Lilly rolls out insulin discount program

http://www.drugstorenews.com/article/lilly-rolls-out-insulin-discount-program?

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Physician-Assisted Dying: Our Society Needs It, Says MD

http://www.medscape.com/viewarticle/872510

Editor’s Note: Arthur Caplan, PhD, interviewed Timothy Quill, MD, as part of the Medscape video series Both Sides Now. Only a portion of Dr Quill’s interview could be included in the video because of time constraints. Here, we are posting the interview in its entirety. In the coming weeks, we will post interviews with other speakers in that video.

Arthur L. Caplan, PhD: It’s my great pleasure to have as a guest on this difficult topic one of the leading voices—for many decades—in physician-assisted dying, Dr Tim Quill. He is a professor at the University of Rochester School of Medicine. He is also the director of the Center for Ethics, Humanities and Palliative Care, and he is board certified in palliative care. It is a pleasure to welcome you to the program. I can’t think of a better voice to listen to about some of the complexities of these issues. Thanks for coming.

Timothy E. Quill, MD: Glad to be here. Thanks for having me.

Physician-Assisted Dying vs Physician-Assisted Suicide

Dr Caplan: Let’s have you do a little cleaning up of the landscape. What is the difference between physician-assisted dying and physician-assisted suicide? Both terms are around. How do you differentiate those in your mind?

Dr Quill: Many times, the two terms are conflated. Those who believe that this should be a legal option prefer to use the language “physician-assisted dying” rather than “physician-assisted suicide.” Why is that? Well, suicide equates the act with mental illness and with people who have other choices. An important fact is that other languages have more than one word for suicide. There can be rational suicide. There can be heroic suicide, the warrior jumping on a bomb. And there might be suicide for mental illness. The opponents of physician-assisted death would like it to be called “physician-assisted suicide” because they want to equate it in some sense with mental illness.

Dr Caplan: When you say mental illness, do you mean depression?

Dr Quill: Depression, psychosis, an act that makes no sense and could be prevented by good medical care. People who are advocates see it as a possible rational approach when suffering is very hard and there aren’t a lot of other good options. We know that it can be rational because we’ve met people who are in that circumstance who have asked for our help.

Dr Caplan: Do you think there’s a subtle difference in terms of the role of the doctor in physician-assisted dying? People are going to die. For physician-assisted suicide, maybe they’re not terminally ill.

Dr Quill: I suppose it could be the lack or the potential absence of terminal illness. Physicians are also regularly involved in helping people to die. I work in palliative care in hospice. You can take a frame on that to say that we’re at least in part helping people to die better. That’s what we do. So, you want to be sure that you know what we’re talking about as well. There is some issue of clarity that could be an argument in this debate in terms of language.

Palliative Care

Dr Caplan: Your field has evolved a lot over the past couple of decades. I think it would be fair to say that you’ve been a pioneer in palliative care as well. We’ve certainly seen palliative care spread out into American healthcare. Not that it’s where it should be everywhere, but it’s certainly available starting earlier for many people. Some physicians are going to say, “Why do we even have this discussion about assistance in dying if we have palliative care?” Continue Reading

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WSJ Publishes Op-Ed on Not Guilty Verdict for Pain Doctor Obtained by Howard Cooper, Benjamin Wish and Hillary Lehmann

http://www.toddweld.com/wsj-publishes-oped-on-not-guilty-verdict-for-pain-doctor-obtained-by-howard-cooper-benjamin-wish-and-hillary-lehmann

The Wall Street Journal on June 13, 2015, published an Op-Ed piece written by prominent Boston criminal defense and civil rights attorney Harvey Silverglate commenting on the recent acquittal of Dr. Joseph Zolot and Nurse Practitioner Lisa Pliner on multiple counts of alleged violations of federal conspiracy and drug distribution laws.

Dr. Zolot was represented by Todd & Weld attorneys Howard M. Cooper, Benjamin J. Wish, and Hillary A. Lehmann and was acquitted after a 26-day trial.

In the WSJ opinion article, attorney Silverglate questions the legitmacy of federal drug prosecutors using drug laws to prosecute pain physicians where there is little, if any, guidance given to physicians about the line between legitimate medical treatment and improper prescribing.

