Ohio Had Most Opioid Overdose Deaths In The Country. What’s Next?

http://radio.wosu.org/post/ohio-had-most-opioid-overdose-deaths-country-whats-next

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Doctors And Hospitals Say ‘Show Me The Money’ Before Treating Patients

http://khn.org/news/doctors-and-hospitals-say-show-me-the-money-before-treating-patients/

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Okla. But the plan has a deductible of $5,000 apiece, and Boxley’s doctor said he won’t do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

“I’m so angry,” Boxley said. “If I need medical care I should be able to get it without having to afford it up front.”

At many doctors’ offices and hospitals, a routine part of doing business these days is estimating patients’ out-of-pocket payments and trying to collect it up front. Eyeing retailers’ practice of keeping credit card information on file, “there’s certainly been a movement by health care providers to store some of this information and be able to access it with patients’ permission,” said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Mass., who works with hospitals on addressing financial barriers to care.

But there’s a big difference between handing over a credit card to cover a $20 copayment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient’s credit limit. Doctors may refuse to dispense needed care before the payment is made, even as patient health hangs in the balance.

The strategy leaves patients financially vulnerable too. Once a charge is on a patient’s credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer’s commitment that the charge was justified, so nonpayment is more likely to harm a credit score. 

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as “point-of-service collections,” estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He could not say how many were doing so for higher priced services or for patients with high-deductible plans, situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

“For providers, there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes,” Gundling said.

But the practice leaves many patients resentful.

After arriving by ambulance at the emergency department, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix at a hospital near her home in Maitland, Fla. A woman in street clothes approached her. Identifying herself as the surgeon’s office manager she demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

“I said, ‘You have got to be kidding. I don’t even have a comb,’” Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. “I don’t have a credit card on me.”

The woman crossed her arms and Bradshaw remembers her saying, “You have to figure it out.”

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. “Patients are essentially paying for their procedures up front,” he said. “It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.”

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year, according to the Kaiser Family Foundation’s annual survey of employer health insurance. (KHN is an editorially independent program of the foundation.)

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

“I’ll make payments,” Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn’t pan out, she figures she’ll have to use student loan money she got for graduate school to cover what she owes.

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it’s not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians’ board of directors.

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful and Bradshaw was home within 24 hours.

“It’s a very murky, unclear situation,” Friedman said of Bradshaw’s experience, noting that a case might be made that her condition wasn’t life threatening. “At the very least it’s poor form, and goes against the intent if not the actual wording of EMTALA.”

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Man dies of emotional distress after being forced to clean Walgreens bathroom, widow says

http://www.wftv.com/news/local/man-dies-of-emotional-distress-after-being-forced-to-clean-walgreens-bathroom-widow-says/473525151

ORLANDO, Fla. – The widow of a 69-year-old man has sued an Orlando Walgreens store, accusing them of holding her husband captive until he cleaned and mopped the store’s bathroom. You can also check out more details here!

Maria Elizarraras claims that the humiliation of the experience caused emotional distress so severe that it killed her husband, Fernando Elizarraras.

The lawsuit was originally filed in state court but was moved to federal court Monday, according to court documents.

According to the suit, Fernando Elizarraras went to the Walgreens on Landstar Boulevard, where he had been a long-term customer, on Oct. 15, 2012.

After using the bathroom at the store, store employees stopped Fernando as he tried to leave and physically escorted him back to the bathroom, the lawsuit alleges.

The employees insisted the 69-year-old man clean the facility because, “You left a mess, (expletive) all over the bathroom,” the suit says.

For 20 minutes, Fernando was threatened and forced to clean and mop the bathroom before he was allowed to leave the store, his wife claims in the suit.

The incident caused Fernando to be “humiliated, disgraced and injured in his feelings, emotionally and mentally,” the lawsuit says.

The emotional distress caused by the situation was so severe that it “resulted in the death of Fernando,” the suit says.

The lawsuit does not say how much time passed between the incident and Fernando’s death.

On behalf of her husband’s estate, Maria Elizarraras was suing the company for an undetermined amount, but according to court documents has a standing offer to settle for $500,000.

