality of my life quickly and dramatically improved, as within two or three days, the pain was reduced substantially and my mobility and mood were significantly better. I could walk comfortably and hug my kids again.

It’s important to understand that this kind of debilitating pain not only causes unnecessary suffering, it prevents patients from healing. It takes every bit of energy you have to fight it, and your body has little to nothing left to use to heal. Some medical professionals call pain “the fifth vital sign” because of the way in which it matters for a patient’s health. Opioids enabled me to relax, to sleep and to heal.

Four months later, I am almost completely pain-free and have been largely able to resume most of my normal activities. Blood work indicates that my chemotherapy is beating back the cancer. Access to opioids has without a doubt been a key factor in how quickly my health has improved.

The controversy around opioids makes people fear legitimate and humane medication. I can’t get back that week I spent in pain. I can’t erase the experience of watching my kids and the rest of my family seeing me suffer.

Policymaking that ignores the benefits of opioids and focuses only on the drawbacks —as serious as they are — is unacceptably one-sided, and passing such policies will mean that thousands, if not millions, will suffer unnecessary pain and fail to heal as they should.

Tackling opioid overuse may indeed require a serious overhaul of a health care system in which some doctors find it easier to throw pills at patients than talk to them. And when those pills are paid for by third parties, the incentives to use them sparingly are weakened.

But in the end, what medications are appropriate will always best be determined within the doctor-patient relationship, not by bureaucratic dictates and bans. The opioid problem might be real, but unilaterally denying relief to those in pain is a cure that’s worse than the disease.

Steven Horwitz is an economist with Ball State University and an affiliated senior scholar with the Mercatus Center at George Mason University.

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https://www.peoplespharmacy.com/2018/04/02/how-does-temperature-affect-mail-order-medicines/

Prescription drugs have become pricey. That’s why insurance companies may try to save money by encouraging patients to buy mail order medicines. Are there problems with this practice?

Many insurance companies love mail order pharmacies. That’s because they can often save money by having patients get their medicines from large services rather than local pharmacies. Pharmacy benefit managers (PBMs) are the middlemen between drug companies, pharmacies and payers. Many large PBMs own or control mail order pharmacies. If patients don’t get their medicines through this channel, they may have to pay more for their prescriptions. Are there any concerns about mail order medicines that have been ignored by PBMs, the FDA and insurance companies? Check these liv pure reviews.

A retired professor of molecular biology performed an experiment that would suggest the answer is yes.

Mail Order Medicines and the Postal Service:

Q. I read your column concerning pharmaceutical drugs left in a cold mailbox in winter. A few years ago, I measured summer temperatures in our mailbox with an accurate electronic thermometer. Read more about Adderall otc.

I was concerned that my drugs might be damaged with the very high temperatures here in Tempe, AZ. The mail is delivered in the afternoon when the sun hits the mailbox.

I am attaching an Excel file of what I found. The temperature of the mailbox was significantly higher than the air temperature. The average daily mailbox temperature between August and October was 121 F. Clearly those high temperatures would be expected to have some effect on many drugs.

Since doing that project, I stopped having my drugs sent by mail and now use an in-store pharmacy. Neither the drug companies nor the FDA seemed to provide helpful information when I asked them about this problem.

Do High Temperatures Affect Mail Order Medicines?

A. Your spreadsheet is fascinating. On some days, the temperature in your mailbox reached 130 to 140 F. That is way outside the acceptable storage range, even for a short period of time.

Guidelines for medications generally call for storage at room temperature (68 to 77 F). During shipping, temporary fluctuations are allowed between 59 and 86 F. Even on the coolest days of your two-month project, your mailbox hit at least 95 F.

How Heat Might Impact Mail Order Medicines:

Some medications could deteriorate rapidly under high heat or extreme cold. Drugs for asthma, diabetes, thyroid and anxiety could be especially vulnerable.

Researchers in the division of Pulmonary and Critical Care Medicine at the Cart T. Hayden VA Medical Center in Phoenix, Arizona performed an interesting experiment (Chest, Dec. 2005). They had heard that the asthma drug formoterol (Foradil) was “aggregating in mailboxes in the summer in Arizona.”

