“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
WASHINGTON, Aug. 30, 2016 /PRNewswire-USNewswire/ — A new White Paper from the Community Oncology Alliance (COA) looks at recent moves by Pharmacy Benefit Managers (PBMs) to increase corporate profits by declaring all physician dispensing to be out-of-network. Prepared for COA by attorneys at the law firm, Frier Levitt, LLC, the White Paper “Pharmacy Benefit Managers’ Attack on Physician Dispensing and Impact on Patient Care,” examines recent PBM actions, notably CVS Caremark’s announced intent to restrict patient access to physician dispensing, effective January 1, 2017.
After decades of classifying and paying claims for physician dispensing as “in-network,” the PBMs are playing a dangerous game with patient care in order to capture revenue in the growing specialty drug market. Despite a strong record and data showing positive patient outcomes from physician dispensing, the nation’s PBMs have begun a disturbing trend of systematically limiting patient access to outpatient medications from their dispensing physicians. Since 2011, PBMs have consolidated into just five major corporations that control 80% of the covered lives in the United States today; limitations, such as those proposed by CVS Caremark, would disrupt the care of tens of millions of patients.
“During my 26 years as an oncologist, I have witnessed a vast improvement in the quality of life as cancer care has moved from the hospitals to physician offices, and now, to oral drugs patients can take at home,” said Bruce Gould, M.D., COA president and a practicing oncologist at Northwest Georgia Oncology Centers, Marietta, Ga. “Now new actions by PBMs, such as CVS Caremark, would set cancer care back immensely. Today, oral drugs are often the best option for cancer patients. If the planned PBM restrictions are implemented, then patients needing oral therapies will find their access to drugs limited and their care fragmented. Meanwhile in many cases, they will also have to deal with delays in obtaining their drugs and costlier care.”
“Patients taking many of the newest and most-effective oral cancer drugs require careful monitoring by their physicians and pharmacists,” said Josh Cox, Pharm.D., BCPS, Community Oncology Pharmacy Association (COPA) co-chair and director of pharmacy at Dayton Physicians Network, Dayton, Ohio. “Community oncology practices have added in-office dispensing to provide that timely treatment and maintain critical monitoring and care management. Other pharmacy models do not have access to important medical records nor a face-to-face relationship with the patients. No PBM can provide the level of care cancer patients require. CVS Caremark, or any other PBMs considering similar action, will make more money, but patients will suffer because of it.”
As the White Paper notes, currently the only PBM that has stated its intention to restrict patient access to physician dispensing is CVS Caremark. Earlier this month COA submitted an appeal to CVS Caremark to delay or cancel their proposed action. The appeal stated that if CVS Caremark does not reverse its position, or the January 1, 2017, implementation date is not postponed, COA, on behalf of patients and the community oncology providers it represents would have no choice but to take affirmative action to prevent CVS Caremark from implementing the change.
The complete White Paper, entitled, Pharmacy Benefit Managers’ Attack on Physician Dispensing and Impact on Patient Care: Case Study of CVS Caremark’s Efforts to Restrict Access to Cancer Care, is available at http://bit.ly/COAPBMWhitePaper.
About Community Oncology Alliance
The Community Oncology Alliance (COA) is a non-profit organization dedicated solely to preserving and protecting access to community cancer care, where the majority of Americans with cancer are treated. COA leads community cancer clinics in navigating an increasingly challenging environment to provide efficiencies, patient advocacy, and proactive solutions to Congress and policy makers. To learn more about COA visit www.CommunityOncology.org.
Those who cannot remember the past, are condemned to repeat it
This is the DEA …FDA….big pharma…. besides this site is NOT about political issues
The following quote appeared in a FB page dedicated to chronic pain.. It was a very long thread with many comments from many people.
IMO… how many are oblivious that we are country of laws and we have even recently seen where published “guidelines” …are illegally turned into laws and that all of this has/will have… a direct impact on the lives of many of the people in our society…
Does this suggest why the chronic pain community is not heard… because all too many in the chronic pain community are not aware of how their pain management – or lack of pain management – and politics are interwoven ?