As of early Tuesday, Walgreens had not responded to the lawsuit in federal court.

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CDC Manipulated Data to Deceive

Durations of Opioid, Nonopioid Drug, and Behavioral Clinical Trials for Chronic Pain: Adequate or Inadequate?

CDC Manipulated Data to Deceive

This commentary presents the case that the CDC manipulated the data it used as a basis for its opioid prescribing guidelines.

By imposing an arbitrary non-standard constraint and excluding some studies that were included in earlier reports, the CDC created a different interpretation by using a different set of data.

Objectives. A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had “inadequate duration.”

To explore the evidence, we examined durations of studies on opioid, nonopioid drug, and behavioral therapies for chronic pain.  

Methods. We retrieved Cochrane reviews of anticonvulsants, antidepressants, NSAIDs, opioids, or behavioral interventions for chronic pain. We also examined all opioid treatment studies retrieved for the federal evidence report but excluded due to “inadequate duration.”

Results. We graphed numbers of trials vs duration for the five treatments reviewed in the Cochrane Library, compared with durations of opioi12690d trials dropped from the federal evidence report. Most graphs were overdispersed Poisson distributions. Nearly all trials had active treatment durations of 12 weeks or less.

Conclusions. 

No common nonopioid treatment for chronic pain has been studied in aggregate over longer intervals of active treatment than opioids.

To dismiss trials as “inadequate” if their observation period is a year or less is inconsistent with current regulatory standards.

The literature on major drug and nondrug treatments for chronic pain reveals similarly shaped distributions across modalities.

Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids.

© 2016 American Academy of Pain Medicine.  

The full article details how the CDC’s conclusions are based on studies selected by using arbitrary non-standard standards of inclusion/exclusion.

Introduction

The use of opioids began in prehistory and is now standard practice in much of the world for the management of acute, chronic, and cancer-related pain.

Balancing the legitimate medical use of opioids for analgesia vs society-wide abuse, misuse, diversion, addiction, and mortality has become a major public health theme.

In March 2016, the US Centers for Disease Control and Prevention (CDC) published a guideline for prescribing opioids for chronic pain on the CDC website.

An important message communicated in the CDC guideline and related press releases is that the body of evidence addressing the effectiveness or efficacy of opioid therapy for outcomes of pain, function, or quality of life was insufficient to contribute any studies for their analyses.

In reaching this conclusion, the minimal duration for inclusion of a long-term study was set by the authors as “>1 year,” the same threshold employed by a 2014 evidence report that informed the 2016 CDC guideline.

The same consultant was the lead methodologist for both the 2014 evidence report and the 2016 CDC guideline.

However, earlier systematic reviews of the effectiveness or efficacy of opioids for chronic noncancer pain, co-authored by the same consultant and based upon the best available evidence, had identified dozens of clinical trials and systematic reviews of this topic.

Although their conclusions were guarded due to the poor overall quality of the literature, both earlier reviews concluded that selected, carefully monitored patients might benefit from such therapy.

Because the 2016 CDC literature review may be viewed as an update of the earlier reviews, it was striking that the 2016 review reached far more negative conclusions about the risk-benefit ratio for long-term opioid therapy than did the 2009 and 2010 reviews.

The 2014 evidence report and the 2016 CDC guideline relied upon the absence of studies of a year or greater duration to advance recommendations reflecting a low perceived benefit-to-risk ratio of opioid use for chronic pain.

And that is how they justified opioid prohibition.

We wondered whether a more standard approach to study retrieval and inclusion would confirm or refute this perception. Issues related to study inclusion also have implications for switching from or preferring one therapy to another

In addition, we examined studies cited in in the Cochrane Library of Systematic Reviews addressing opioids, antidepressants, anticonvulsants, NSAIDs, and behavioral treatments.

Our objective was to assess whether differences exist between the duration of treatment trials for chronic pain using each of these modalities, if analyzed without applying the one-year minimum threshold for inclusion newly introduced in the 2014 AHRQ and 2016 CDC reports.

