Kentucky House votes to tax opioids to close budget gap

http://abcnews.go.com/US/wireStory/kentucky-house-votes-tax-opioids-close-budget-gap-53447557

For six years, a pharmaceutical distributor sent more than 50 million doses of prescription opioids to five eastern Kentucky counties, enough for every person there to have 417 pills each.

Kentucky’s attorney general has sued that company and others like it. Thursday, state lawmakers voted to tax them.

In a state with the fifth highest drug overdose death rate in the country, Kentucky’s Republican-controlled House of Representatives approved a tax on prescription opioids Thursday. If approved by the state Senate, Kentucky could become the first state in the country to tax the addictive prescription painkillers that have spurred a wave of addiction across the country.

Lawmakers say the goal is to reduce the number of opioids available in Kentucky. But they won’t use the money from the tax specifically for drug treatment, instead using it to fund public education and other services.

“These pills are profiting the big pharmaceutical drug companies billions and billions and billions of dollars a year. You know how much our state budget gets? Zero,” Democratic Rep. James Kay said.

As the opioid epidemic rages across the country, state and local governments have filed hundreds of lawsuits against pharmaceutical companies and distributors to recoup some of the costs to their health care systems.

Kentucky’s proposal is a step in the other direction, using taxes to fill sparse state coffers while discouraging aggressive prescription of the drugs.

“I think it could help reduce aggressive prescribing,” said Dr. Andrew Kolodny, director of opioid policy research at Brandeis University and an expert advising the court in lawsuits against pharmaceutical companies. “Right now it is too cheap and easy to give a patient a narcotic when they have a pain problem.“

Kentucky is one of at least 13 states with pending legislation to tax opioids, according to the National Conference of State Legislatures. None of those proposals have been enacted.

The Kentucky proposal would tax each dose of opioids 25 cents.

State officials say it would generate about $70 million per year. In Minnesota, Gov. Mark Dayton has proposed a “penny a pill” tax on narcotic medications to raise about $20 million to pay for drug treatment programs.

Kentucky’s opioid tax revenue would not be set aside for drug treatment, instead going to fill a budget gap caused by the state’s struggling pension system.

“I think that’s a mistake,” Kolodny said. “States (need) to be investing and building out a treatment system that doesn’t really exist yet. This is a very sensible place to get that money.”

Some Kentucky lawmakers complained that the opioid tax, coupled with an accompanying 50-cent tax hike on cigarettes, disproportionately affects poor people.

But the proposal gives Kentucky’s attorney general authority to prosecute drug companies that pass the tax along to their customers.

That might not be legal, according to Nick McGee, spokesman for the Pharmaceutical Research and Manufacturers of America. He said that idea, plus the tax itself, have “some serious legal and policy questions.”

“Taxing prescribed medicines that people legitimately rely on to raise revenue for a budget shortfall is a pretty problematic precedent,” McGee said.

It’s unclear how the proposal will fair in the state Senate, a smaller legislative body that is dominated by Republicans. Senate President Robert Stivers said it would be “difficult” to pass any tax increase without a comprehensive reform of the tax code.

Republican Gov. Matt Bevin told WSON radio he would “reserve my thoughts” on the opioid tax. But later in the interview, he indicated he would not favor raising taxes just to balance the state budget.

“They are trying to put certain monies back in certain areas based on certain political pressure, when I think we need to have a collective effort in Kentucky,” Bevin said.

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https://www.medpagetoday.com/publichealthpolicy/opioids/71434

WASHINGTON — Interoperability, predictive analytics, e-prescribing: these were some of the terms buzzing around the dais at a hearing of the Senate Health, Education, Labor and Pensions Committee on Tuesday.

The focus of the hearing was to solicit expert input on the role of technology and data in addressing the opioid crisis. The committee is currently drafting legislation related to the epidemic, which it plans to mark-up as soon as late March.

Specifically, Chairman Lamar Alexander (R-Tenn.) asked the experts how the federal government can use the data it collects to identify and stop the overprescribing of opioids.

Sen. Patty Murray (D-Wash.), the committee’s top Democrat, also spoke of the challenge of interoperability with prescription drug monitoring programs, noting that “the prescription a patient receives in one state may not show up in the system of another state. Two doctors in different states may not see they are writing prescriptions for the same patient.”

The concern is that providers may miss meaningful data that could alert providers to signs of a substance use disorder, she added.

Snezana Mahon, PharmD, vice president of clinical product development for pharmacy benefit manager Express Scripts in St. Louis, offered several recommendations to the committee.

