Father-son informants trafficked drugs while on US payroll

http://www.myplainview.com/news/crime/article/Father-son-informants-trafficked-drugs-while-on-10625092.php

NEW YORK (AP) — Informants with dirty pasts are a fixture at drug trials, but even by those standards, the father-son team that played a central role in the cocaine trafficking prosecution of the nephews of Venezuela’s first lady stands out.

Over several years, the U.S. government and other law enforcement agencies paid about $1 million to Jose Santos-Pena, 55, and hundreds of thousands of dollars more to his son, Jose Santos-Hernandez, 34, for information about drug dealers.

The pair traveled to multiple countries, including some where Drug Enforcement Administration agents aren’t welcome, to make secret recordings of people believed to be involved in drug trafficking. That included Venezuela, where Santos-Pena recorded two nephews of Cilia Flores, the wife of Venezuelan President Nicolas Maduro, handling a block of cocaine.

Then, in April, prosecutors learned that while working for the DEA, Santos-Pena and Santos-Hernandez were also hard at work smuggling drugs themselves.

In late summer, just as the case against Flores’ nephews was getting ready to go to trial in New York, Santos-Pena and Santos-Hernandez pleaded guilty to trafficking charges, admitting dealing drugs for at least four years, including while they were building the Venezuelan case last fall under the direction of the DEA.

Prosecutors went ahead anyway with their case against Venezuelans Francisco Flores, 31, and his cousin, Efrain Campo, 30, who were accused of conspiring to ship over 1,700 pounds of cocaine into the U.S. They were arrested in Haiti last year and flown to the U.S. for trial.

The government, though, did not know that more surprises lay ahead for its star witness, Santos-Pena. His son did not testify at the trial.

At a court hearing in September, Santos-Pena confessed to prosecutors during a lunch break that he had used a prostitute twice during a trip in Caracas, Venezuela, last year. He had also allowed his son’s friend to sit in on some of the DEA-orchestrated meetings with their Venezuelan targets. And he admitted that he’d been using cocaine regularly while working for the DEA.

And as the trial against Campo and Flores neared its conclusion this month, defense attorney Randall Jackson revealed that he had jailhouse tapes that proved Santos-Pena continued to communicate about drug deals in recent weeks.

After the tapes were played for jurors, a prosecutor notified Santos-Pena that his continued lies, including that he had not communicated with his son while in prison, meant the government was ripping up a cooperation agreement that he was counting on to win leniency. Without it, he faces a minimum of 10 years in prison and a maximum of life. Santos-Pena seemed surprised.

Prosecutors overcame the humiliation of their star witness when the jury returned a guilty verdict Friday against the nephews.

“He was slime,” juror Robert Lewis, a 69-year-old architect, said of Santos-Pena. He said other evidence, including transcripts of conversations involving the nephews and text messages, were enough to prove guilt.

“We had to rely on those things,” Lewis said.

“It’s the nature of the business to have cooperators with really unseemly pasts,” said Daniel C. Richman, a law professor at Columbia Law School. “Making deals with bad guys are par for the course in a whole range of cases. I don’t think it’s the nature of the business to have the cooperators breaking the law while purporting to have agreements with the government.”

Prosecutors knew going in that Santos-Pena had a shady past. Before he began cooperating with U.S. authorities in 2007, he testified that he had been a member of the Mexico-based Sinaloa drug trafficking cartel for a decade. He moved to the U.S. in 2003. He said he was involved in deals this year in Los Angeles and Pomona, California, involving about 7 kilograms of cocaine.

In court papers praising the two informants earlier this year, federal prosecutors wrote that Santos-Pena and Santos-Hernandez had “participated in multiple significant international drug trafficking investigations, including cases focusing on some of the most violent places in the world targeting extremely violent criminals.”

Lawyers for Campo and Flores said in their closing statements to jurors Thursday that the informants are simply liars who shouldn’t be believed.

“You saw a rare thing, a government cooperator get ripped up in court,” attorney David Rody said.