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Orrick, Representing Marijuana Advocate, Challenges DEA Statements About Pot

http://www.therecorder.com/home/id=1202773915178/Orrick-Representing-Marijuana-Advocate-Challenges-DEA-Statements-About-Pot?

A national nonprofit advocacy group supporting legal access to medical marijuana has petitioned the U.S. Justice Department to require drug enforcers to correct allegedly false and misleading information about cannabis use on its website.

Americans for Safe Access, represented pro bono by Orrick, Herrington & Sutcliffe, cites 25 alleged violations by the U.S. Drug Enforcement Administration of the Information Quality Act. The law, also known as the Data Quality Act, requires federal agencies to draft guidelines that ensure the “quality, objectivity, utility and integrity of information” that they distribute and to provide a mechanism to correct any misinformation.

“We have taken this action to stop the DEA’s relentless campaign of misinformation about the health risks of medical cannabis in its tracks,” said Vickie Feeman of Orrick, a Silicon Valley partner who’s pro bono counsel to the nonprofit petitioners. “We’re hoping this is a very straightforward petition. We’re going after specific statements they themselves have said in recent reports are wrong.”

A representative of the DEA did not immediately comment Monday on the petition. Under the Justice Department’s guidelines, the department has 60 days to respond to the petition.

The petition states that the DEA continues “to disseminate certain statements about the health risks of medical cannabis use that have been incontrovertibly refuted by the DEA itself.” The petition pointed to statements the agency recently made in its refusal to reschedule marijuana to a lower classification of controlled substances. The petition contends “the DEA’s recent statements confirm scientific facts about medical cannabis that have long been accepted by a majority of the scientific community.”

Among the alleged DEA misstatements that are challenged in the petition: “Evidence of the damage to mental health caused by cannabis use—from loss of concentration to paranoia, aggressiveness and outright psychosis—is mounting and cannot be ignored.”

In its recent refusal reclassify marijuana, the agency said: At present, the available data do not suggest a causative link between marijuana use and the development of psychosis. And also: Numerous large, longitudinal studies show that subjects who used marijuana do not have a greater incidence of psychotic diagnoses compared to those who do not use marijuana.

Americans for Safe Access states in its petition that members of Congress are using DEA’s inaccurate information to inform their votes on recent legislation, including the Compassionate Access, Research Expansion, and Respect States. The bill would protect patient access to medical cannabis in states with existing medical cannabis programs from federal intervention. And it would also would also reschedule marijuana, easing restrictions on medical and scientific research of the substance.

The Information Quality Act’s requirements govern nearly all federal agencies and are enforced by the office of information and regulatory affairs within the Office of Management and Budget.

“We are simply taking the DEA’s own statements, which confirm scientific facts about medical cannabis, and analysis that has long been accepted by a majority of the scientific community,” said Steph Sherer, executive director of Americans for Safe Access, in a statement. “Our request is simple: the DEA must change its public information to better comport with its own expressed views, so that Congress has access to the appropriate tools to make informed decisions about public health.”

The petition from Americans for Safe Access is posted below.

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G.O.P. Plans Immediate Repeal of Health Law, Then a Delay

www.nytimes.com/2016/12/02/us/politics/obamacare-repeal.html

Obamacare was signed into law March 2010… with the “worse part – higher premiums ” of it not kicking in until 2017… when Obama would be out of office.  Part of their “bad timing” was that the 2017 HIGHER premiums were announced right before the Nov election.  There is a disproportion number of Republicans in the Senate up for re-election in 2018.  So … any more “bad news” from Congress about the replacement for Obamacare will be pushed off until after the 2018 election. It would appear that “the swamp” is going to be alive and well for another couple of years… AT LEAST !

It is not sheer coincidence that at least one idea envisions putting the effective date well beyond the midterm congressional elections in 2018.

“We are not going to rip health care away from Americans,” said Representative Kevin Brady, Republican of Texas and chairman of the Ways and Means Committee, which shares jurisdiction over health care. “We will have a transition period so Congress can develop the right policies and the American people can have time to look for better health care options.”