“This prosecution,” Silverglate writes, ” shows why drug warriors need either to clarify the currently indecipherable line between treating pain and unlawfully feeding drug addicts’ habits, or get out of the business of policing and terrorizing physicians. Unfortunately, the government uses legal ambiguity for tactical advantage and will not readily clarify the lines it expects doctors to follow at their peril.”

Dr. Zolot was a Needham, Mass.-based pain medicine physician whose office was raided by the government in May 2007, after which he was indicted on multiple counts of unlawfully prescribing opioids such as OxyContin, Fentanyl and Methadone to patients. Nurse Pliner was accused of participating in the drug dealing operation. A first trial resulted in a hung jury, after which U.S. Attorney Carmen Ortiz decided to retry the case.

Following his acquittal, Dr. Zolot publicly expressed his hope that the verdict would help doctors feel less intimidated by the federal government in treating patients who are in chronic pain with available pain medications.

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Pharmacy benefit managers face crack down on drug pricing

http://www.healthcarefinancenews.com/news/pharmacy-benefit-managers-facing-crackdown-drug-pricing

New coalition, health plans, employers and legislators will want greater assurances that PBMs are controlling costs.

The financial future of pharmacy benefit managers is uncertain as payers, legislators and regulators focus on rising drug prices, according to Moody’s Investors Service.

The rising price of drugs such as Mylan’s EpiPen has resulted in a  firestorm of scrutiny from legislators and PBM customers.

[Also: Mylan will pay $465 million settlement over CMS classification of epipen for Medicaid Drug Rebate Program]

Humira and Enbrel, popular anti inflammatories that represent a significant portion of the drug spend, saw double digit increases, even after rebates, between 2014 and 2015, Moody’s said.

Because of the growing public attention, manufacturers are expected to moderate drug price increases over the coming year, a factor confirmed by large drug distributors and some drug manufacturers.

However, specialty drugs will account for a larger portion of the nation’s drug spend, due in part to innovation and higher pricing.

[Also: Healthcare spending, driven by prescription drug costs, outpaces economy]

The current PBM model could be altered or undermined by changes proposed by employers, customer groups and legislation that is aimed at drug companies, or even a slowing of brand drug price inflation, Moody’s said.

Earnings guidance is down because branded drug inflation will moderate between 7-9 percent, from around 10 percent.

Pharmacy benefit managers feeling the heat include Express Scripts, CVS Health and Optum RX, which is part of UnitedHealth Group.

Both Express Scripts and CVS Caremark will continue to exclude certain drugs from their formularies to help clients cut drug spending, Moody’s said.

The number of drugs on the PBM formulary exclusion lists for both CVS health and Express Scripts has risen from 76 and 48 respectively, in 2014, to 154 and 85 for 2017.

The problem is, Moody’s says, that with limited transparency on actual pricing and discounts and rebates, it’s not easy to determine if PBMs are making formulary decisions that are best for their clients or for themselves.

PBMs have disclosed little about the profits gained from placing certain drugs on their formularies, Moody’s said.

PBMs have said they pass on the lion’s share of the rebates they receive to their clients.

“We estimate that Express Scripts keeps about 15 percent of the rebates,” Moody’s said.

But none disclose this information.

A Health Transformation Alliance has highlighted employer concerns regarding rising drug costs. The coalition of more than 20 high-profile employers focuses on making the healthcare benefit market most cost-effective by changing how PMBs purchase and pay for prescription drugs.

[Also: Coca-Cola and AMEX among major companies to form Health Transformation Alliance to combine population health data]

They will do this by renegotiating contracts with PBMs, Moody’s said. Branded drug price inflation will slow, but the impact on PBMs depends on contract terms.

The coalition has yet to release firm proposals, but are considering fee for service payment models, in which the PBM client would pay for the cost of the drug, plus an agreed upon fee.

Legislative proposals include allowing the federal government to negotiate drug prices for seniors covered under Medicare Part D, and modifying the reimbursement structure for dual-eligible patients.

In January 2015, a bipartisan bill introduced in the House would help pharmacies receive appropriate levels of reimbursement from PBMs. Independent pharmacies had argued they were losing money because they were being reimbursed by PBMs for less than it cost them to buy the drugs.