And we wonder why those in the chronic pain community are getting
The original numbers were startling enough — 30 heroin overdoses across Cincinnati in a single weekend.
Then they just kept climbing.
Another 78 overdoses and at least three deaths were reported during a 48-hour period Aug. 23 and 24.
And at the end of last week, after a six-day stretch of emergency room visits that exhausted first responders and their medical supplies, the overdose tally soared to a number health officials are calling “unprecedented”: 174.
On average, Cincinnati sees four overdose reports per day, the Cincinnati Enquirer reported, and usually no more than 20 or 25 in a given week.
But pure heroin is what’s responsible for that average. And that’s not what’s on the streets now, they say. The culprit responsible for the staggering number of 174 was likely heroin cut with the latest opioid boost meant to deliver consumers a stronger, extended high — carfentanil. That’s a tranquilizer for, among other large animals, elephants. And it’s 100,000 times stronger than morphine.
For now, law enforcement officials have been unable to track down the source of the toxic cocktail but believe the spate of record-high overdoses could be caused by a single heroin batch laced with carfentanil.
State, local and federal authorities have mobilized across Hamilton County — home to Cincinnati — to investigate the source or sources, Newtown police Chief Tom Synan told the Enquirer.
Synan also heads the law enforcement task force for the Hamilton County Heroin Coalition, which was created so public health and law enforcement officials from Ohio, Indiana and Kentucky could collaboratively combat the heroin epidemic plaguing the tri-state area.
Additional heroin overdoses reported in that area, plus New Jersey, tipped the total to 225-plus, according to reporting on Fox 13 News Now.
In the same time period of the Cincinnati overdoses, 13 were reported in Jennings County, Ind., on Aug. 23, 12 were reported on Aug. 24 in Montgomery County, Kentucky, and 29 overdoses linked to free samples of heroin, marked with a Batman symbol, were reported between Aug. 23 and Aug. 25 in Camden, New Jersey.
That comes after 27 people overdosed during a five hour period on Aug. 15 in one town in West Virginia.
But the epidemic surrounding Cincinnati has captured the most national attention — and area leaders are not sugarcoating the situation.
“It’s unlike anything we’ve seen before,” Hamilton County Commissioner Dennis Deters told the Enquirer.
He called the startling uptick a public health emergency.
“This is unprecedented to see as many alerts as we’ve seen in the last six days,” the county’s health commissioner, Tim Ingram, told the Enquirer on Aug. 26.
Officials have even begged people to turn away from the drug while the source of this potent batch is still a mystery.
“We’re urging you, please don’t do heroin right now,” Synan said, according to WCPO Cincinnati. “If for no other reason, because we don’t know what’s in the stuff on the street.”
Carfentanil, a cousin of the less potent but still dangerous opioid fentanyl, is the strongest commercially used opioid. As they continue to do with fentanyl, drug dealers have begun cutting their heroin supplies with carfentanil to make it stretch for longer periods of time and deliver stronger — and more addictive — highs.
“These people are intentionally putting in drugs they know can kill someone,” Synan told WCPO. “The benefit for them is if the user survives it is such a powerful high for them, they tend to come back. … If one or two people die, they could care less. They know the supply is so big right now that if you lose some customers in their eyes there’s always more in line.”
Further complicating matters is that Narcan, the nasal-spray version of the drug Naxalone, which reverses the side effects of an overdose, isn’t working anymore, at least not as reliably. Usually one, maybe two doses of Narcan will stabilize a patient. But the recent overdoses required two or three times that dosage.
Tests to determine if the heroin contained fentanyl or carfentanil aren’t yet available at most hospitals in the city, the Enquirer reported.
“We can’t confirm in the short term if someone’s had fentanyl, carfentanil or heroin — the tests flag only as positive or negative for opiates,” Nanette Bentley, spokeswoman for Mercy Health, told the newspaper.
Ultimately, this past week’s outbreak has been most taxing on the first responders.
“It’s been exhausting,” Cincinnati police Lt. Col. Mike John told the Enquirer. “They’re running from one run to another. It’s been very taxing on the officers and the fire department.”
