“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
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Hi, I apologize for not reading thru your web site. But I am in pain since CVS has made my doctor decrease my pain medicines in half to the dose that gave me relief. Right now I am in pain.
Please tell me where to turn. I am a 56 yr old with multiple spinal injuries. I have been on opioids for pain management for 13 years. I live in New Jersey, Mickleton. I have thought about changing my residency to Florida to reside with my daughter. Another option is to return to my Philadelphia home. Which state offers the best protections from these rules set up by the pharmaceutical companies to minimalize my medications.
I am on disability for my illnesses. My insurance is with my employer out of Philadelphia PA. Primary coverage is with Blue Cross but Prescriptions are with CareMark, CVS. How do I file a case against this discrimination. My life is dreadful as I am in pain every hour of the day.
It would seem that all too many in corporate America seems to work under the premise that “nothing is illegal until you get caught”.. and as long as no one “pushes back” they will continue to do as they please…. regardless of the harm caused to their employees or customers.
Growing up, Amie was always double-jointed. Compared to her peers, she could extend her joints far past what was normal. For some kids, double-jointedness is like a party trick. But as Amie grew older, it became painful. She started dislocating her joints. Eventually, Amie was diagnosed with Ehlers-Danlos syndrome, characterized by hyper-mobility and chronic pain.
For a while, Amie mostly resigned to staying home. The pain got so bad some days that she couldn’t get out of bed. She couldn’t concentrate on work, and she had to quit her job as a Center City health care attorney in 2012.
In the years since her initial diagnosis, one technique has worked better than the rest to manage her pain: opioids.
Amie is among more than 460,000 Philadelphians who have taken a prescription opioid in the last year. Many of them, like Amie, take them for legitimate reasons.
But now, due to strict CDC guidelines inspired by the nation’s worsening opioid abuse epidemic, people suffering from chronic pain are having trouble getting their meds.
“The public perception is…people were prescribed opioids to treat pain, and they accidentally became addicted and moved onto heroin,” said Brooke Feldman, a person in longterm recovery who has written about the topic. “But there are people who benefit from these medications.”
Indeed, the grand majority of people who take prescription opioids do not fall into the addiction trap.
Per stats from the National Institute on Drug Abuse, between 8 and 12 percent of people develop substance use disorder after being prescribed opioids, and an estimated 4 to 6 percent of people who misuse prescription opioids transition to heroin.
‘Gun-shy’ doctors
Dr. Ira Cantor of Phoenixville, Pa., said he treats many patients with chronic pain — often by prescribing opioids.
It does require “considerable attention to detail,” he said. “When you’re dealing with patients with chronic pain, the decision to prescribe an opioid or change a dose requires you to look at a lot of other factors,” like a patient’s past prescription history, their co-occurring medical conditions and any side effects.
But in many cases, he finds opioids are still the best solution, something he thinks many doctors are now fearful of doing.
There are precautions doctors can take, per Cantor. The CDC recently released prescription drug monitoring programs, which give access to a patient’s full prescription history. Using the PDMPs, a doctor can tell if patients are getting drugs from several doctors at once.
“If they have, that’s a red flag,” Cantor said.
Cantor also performs toxicology tests — like the traditional urine drug test — and he asks patients to complete a questionnaire that includes tip-offs to potential addiction or misuse.
Every day, Cantor said he sees “loads of patients” because their previous doctor refused to continue prescribing their opioids.
“It’s been very common that…their doctors started tapering their medications, and they became much less functional,” Cantor said. “Many patients end up being bed-bound.”
Meeting in the middle
There are actually two opioid epidemics occurring at once in the United States, Cantor insists.
One is the opioid addiction and overdose epidemic. The other is people with chronic pain.
“The other epidemic, in many ways, is even larger,” Cantor said. “There are millions of people who have chronic pain, and they’re being forgotten. They’re being ignored.”
Amie counts herself as one of the lucky ones, despite her double-jointed condition — her physician hasn’t attempted to taper her off her medication.