For all the dirt revealed about the informants in the Venezuelan case, they will never rival the notorious history of Salvatore “Sammy the Bull” Gravano, who admitted his role in 19 murders in a sweetheart deal that resulted in a five-year prison sentence in exchange for his testimony against the late Gambino boss John Gotti.

Still, Richman noted, the issue for jurors is the credibility of the witness.

As for Gravano, Richman said: “He was just a murderer, not a liar.”

Filed under: General Problems | 3 Comments »

President elect Trump has chosen potentially the next Attorney General

Senator JEFF SESSIONS https://en.wikipedia.org/wiki/Jeff_Sessions

Of course, all of Trump’s choices for various position will have to be approved by  a majority of the 100 Senators…

The current Surgeon General Vivek Murthy announced last week that:

Surgeon General: Addiction Is A Chronic Brain Disease, Not A Moral Failing

So has the Surgeon General claimed that the 1917 court ruling that opiate addiction is a crime and not a disease has started the process that … that ruling should be overturned ?

Since about 98% of the incumbents running for reelection in the House and Senate got reelected… the chronic pain community apparently voted their political beliefs rather than making a political statement of wanting a change.  So now we MAY have an additional opportunity to cause change.  Apparently it takes a SUPER MAJORITY of the Senate – 60 votes – for any nominee to get approved. Communicating with your Senator about your approval or objection for a particular nominee is the only way to make a impact on the new administration over the next FOUR to EIGHT YEARS.

IF DAMN FEW chronic pain pts contact their Senators… NO ONE is going to believe that there are some 100 + million chronic pain pts….and/or those in the chronic pain community are not having any problems and/or most/all are ADDICTS and don’t want to SPEAK UP.

We are seeing a dramatic increase in SUICIDES… we don’t know how many suicides that we don’t hear about and/or they are being classified as “opiate related death”.  It would appear that even when a death is – without a doubt – a suicide.. at best it might get local media coverage.   It would seem that the national/local media doesn’t want to address the epidemic of suicides and denial of adequate therapy for all those pts suffering from various subjective diseases ( pain, anxiety, depression, ADD/ADHD, mental health).

IMO… the chronic pain community has come to a CROSS ROAD… it is well documented what has happened to those in the chronic pain community over the last 8+ yrs…  Remaining silent, whining, bitching and moaning to each other on closed Face Book pages… will not cause any positive changes.

A fair number of my readers send me links to various new articles about things happening to/with the chronic pain community… and I reposts them… but.. how many of my readers take those articles demonstrating how badly those in the chronic pain community is being treated and/or abused … and share it with the Facebook page of their local TV station, newspaper,  Twitter feeds for reporters of local TV and newspaper… and send them to your state and Federal Representatives and Senators… ?

Politicians/bureaucrats/legislators work with NUMBERS… if they are contacted by few constituents… they will presume that there is NO ISSUES…

Feel free to use my blog as a “clearing house” … I never use a chronic painer’s name when they send me stuff that I re-post…use it as a start for a daisy chain to “spread the word” thru other channels…

Continue to whine … bitch… moan… to each other … and do nothing… and the last EIGHT YEARS will just be a PRELUDE to what is going to be coming your way over the next FOUR to EIGHT YEARS.

I am just an OBSERVER…. a MESSENGER….

Filed under: General Problems | 6 Comments »

The fuzzy line between medication use and abuse

www.kevinmd.com/blog/2016/11/fuzzy-line-medication-use-abuse.html

Opioid painkillers, such as Vicodin (hydrocodone) and OxyContin (oxycodone), are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, like Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal risks. Stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine) ease the burden of ADHD but are also widely used as college study aids as well as recreationally. All of these medications are available only by prescription. This means prescribers serve as
gatekeepers, permitting access for medical needs and denying it otherwise.

This gatekeeping can be difficult. Doctors are imperfect lie detectors and can be fooled with a plausible story. Pain, anxiety, insomnia and inattention are mostly invisible. The internet offers quick lessons in how to fake a medical history. Beyond the initial assessment, every physician has patients who repeatedly “lose” bottles of painkillers or tranquilizers and request more. Secretly seeing multiple doctors to obtain the same drug remains fairly easy. While a few doctors run illegal “pill mills” and flout the gatekeeper role, many more are simply too overworked to be vigilant with every patient.