Senator Lamar Alexander, Republican of Tennessee and chairman of the Senate health committee, said: “I imagine this will take several years to completely make that sort of transition — to make sure we do no harm, create a good health care system that everyone has access to, and that we repeal the parts of Obamacare that need to be repealed.”

But health policy experts suggest “repeal and delay” would be extremely damaging to a health care system already on edge.

OPEN Graphic

“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

Details of the strategy are in flux, and there are disagreements among Republicans about how to proceed. In the House, the emerging plan, tightly coordinated between Mr. Ryan and Mr. Pence, is meant to give Mr. Trump’s supporters the repeal of the health law that he repeatedly promised at rallies. It would also give Republicans time to try to assure consumers and the health industry that they will not instantly upend the health insurance market, and to pressure some Democrats to support a Republican alternative.

“I don’t think you have to wait,” Representative Kevin McCarthy of California, the majority leader, told reporters this week. “I would move through and repeal and then go to work on replacing. I think once it’s repealed, you will have hopefully fewer people playing politics, and everybody coming to the table to find the best policy.”

Under the plan discussed this week, Republicans said, repeal will be on a fast track. They hope to move forward in January or February with a budget blueprint using so-called reconciliation instructions, which would allow parts of the health care law to be dismembered with a simple majority vote, denying Senate Democrats the chance to filibuster. They would follow up with legislation similar to a bill vetoed in January, which would have repealed the tax penalties for people who go without insurance and the penalties for larger employers who fail to offer coverage.

That bill would also have eliminated federal insurance subsidies, ended federal spending for the expansion of Medicaid, and barred federal payments to Planned Parenthood clinics.

But in the Senate, Republicans would need support from some Democrats if they are to replace the Affordable Care Act.

The budget reconciliation rules that would allow Republicans to dismantle the Affordable Care Act have strict limits. The rules are primarily intended to protect legislation that affects spending or revenues. The health law includes insurance market standards and other policies that do not directly affect the budget, and Senate Republicans would, in many cases, need 60 votes to change such provisions.

Repealing the funding mechanisms but leaving in place the regulations risks a meltdown of the individual insurance market. Insurers could not deny coverage, but they would not get as many healthy new customers as they were expecting. Hospitals would again face many uninsured patients in their emergency rooms, without the extra Medicaid money they have been expecting.

Even a delay of two to three years could be damaging. Health policy experts said the uncertainty could destabilize markets, unnerving insurers that have already lost hundreds of millions of dollars on policies sold in insurance exchanges under the Affordable Care Act.

 Republicans hope to pressure vulnerable Democrats like Senator Joe Manchin III of West Virginia to support a replacement of the health care law. Credit Al Drago/The New York Times

“Insurers would like clarity on the shape of the replacement plan to continue participating on exchanges if Obamacare is repealed,” Ana Gupte, an analyst at Leerink Partners who follows the insurance industry, said Friday.

Republicans are hoping that Mr. Trump will be able to use his bully pulpit to lean on vulnerable Democrats up for re-election in states Mr. Trump won, such as Senators Joe Manchin III of West Virginia and Jon Tester of Montana.

“When that date came and you did nothing, if you want to play politics, I think the blame would go to people who didn’t want to do anything,” Mr. McCarthy said.

But Democrats may not be so quick to break.

“If they are looking at fixing what’s there, I’ve been wanting to work with Republicans for years now,” said Mr. Tester, whose state cast just 36 percent of its vote for Hillary Clinton. “But if they are going to take away provisions like pre-existing conditions, lifetime caps, 26-year-olds, I think they are barking up the wrong tree.”

And some moderate Republicans see peril in repealing first and replacing later, favoring instead a simultaneous replacement to ensure a smooth transition.

“We are firing live rounds this time,” Representative Charlie Dent, Republican of Pennsylvania, said. “If we repeal under reconciliation, we have to replace it under normal processes, and does anyone believe that the Senate Democrats, with their gentle tender mercies will help us?”