With a low dose, she can finally get out of bed in the morning, and she even started volunteering for the Coalition of 50 State Pain Advocacy Groups. But from her advocacy work, she now knows knows countless chronic pain patients who have lost access to their medication because their doctors are wary to prescribe. Through Facebook, she’s even heard of people committing suicide because they lost access to their opioids.
Feldman, the recovery advocate writer, has also heard of pain sufferers ending their own lives because they were kicked off their prescriptions.
“When you’re living with pain and it’s not being treated properly,” Feldman said, “the thought of suicide becomes very real.”
A newly-discovered report gives a much clearer picture as to Prince’s cause of death in 2016.
According to a toxicology report obtained by the Associated Press from Prince’s autopsy, he had what experts call an “exceedingly high” concentration of fentanyl in his body at the time of his death. For those unfamiliar, fentanyl is a synthetic opioid that is said to be 50 times more powerful than heroin.
Prince was found dead in an elevator at his Paisley Park estate and many were curious if drugs played a role in the famed musician’s demise. News that he had the drug in his system is not new, as that information came to light roughly six weeks after his death. However, the new confidential report gives a bit of scope as to how much he was dealing with when he died.
Experts say the amount in his system was high, even for someone suffering from chronic pain. The report notes that he had 67.8 micrograms per liter in his system. Fatalities from the drug have been documented in people with blood levels ranging anywhere from three to 58 micrograms per liter.
The report also says the level of fentanyl in Prince’s liver was 450 micrograms per kilogram, and notes that liver concentrations greater than 69 micrograms per kilogram “seem to represent overdose or fatal toxicity cases.”
Based on findings of the drug in his stomach and blood, it’s clear that he took the drug orally
and had enough time for it to spread into his system a bit before he died. Reports from the time of Prince’s death indicated that police found multiple bottles of pills around his residence and that the origin of those pills was still undetermined.
There is NO COMMERCIALLY AVAILABLE ORAL FENTANYL available in the USA.. This would suggest that Prince obtained his “Fentanyl” from some ILLEGAL SOURCE that produced some “FENTANYL ” in a solid oral dosage form. Notice in this report they only talk about “FENTANYL” there is one single legal Fentanyl in the USA and that is Fentanyl Citrate but.. there is some 18 different ILLEGAL FENTANYL ANALOGS coming in from China and Mexico. Whose agenda is it to confuse the public about all of these OD’s being caused by the ILLEGAL FENTANYL ANALOGS and leading them to believe that it is the same Fentanyl that is legally prescribed in this country ?
A class action lawsuit claims that CVS violated patient privacy by exposing the HIV status of 6,000 Ohio residents.
A number of anonymous Ohio residents allege that CVS had a practice of mailing out information related to patients’ involvement in Ohio’s HIV Drug Assistance Program, and those mailings were labeled clearly with a patient code and the acronym HIV.
According to the CVS HIV status disclosure class action lawsuit, patients received information about their HIV medications and benefits for the Ohio HIV Drug Assistance program mailings sent out by CVS.
The Ohio CVS HIV privacy violation class action lawsuit states that the program is one that assists individuals with the copays for life-saving HIV medications.
Allegedly these mailings were in envelopes that bore the words “personal and confidential — please open right away,” but clearly listed the patient’s name, as well as a code involving the acronym “HIV” through two transparent windows. The Ohio residents claim that the envelopes were dropped off at patients’ places of residence, where they could be seen by anyone who looked.
According to the CVS HIV status disclosure class action lawsuit, CVS “clearly made no advance effort to test or review the disclosure of such information prior to disseminating the mailing, since had they done so they would have seen that the identification number with ‘HIV’ next to it was prominently visible through the envelope.”
The Ohio residents claim that this disclosure of status information violates CVS’ own “Notice of Privacy Practices,” which states that they are “required by law to protect the privacy of your PHII and to provide you with this Notice explaining our legal duties and privacy practices.”
The plaintiffs allege that this disclosure also violates the Health Insurance Portability and Accountability Act (HIPAA), compliance with which was a “condition of CVS’s contract with the State of Ohio.”