None of us became physicians to fight the war on drugs. On the contrary, most of us are uncomfortable doubting our patients’ honesty. It’s stressful to worry about being too suspicious or too gullible, and it’s a waste of valuable time.

The possibility of tranquilizer abuse arose with a new patient of mine recently. My concern led to multiple phone calls to pharmacies and to consulting California’s CURES database online. I was convinced enough that something was amiss that I confronted my patient, who responded by calling me names, making vague threats and leaving in a huff without paying for the appointment (and, of course, never coming back). Although the reaction seemed confirmatory, in truth I’m still not certain my suspicions were correct. Why did I put my patient and myself through such grief? Because I wanted to “do no harm.” Accepting the gatekeeper role requires scrutinizing and sometimes confronting the patient at the gate.

Let’s consider other drugs that are used both medically and recreationally — but unlike those mentioned above, do not involve a physician gatekeeper.

The best candidate may be cannabis. Currently legal in 25 states, medical marijuana requires a doctor’s authorization but not a prescription that specifies dosage, frequency and duration of treatment or route of administration. By definition, a Schedule 1 drug, like marijuana, is not “FDA approved” for any medical use. Yet cannabis is very much like the Schedule 2 drug Adderall: it has a few solid medical uses, a much larger set of dubious or controversial ones and a sea of mostly illegal recreational use. A lot of medical marijuana is used for relaxation or sleep, blurring the medical-recreational distinction in much the way Adderall does when used for studying. Purely recreational use is legal in four states as of this writing. Legalization is on the ballot this November in five additional states, including California where I practice.

I have never authorized medical marijuana, although several of my patients were approved by other physicians and use it regularly. Once a patient tells me he or she uses marijuana, whether doctor-approved or (for now) illegally, I can act in my preferred role as advisor. We can discuss risks and benefits, sativa vs indica, THC and CBD, all without me having to second-guess my patient’s story, make a paternalistic decision about whether to authorize access or even cast judgment on the decision to use it.

In states where recreational cannabis is newly legal, it joins the three drugs already native to our cultural landscape. Adults consume alcohol, caffeine and nicotine with nary a prescription, gatekeeper or hoop to jump through. And although we rarely think about it, all three have medicinal effects. Alcohol can reduce stress, aid sleep and may promote health in a number of other ways. Caffeine treats fatigue, migraine headaches and possibly obesity. Nicotine eases Parkinson’s disease and perhaps schizophrenia and helps with weight loss. While smoking rates are declining in the U.S., most Americans continue to use alcohol and caffeine often for a complex mixture of reasons: taste, psychoactive effects, social custom and sometimes for plainly medicinal purposes. Widespread use also leads to addiction in a significant subset of the population: caffeine becomes necessary and not just optional, and we go to extraordinary efforts to manage alcoholism. As tragic as this is, nearly everyone agrees that Prohibition was the greater evil.

I like that I’m an advisor, not a gatekeeper, for marijuana and the (other) legal vices. I also reject the gatekeeper role for stimulants by telling callers I don’t treat ADHD. This is trickier, my refusal to treat a legitimate psychiatric disorder is arguably too finicky. It can be hard for an earnest sufferer to obtain a thorough evaluation and treatment, even if, paradoxically, it is all too easy for a drug abuser to tell a sob story and score a prescription. Nonetheless, with stimulants, as with medical marijuana, I’m uncomfortable making Solomonic distinctions where medical and non-medical uses lie so closely on a continuum.

In any event, I draw the line there. I continue to prescribe tranquilizers and sleeping pills for my patients who seem to need them. I may unwittingly abet substance abuse in some cases, but the alternative is to not prescribe any abusable medication, a stance that feels far too finicky. After all, medication gatekeeping is the norm for many physicians. Oncologists, surgeons and ER doctors can’t tell patients they don’t treat pain. Surgeon General Vivek Murthy sent a letter to every U.S. physician in August urging us to help fight the “opioid epidemic” by limiting dosages and durations of opioid prescriptions and by substituting non-narcotic alternatives — in essence, by being better gatekeepers.