These investigators exposed capsules of formoterol to temperatures between 104 and 158 F for three hours and at 158 F for 15 to 180 minutes. The results were worrisome.

They concluded:

“These data demonstrate that the exposure of formoterol to heat decreases drug delivery and that caution should be used when mailing, transporting or storing formoterol.

“The use of mail-order pharmacies appears to be increasing both in the private sector as well as in the Veterans Healthcare Administration. It is usually assumed that the conditions of mail shipment approximate room temperature and humidity. However, it seems likely that shipped medications might be subjected to extremes in temperature such as those during the time spent in a mailbox prior to patient pick up. In addition, medications already in the patient’s possession might be subjected to environmental extremes such as being left in an automobile for an extended time on a hot day.

“The present study demonstrates that heating formoterol to temperatures that might be encountered during an Arizona summer lowers powder delivery. Combined with the reports from patients who received deformed formoterol capsules in mailboxes during summer months, it seems likely that temperature led to the decrease in powder delivery.”

What Should You Do About Mail Order Medicines?

Arizona gets especially hot during the summer. But you do not have to live in Phoenix or Tempe to be exposed to high temperatures. When medicines sit in a hot car or a mail box for hours, they will almost assuredly be exposed to temperatures outside the mandated shipping range (59 to 86 F). And in the winter they could easily be exposed to freezing temperatures.

Mail order pharmacies and the FDA need to address this weakness in our drug delivery system. Medications that are exposed to severe temperature fluctuations may not perform as anticipated. They may also deteriorate more rapidly.

The People’s Pharmacy Solution:

We think that there is an answer to the dilemma that patients are faced with when they receive mail order medicines. There are affordable temperature and humidity sensors that can be placed in every prescription (and vitamin) package. These disposable monitors will reveal if the contents of the package have been exposed to temperatures outside the limits for that medication (or dietary supplement).

We think mail order pharmacies and PBMs have an obligation to their clients to verify that drugs are kept within the guidelines during shipping. If they cannot demonstrate that successfully they should either send another package or refund the patient’s money and allow people to purchase their medication in a pharmacy at no additional cost.

What do you think?

Share your own experience with mail order medicines in the comment section below.

Federal law requires the Manufacturer, Wholesaler and Pharmacy to store medication within a specific range – normally 59-86 F –  Once a pharmacy hands off the medication to a shipper (USPS, FEDX, UPS) they don’t have any legal requirement to maintain those storage temp and unless the pharmacy has packaged the medication is some sort of shipping container to maintain the specific temperature, the shipper is none the wiser and will handle the package as they do any other package.

While use of mail order pharmacy may seem convenient,  the pt’s medication and in turn their health may being put at risk.  Many mail order pharmacies give financial incentive to use them…

As long as the pts know the potential risk for using mail order… it is their choice … some may have to use mail order for personal financial reasons.

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https://www.washingtonpost.com/news/wonk/wp/2017/03/29/since-2007-the-dea-has-taken-3-2-billion-in-cash-from-people-not-charged-with-a-crime

The Drug Enforcement Administration takes billions of dollars in cash from people who are never charged with criminal activity, according to a report issued today by the Justice Department’s Inspector General.

Since 2007, the report found, the DEA has seized more than $4 billion in cash from people suspected of involvement with the drug trade. But 81 percent of those seizures, totaling $3.2 billion, were conducted administratively, meaning no civil or criminal charges were brought against the owners of the cash and no judicial review of the seizures ever occurred.

That total does not include the dollar value of other seized assets, like cars, homes, electronics and clothing.

These seizures are all legal under the controversial practice of civil asset forfeiture, which allows authorities to take cash, contraband and property from people suspected of crime. But the practice does not require authorities to obtain a criminal conviction, and it allows departments to keep seized cash and property for themselves unless individuals successfully challenge the forfeiture in court. Critics across the political spectrum say this creates a perverse profit motive, incentivizing police to seize goods not for the purpose of fighting crime, but for padding department budgets.