First, pass the “Every Prescription Conveyed Securely Act,” which would mandate e-prescribing for opioids for all Medicare enrollees, she said.

“Encouraging e-prescribing of controlled substances would restrict pharmacy shopping [and] enable better prescription tracking, as well as reducing fraud waste and abuse,” Mahon explained.

Second, limit prescription for a first-time opioid user to 7 days (with exceptions for cancer, hospice, and palliative care) in keeping with the “Opioid Addiction Prevention Act,” she said.

Mahon also urged Congress not to mandate coverage for abuse-deterrent opioids saying that it was a “flawed approach” because some providers and patients mistakenly believe such products are less addictive.

Sherry Green, CEO of Sherry L. Green & Associates and co-founder of the National Alliance for Model State Drug Laws in Santa Fe, New Mexico, urged the committee to establish a federally funded hub that would break down the data silos and have consistent standards.

Green told MedPage Today after the hearing that there needs to be standards in each state for three key elements: what data is recorded, who can access it, and for what purpose.

In addition, she recommended that all states should integrate Prescription Drug Monitoring Programs (PDMP) into electronic health record (EHR) systems.

“We’ve got to get this information integrated seamlessly into these [health information exchanges] and [EHR] to get this information to professionals during their clinical work flow, so that they have it when they’re trying to make a decision,” she said.

In his testimony, Sanket Shah, a clinical assistant professor of health informatics at the University of Illinois at Chicago, focused on the impact of predictive analytics to leverage data, and identify warning signs of potential opioid dependency.

He cited a recent study that found “each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period.”

Shah also stressed that “To truly have predictive analytics we need more data sources.”

He explained in a follow-up email to MedPage Today that self-reported data from people on opioids, after they’re discharged, such as the Current Opioid Misuse Measure, is one type of data that he’d like to see leveraged as it might be more accurate than information patients share in a doctor’s presence. Such data could be used to improve risk assessment tools, and better predict factors leading to relapse for those in recovery, he said.

Shah specifically recommended passage of the Prescription Drug Monitoring Act of 2017, which mandates that any state that receives funding from the federal government for a PDMP must share their data with other states. The bill also includes language around helping fund a data-sharing hub.

He noted in his testimony that the federal government has both “the means and the infrastructure” to develop an “integrated data environment” that could use factors such as social determinants of health, family and medical history and access to complete episodes of care to help health informaticists improve their predictive capabilities.

Alexander balked at the idea of the federal government overseeing a federal hub, and being responsible for data-sharing on a large scale. He pointed to Healthcare.gov and Meaningful Use as examples of government-failed experiments in this same realm.

“Why not instead establish the standards that states can use and why not leave room for Amazon, Google, Delta … Why not let the private sectors come in and offer a way to fill in whatever gap remains after we gradually improve the state PDMP?”

Alexander also asked whether e-prescribing should be tested more gradually, rather than mandated because “the technology is still evolving.”

“Because we have an epidemic, I don’t think we have time to wait. What we can do is carefully figure out what are some of those areas that we could leave some exceptions and give them extended dates of when they should be ready” for e-prescribing, “but certainly the rest of the physician practices that do have the ability to do e-prescribing. We should move on them now,” Mahon said.

As for the idea of a federal hub, Green stressed that the federal government would not need to run the hub.

After the hearing, she suggested to MedPage Today that one program in particular, the National All Schedules Prescription Electronic Reporting program within the Department of Health and Human Services (which has been authorized but not funded), could potentially put out a grant for running such a hub.

Maintaining the right standards would be critical as the data is valuable itself and could become a commercial commodity, if the government isn’t careful.

But “this an area where there truly needs to be a public-private partnership,” she said.

What this group of people are doing.. intentionally, unintentionally or out of ignorance… first of all … faked/forged sets of ID’s are readily available and without giving the healthcare professional the means of validating those ID’s that are presented. A dedicated/organized addict/diverter could cycle thru 1-2-3 office visits a day – 5 days a week… meaning that they could potentially get a 30 days supply of controlled meds 22-66 times a month and NEVER SHOW UP ON ANY PMP DATABASE PRINTOUT… and may never get caught.

They are also ignoring that most/all pts dealing the subjective diseases – including the mental health disease of addiction – are part of a protected class of the Americans with Disability Act and/or Civil Rights Act.

What they are attempting to do is prevent anyone with a undiagnosed disease of addictive personality from encountering “their trigger”, but their trigger may be Caffeine, Nicotine, Alcohol or some substance they got from a friend or off the street… and once they encounter a trigger could cascade into a whole range of experimenting with other substances legal and illegal… They may get to this point without ever having a legal opiate prescription filled for them. Yet, all those millions of chronic pain pts are going to be expected to live in a torturous level of pain to attempt to protect those with mental health issues from falling in that “hole of addiction” that the odds are that they will eventually fall into sooner or later.