The three plaintiffs, all HIV-positive men, leading the HIV status class action lawsuit cite emotional distress in the injuries caused by the disclosure. They claim that due to the stigma surrounding HIV, their lives could be damaged. One man states that he “feels that CVS has essentially handed a weapon to anyone who handled the envelope, giving them the opportunity to attack his identity or cause other harm to him.”
The Ohio HIV status class action lawsuit notes that CVS isn’t the first company to be hit with a similar allegations, and states that last year, Aetna Inc. was also accused of revealing patient HIV status in envelopes with clear windows, exposing the information of more than 12,000 patients. The CVS Ohio HIV class action lawsuit goes on to note that the company settled the issue for $17 million.
In another CVS class action lawsuit filed last month, plaintiffs claimed that CVS Caremark forces patients to get their HIV/AIDS medications at CVS instead of from the pharmacy of their choice.
The Ohio residents are represented by Joe R. Whatley, Edith M. Kallas, Alan M. Mansfield, and Henry C. Quillen of Whatley Kallas LLP, Jerry Flanagan of Consumer Watchdog and Terry L. Kilgore.
The CVS Ohio HIV Status Disclosure Class Action Lawsuit is Doe One, et al. v. CVS Health Corp., et al., Case No. 2:18-cv-00238, in the U.S. District Court for the Southern District of Ohio.
Cherry Hill, N.J. — The federal government will spend a record $4.6 billion this year to fight the nation’s deepening opioid crisis, which killed 42,000 Americans in 2016.
But some advocates say the funding included in the spending plan the president signed Friday is not nearly enough to establish the kind of treatment system needed to reverse the crisis. A White House report last fall put the cost to the country of the overdose epidemic at more than $500 billion a year.
Former U.S. Rep. Patrick Kennedy, a Democrat who served on President Donald Trump’s opioid commission last year, said there are clear solutions but that Congress needs to devote more money to them.
“We still have lacked the insight that this is a crisis, a cataclysmic crisis,” he said.
By comparison, the Kaiser Family Foundation found the U.S. is spending more than $7 billion annually on discretionary domestic funding on AIDS, an epidemic with a death toll that peaked in 1995 at 43,000.
States also have begun putting money toward the opioid epidemic. The office of Ohio Gov. John Kasich estimates the state is spending $1 billion a year to address the crisis. Last year, New Jersey allocated $200 million to opioid programs, and the budget proposal in Minnesota calls for spending $12 million in the coming fiscal year.
A spokesman for Massachusetts Gov. Charlie Baker, a Republican who also served on the Trump commission, said the federal government still needs to do more.
“Governor Baker encourages members of Congress to work together on a plan forward to fully fund the bipartisan recommendations,” spokesman Brendan Moss said.
The commission’s chairman, former New Jersey Gov. Chris Christie, declined through a spokesman to comment.
The opioid allocation is part of the $1.3 trillion budget appropriation Trump signed Friday. In a budget deal full of compromises, this was one element both parties heralded.
Addiction to opioid painkillers, including prescription drugs such a Vicodin and OxyContin and illicit drugs such as heroin and fentanyl, is causing deep problems across the country. It’s being blamed for shortened life expectancies, growing burdens on foster care systems, and strains on police and fire departments.
The budgeted response amounts to about three times as much as the federal government is spending currently to address the epidemic, not counting treatment money that flows through Medicaid and Medicare. A spokesman for the U.S. Centers for Medicare and Medicaid Services said the agency does not track how much money it spends on drug treatment.
“This bill provides the funding necessary to tackle this crisis from every angle,” U.S. Sen. Roy Blunt, a Missouri Republican who is chairman of a subcommittee overseeing much of the funding, said in a statement. “It’s another major step in our effort to get this epidemic under control and save lives.”
The biggest chunk of new money in the congressional appropriation – $1 billion – is to be distributed to states and American Indian tribes. States with the highest overdose mortality rates would receive larger shares, a provision that’s important to hard-hit states with small populations such as West Virginia and New Hampshire. Every state would receive at least $4 million.
The plan also includes $500 million for opioid-related research and hundreds of millions more to expand treatment availability.