Republicans said they would work with the Trump administration on replacement legislation that would draw on comprehensive plans drafted by Mr. Ryan and Representative Tom Price, the Georgia Republican picked by Mr. Trump to be his secretary of health and human services.

Any legislation is likely to include elements on which Republicans generally agree: tax credits for health insurance; new incentives for health savings accounts; subsidies for state high-risk pools, to help people who could not otherwise obtain insurance; authority for sales of insurance across state lines; and some protection for people with pre-existing conditions who have maintained continuous coverage.

Republicans said they hoped that the certainty of repeal would increase pressure on Democrats to sign on to some of these ideas.

Democratic leaders, for now, feel no such pressure. Republicans “are going to have an awfully hard time” if they try to repeal the health law without proposing a replacement, said Senator Chuck Schumer of New York, the next Democratic leader. “There would be consequences for so many millions of people.”

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Trump’s pick for key health post (CMS) known for punitive Medicaid plan

https://www.theguardian.com/us-news/2016/dec/04/seema-verma-trump-centers-medicare-medicaid-cms

 

Jessica Glenza in New York

@JessicaGlenza

Sunday 4 December 2016 07.00 EST

 Seema Verma, Donald Trump’s choice to head the two largest public health insurance programs in the US, is a conservative darling who has introduced work requirements and lockout periods for impoverished recipients into the medical safety net in three states.

A close adviser to vice-president-elect Mike Pence, Verma – Trump’s nominee for administrator of the Centers for Medicare and Medicaid Services (CMS) – made her name devising Indiana’s Medicaid plan, one of the most punitive in the country.

Medicaid is a public health program that ensures America’s poor and disabled have health insurance. Obamacare dramatically expanded the program, which now serves more than 73 million people.

The unique requirements Verma and her consultancy firm SVC Inc   http://www.svcinc.org/  designed for Indiana require that the destitute in that state have “skin in the game” by paying “premiums”, even if they were just $1.

In Ohio, a plan designed by Verma’s company and rejected by the current leaders of CMS required people with low incomes to be barred from public health insurance until all “premium” arrears were up to date.

Her plans were “about saving the dollars by any means possible”, said Indiana Representative Charlie Brown, the ranking Democrat on the public health committee.

As a consultant in each state, Verma was the driving force in designing Indiana’s “HIP 2.0” public insurance plan for the poor, and is highly regarded in conservative circles because of its emphasis on personal and fiscal “responsibility”.

Though her plan expanded Medicaid to nearly 400,000 Hoosiers, she has argued that new recipients are “able-bodied” enough to not need “the same set of policy protections” as the “aged, blind, or disabled”. Instead, Verma’s plan forces recipients to pay up to 2% of their income to “premiums”, held in a system similar to tax-free accounts available to commercial plans.

It is a plan meant to mimic the commercial market, as a financial lesson for its recipients. It remains one of the most complex and punitive Medicaid expansions in the country, an outlier in a system of state-run safety nets largely free for the poor.

Further, it is built on the back of the Affordable Care Act, a law that her potential future boss, Congressman Tom Price, explicitly opposes. Trump has nominated Price to be health secretary.

She is often described as a behind-the-scenes Republican operative. Regarded as smart and talented, she is also considered single-minded and conservative. She is a registered Republican, and recently agreed to participate in the “leadership network” of the American Enterprise Institute, a rightwing thinktank.

Her father, Jugal Verma, 77, described her as someone with “passion” for her work, and sympathy for the poor. Each morning on her way to work, he said, she pulled her car to the side of the road to hand the same homeless man cash. “It used to amaze me,” he said.

“She grew up in a Democratic household. I am a staunch Democrat,” said Jugal Verma, discussing his daughter’s work in the deeply conservative Pence administration. “She doesn’t do anything if she doesn’t believe in it.”

  Tom Price is poised to be the next US health secretary. Photograph: Jim Lo Scalzo/EPA

She and Price, if he is confirmed by the Senate, will be charged with helming a more than $1.1tn budget dominated by public health programs for the very poor, disabled and elderly. Medicaid alone covers more than 73 million Americans, nearly one-quarter of the American population. Neither Verma nor a Pence spokesman replied to a request for comment.

