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Concern over opioid abuse is amplifying interest in opioid induced hyperalgesia among governing bodies and payor organizations. Dr. Harden discusses the current state of the science surrounding OIH, including terminology, technology/methodology, and existing evidence. Additionally, he offers some observations on the 2016 CDC prescribing guidelines for primary care practitioners.
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http://www.sltrib.com/home/5243304-155/cvs-health-profit-slides-17-still
OMG , so i guess there will not be more techs hours then , it will be just the pharmacist and his customers to compensate their loss, actually 17% is less than what i expected , with a company treats employess and patients like they are their own slaves , with no patients safety measurements under supervision of assholes midlevel managements , with the loss of tricare and ranked as one the worst corporate to work for , the profit should slide by 50% at least and you know it will happen and the day will come when this fake health care corporate collapse
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Government Releases Massive Trove of Data on Doctors’ Prescribing PatternsThe federal government released detailed data today on nearly 1.4 billion prescriptions dispensed to seniors and disabled people in the Medicare program in 2013, bringing more openness to the medication choices of doctors nationwide.
The data release comes two years after ProPublica reported that the Centers for Medicare and Medicaid Services had done little to detect or deter hazardous prescribing in its drug program, known as Medicare Part D. ProPublica analyzed several years’ worth of prescription data, obtained under the Freedom of Information Act, and created a tool called Prescriber Checkup that lets users compare individual physicians to others in the same specialty and state.
But Medicare itself hadn’t made this information easily accessible—until now.
“This transparency will give patients, researchers, and providers access to information that will help shape the future of our nation’s health for the better,” said acting CMS Administrator Andy Slavitt in a statement accompanying the data’s release.
The information released by CMS is part of the agency’s data transparency initiative. In recent years, CMS has released data on hospital charges, geographic variations in the way health care is delivered, and Medicare’s payments to doctors. The payment data, first released last year, came after the Wall Street Journal and its parent company challenged a long-standing legal injunction that had kept the information private.
Medicare changed its approach to overseeing Part D after the ProPublica reports.
Before, agency officials insisted that monitoring problem prescription patterns fell to the private health plans that administer the program, not the government itself. Congress never intended for CMS to second-guess doctors – and didn’t give it that authority, officials said.
Doctors didn’t even have to be enrolled in Medicare to prescribe to patients in Part D, making it impossible for the program to know basic facts about whether the prescriptions these doctors wrote were appropriate.
Since our reports, CMS has moved to fix Part D’s excesses and blind spots. In May 2014, the agency gave itself the authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways. Beginning next month, the agency also will compel health providers to enroll in Medicare to order medications for patients in Part D, closing the loophole that has allowed some practitioners to operate with little or no oversight.
Medicare Part D is popular among seniors for helping to lower their drug costs. But experts have complained that since Part D began in 2006, Medicare has placed a higher priority on getting prescriptions into patients’ hands than on targeting problem prescribers. The U.S. Department of Health and Human Services’ inspector general has repeatedly called for tighter controls.
Among ProPublica’s findings:
One Miami psychiatrist, for example, wrote 8,900 prescriptions in 2010 for powerful antipsychotics to patients older than 65, including many with dementia. A black-box warning on the drugs says they should not be used by such patients because it increases their risk of death. The doctor said he’d never been contacted by Medicare.
ProPublica also found that many of the top prescribers of the most abused painkillers had been charged with crimes, convicted, disciplined by their state medical boards or terminated from Medicaid. Nearly all remained eligible to prescribe in Medicare.
The data released by Medicare today includes summary information, such as the total number of prescriptions written by each doctor in 2013, as well as more detailed information about each drug a doctor prescribed. It covers prescriptions worth more than $103 billion, not including rebates that lower the cost by an undisclosed amount.
The top prescribed drug in the program in 2013 was the blood pressure drug Lisinopril, prescribed 36.9 million times, including refills. Medicare spent the most on Nexium, $2.5 billion, not including rebates. The drug taken by the most Part D patients was the narcotic hydrocodone-acetaminophen. More than 8 million users filled at least one prescription for it.