Andrew Kolodny, the co-director of an opioid policy research group at Brandeis University, said he believes it would take a 10-year commitment to funding $6 billion annually to build a system that would make medication-assisted treatment accessible to everyone who needs it.
The federal appropriation also contains money for law enforcement and equipment to help identify and intercept opioids at borders and ports of entry.
Van Ingram, executive director for the Kentucky Office of Drug Control Policy, said he believes law enforcement is not the key to solving the epidemic but appreciates the additional federal money for policing.
“We are many years into this drug epidemic and the worst one in our history, and there have never been any new dollars for law enforcement to speak of,” he said.
Providing law enforcement in Kentucky with naloxone, a drug that can reverse overdoses, is a major expense for his office. Federal help is now available to defray some of those costs.
Some of the federal money also will go toward helping people being released from prison avoid the drugs and to expand specialized courts for veterans and people with drug dependency.
The federal spending plan also incorporates language inspired by the 2016 death of a 30-year-old woman, who overdosed on pain pills she was prescribed as she left a hospital following surgery.
The woman, Jessie Grubb, received the pills from a Michigan hospital despite medical records reflecting her past heroin addiction and recovery. Under the law, federal authorities are encouraged to establish procedures for health care providers to share information about addiction histories.
“In honor of Jessie, but really in honor of thousands of families and recovering addicts, this legislation will go a long way to save lives,” Grubb’s father, David Grubb, said this past week from the family’s home state of West Virginia.
As the high rate of opioid abuse continues in northwest Ohio, state and federal officials unveiled proposals Monday
they hope stop addiction before it starts.
The day’s three events in Toledo included a visit by directors from the state departments of mental health and addiction services; department of health; medical board, and pharmacy board. They touted a new campaign to reduce prescription opioid abuse.
The “Take Charge Ohio” program educates on the dangers of unsafe use and suggests alternative treatments. A news conference took place at the Mental Health and Recovery Services Board of Lucas County.
This awareness effort is for doctors, patients, and the public to cut the risk of dependence while still managing pain, said Dr. Mark Hurst, medical director at the Ohio Department of Mental Health and Addiction Services.
It is clear the opioid abuse problem did not occur overnight, but leaders are pushing back, Dr. Hurst said.
“With the support of Ohio’s physician and prescriber community, Ohio’s making promising progress in reducing the number of prescription opioids available for abuse,” Dr. Hurst said.
The www.takechargeohio.org website provides up-to-date information on disposing opioids and seeking help, said Dr. Clint Koenig, medical director of the Ohio Department of Health.
“For patients, Take Charge Ohio offers the opportunity to answer the question, ‘Is this medication right for me?’ and ‘What can I do to help best manage my pain?’ ” Dr. Koenig said.
More information can be found at the website. Funding for the program came as part of a $925,000 Centers for Disease Control and Prevention grant. It also covers media and opioid education prescribing.
Democratic candidate for governor Rich Cordray visited the city as well. Mr. Cordray stopped at the Lucas County Sheriff’s Office for a meeting with its Drug Abuse Response Team.
Opioid abuse is an enormous issue across the state, Mr. Cordray said. This team is a significant intervention they wish to further model, he said.
“It’s an ongoing crisis in the state of Ohio, and it’s impossible to get away from it, no matter where you go,” Mr. Cordray said.
In campaign materials, Mr. Cordray said Ohio Attorney General Mike DeWine and Republicans in Columbus have been “asleep at the switch while the opioid epidemic has spread across Ohio.” Mr. Cordray proposes declaring a public health state of emergency, protecting Ohio’s Medicaid expansion, and growing funding for prevention and treatment.
In a statement, Mr. DeWine’s campaign for governor cited Sheriff John Tharp’s work, about $800,000 in grants from Mr. DeWine’s office, and support from the attorney general’s staff in assisting the Drug Abuse Response Team’s growth.
“The fact that Richard Cordray would criticize Mike DeWine at Lucas County Sheriff John Tharp’s office shows just how little Richard Cordray has been paying attention to Ohio and the opioid epidemic” spokesman Ryan Stubenrauch said.