To the best of knowledge there has never been any clinical study that documents/proves that abstinence, jail, prison has every been the most appropriate treatment for mental health issues nor a means of controlling/curing mental health issues

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http://thehill.com/policy/healthcare/375903-lawmakers-seek-information-on-curbing-opioid-addition-in-medicare

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tps://www.nbcnews.com/storyline/americas-heroin-epidemic/attorney-general-jeff-sessions-really-going-war-against-big-pharma-n852136

When Attorney General Jeff Sessions appears Thursday at a White House opioids summit, skeptics are likely to hit him with this question: Was his “statement of interest” in support of local governments suing Big Pharma a declaration of war — or saber-rattling?

Defense attorneys who have crossed swords with the federal government before, and advocates who have been pushing the Trump administration to make good on a promise to end the opioid epidemic, say Sessions’ tough talk is likely more of the latter than the former.

“While it is difficult to assign motives to an act of the DOJ, this is a PR move, not a sincere attempt to address the opioid crisis,” attorney David Cattie said.

The targeted drugmakers and distributors most likely are already “preparing to offer compensation to resolve this litigation anyway,” Cattie said. “Is this the administration’s way of signaling to pharma that it wants the companies to settle these cases for some ‘big’ number so the administration can take credit for it? Perhaps.”

Trial lawyer Jesse Gessin said that if the DOJ were serious about holding pharmaceutical company’s feet to the fire, it would join the hundreds of cities, states and other local governments that have accused the companies of creating a crisis by fooling the public into thinking opioids were safe.

“The statement of interest does not make the government a party to the lawsuit,” Gessin said.

It also enables the Trump administration to make it appear they are taking a hard line with an industry that has given millions in campaign contributions to Republicans and Democrats alike.

“The DEA has known for some time that the pharmaceutical manufacturers and distributors were violating federal law, “ Gessin said. “If the government was going to bring a criminal case, they would have brought it. In fact, the government will not commit to joining the multidistrict civil litigation, why should the companies be concerned about criminal liability?”

Greg Williams, co-founder and executive vice president of Facing Addiction, within the National Council on Alcoholism and Drug Addiction, said in a statement they “applaud the Department of Justice for getting involved in this important litigation against opioids manufacturers and distributors.”

“They must be held accountable and must pay billions, not millions, in reparations to our communities and federal government,” Williams said.

Williams also said he expects Sessions will be grilled about what exactly the DOJ will be doing in support of the hundreds of lawsuits that have already landed on the desk of U.S. District Court Judge Dan Polster in Cleveland.

“The attorney general’s move is mostly symbolic,” said Daniel Raymond, deputy director of policy and planning with the Harm Reduction Coalition. “For an administration that has been remarkably friendly to corporate interests, it does beg the question about the Justice Department’s appetite to more directly taking on those companies.”

The deadly opioid epidemic has been a public relations disaster for the drug companies, as they have drawn bipartisan and national scorn.

Gessin said that if he was defending them the fact that Sessions has been talking tough would not cause him to rethink his legal strategy.

“I’d be more afraid of the big time plaintiff’s lawyer on the multidistrict civil litigation than the government,” he said.

How would he defend the drugmakers? Blame the distributors.

“That would be my strategy,” he said. “Blame it on them for not following federal law. That’s why they exist. What good is the distributor if they can’t distribute lawfully? This is really a distribution case, not a manufacturing case.”

Cattie said whatever happens the drugmakers and distributors will wind up the winners.

“This is just the cost of doing business for opioid manufacturers and distributors,” he said. “If I told you that you could make billions of dollars selling a product but that one day the government would make you pay a fine or settlement or some small percentage of that, I am assuming you would sell the product anyway.”

What worries Cattie is what will happen to the doctors who prescribed the opioids.

“It is important to note that while opioids are abused, they are legitimate pain relievers,” Cattie said.

“Sessions is a 1980s drug warrior and I can guarantee you he will be ramping up prosecution of physicians who specialize in pain management,” he added. “For every ‘pill mill’ doctor, there are 100 other doctors whose only concern is the alleviation of human suffering. These doctors are already caught between their oath to their patients and fear that the DOJ will come after them.”

In fact, the DOJ’s new opioid fraud squad’s first indictment was handed down against a Pittsburgh-area doctor, Andrzej Kazimierz Zielke, who allegedly prescribed addictive painkillers to patients and insisted on being paid in cash.