Verma’s best known work used a little-known provision of federal health law to push conservative ideas through despite the Obama administration. The strategy made her an influential consultant to Republican state administrations.

In Indiana, for example, some of the most controversial provisions of the state’s law were pushed through using this obscure 1115, or “eleven-fifteen”, waiver. While Obama’s administrator of the Centers for Medicare and Medicaid Services did not approve all of Verma’s plans – a punitive provision developed with Ohio was denied – some were successful. Others are still pending the approval of an agency she may soon run.

“One example of a provision in Indiana, which I think is very severe, burdensome, and in fact does not promote the objectives of the Medicaid program, [is] if someone [can’t pay premiums], they get kicked off the program,” said Andrea Callow, a policy analyst at Families USA, a not-for-profit organization focused on consumer health.

Premiums are typical of commercial insurance plans – they require beneficiaries to make a monthly payment. But Medicaid recipients typically do not pay premiums because their incomes are so low. The Medicaid expansion carried out under Obamacare allows people to earn a salary of about 138% of the poverty level, about $16,000 for an individual, and remain eligible.

In Indiana, if people on Medicaid earning between $11,000 and $16,000 don’t pay their “premiums”, they can be locked out of the program for up to six months, a provision even commercial insurance does not impose.

“If someone can’t scrape up the money for premiums for two months, they get dis-enrolled, and they get locked out for six months,” said Kallow. “Then say they get cancer, they get hit by a truck, they have an accident. They have absolutely no place to turn for health coverage.”

Kentucky’s 1115 waiver, on which Verma’s company SVC also consulted, proved equally complex and even more controversial. The state asked CMS to allow Kentucky to impose work requirements beginning three months after benefits began, something no state in the country requires as a condition of Medicaid.

“Kentucky’s new expansion proposal has work requirements,” said Kallow, “There’s even sort of unpaid community service, which is very troubling.”

After three months, “able-bodied” adults of working age would need to participate in a “work activity” for at least five hours per week. After one year, that requirement would increase to up to 20 hours per week. If that requirement were not met, the state could end the person’s benefits.

“There seemed to be a paralysis of analysis as it relates to the downtrodden, those who are in the greatest needs,” said Brown.

During a public comment period on Kentucky’s 1115 waiver, 90% of the 1,700 comments received were negative. Analysts also contend that such requirements mean building a new, large bureaucracy just to track whether Medicaid beneficiaries are complying.

“I have no problem with the personal responsibility features to the extent that they improve outcomes,” said Ed Clere, former Republican chair of the Indiana House public health committee. “One of the big questions going forward, both for Indiana and now for the country, will be: is there a link between these personal responsibility features in the way of financial participation and improved healthy outcomes?

“I haven’t seen any evidence.”

However, even critics said portions of the plan designed by Verma improved services. The fact that a voluntary, Obamacare-sponsored Medicaid expansion took place at all in Indiana, a deep red state, had a huge impact in the eyes of many serving poor patients there. Another 19 states still have not expanded Medicaid, even though Obamacare pays for 90% of expansions.

“I have insurance, my child is sick, I take her to the doctor,” said Lauren Lamb, outreach coordinator at a chain of north-west Indiana health clinics, HealthLinc. “I don’t think about it, but when you see people that don’t have that coverage … they worry if their kid is sick, if they can even take them to the doctor.”

The change, Lamb said, comes when patients realize they are eligible for health insurance they can afford.

“You see them, and they leave, and they’ve got tears in their eyes, because they can’t believe how lucky they feel that day. It just sits in your heart.”

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Free Event to Answer Insurance Related  Questions

LiveSupportgroup.com is hosting a free event on Monday, the 5th of December at 8:00 PM est, to answer questions and educate the members on insurance for 2017…

The group will have a licensed insurance agent on hand to answer insurance questions ranging on “Everything from policies on Medicare/Medicaid/Obamacare, understanding prescription plans etc.  This also includes private insurance also, and ‘what if you have both’ – cost factors / how to save, etc.”