A spokesman for the Dennis Kucinich for governor campaign said they are proposing affordable, accessible health care services, a sensible drug enforcement policy, and legalization of cannabis for pain management.
“‘Declaring a state of emergency’ is a dramatic-sounding but hollow attempt to compensate for the fact that he did nothing as attorney general and, until today, did nothing as a candidate to prove that he’s serious about this problem,” said spokesman Andy Juniewicz.
Also Monday, U.S. Rep. Marcy Kaptur (D., Toledo) at a news conference identified Ohio as a priority state for millions in new federal grant funding for the opioid crisis.
Miss Kaptur said she helped lead a provision in the recently signed Omnibus bill that gives Ohio priority access to state-level grants. It includes $950 million in new opioid response grants for states highly affected by the crisis, including Ohio. An additional $330 million will be available to law enforcement across the country.
A prominent California pain physician and a longtime champion of the pain community has announced his retirement. Dr. Forest Tennant, and his wife and office manager, Miriam, have informed patients that they are closing their pain clinic in the Los Angeles suburb of West Covina, effective April 1. He also mentioned that he is looking forward to spending more time with his family, enjoying his hobbies, and sharing the joy of receiving a great 榮休禮物.
“On strong legal and medical advice, as I am 77 and Miriam 76, we are closing the Veract Intractable Pain Medical Clinic and taking retirement. I will write no additional opioid prescriptions after this date,” Tennant wrote in a letter to patients. “We very much regret this situation as the clinic is filled with patients we consider beloved family and friends.”
Tennant’s retirement is largely due to an ongoing DEA investigation of his opioid prescribing practices. DEA agents raided the Tennants’ home and clinic last November, while Tennant was testifying in Montana as a defense witness in the trial of doctor accused of negligent homicide in the overdose of two patients. The Tennants arrived home to find the front door of their home had been kicked in by DEA agents.
A search warrant alleged that Tennant was part of a “drug trafficking organization” and had personally profited from the sale of high dose opioid prescriptions. Tennant has denied any wrongdoing and no charges have been filed against him, but the investigation remains open and the resulting stress and uncertainty have taken their toll.
“It’s hard to continue operating when they never closed my case, and so I’m going to retire and move on,” Tennant told PNN. “That’s on the advice of both my lawyers and my doctors.”
DR. FOREST TENNANT
Tennant is a revered figure in the pain community because of his willingness to treat patients with intractable pain who are unable to find effective treatment or have been abandoned by their doctors. Many travel to California from out-of-state, and some are in palliative care and near death.
Tennant and his colleague, Dr. Scott Guess, treat about 150 intractable pain patients with a complex formula of high dose opioid prescriptions, hormones, anti-inflammatory drugs and other medications.
Tennant says the DEA effectively forced him into retirement by refusing to drop the case.
“You can’t do the kind of work I do and operate in legal uncertainty,” Tennant said. “You’ve got to have legal backing to treat these individuals. And I don’t know what the law is anymore.”
‘Many Patients Will Die’
“I believe many of Dr. Tennant’s patients will die because they will never find another doctor to treat their painful condition,” says Gary Snook, a Tennant patient who lives with adhesive arachnoiditis, a painful and incurable inflammation in his spinal nerves. “I haven’t decided if I will even look for another doctor, nobody will take a patient like me. And and to be honest with you, I am tired of looking, tired of being treated like an addict, tired of being treated like a curiosity and nothing more, not a human being with a serious health issue that deserves to be treated.
“Forest and Miriam treated me like a son as they did all their family, their patients. They did their best to take care of us. How could any doctor do so and pay $1,000 an hour in legal fees just to defend himself from false charges from the DEA?”
Tennant says he has operated his pain clinic basically as a charity for years. He and his wife live modestly, and drive cars that are nearly 30 years old.
“They (the DEA) think my clinic has been operated to make a great deal of money. Some years it loses money. The last two years, it actually lost money. We subsidize it,” Tennant explained.