Eric Hammelman, a vice president at the consulting firm Avalere Health, said the prescribing data could unlock clues about differences in how doctors practice medicine. Take, for instance, antibiotics, he said, which are often prescribed for inappropriate reasons. While the new data won’t show which prescriptions are inappropriate, it may flag providers who should be asked questions because they prescribe the drugs to a high proportion of their patients.
Beyond that, if consumers compare the prescribing data to data on the payments drug companies have made to doctors, they can see how often doctors prescribe products sold by companies with whom they have financial relationships.
“Knock on wood, these files are coming out on a regular basis. I think some of the doctors and manufacturers would prefer this goes away,” Hammelman said.
Robert M. Wah, president of the American Medical Association, said in a statement that the data “is much more complex than initially meets the eye. The limitations of it should be more comprehensively listed and highlighted more prominently so that patients can clearly understand them.”
ProPublica will be analyzing the information in coming weeks and incorporating the data into our Prescriber Checkup tool.
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Because who doesn’t like a story—especially when it’s true?
Pharmacy benefit managers (PBMs) say they reduce drug prices and increase patient access, but the facts just don’t bear that out. A new NCPA resource—The PBM Story: What They Say, What They Do, and What Can Be Done About It—tells the real story of how PBMs got their start as useful claims processors but then morphed into large corporations more interested in extracting profits from the prescription drug supply chain than in ensuring medication affordability and access. And that’s the real story: PBMs have done more to enrich themselves over the past 25 years than they have done to bring down drug costs.
Download The PBM Story (download the 6-page pdf or the 12-page pdf or the brief one-pager) and share it with your members of Congress, your state legislators, other policymakers, local employers, and anyone else who needs to understand the discrepancy between what PBMs say and the actual effect they have in driving up prescription drug prices and limiting patient access to medications. Watch our 3-minute video describing how PBMs raise prescription drug costs for patients below.
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Many different entities (state legislatures, insurance companies, medical practices) are imposing days supply – up to 7 days – that opiates can be prescribed for acute pain.
Many insurance companies are requiring PRIOR AUTHORIZATION on all opiates and have REMOVED PRIOR AUTHORIZATIONS on Suboxone and other medications used to treat addiction.
Just like school yard bullies that pick on the weak, meek and the easily intimidated… the “medical school yard” seems to have amassed a “army of bullies”.
It has been reported in surveys that 90% of the families that have a chronic pain pt… are struggling financially because one spouse can’t work and/or the cost of therapy/treatment.
Generally, the chronic pain pts are physically, mentally, financially exhausted and if there is still a spouse around – a lot of divorces among chronic painers – that has to “pick up the slack – because of the physical limitations of the chronic painer… Making them have less time to “put up a fight” against the discrimination that chronic painers are experiencing
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FARGO, N.D. (Valley News Live): It’s a type of fentanyl that’s resistant to Narcan, and it’s popping up across the country. The DEA in Pennsylvania is warning people to be on the lookout as this drug continues devastating lives, unlike its medically based cousin. It’s called acryl fentanyl, another form of the drug that’s 100 times more powerful than morphine.
“Narcan is not the 100% fail safe that people may think it is, it does not always work,” explained West Fargo Police Interim Chief Jerry Boyer.
At a recent news conference, police and health officials warned about the deadly opioids like fentanyl. But unlike fentanyl which has a medical use, and carfentanil which is used by veterinarians, acryl fentanyl has no purpose.
“It’s a Schedule I drug, so this one has no medical use at all. At all. So it’s here illegally,” said DEA Special Agent David Battiste.
A DEA report shows the different types of fentanyl and derivatives recently seized and tested by their forensic lab in the first quarter of the year. Acryl fentanyl started appearing to the DEA last fall, and comes in a powder, looking similar to other forms. The DEA says that even narcotics experts couldn’t tell the difference without testing.
“These are dangerous drugs. They’re cut by these dealers who don’t care about anything other than making a profit. It can be cut with anything,” said DEA Special Agent Battiste.