The agent can also provide a number for people to call in their various states, and it should be known that the cost of getting private help is completely free.

According to the group, if anyone has a questions that the specialist does not know, she will personally get back to the group with the answers.

You do have to sign up in order to be able to access the group – and that is free, as well.

Here’s what they shared with us about how to sign up in advance of the Monday event:

1. To attend, please join livesupportgroup.com on our main website at www.livesupportgroup.com.  We ask for first name, last initial and a current email address, that’s all!  Once you join, please go to your email and confirm your free membership.  Just an FYI – LSG does not allow any 2nd/3rd party advertising to your emails and the site is SSL secured!
2. Please make sure you sign up as soon as possible so that you can receive your personal link in time for the event. If you join last minute, you may not be able to get the link in time.

Live Support Group is a non-profit corporation which has created an online support group for chronic pain patients that has begun to attract a wide audience. 

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Few are buying non-prescription naloxone at pharmacies

http://www.mansfieldnewsjournal.com/story/news/local/2016/12/03/few-buying-non-prescription-naloxone-pharmacies/94686092/

Eighteen Richland County pharmacies started selling naloxone without a prescription this year, but few residents apparently are purchasing the opioid overdose-reversal medication.

In fact, at the five local pharmacies willing to discuss the specifics of their naloxone sales, no doses of the drug have been sold over the counter without a prescription.

Pharmacists and public health officials say a combination of a lack of awareness, the stigma surrounding drug addiction, the high cost for consumers without insurance and the preventative nature of the drug account for the lack of sales.

Naloxone, sold under the brand names Narcan and Evzio, blocks the effects of prescription opioids, heroin and fentanyl on the brain and reverses an overdose. It has become the primary tool in fighting the epidemic of opiate overdoses.

Jay Fordyce, a pharmacist with Discount Drug Mart in Shelby, said he believes the lack of sales could be due to a lack of awareness, with the public not realizing they now can walk into a pharmacy and purchase the drug without a prescription.

“I don’t know if people are afraid to come up to the pharmacy and ask for naloxone or what,” he said. “I think people just don’t know about it.”

The Shelby store keeps one box of the drug in stock, containing two nasal pumps.

Chris Peshek, a regional pharmacy supervisor with Discount Drug Mart, said the Discount Drug Mart stores on Briggs Drive in Mansfield and Mansfield Avenue in Shelby have not sold any doses of naloxone since the chain started doing so in April.

He said it could be related to the sense of shame that can surround drug addiction.

“It keeps coming back to that stigma of not wanting to admit you have a problem or not wanting to get help for the problem because you’re afraid that somebody’s going to find out,” he said. “Because of that really strong stigma associated with drug addiction, people don’t want to be seen walking into a drugstore to buy naloxone.”

Three-quarters of the 24  pharmacies in Richland County sell naloxone — four CVS pharmacies, two Discount Drug Mart pharmacies, three Kroger pharmacies, one Meijer pharmacy, five Rite Aid pharmacies and three Walgreens pharmacies.

Map of drug stores selling naloxone

Twelve of the pharmacies are in Mansfield, three are in Ontario, two are in Shelby and one is in Lexington.

CVS, Meijer, Rite Aid and Walgreens declined to share their sales numbers, citing corporate privacy policies.

Similar to Discount Drug Mart’s lack of sales, the three local Kroger pharmacies have not sold any naloxone doses, according to Jennifer Jarrell, a Kroger media relations representative. The Kroger pharmacies on Park Avenue West, Ashland Road and Lexington Avenue, all in Mansfield, have been selling naloxone over the counter since February.

Costs range from $40-$145 a dose

Cost could be another prohibitive factor for buying naloxone at pharmacies.

A two-pack dose sells for about $40 at Meijer and $136 at Walgreens. A single dose of the drug is $45 at Kroger and up to $140 at Rite Aid and $145 at CVS. When it’s bought as a preventative measure, it can be difficult to rationalize spending that much money on it, pharmacists say.

Fordyce has customers come in interested in purchasing naloxone, but no one’s bought any from him yet.