One medical professional who has been sharply critical of Tennant’s prescribing practices is Dr. Timothy Munzing, a Kaiser Permanente family practice physician who was hired by the DEA to review Tennant’s prescriptions.
Munzing was quoted in a DEA search warrant saying that “many patients are traveling long distances to see Dr. Tennant” and that it was unusual that so many were prescribed “extremely high numbers of pills/tablets.”
“I find to a high level of certainty that after review of the medical records… that Dr. Tennant failed to meet the requirements in prescribing these dangerous medications. These prescribing patterns are highly suspicious for medication abuse/and or diversion,” Munzing wrote.
Munzing has worked for several years as a consultant for the DEA and the Medical Board of California, creating a lucrative second career for himself.
dr. timothy munzing
According to GovTribe, a website that tracks payments to federal contractors, Munzing is paid $300 an hour by the DEA.
In the past few months, Munzing has been paid over $250,000 by the DEA to review patient records and testify as an expert witness in DEA cases.
The agency recently created a task force to focus on doctors like Tennant who prescribe high doses of opioids. The task force appears focused solely on the dose and number of prescriptions, not on the quality of life of patients or whether they’ve been harmed.
After three years of investigation, the DEA has not publicly produced evidence that any of Tennant’s patients have overdosed, been harmed by his treatments, or that they are selling their drugs.
Tennant says he and his wife plan to retire to Kansas, where they have real estate investments. Once out of the picture, he hopes the medical profession and law enforcement will someday come to a sensible approach about how to deal with patients who need high doses of opioids.
“I have learned that my personality and my image is such that I think its prohibiting a good debate and discussion as to how the country is going to deal with people with really severe pain relative to their opioids,” he said.
For the record, Dr. Tennant and the Tennant Foundation have given financial support to Pain News Network and are currently sponsoring PNN’s Patient Resources section.
I guess that Dr Munzing salary as an employee of Kaiser Permanente could not fund the “life style” that he wanted to live. I find it also interesting that both the DEA and the Medical Board of CA has hired a physician whose “specialty” is “FAMILY PRACTICE” and he comes to the conclusion – after reviewing medical records… not examining the pts… nor interviewing the pts… that he finds a “high level of certainty” and “…These prescribing patterns are highly suspicious for medication abuse/and or diversion“
WHERE IS THE PROOF ?… over the LAST FEW MONTHS.. .he has been paid > $250,000 … at $300/hr that is 833 hrs.. at 40 hr/wk.. that would be abt FIVE MONTHS… and there is no mention of the $$ or time devoted to the Medical Board of CA… when did he find time to practice medicine at Kaiser Permanente ?
Out of the 150 pts that Dr Tennant treated… I wonder how many will die from untreated pain and co-morbidity issues and/or ends up committing suicide ? For those who end up committing suicide.. will their deaths just be covered up as a “opiate related death”.. I am sure that no one involved with causing Dr Tennant to give up his practice and retiring will – or could be – viewed as assisting or contributing to those suicides 🙁
If you have a copay, chances are you’ve overpaid for a prescription at some point.
That’s because an insurance copay can be more expensive than the cash price of the drug — more expensive than if you’d had no insurance and paid out of pocket.
And because of “gag clauses” in contracts between pharmacies and the insurance claims payers, you’d never know this. Until now.
In a bill Gov. Phil Bryant signed in March, which will take effect in July, insurers can no longer prevent pharmacists from telling patients whether their copay is higher than the cash cost of their medication.
A couple of weeks ago, Valerie McClellan went to the Kroger pharmacy in Madison to pick up a prescription for an allergy medication. She learned the copay was going to cost her $50.
“I must have gone ‘whoa,'” McClellan said, because the pharmacist did something unusual: he told McClellan how she could get the medication for just $10 by using a coupon online.
“At the time, I remember thinking, ‘Wow, I’ve never had a pharmacist tell me where I can go to save some money,'” she said.
Insurance copays don’t take into account the actual price of the medication, so a beneficiary will pay the same amount — whether $5, $25 or $50 — even if the drug is less expensive.