The only way to avoid doctor-as-gatekeeper entirely is to make all drugs available without a prescription. The prospect of narcotics and amphetamines on the open market strikes most of us as extremely foolish, even though Prohibition and the failed war on drugs should give us pause. Another strategy is to embrace gatekeeping even more seriously, as Dr. Murthy advises. Careful comprehensive evaluation, “start low and go slow” prescribing, close monitoring using a system like CURES and strictly limiting refills should drive down prescription drug abuse. Unfortunately, this takes more clinical time, one thing most physicians can’t spare, and trades away doctor-patient collaboration for something more wary and legalistic. As usual, physicians are asked to erode the traditional doctor-patient relationship and do more work to keep the system afloat. Meanwhile, patients suffer further small indignities and colder encounters.

Alternatively, we could wait it out. The line between medical treatment and personal enhancement or optimization gets fuzzier all the time. Society may soon fail to distinguish treating an anxiety disorder and taking something to relax in the evening or treating ADHD and simply maximizing one’s mental sharpness. The medical-recreational divide already looks more like a continuum for marijuana and stimulants, and it is essentially gone with respect to alcohol, caffeine, and nicotine. If this trend continues, physicians may no longer be called upon to distinguish legitimate from illegitimate drug use. Our focus as medication gatekeepers may shift from the purpose of the prescription to its safety, making us more like pharmacists than judges.

Filed under: General Problems | 7 Comments »

Michael Pendleton, MD

doctorsofcourage.org/index.php/2016/11/17/michael-pendleton-md/

Internist Michael Pendleton, MD of Corpus Christi Texas is the next innocent black physician to be attacked by government overreach into medicine. In fact, the overreach goes much farther than other attacks, because they closed his office as part of “an active investigation”. Does the DEA even have the right to close a primary care practice? I don’t think so. Primary care physicians take care of everything, from Asthma to Zica virus. All the DEA has authority to do is issue a special certificate for the prescribing of controlled drugs. Even if they had rescinded Dr. Pendleton’s certificate, he should be able to maintain his medical practice for all other primary care matters.

Agents did the usual collection of files and boxes of routine medical records, working throughout the day Nov. 15, 2016 and into the evening. The same thing happened when they raided me, coming in at 1:30 PM and not leaving until 10:00 PM. The Corpus Christi police department was involved in the raid as well. For my raid, 20 local, state and federal officers were present. That’s what’s called job security and why these illegal attacks are going on.

Dr. Pendleton appears to have been targeted because of the type of patient he serves. It would appear that Dr. Pendleton takes his Hippocratic Oath seriously, and is another one of the doctors that treats the uninsured/Medicare/Medicaid crowd—the patients that the government would rather see dead. They target the doctors in the country that fit this profile.

In an interview with 6 investigates, a news program. Dr. Pendleton said that he is meeting a need left by a healthcare vacuum created by these three factors:

•   a growing uninsured or underinsured population
•  funding shortfalls which shift the burden of care to County Health Districts
•   low reimbursement rates for physicians

When asked where his patients would go if he chose not to see them, he said “I’m not sure.”

Dr. Mary Peterson of the Nueces County Medical Society, agrees. “I think we do have a shortage of primary care physicians. Especially, adult primary care.”  Approximately 6 million Texans are uninsured—the highest in the nation. And then Texas decided to opt-out the Affordable Care Act. Medicaid reimbursement rates are so low some doctors cannot afford to care for Medicaid patients. 

Pendleton says any primary care doctor or internist must choose another motivation for staying in business.

“(They) may not get the glory but they will get some satisfaction. And it’ll help the community.” 

That is the heart of a good doctor, and an example of all of the doctors that have been targeted by the Federal government and turned into felons.