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From a chronic pain pt:

I just tried to get my morphine filled. I take six pill day  15 mg.  the pharmacist said he can only fill 5.6 pills per day . So my dr has to write new perscription. 

Any input Steve. 

Forcing everyone on Hospice ?

My recommendation:

Ask the pharmacist where that “limit” is coming from… one of the basics of the practice of medicine is the starting, changing, stopping a pt’s medication…  So who is attempting to practice medicine on you?   If it is a reject from your insurance ask the pharmacist to give you a screen print of the rejection when he submitted the claim.. or if it the store’s/chain’s policy then a copy of that policy.. if he can’t/won’t do either…then … someone is telling the truth

Response from chronic pain pt:

Steve insurance company playing doctor. My doctor jumped on that and straightened everything out. She is fast . I’m happy. 

Thank you

At least this insurance company just hopes that the pt caves to their demands… and will back down… when the doc pushing back…They are able to DODGE being accused to practicing medicine without a license by getting the pt’s prescriber to re-write the prescription to meet their demands.

In this particular example, the pt’s daily dose was 90 MME… the limit on the published CDC guidelines…  Where this pt’s insurance company came up with the 5.6 doses/day.. is beyond me.

I will leave you with this quote from the movie Galaxy Quest and Tim Allen

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Inhumane Torture Post Surgery

Torture exists in the United States in 2018 for people seeking medical treatment for chronic conditions.

This strong lady went into the hospital to have subtemporal decompression. Subtemporal decompression is removal of part of the temporal skull bone for relief of intracranial pressure.

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Silver Scripts is in the top three Part D providers… I have had this Part D program since 06/2012 and Barb has been with this company since 01/2006.

Yesterday I did this post:  Maybe you should find another company !

My monthly premiums for this policy has been done as a automatic ACH thru the same bank account, since I started.. and I use Quicken that is set up to place in the appropriate register repeat debits a couple of days before it is to hit the account.

In reviewing the bank account register the last week of Feb, where this premium has been debited from .. I couldn’t help but notice that there was not a “c” flag – as in CLEARED.. besides the Feb 11th entry for Silver Scripts. I go to my bank website to check if the ACH was there and not downloaded to Quicken for some reason — NONE THERE…

So I called Silver Script customer service one person told me that Jan 11, 2018 was made and another told me that Jan 11, 2018 “bounced”.. and that they had put my account on “direct bill”.. but I had not gotten the first piece of communication from them.

So back to the bank statement… and there on Jan 11th, 2018 was a debit to Silver Script.. with a 15 DIGIT ACH number including the specific date and time – down to the SECOND – basically a digital paper trail that it was sent by Silver Script and paid by my bank.

Back to Silver Script CS… how do I get this back on automatic ACH… since it a ACH.. NEW PAPERWORK NEEDS TO BE SUBMITTED – I was told that if you used a credit card… she could set it up over the phone.  So I give her my credit card number… BFD – it all comes out of the same bank account in the end.

I get a confirmation email that the credit card had been set up, but two days latter… there is no charge for the premiums due on the credit card… so I went to Silver Script website and there was a point where you can pay on line… so I went thru the process and they wanted THREE MONTHS premium…  I must presume for Jan, Feb, and Mar and March isn’t due for another 10 days.  The next day it shows up on my on line charge card statement.

Back to CS at Silver Script and supposedly I am now talking to a SUPERVISOR … and according to her… I need to have the bank to document – somehow – that they could produce more than the ACH tracking number, date/time.. because it was a electronic transaction.

Now the BACK STORY… according to my bank, Silver Scripts submitted the same ACH debit twice in one day .. about 38 minutes apart and the bank rejected the second one as a duplicate and rejected the duplicate… but apparently Silver Script treated it both ACH’s rejected and changed my policy to a DIRECT BILL… and did not send me the first piece of communication.

The major troublesome part of this is that if someone on Medicare Part D is without coverage for 63 days… you can’t get back on until the first of the year and you have to pay a 1%/month premium penalty for every month you don’t have coverage – FOR THE REST OF YOUR LIFE.

The jury is still out if this whole CLUSTER -F was intentional, poor training, incompetence or some other moronic reason(s).

Like I recommend to others… I have called 800-MEDICARE and spent a extended period of time speaking with a representative filing a grievance.

Since all the people on these Part D programs are disabled or elderly and not everyone has the where-for-all to know how to deal with such screw up by these huge companies…. and if it was done to me ..it is hard to believe that I was the only person that it has been happened to.. unless it was intentional ?