“The consumers, they think that they have insurance, therefore the insurance company or the pharmacy benefit manager is helping lower their drug costs,” said Robert Dozier, executive director of the Mississippi Independent Pharmacies Association. “And in some cases, it’s not.”
In a study released in March, customers paid copays that effectively overcharged them for medications nearly one-fourth of the time.
The analysis, conducted by University of Southern California Schaeffer Center for Health Policy & Economics, included 1.6 million people who paid for 9.5 million prescriptions.
The study’s authors are calling it the “Copay Clawback Phenomenon” because the overpayments — the difference between the copay and the cash price of the prescription — go to the pharmacy benefit manager, the middlemen that pay drug claims for insurance companies. These include Express Scripts, CVS Caremark and OptumRx.
And until a few weeks ago, many pharmacists in Mississippi couldn’t tell the patient what was going on.
Pharmacy benefit managers in the state were able to include “gag clauses” as part of their contract, so pharmacists couldn’t notify a patient if the cost of their prescription was cheaper than their copay, even if they asked.
With a bill this legislative session, Mississippi joined 14 states that have enacted laws prohibiting these gag orders.
“It gives us an extra tool to help people without the fear of retribution,” said Jackson’s Beemon Drugs owner Lester Hailey. “We’re proud of the state for passing this and giving us the freedom to save some money for the consumers. I think it’s a great step.”
Express Scripts and CVS Caremark both told Clarion Ledger they do not endorse the use of gag orders.
OptumRx and CVS Health have both faced lawsuits alleging they use the clawbacks. OptumRx told NBC it supports charging the lowest amount to customers while CVS has outright denied the allegation.
Several other insurers face lawsuits regarding the alleged scheme.
On March 8, Gov. Phil Bryant signed the Prescription Drugs Consumer Affordable Alternative Payment Options Act, sponsored by House Public Health and Human Services Chairman Sam Mims, R-McComb, and others, encouraging pharmacies to communicate with customers about cheaper payment options.
“I feel awesome that that’s changed now, that you can have that conversation with your pharmacist, and they can assist you,” McClellan said.
Hydrocodone, an opioid, is the most prescribed medication in Mississippi. In the Schaeffer Center study, patients were overcharged for the pill more than one-third of the time. For folks whose copays were higher than the cost of hydrocodone, the average upcharge totaled $6.94.
For other drugs, the average overpayment was much higher — $14.56 for the cholesterol medication Crestor, $17.55 for fluticasone propionate nasal spray and almost $20 for bronchitis medication Ventolin.
For four drugs — zolpidem tartrates like Ambien, cholesterol medication simvastatin, calcium blocker amlodipine besylate and prednisone steroid — patients were overcharged more than half of the time.
Around the time McClellan bought the allergy medication, she said she also paid out of pocket, instead of a copay, for her husband’s heart medication, saving her roughly $30.
Add it up, McClellan said, and that’s a monthly water bill. Or a tank full of gas.
Had the pharmacist not told her about other payment options, McClellan said she wouldn’t have known to ask.
“We just accept that insurance is this, my copay is this, and that’s it,” she said. “We’ve been taught we don’t have any power over what doctors charge, what medications cost. We just pay it.”
That may be starting to change. In an often difficult-to-navigate health care system, Mississippians can save money by asking their pharmacist if their copay is higher than the out-of-pocket cost of their prescription.
This article is about prescription prices and the graphic that they use at the top of the article HYDROCODONE… and if you do a word search in the 800+ word article you will find the word HYDROCODONE – TWICE IN THE ENTIRE ARTICLE !!! – in the same sentence.
It would appear that some/many in the media will pull in a opiate – somehow – into just about any article that deals with just about anything that has to do with prescriptions.
A commonly cited factor in the opioid crisis is “doctor shopping” — the act of seeing multiple physicians in order to get an opioid prescription without medical justification. States like Indiana are passing prescribing laws with the specific goal of preventing doctor shopping in an effort to address the opioid crisis.