But are people in this country concerned? Not until it happens to them. Today’s raid surprised many of Pendleton’s patients, although they know this is happening across the country. “I have to go without my meds, and don’t know what to do, just like a whole bunch of other people right now,” said one patient. 

Patient’s rights were also violated, as they were forced to remain at the clinic for up to four hours waiting to be questioned by agents.

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With 2 Weeks To Go: American Kratom Association Urges Kratom Community To “Speak Up Now!” And Get 10,000 Comments In To DEA

http://www.prnewswire.com/news-releases/with-2-weeks-to-go-american-kratom-association-urges-kratom-community-to-speak-up-now-and-get-10000-comments-in-to-dea-300365196.html

Filed under: General Problems | Leave a Comment »

UnitedHealth Hit Again in Drug Price Litigation Wave

http://www.bna.com/unitedhealth-hit-again-n57982082861/

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Surgeon General Vivek Murthy: Addiction Is A Chronic Brain Disease, Not A Moral Failing

http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c

If addiction is now being – FINALLY – declared a MEDICAL CONDITION… why is the DEA/judicial system still in charge of doling out “treatment” for those who abuse opiates ?

The way forward includes needle exchanges and calling addiction what it is: a medical condition.

Surgeon General Dr. Vivek Murthy hopes his new report on drugs and alcohol will call attention to the public health crisis of addiction in America.

For far too long people have thought about addiction as a character flaw or a moral failing. Surgeon General Vivek Murthy

There are still millions of people in our country who are struggling without insurance coverage.

Filed under: General Problems | 4 Comments »

DEA chief Chuck Rosenberg on America’s “growing” opioid epidemic

http://www.cbsnews.com/news/america-opioid-prescription-pills-problem-drug-enforcement-agency-chuck-rosenberg/

Rosenberg misquotes so many things about the TRUE FACTS… I get tired of trying to point out these obvious MISSTATEMENTS OF THE TRUTH.  Hopefully Rosenberg is at the end of his career as head of the DEA.. with the incoming President Trump. If you can’t see the video, you can go to the link on the post to view it directly on CBS… for some reason CBS gives you the code to embed a link to the video … but I have not had one yet that will allow it to play on my blog.

A groundbreaking new report calls substance abuse one of America’s most pressing public health problems. And according to Chuck Rosenberg, acting administrator of the Drug Enforcement Administration, the problem is “growing fast.”

Rosenberg blames it on the excess of prescription pills. According to him, a “pill problem” ultimately becomes a “heroin and opioid problem.”

“We know that 4 out of 5 new heroin users started on prescription pills, and most of the people who start on prescription pills get them out of someone’s medicine cabinet, get it ‘legitimately.’”

According to the surgeon general’s first report dedicated to addiction, 12.5 million Americans abused prescription painkillers in the last year. On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed, 580 people start using heroin, and 78 people die from opioid-related overdose – more than from car accidents or gun violence.  

“There’s plenty of blame to go around,” Rosenberg said, referencing both the over-prescription of painkillers by doctors and their illicit sale on the street. 

“We are 5 percent of the world’s population, we consume in one way or another 99 percent of the world’s hydrocodone. That’s crazy, that’s crazy.”

But the DEA has been blamed for being part of the problem. Back in July, Sen. Richard Durbin ripped the agency at a Senate Judiciary Committee Hearing, saying: “The Drug Enforcement Agency has decided to floor America with opioid pills, far beyond any medical purpose.”

Rosenberg said he didn’t think that characterization was “accurate,” and has since met with Durbin and his colleagues to clear “some misunderstandings.”

But the DEA has the power to set the limit for the manufacture of pills. In 2014, an estimated 14 billion opioids were dispensed.

“That seems too high,” co-host Norah O’Donnell said. 

“It’s very high, but we don’t regulate the practice of medicine. We do allocate the amount that folks can manufacture,” Rosenberg responded.

“But why not bring down that amount?” O’Donnell asked.

Rosenberg said the DEA has brought the number down, but that there is still “plenty of capacity.”

“The DEA is really good at supply reduction. We’re a traditional law enforcement. We attack that unholy alliance between international cartels and violent street gangs,” Rosenberg said. 