CINCINNATI —Randy and Carmen Crews are facing a legal and medical fight. They have a lawsuit against one of the largest retailers in the world. They accuse Kroger of a medicine mix-up they say could have cost Randy Crews, a Navy veteran and retired iron worker, his life.
Randy takes medication to control high blood pressure. In December of 2013, he received a prescription for 90 pills of labetalol, a blood pressure medicine Randy had been using for about a year. The medicine was purchased at the Kroger pharmacy on Kenard Avenue. After Crews began taking the pills, he became sick.
Court documents show Kroger admits the wrong pills were dispensed. Randy was given lamotrigine, a medicine to treat seizures and bipolar disorder.
He started taking the medication and Randy said he had very little energy, very little strength and he couldn’t get his blood pressure down.
“By the time I took him to the doctor, he was just he was just out of it and by the time he hit the hospital, he was really sick,” Carmen Crews said.
After three or four days of taking the medicine, they inquired about the problem and Randy said they found out it was the wrong medication.
“Next thing we know, they’re saying he was looking at, it was a lot to digest in that week, we were actually looking at him having to go on dialysis,” Carmen said.
WLWT contacted the Ohio Board of Pharmacy in Columbus and was told, “All pharmacies are required to account for any drugs received, kept on hand and dispensed.”
Spokesman Jesse Wimberly described dispensing errors as rare, but serious.
“At this this time there is not a mandatory reporting in Ohio for a pharmacist to report an error in dispensing” Wimberly said.
WLWT’s investigation revealed the majority of complaints to the Pharmacy Board come directly from people like Randy and Carmen.
After looking at more than two years of court documents while preparing this story, WLWT found workers had an alert Randy was getting the wrong medication, but they overrode it.
Court documents WLWT obtained show Randy Crews was diagnosed with chronic kidney disease prior to the misfill of medication, but he said his condition deteriorated to end stage renal failure and he’s in need of a kidney transplant. He said he receives dialysis every day.
Carmen said, “This has just (it) has really impacted not just his life, but it has really impacted our lives.”
WLWT contacted Kroger and was told, “We (Kroger) cannot comment on ongoing litigation cases.”
Court documents show Kroger argues that Randy Crews’ renal failure was inevitable.
The records also show medical supplies, dialysis and the possibility of a kidney transplant, could cost the couple hundreds of thousands to several million dollars by 2019.
Randy Crews, a longtime church deacon, said he’s holding on to his faith.
He said, “I believe in God and Carmen and I pray often and I believe I’m going to make it through this ordeal.”
The Ohio Pharmacy Board said the onus for dispensing the correct medication falls solely on the pharmacist.
However, customers can protect themselves by double-checking their medication before leaving the pharmacy.
The case is set to go to trial before a jury on Sept. 6. Randy Crews is currently on a kidney transplant waiting list.
Anyone interested in becoming a donor should contact the Christ Hospital transplant center.
The annual payouts from “Tobacco Money” lawsuit from the late 20th century will be running in the next few years. Have the states become “addicted” to this cash and looking for the next “cash cow” ?
Manchin’s daughter is CEO of Mylan … who is a major manufacturer of generic prescription opiates.. the state has sued drug wholesalers for fueling the WV addiction.
Manchin is also supporting a $0.01/mg opiate prescription TAX.. to help fund the treatment for those who are suffering from opiate addiction. He is also not up for re-election until 2018… typically people will not remember what he did in 2016 by then… His opiate prescription tax has also been endorsed by Hillary Clinton. While a $0.01/mg tax may not sound like much.. that means that #100 Norco 10 will cost $10 more per refill and #100 Oxycodone 30 mg will cost $30 more per refill.. that is …if the tax stays at $0.01/mg and doesn’t go up in the future ..so that places like the Phoenix House needs to make more money.
A West Virginia senator whose daughter is embroiled in the EpiPen price-gouging scandal backs a lawsuit filed by dozens of former painkiller addicts and their families against doctors and drug makers.
The lawsuit, which is expected to go to trial later this year, accuses doctors, pharmacies and distributors of conspiring to deliberately get them addicted to opioid-based prescription pills, reported The Guardian.