The DEA says it is not clear how and why this acryl fentanyl is resistant to Narcan. The drug is being manufactured overseas, and smuggled into the U.S. The DEA says it mainly comes from China, but in March that country made it illegal to export four fentanyl classes including carfentanil and acryl fentanyl.
In 2016, there were about 30 opioid overdose deaths in Cass County alone according to Fargo Cass Public Health. They report seeing several deaths a month so far this year.
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(HealthDay News) — A dosage of 1 g intravenous acetaminophen every 6 hours yields serum concentrations below 10 µg/mL for critically ill multiple-trauma patients, according to a study published in the Journal of Clinical Pharmacology.
Oscar Fuster-Lluch, PhD, from the Hospital Universitari i Politècnic La Fe in Valencia, Spain, and colleagues examined the pharmacokinetic profile of intravenous acetaminophen administered to critically ill multiple-trauma patients after 4 doses of 1 g every 6 hours. Serum and urine acetaminophen concentrations were assessed and used to calculate pharmacokinetic parameters. Data were included for 22 patients (age, 44 years), mostly males (68%), who were not obese.
The researchers found that the maximum acetaminophen concentration was 33.6 µg/mL and the minimum concentration was 0.5 µg/mL. All values were below 10 µg/mL and 8 were below the limit of detection. Serum and renal clearance were 28.8 L/hour and 15 mL/min, respectively. For a steady-state minimum concentration of 10 µg/mL, the theoretical daily dose would be 12.2 g/day; the dose would be 6.9 g/day for an average steady-state concentration of 10 µg/mL.
“In conclusion, administration of acetaminophen at the recommended dosage of 1 g per 6 hours to critically ill multiple-trauma patients yields serum concentrations below 10 µg/mL due to increased elimination,” the authors write. “To reach the 10 µg/mL target, and from a strictly pharmacokinetic point of view, continuous infusion may be more feasible than bolus dosing.”
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As part of Maryland’s effort to combat the national opioid epidemic, Maryland Medicaid is focused on improving the opioid prescribing process in the effort to reduce opioid misuse, dependence, overdose and death.
Here, you’ll find information about the opioid epidemic landscape in Maryland, the HealthChoice program’s response, and resources for providers and HealthChoice managed care organizations made available through the Drug Utilization Review process.
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This is one amazing company… we use to buy our 14.5 y/o.. Shih Tzu’s (Sammy)
special diet food from our vet. We mis-estimated how much he was going to eat while we were in FL for the winter and Barb found this company stocked the specific special dog food and she ordered a case. Unfortunately, either her fault or theirs we were sent the right brand but the wrong version. So Barb contacted them to order the correct food… They told us to donate the case to a local shelter and they sent us another case AT NO CHARGE…
We have since purchased all if Sammy’s food from them.. one order had a couple of slightly “bent cans” in the order and Barb made them aware of it.. Another order had a can so seriously bend that the seal was broken on the can and it was leaking…
The next day.. there is a new case of the dog food at our front door – AT NO CHARGE…
Barb has set up auto ship on his foods and other treats from them…
Last Thursday and Friday… Sammy is drinking water excessively and loading his “pads” equally with urine… we called the vet Friday afternoon and they are only opened Saturday 9 AM to noon and they were booked solid but if we brought him at opening they would look at him.. They ran labs and some of his liver values .. were off the scale.. and suggested that he be put on IV for the weekend… which we agreed to …
Barb sent a message to www.chew.com to suspend our automatic shipping orders…
Today the front door bell rang and there is a gentleman at the door with this:
with the attached note:
The two days of IV has lowered some of his liver values but no where near normal… We had a sonogram on Sammy as they recommended and the BAD NEWS is that it appears that Sammy has several small malignant masses in his liver. Because there are several masses and his age… surgery is not an option… and likewise because of his age neither is chemo. The vet did say that typically this type of cancer is SLOW GROWING…
He is back home and seems rather “normal” … how many more “normal days” that he has…
This breed has a life expectancy of 12-15 years and he turned 14 this past Dec…
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