But he said that’s not enough, and that the issue must be tackled in “other ways,” especially in reducing demand.

“We’re not going to enforce or prosecute [ourselves] out of this mess, so we have to do demand reduction,” Rosenberg said.

 “How do you reduce the demand?” co-host Charlie Rose asked. 

“Public education is part of it, but we’ve got to teach, we’ve got to rehabilitate, we’ve got to treat,” Rosenberg said. One example of the DEA’s efforts is its collaboration with Discovery Education, to bring a STEM-based curriculum to schools to teach the science of opioid addiction and open up conversations for students, teachers and parents. 

Then there’s National Prescription Drug Take-Back Day – an opportunity for people to dispose of unwanted pills anonymously, “no questions asked.”

“So we did it twice in the past year. Here’s a big number. We took in 1.6 million pounds of unwanted and expired drugs,” Rosenberg said. “Now by some estimates, only about 10 percent of what we get on take-back are opioids. That’s still 160,000 pounds of opioids out of medicine cabinets and off the streets. So this is a good thing.”

Rosenberg touted the work of the DEA, but said there is still “a lot of help to be had.”

“The men and women of DEA are amazing. They have a really hard job, they have a dangerous job. But we need help,” Rosenberg said, calling on doctors, pharmacies, manufacturers, and Congress. 

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Controversial question: Is pot part of the answer to the heroin epidemic?

fox8.com/2016/11/17/controversial-question-is-pot-part-of-the-answer-to-the-heroin-epidemic/

If we are a country that works by “majority rule” and the MAJORITY of states has made marijuana LEGAL… why isn’t the Feds conforming to the voice of the majority of our country ?

CLEVELAND – One week after seven additional states legalized some form of marijuana use, a controversial question is now getting more serious attention.

And that is: with so many people now dying from addictions to opiate painkillers (about 47,000 nationwide this year alone, and close to 700 just in Cuyahoga County), should we be looking more closely at marijuana as a possible alternative for treating pain?

“This isn’t some stoner stereotype about ‘getting high man'”, says 38 year-old Bob Ellison, “this saved my life.”

Ellison has bone-on-bone arthritis in his right knee. He says his doctor put him on opiates for the pain, but soon, he felt the need to take more and more to try and control the pain.

“I was taking twelve, fourteen, sixteen pills a day,” he says, “I was suppose to be taking three.”
Worried that he was soon going to overdose in his sleep, Ellison made a radical decision: to switch from taking opiates to using marijuana to help control his pain.

“I want to take medical marijuana for pain because I don’t want to be an opiate drug addict,” he says.

While states have been legalizing medical marijuana at a rapid rate recently (Ohio did so in September), the federal government still classifies marijuana use as illegal.

And many experts in medicine and law enforcement regard marijuana as a so-called “gateway drug” that leads users to to other, harder drugs.

The Drug Enforcement Administration classifies many opiates as “Schedule 2” drugs – meaning they can be abused, but have medical value.

But the DEA classifies marijuana on “Schedule 1” – meaning it can be abused, and has no medical value.

“We have to end the DEA’s monopoly on medical marijuana research,” says Sen. Cory Booker of New Jersey.

Sen. Booker and Sen. Kirsten Gillibrand of New York testified at a hearing this year on Capitol Hill that more research needs to be done into marijuana, but that its Schedule 1 classification prevents a lot of work from being done.

“The problem,” Sen. Gillibrand testified, “is the law.”

“(Marijuana) is harder to study because there are more restrictions on it,” says DEA Acting Administrator Chuck Rosenberg, “but the restrictions are there for a reason. But the most important thing – it’s not impossible.”

The DEA bases its decision of how to schedule drugs on scientific studies reviewed by the Food and Drug Administration.

But, in its most recent review, the FDA found only eleven studies that met its criteria, and said that sample size was too small to draw any conclusions.

Still, the FDA wrote that “the studies reviewed produced positive results, suggesting marijuana should be further evaluated as an adjunct treatment for neuropathic pain….”