The defendants argued that the former addicts should not be allowed to sue because their own criminal actions caused them to become physically dependent on the prescribed medications — but the state supreme court rejected that claim and allowed the case to proceed.
Their argument is backed by pharmaceutical manufacturers, who stand to lose millions of dollars if the lawsuit succeeds.
Sen. Joe Manchin (D-WV) backs the former addicts and their families, comparing the pharmaceutical companies to cigarette manufacturers.
“That’s the same argument that the tobacco industry used,” Manchin said. “They can’t go down that path. It’s an epidemic because we have a business model for it. Follow the money. Look at the amount of pills they shipped into certain parts of our state. It was a business model.”
Manchin has been dragged into the widening scandal over the increasing cost of the life-saving EpiPen allergy drug involving his daughter, Heather Bresch, who is CEO of the pharmaceutical manufacturer Mylan.
Bresch enjoyed a 671 percent pay raise after acquiring EpiPens and raising the cost by more than 400 percent — then dumping more than 100,000 shares of Mylan stock after analysts warned she and the company faced a potential public relations nightmare.
Mylan shares dropped from $49 on Aug. 18 to $42.91 on Aug. 26, after the EpiPen controversy erupted.
West Virginia has been hit particularly hard by prescription drug addiction, and the related heroin epidemic.
Six drug wholesalers agreed this year to a $6.7 million settlement with the state after they were accused of distributing millions of prescription opioids, although McKesson Corp. and other drugmakers are continuing to fight the accusations.
The companies argue that West Virginia’s pharmacy board, which licenses drug wholesalers, would have taken action if they were at fault — but Manchin disagreed.
“Look at the amount of pills they shipped into certain parts of our state and the pill mills that sprouted up and everyone trying to hide behind thinking it was legal,” Manchin said. “It was awful, absolutely awful. I believe it was business-driven, it was a business model. Those who have done extremely well on that and been rewarded very highly for that have looked at it as a legal business plan like any other business plan.”
Wilbert Hatcher is one of 29 former addicts or their relatives who have sued “a veritable rogue’s gallery of pill-pushing doctors and pharmacies” who he claims knowingly and intentionally got him addicted to pain pills and then refused to help him get clean.
“It was a conspiracy,” said attorney Jim Cagle, who represents Hatcher and the others. “Doctors and pharmacies were keeping them hooked. They were feeding the addiction.”
Some of the physicians and pharmacists named in the suit have been jailed or lost their medical licenses.
“It’s a circle — you go to the doctor and they bill you,” said Hatcher, who has been clean for about three years but lost a decade to drug addiction. “The pharmacy, they’re a part of it because they were giving out a whole bunch of pills. It’s business. This is spit town. How many pills were they selling? Enough for a major city. This is ridiculous.”
CEDAR RAPIDS, Iowa (KCRG-TV9) – Iowa’s Insurance Division approved big rate hikes Monday for companies offering insurance plans under the Affordable Care Act, also known as Obamacare.
The largest hike was for Wellmark, which will raise rates an average of 42.6%. This will be the first year Wellmark will offer plans on the state’s Health Insurance Marketplace. Aetna, which is the largest provider on the marketplace right now, will raise rates an average of 22.6% in January. Gunderson rates will rise 19.8% and Medica rates will increase 19%. Avera, another newcomer to the marketplace in 2017, has asked for a 5% hike.
The division held hearings on the rate hikes in July where consumers expressed anger over the rising insurance costs. Insurance companies say the rate increases are in line with the rising costs of health care with more people now insured and seeking care.
Subsidies will help most of the 55,000 people enrolled through Iowa’s Health Exchange cover some of the costs of the increase. 87% of enrollees now are getting subsidies.
Legislators in 31 states have left your PHI (Private Health Information) as described by HIPAA … OPEN for law enforcement to rummage thru at their discretion and come to conclusion of your legal/illegal prescription records and take actions on their OPINION on YOUR FACTS.
The prescriptions you have in your medicine cabinet might not be as private as you believe they are. Thirty-one states grant law enforcement warrantless access to databases containing drug histories, and the U.S. Drug Enforcement Administration is pushing hard to search records even in states that have privacy safeguards.