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Invokana Lawsuits Coordinated Into MDL

baddrug.news/news/invokana-lawsuits-coordinated-mdl/

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State Board to Request Reports of Painkiller Orders

http://wvpublic.org/post/state-board-request-reports-painkiller-orders

West Virginia’s Board of Pharmacy plans to ask prescription drug wholesalers to report pharmacies that place suspiciously large orders of painkillers or other controlled substances.

 

Credit RayNata / wikimedia

The board plans to forward those reports to the state Attorney General’s Office, which last week sued a pharmacy in Boone County, alleging it provided too many highly addictive painkillers over more than a decade.

The distributors McKesson Corp. and Cardinal Health now notify the state of such questionable orders.

The Charleston Gazette-Mail (http://bit.ly/2hAI2Wi) reports the pharmacy board has agreed to send letters asking other wholesalers.

The board’s rules require they report suspicious prescription drug orders, but the regulations don’t spell out the criteria.

Distributors already submit reports on suspicious drug orders to the U.S. Drug Enforcement Administration.

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Tell all contacts from your list not to accept a video called the “Dance of the Pope”. It is a virus that formats your mobile. Beware it is very dangerous. They announced it today on the radio. Fwd this msg to as many as you can!

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DEA Lays Out New Dynamic for Regional Heroin Trafficking

http://www.insightcrime.org/news-briefs/dea-lays-out-new-dynamic-regional-heroin-trafficking

A top DEA official has sounded the alarm over how heroin traffickers in Mexico have massively increased poppy cultivation and expanded their distribution networks into the east coast of the United States as they look to cash in on the growing number of US heroin users.

In Congressional testimony (pdf) on October 8 regarding drug abuse, Acting Deputy Administrator of the Drug Enforcement Administration (DEA) Jack Riley said the DEA had documented a 50 percent increase in the cultivation of poppy (the plant used to make heroin) in Mexico, primarily in the state of Guerrero and the Mexican “Golden Triangle” of Durango, Sinaloa, and Chihuahua.

Mexican criminal organizations such as the Sinaloa Cartel have also been expanding territorially in US markets and developing more sophisticated production techniques, Riley asserted. 

Traditionally, Riley said, the US heroin market has been divided by the Mississippi River: markets west of the river used Mexican black tar and brown powder heroin, while the most lucrative markets, the large east coast urban centers, were dominated by higher quality Colombian-produced white powder heroin. However, Mexican drug traffickers are now also competing for the lucrative East Coast market, introducing Mexican brown/black tar heroin but also seeking to produce their own version of the more refined white powder variety.

The preferred trafficking routes for these networks is the Southwest US-Mexico border, where heroin seizures doubled between 2009 and 2013 from 846 to 2,196 kilograms, according to Riley

The Mexican traffickers are supplying a rapidly increasing number of US heroin users, which more than doubled between 2007 and 2014, from 373,000 to 914,000, according to Riley. Today, he said, heroin is higher in purity, less expensive, and often easier to obtain than prescription opioids — such as the painkillers oxycodone and hydrocodone. .

InSight Crime Analysis

There are numerous market forces that explain the changing dynamic in regional heroin production, trafficking and distribution.

One of most important is the rapidly rising demand as a result of the growing number of US users. As Riley elaborates on in his testimony, rising US heroin use is closely linked to abuse of prescription painkillers, the most commonly used illegal drug in the United States after marijuana. Many users start off on pills but turn to heroin because it is cheaper, more easily available or because it has a stronger effect.

Exploiting this growing market may also be making up for shortfalls in revenues elsewhere for Mexican traffickers. In recent years, US cocaine consumption has decreased and the legalization of marijuana in several US states has opened that market to increased competition, and the cartels may see heroin as a profitable replacement for these shrinking markets.

These new conditions appear to have led to Mexican traffickers developing a strategy based on three pillars; ramping up production, expanding into new markets, and innovating production techniques to better compete with the superior product of their Colombian rivals.  

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https://youtu.be/dm6xexu_wJY?t=3m32s

Former DEA agent gets a year in federal prison for tax evasion, witness tampering

http://www.tampabay.com/news/courts/criminal/former-dea-agent-gets-a-year-in-federal-prison-for-tax-evasion-witness/2306177

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The FDA Should Approve Drugs Based on Evidence, Not Emotions

http://www.slate.com/articles/health_and_science/medical_examiner/2016/12/the_21st_century_cares_act_could_be_dangerous_for_everyone.html

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