“A lot of studies have not been done simply because of the classification that the drug currently has,” says Jim Besier, PhD., the Director of Pharmacy at University Hospitals’ Rainbow Babies and Children’s’ Hospital.

“I believe,” he adds, “additional research would certainly be helpful.”

Sen. Booker says the experience of many Americans shows that marijuana deserves more study.

And, speaking just about his own life, Bob Eillison couldn’t agree more.

“I don’t think I’d still be alive today if I were still on opiates and not marijuana,” he says, “it saved my life.”

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High-dollar Prescribers Proliferate in Medicare’s Drug Program

https://www.propublica.org/article/high-dollar-prescribers-proliferate-in-medicare-drug-program?

This story was co-published with NPR’s Shots blog.

The number of doctors who each prescribe millions of dollars of medications annually in Medicare’s drug program has soared, driven by expensive hepatitis C treatments and rising drug prices overall, federal data obtained by ProPublica shows.

The number of providers who topped the $5 million mark for prescriptions increased more than tenfold, from 41 in 2011 to 514 in 2015. The number of prescribers—mostly physicians but also nurse practitioners–exceeding $10 million in drug costs jumped from two to 70 over the same time period, according to the data.

The Doctors and Drugs in Medicare Part D

Use this tool to compare how your doctor prescribes medications in Medicare’s drug program with other doctors in the same specialty and state. Explore the app.

Most of the doctors atop the spending list prescribed Harvoni or Sovaldi, relatively new drugs that cure hepatitis C. Other providers on the list prescribed pricey drugs to treat cancer, multiple sclerosis and rheumatoid arthritis.

Medicare’s drug program, known as Part D, covers more than 41 million seniors and disabled people. In 2015, it accounted for $137.4 billion in drug spending, before factoring in rebates from drug companies. That was up from $121.5 billion a year earlier.

“The trends in this space are troubling and don’t show any signs of abating,” said Tim Gronniger, deputy chief of staff at the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare. “It’s going to be a pressure point for patients and the program for the foreseeable future.”

During the recent presidential campaign, both Hillary Clinton and Donald Trump pledged to tackle the rising costs of prescription drugs. Since his election, however, President-elect Trump’s transition agenda for health care hasn’t featured the topic, a shift the Los Angeles Times reported.

Medicare has released top-level data on drug spending for 2015, including the number of doctors who prescribed medications worth more than $1 million. But the agency has only published data on individual doctors up to 2014.

Dr. Ben Thrower, medical director of the Multiple Sclerosis Institute at the Shepherd Center in Atlanta, was near the top of the list in 2014. He prescribed medications costing $11.5 million that year, mostly for multiple sclerosis drugs. “We get that it’s very expensive,” Thrower said. “I think all the MS providers working in the U.S. would like to see the costs go down.” But prices have climbed steadily in recent years for drugs used to treat the neurological condition, even those that have been on the market for quite a while.

Most of the spending on Thrower’s prescriptions – $8.5 million — was for MS drugs Tecfidera and Copaxone, which can slow progression of MS and reduce the chance of relapse. Thrower has received payments from the makers of those and other MS drugs, but said he cut ties with the companies in January of this year.

“It was kind of exciting when the first one came out,” Thrower said. “The problem we’ve seen is the cost for these drugs has just gone up and up and up.”

Thrower said he no longer prescribes Tecfidera to new patients because it can lower white blood cell counts, putting them at risk for infections.

Medicare Part D Totals by the Numbers, 2014

37.1MBeneficiaries with Part D Claims

1.4BPrescriptions (Including Refills)

$121.5BRetail Price of All Prescriptions

1.35MNumber of Prescribers

38Average Prescriptions Per Beneficiary

$85.82Average Retail Price of a Prescription

46%Portion of Claims to Patients Receiving Low-Income Subsidy

10.1Average Prescriptions Per Patient, Per Provider*

Notes: Counts include initial prescriptions and refills dispensed. Retail price includes patients’ out-of-pocket costs but does not reflect drug maker rebates. *Average prescriptions per patient, per provider has been adjusted to give more weight to doctors who treat more patients. (The unadjusted average is 5.6).