Law enforcement groups say the practice is a valuable tool for fighting criminal organizations, allowing them to seize drug profits and other ill-gotten goods. But the Inspector General’s report “raises serious concerns that maybe real purpose here is not to fight crime, but to seize and forfeit property,” said Darpana Sheth, senior attorney of the Institute for Justice, a civil liberties law form that has fought for forfeiture reform.

The Inspector General found that the Department of Justice “does not collect or evaluate the data necessary to know whether its seizures and forfeitures are effective, or the extent to which seizures present potential risks to civil liberties.”

In the absence of this information, the report examined 100 DEA cash seizures that occurred “without a court-issued warrant and without the presence of narcotics, the latter of which would provide strong evidence of related criminal behavior.”

Fewer than half of those seizures were related to a new or ongoing criminal investigation, or led to an arrest or prosecution, the Inspector General found.

“When seizure and administrative forfeitures do not ultimately advance an investigation or prosecution,” the report concludes, “law enforcement creates the appearance, and risks the reality, that it is more interested in seizing and forfeiting cash than advancing an investigation or prosecution.”

The scope of asset forfeiture is staggering. Since 2007 the Department of Justice’s Asset Forfeiture Fund, which collects proceeds from seized cash and other property, has ballooned to $28 billion. In 2014 alone authorities seized $5 billion in cash and property from people — greater than the value of all documented losses to burglary that year.

In most of the seizures examined by the Inspector General, DEA officers initiated encounters with people based on whether they met certain criteria, like “traveling to or from a known source city for drug trafficking, purchasing a ticket within 24 hours of travel, purchasing a ticket for a long flight with an immediate return, purchasing a one-way ticket, and traveling without checked luggage.”

Some of the encounters were based on tips from confidential sources working in the travel industry, a number of whom have received large sums of money in exchange for their cooperation. In one case, officers targeted an individual for questioning on a tip from a travel industry informant that the individual had paid for a plane ticket with a pre-paid debit card and cash.

Most individuals who have cash or property seized by law enforcement do not dispute the seizure. There’s no right to an attorney in forfeiture proceedings, meaning defendants must foot the bill for a lawyer themselves. In many cases, forfeiture amounts are so small that they’re not worth fighting in court.

Forfeiture cases are also legally complex and difficult for individuals to win. Forfeiture cases are brought against the property, rather than the individual, leading to Kafkaesque case titles like United States v. $8,850 in U.S. Currency and  United States of America v. One Men’s Rolex Pearl Master Watch.

While criminal proceedings assume the defendant’s innocence, forfeiture proceedings start from the presumption of guilt. That means that individuals who fight forfeiture must prove their innocence in court.

For these reasons, many defendants don’t bother disputing forfeitures. The Inspector General’s report, however, finds that those who do often get at least a portion of their cash returned. Only one-fifth of people who had their cash seized by the DEA disputed the seizures in court. But among those who contested the seizure, nearly 40 percent ended up getting all or some of their cash returned, suggesting that the DEA’s forfeiture net ensnares many individuals not involved in wrongdoing.

In a written response to the Inspector General, the Department of Justice said it had “significant concerns” with the report, noting that global criminal enterprises launder trillions of dollars annually and calling asset forfeiture “a critical tool to fight the current heroin and opioid epidemic that is raging in the United States.”

It also took issue with the Inspector General’s analysis of the 100 DEA cash seizures it examined, saying more of them were connected with criminal activity than the report suggested.

The Inspector General stood by the report and dismissed the Department’s concerns as “assumptions and speculation.” The Drug Enforcement Administration did not respond to a request for comment.

“Nobody in America should lose their property without being convicted of a crime,” said the Institute for Justice’s Sheth. “If our goal is to curb crime, we should simply abolish civil forfeiture” and only forfeit property after a criminal conviction is obtained, she added.

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www.painnewsnetwork.org/stories/2018/3/22/opioid-painkillers-top-selling-drug-in-10-states

If you live in Oklahoma, the drug you’re most likely to be prescribed is the opioid painkiller Vicodin — or some other combination of hydrocodone and acetaminophen.

In Texas, the #1 drug is Synthroid (levothyroxine) – which is used to treat thyroid deficiencies.