“I guess he decided he didn’t need it that bad,” Fordyce said of a man who came in to buy naloxone but who walked away when he found it it was $75 to $80 per single dose at Discount Drug Mart.

But patients with insurance usually pay a maximum of about $10 out-of-pocket, Peshek said.

Fordyce said the pharmacy bills the insurance of the person buying the drug, not the person who uses it.

“I would encourage people first thing to the call their prescription insurance and ask if they cover (naloxone) and what their co-pay would be,” Fordyce said.

The nature of naloxone’s preventative nature also could be a prohibitive factor. People who can stop an overdose have to prepare in advance to help a loved one who overdoses in the future.

“You have to be thinking way ahead,” Peshek said. “You need it right away, so you’re just going to go to the hospital or ER.”

Fordyce emphasized people who are overdosing still need medical attention, even if they get a dose of naloxone.

The effects of opioids can last between six and 12 hours, but naloxone wears off in 20 to 30 minutes.

“This is just the first step if there’s an overdose,” he said. “You should still call 911 or go to the hospital. Odds are, they’re going to need more (naloxone).”

Legislature passed bill unanimously

Ohio Gov. John Kasich signed House Bill 4 into law in July 2015 to allow pharmacists to dispense naloxone without a prescription to at-risk opioid users and those who can intervene during overdoses, such as family members, friends or roommates. The bill had passed both the Ohio House and Senate unanimously.

“For friends and family members, pharmacies play a unique role,” said Cameron McNamee, director of policy and communications for the State of Ohio Board of Pharmacy. “If you have an active opioid user in your family and they feel like they’re not ready to get help yet, getting naloxone from a pharmacy is one of the best things you can do to get a little bit of peace of mind.”

Previously, pharmacies could not sell the drug without a prescription from a doctor.

Nearly 1,400 pharmacies, or 65 percent of all Ohio retail pharmacies, in 84 of Ohio’s 88 counties sell naloxone without a prescription as of the end of November.

Holmes, Morgan, Noble and Vinton counties do not have any pharmacies selling naloxone.

Not many other alternatives

Currently, the only other way to receive naloxone is from first responders or high-risk agencies, such as hospitals or mental health agencies.

Richland Public Health started providing naloxone kits to first responders and their high-risk contacts in February with funding from the Ohio Department of Health.

The kits, known as Project DAWN kits, come with two pocket masks, two atomizers, two two-milliliter syringes and two milligrams of naloxone.

Project DAWN, which stands for “deaths avoided with naloxone,” is an Ohio community-based overdose education and naloxone distribution program.

The first site was created in Portsmouth in 2012.

First responders administer naloxone if they believe someone has overdosed or if they observe symptoms such as blue or gray skin, sweating, unresponsiveness, absent or shallow breathing, absent or shallow pulse or pinpoint pupils, said Keith Evans, public health nursing supervisor with Richland Public Health.

It can be administered via intravenous (through the veins), intraosseous (into the bone marrow) or intranasal (in the nose) methods, Evans said.

Richland Public Health has provided 30 to 40 kits to first responders since January.

But the organization started discussions with the Ohio Department of Health in October to receive shipments of naloxone kits available to the public.

“Like any disease, if you get rid of that disease, then you can start the healing process,” Evans said. “Easier said than done to eliminate the product from the community.”

There are more than 50 Project DAWN naloxone distribution and training sites across Ohio, where members of the public can receive naloxone kits and training on how to administer the drug, but there are none in Richland County.

“When I see things like that where the county has a drug problem and then I also see that same county doesn’t have a Project DAWN, it always kind of makes me scratch my head,” Peshek said.

55 overdose deaths in 2016

So far in 2016, there have been 55 drug overdose deaths in Richland County, according to the Richland County Opiate Board’s Keith Porch, who is assistant police chief with the Mansfield Police Department.

Richland County has seen an increase in the number of overdose deaths since 2012, when there were seven overdose deaths.

In 2013, there were 22 deaths, in 2014, there were 25 deaths and in 2015, there were 42 deaths.

ejmills@mansfieldnewsjournal.com

419-521-7205

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