Just because a doctor prescribes costly drugs doesn’t mean he or she has done anything wrong, Gronniger said. “It’s much more about drug pricing … than it is about the behavior of any individual physician, many of whom are equally concerned about the price of these products as we are.”

Today, ProPublica is updating its Prescriber Checkup online tool, which allows you to look up your doctor and see how his or her prescribing in Medicare Part D compares to others in the same specialty and state. Our tool covers the year 2014. You can compare the percentage of each doctor’s prescriptions that were for brand-name medications, the average cost per prescription and the average number of prescriptions per patient, among other things.

Allyson Funk, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry trade group, said Medicare’s figures leave out important context.

“It is important to note physicians’ prescribing patterns are dynamic and based on individual patient needs,” she said in a statement. “When looking at Medicare Part D, government data on spending at the point of sale does not include the substantial rebates for brand name medicines negotiated between manufacturers and plans and therefore does not accurately reflect actual prescribing dollars or program spending.”

These rebates are confidential by law, but Medicare said this week that the average rebate for brand-name drugs in 2014 was 17.5 percent.

The new data on high-spending prescribers is the latest indication of the burden of drug prices on government health programs.

$10 Million Prescribers

Total prescribers under Medicare’s Prescription Drug Program who wrote at least $10m in prescriptions, 2011-2015

 

Source: The Centers for Medicare & Medicaid Services.

In the past couple of years, Medicare’s drug tab has surged, in large part because it picks up the vast majority of the cost of drugs once enrollees exceed a certain threshold each year. In 2015, beneficiaries over the limit, which was $4,700, spent $51.3 billion on drugs. In 2013, the figure was $27.7 billion, government data shows. (Taxpayers, through Medicare, pick up 80 percent of the cost of this so-called catastrophic benefit.) The Associated Press first reported the ballooning cost in July.

Another sign could be seen in a drug dashboard released by Medicare this week. It showed that 1 percent of drugs prescribed in the Part D program accounted for more than one-third of the program’s cost in 2015 (before rebates). Some drugs were incredibly expensive. The drug H.P. Acthar Gel, used to treat several conditions, such as multiple sclerosis relapses and a rare kidney disease, cost an average of $162,371 for each of its 3,104 users—a higher per-user cost than any other drug in the program. That’s up significantly from several years ago, when ProPublica flagged the drug’s expense.

Harvoni, used by more than 75,000 people, cost an average of $92,847 per person, for a total cost of $7 billion (also before any rebates).

Michael Chernew, a professor of health care policy and director of the Healthcare Markets and Regulation Lab at Harvard Medical School, said the number of high-dollar prescribers in Medicare doesn’t surprise him. Given the increased cost of prescription drugs and the latest treatment advances, “the entire distribution is shifting to the right.”

Chernew said that, in the long term, Medicare and insurance companies have to examine the total cost of caring for patients with certain diseases, taking into account drugs, hospital visits, medical tests and more. Only then can anyone tell if certain expenses, such as a pricey new drug, are justified.

For now, he said, “How do we know what’s good or bad?”

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Physicians say their top priority must be the patients in front of them, not the costs to the system.

Dr. Bruce Bacon, a liver specialist at St. Louis University, had the highest total Part D drug costs in 2014, $22.7 million. He was a frequent prescriber of Sovaldi and Olysio, another expensive hepatitis C medication.

Bacon did not return a call for comment for this story. In a 2015 interview, he said he did not realize his prescriptions were so costly to Medicare.

“I really don’t think about the cost,” he said. “I think about taking care of the patients. Should I not take care of the patients because the cost is expensive?”

Thrower, the multiple sclerosis specialist, said the high cost of drugs frustrates him and his colleagues, but ultimately the successful treatment of patients comes first.

“On one hand, we get that,” he said. “On the other hand, when you’re sitting in the exam room and looking someone in the eye, you can’t say, ‘I’m not going to treat you because of the cost.’”

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