However, doctor shopping has not at any time in the past decade been a statistically significant factor in the opioid crisis. The National Institute of Drug Abuse tells us that only one out of every 143 patients who received a prescription for an opioid painkiller in 2008 obtained prescriptions from multiple physicians “in a pattern that suggests misuse or abuse of the drugs.” That’s a rate of about 0.7 percent.
The importance of doctor shopping over the last decade was not because of frequency — it has more to do with quantity. Research shows that the 0.7% of people who doctor-shopped were buying about 2 percent of the prescriptions for opioid medications, constituting about 4% of the amount dispensed.
Moreover, these doctor-shoppers tended to be young, to pay in cash, and to see five or six prescribers in a short period of time, so they are easily identifiable and can be thwarted with prescription drug monitoring programs (PDMP’s).
Diversion prevention had long been seen as important. Back in 1999, the Drug Enforcement Administration published “Don’t Be Scammed by a Drug Abuser,” which included advice to doctors and pharmacists on how to recognize drug abusers and prevent doctor-shopping. And states like Washington specifically list doctor shopping among the indicators of opioid addiction in prescribing guidelines, making recognition and intervention key goals for prescribers.
These efforts have paid off. A study in the journal Substance Abuse found that the number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012. The study concluded that “diversion control efforts have likely been effective.”
Similarly, Pharmacy Times reported a 40% decrease in doctor shopping in West Virginia between 2014 and 2015, thanks in part to efforts by that state’s Board of Pharmacy Controlled Substance Monitoring Program.
“You have this narrative that there are these opioid shoppers and rogue prescribers and they’re driving the epidemic, and in fact the data suggests otherwise,” says Dr. Caleb Alexander, who co-authored a 2017 study in the journal Addiction.
“The study found that of those prescribed opioids in 2015, doctor shoppers were exceedingly rare, making up less than one percent of prescription opioid users,” Alexander told Mother Jones.
Doctor shopping is still a problem in other contexts. Opioids are not the only class of medication that people seek to obtain illicitly for a variety of reasons, from hypochondriasis to malingering. PDMPs and other law enforcement efforts have a useful role to play in addressing these issues, and the opioid crisis requires ongoing efforts to prevent drug theft and diversion at all levels of the supply chain.
But claims that doctor shopping is a significant factor in the opioid crisis are mistaken. Doctor shopping was not significant in 2008, and measures to reduce diversion have succeeded, making doctor shopping in 2018 that much rarer.
Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.
The numbers in this article may be LOWER THAN REALITY… everyone functions on the presumption that a healthcare professional is never presented a fake/forged/stolen ID. In fact, the law states that a Pharmacist much be presented a “legal ID”.. from what I have been told, most Rx dept staff looks for the expiration date on the license and other than that… with today’s technology… a semi-dedicated grade schooler could probably produce a passable fake driver’s license. If anyone doubts that .. just do a web search for “how do I get a fake driver’s license” . I just did and got back 8.5 MILLION responses… Let’s presume that 99.99% or duplicates or invalid responses.. that leaves 8,500 that could be valid… all you really need is ONE VALID WEBSITE to get all the fake driver’s licenses that one serious diverter/abuser really needs/wants.
I am not aware of any state, that allows a healthcare provider to access the state’s BMV’s online database to validate a presented driver’s license.. so the pharmacy/pharmacist has no choice but to put into the state’s PMP database .. the driver’s license presented along with a controlled prescriptions.. How many controlled prescriptions would not be written nor dispensed if the healthcare provider had access to the state’s BMV’s online database ?
Scan the driver’s license bar code and if the license presented does not match the graphic of the one issued by the BMV… why would a healthcare provider prescribe or dispense a controlled substance to them… if they are lying about who they are… what else are they misrepresenting ?
The question has to be asked, why wouldn’t let healthcare professionals access to the state’s BMV’s online database for this use ? Is their mindset still in the mid 20th century before the PC revolution… or they are just in denial that it is happening… or they are quite content to keep the “crisis” on going and this could cause “the bureaucracy” to shrink… which in the “bureaucratic world” may be considered a heresy
Here is a post I made back with CVS publicly stated that they were going to start imposing daily opiate limits CVS Pharmacy Will Limit Prescriptions for Opioids