In California, its Lipitor (atorvastatin) – a statin used to treat high cholesterol.

And Tennessee has the unique distinction of being the only state in the country where the addiction treatment drug Suboxone (buprenorphine/naloxone) is the most prescribed drug.

These findings are part of an interesting study by GoodRx, an online discount drug company, on prescribing trends in all 50 states. GoodRx looked at pharmacy and insurance data from around the country – not just its own customers — from March 2017 to February 2018.

It then developed a map to show how prescription trends can vary by region and by state.

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Opioid overdoses spike 30 percent, hospitals report

https://www.cbsnews.com/news/opioid-overdoses-increase-across-us/

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Using Marijuana 2 Times a Month Cost This Doctor His License

https://www.doximity.com/doc_news/v2/entries/11612578

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www.chronicdiseasecoalition.com/news-three-states-harmful-health-insurance-practices-making-headlines/

Patients, advocates and elected officials often use the media to promote legislation and bring awareness to chronic disease. During the month of March, we read articles, letters to the editor and op-eds that addressed how to protect patients’ rights. We’ve outlined three of our favorites below:

1. For years, epilepsy patient Erin Guard could not find a treatment that controlled her seizures without experiencing intense side effects, including dizziness and slurred speech. Finally, when Guard was a teenager, her doctors found a substitute that helped prevent seizures without the dangerous side effects. Four months after her doctors prescribed the effective treatment, however, her insurance notified her and said she would have to go back to her original medication or pay out of pocket for the new medication, regardless of whether she could afford it.

Guard, who lives in Illinois, became the latest victim of non-medical switching, an increasingly common – and dangerous – insurance practice that occurs when a provider switches a patient’s prescribed treatment for reasons other than health and safety. The Illinois Legislature is currently considering House Bill 4146, which would prevent insurance providers from changing drug coverage during the middle of a plan year if it had previously approved the treatment. The bill has been assigned to the House Insurance: Health & Life Committee.

To read about Guard’s story, click here: http://www.chicagotribune.com/business/ct-biz-illinois-nonmedical-switching-bill-0315-story.html

2. Fred Jorgenson, president of the Academy of Medicine of Cleveland & Northern Ohio, recently published an article on Cleveland.com raising awareness about two step therapy bills that are currently in the Ohio General Assembly, Senate Bill 56 and House Bill 72. In his letter to the editor, he explains that step therapy can have dangerous health consequences to patients who suffer from chronic illness. Step therapy, otherwise known as fail first, is another harmful insurance practice that happens when an insurance provider believes a cheaper, riskier drug is a better than a doctor-prescribed treatment. Providers will only cover the original treatment if a patient first fails the cheaper medication.

Dr. Jorgenson said, “For a person with epilepsy, it could mean having a seizure. For someone with inflammatory bowel disease, it could mean serious flare ups that can sideline a person for days. For someone with cancer, it could mean that their disease progresses.”

He called for the Ohio General Assembly to act on behalf of patients and pass the two bills that would reform step therapy requirements.

To read Dr. Jorgenson’s letter the editor, click here: http://www.cleveland.com/letters/index.ssf/2018/03/ohio_lawmakers_can_reform_step.htm

3. Finally, two state representatives in Maine, Bob Foley and Health Sanborn, authored an op-ed published in the Maine Press Herald bringing attention to non-medical switching, a problem many Mainers with chronic health conditions face. While insurance companies attempt to justify non-medical switching by saying it keeps medical costs down, Foley and Sanborn cite a recent analysis from the Institute for Patient Access disproving that theory. (And, in fact, this study found that step therapy may actually lead to an increase in costs due to nondrug expenses.)

The two representatives have introduced a bill in the Maine Legislature, Legislative Document 696, that would address this issue and stop insurers from denying patients access to their prescribed treatment.

Read Representatives Foley and Sanborn’s op-ed here: https://www.centralmaine.com/2018/03/09/from-the-state-house-doctors-not-insurers-should-prescribe-mainers-medications-and-treatment/?rel=related

The Chronic Disease Coalition supports legislation on the state and federal level that puts patients over insurance profits.

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