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Mr. Ariens,

I am writing you in regards to a recent incident that occurred when I was trying to obtain a prescription from a local pharmacy. The prescription was for a narcotic that I take on a daily basis and have been doing so for several years now. I take this medication for severe chronic pain that has failed to resolve/improve despite several other modalities of treatment including but not limited to physical therapy, chiropractic intervention, multiple epidurals, acupuncture and massage, as well as a long list of other medications. I’ve been a patient of the same pain management office for the duration of my treatment. Of recent, my doctor prescribed me my usual monthly pain medication and upon learning that my pharmacy (CVS) was out of stock he then sent it another local CVS. I was leaving to go on vacation and since my renewal date was 2 days early he changed the frequency from q 8 hrs to q 6 hours so that I could obtain my medication prior to leaving on my trip. When I called the pharmacy to inquire about when the medication would be ready the Pharmacist stated that although the frequency was changed she wouldn’t be filling it at that time. I explained my situation to her regarding my trip and she stated that she “did not feel comfortable filling the medication two days early”. After going back and forth with her she then also added that the med was not in stock and would need to be ordered. I told her I would have my doctor contact her directly. My doctors assistant called her and despite reassuring her that I was a long time patient of theirs with no history of abusing my medication, the pharmacist again stated that she would not fill the medication early. My doctors assistant contacted me to make me aware of the details of the conversation and we decided that it was best to not push the issue further and wait for the pharmacy to fill it on regular schedule. The following day I called the pharmacy to get an estimate of when it would be filled knowing that ordering the medication could take a few days. At that point the same pharmacist from the day prior got on the phone and stated that the prescription couldn’t be filled until march 1st. I stated that I knew it would be filled on the scheduled date but wanted to see if there would be a delay due to having restock it. She then went on to say “well I thought you were going on vacation so I cancelled the prescription.” I informed her I had to cancel my trip due to the wait for my med. She said she spoke to my doctors office yesterday and according to her they had canceled the prescription. I informed her that they had called me after speaking with her and the doctors assistant specifically stated that she had not canceled the prescription. (I purposely asked the doctors assistant that specific question because I was debating on just having them send it back to my usual pharmacy.) The pharmacist said that’s how their conversation ended (the doctor cancelling the script) and the pharmacist said she cancelled my prescription. She told me that I would now have to contact my doctor and with me being in mid-sentence hung up on me. I proceeded to call my doctors office and spoke to the same doctors assistant who reassured me she indeed never canceled the prescription and commented on how unprofessional and rude the particular pharmacist was with her as well. We ended up sending my script to a different pharmacy entirely at that point because I knew the pharmacist would go to whatever lengths necessary to make it as difficult as possible for me to get it filled.

      My experiences over the years of being on a narcotic for pain have unfortunately subjected me to the cruel,  treatment of people such as that pharmacist. For the most part you are treated with a lack of compassion, a dismissive attitude and are judged harshly. I rely on this medication daily to have any kind of quality of life for without it I’m not able to perform the basic activities of daily living without being in terrible pain. My question now to you is am I able to file a complaint against this pharmacist for the incident described above, not only for myself, but also to help prevent it from happening to the next victim. People who live with daily pain have it bad enough and this kind of treatment is unwarranted and frankly heartbreaking. Thank you for taking the time to read my story and I look forward to your anticipated response.

Just another CHAIN PHARMACIST that is all “about the numbers”.. 30 days means 30 days… change of dosage… still means 30 days.. You try to rationalize the issue with them.. the just dig their heels in more.  They are ALWAYS RIGHT – just ask them … As usual, I recommend that this pt find a independent pharmacy http://www.ncpanet.org/home/find-your-local-pharmacy  It is the rare situation where a pt takes my advice and changes all their medications to a independent and they still have complaints.  Having had my own independent pharmacy for 20 yrs… I understand the mindset of taking care of pts is JOB ONE.

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https://www.change.org/p/1780490/u/22447277

Feb 28, 2018 — “In written testimony prepared for the congressional committees, the Legion’s Rohan called on lawmakers and the Trump administration to take three specific steps:

Immediately reschedule cannabis from Schedule I to Schedule III on the DEA Controlled Substance Act Scheduling. „

Direct departments and agencies within the administration to fully cooperate in all federally authorized scientific research and offer assistance as needed. „

Authorize extensive research, conduct oversight hearings and support legislation that enables research on cannabis and the medical impact it could have for Americans suffering from opioid over-prescription, pain, depression and a host of other known ailments.”

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