The disclosures to police agencies often take place without notifying the person targeted in a search and without offering a chance to object. That means no court ever approves the release of records that can reveal treatment for private medical conditions such as cancer, psychiatric disorders, HIV or gender reassignment.
Prescription drug monitoring programs are operated by every state except Missouri and the District of Columbia. Missouri’s program awaits state legislative approval, and D.C. expects to have its program fully operational by the end of the year. The primary goal of the state programs is to track and analyze prescription data to help doctors and pharmacists curb the overuse of addictive drugs such as painkillers. But a patchwork of state laws has left the privacy of Americans largely unguarded, allowing police agencies easy access.
Scripps News found during a five-month investigation that law enforcement tapped into at least 344,921 prescription histories of Americans between 2014-2015 in the states that don’t require a warrant or another form of court authorization. That is more than six times the number of searches that took place by law enforcement in states that have more privacy safeguards enacted. It is access without oversight that leaves the door open for abuses.
Their lives were almost ruined
“I could have lost my family, I could have lost my career,” said Marlon Jones, an assistant fire chief with the Unified Fire Authority of Salt Lake County, Utah. Jones says he was falsely charged with felonies related to doctor shopping as a result of a warrantless search by local police in Cottonwood Heights.
Investigators were looking into the theft of prescription drugs from area ambulances. With no suspects, no probable cause and no warrant, a police officer working the case logged into Utah’s controlled substance database and searched the prescription drug records for all 480 fire department employees.
“I had no idea that a police officer, just on a whim, could go into my medical records and then determine what’s appropriate, in his opinion,” recounted Ryan Pyle, a fellow firefighter paramedic whose prescription records got swept up in the same warrantless search.
Police never made an arrest in the drug thefts but instead zeroed in on the prescription histories of Jones and Pyle and charged them with acquiring controlled substances under false pretenses. The charges had nothing to do with the crime police were initially investigating.
Firefighter/paramedic Ryan Pyle, left, and Assistant Chief Marlon Jones, both of the Greater Salt Lake Unified Fire Authority. (Scripps News photo by Matt Anzur, National Investigative Photographer)
“It impacted every bit of our lives,” said Jones, who was placed on suspension just months after having been promoted. “What (the investigator) did threatened to take everything I held dear.”
Pyle’s arrest came as he and his wife were in the middle of adopting two boys. “When I was initially charged, that’s the first thing I thought of: We’re going to lose these kids,” he said.
Kelvyn Cullimore Jr., the mayor of Cottonwood Heights, said police followed proper protocol and used the tools they had available.
“We would not do anything that would go beyond the bounds of what the law allows,” he said. “We were acting purely according to the way the state law permitted.”
In hindsight, Cullimore said, police could have conducted a more narrowly tailored search, but he said sees no problem with warrantless searches if state laws allows them.
Prosecutors eventually dropped the charges but the controversy prompted Utah lawmakers to enact a new law in May 2015 requiring police agencies to obtain a search warrant before they can access the prescription database.
Last December, a state legislative audit looking back at police use of the database before the new law revealed police overreach might have been more widespread. Auditors reviewed records for four police agencies in Utah and concluded warrantless access “may have resulted in questionable use” of the database by police in more than half the cases sampled.
National battles brewing
Concern about privacy rights and potential abuses of the information stored in Utah’s database date back to when the state launched the program in the mid-90s. In a March 1995 letter to the Speaker of the House and President of the Senate, then Governor Mike Leavitt warned, “I will be watching the use of this database. If the information from the database is used in any manner other than its intended purpose, I will seek to have the database disbanded.”
Two decades later, controversies in Utah have helped shape the state into one of a handful of emerging legal battlegrounds where privacy advocates and law enforcement agencies from across the nation will be pitted against each other in a fight that could ultimately help determine how private Americans’ prescription records are.
“Permitting law enforcement officers to go on fishing expeditions in people’s personal information, then make their own untrained medical judgments and prosecute people as a result, has the power to destroy lives,” said Scott Michelman, an attorney for the Washington, D.C.-based watchdog Public Citizen.
Michelman says warrantless searches of prescription records violate the Constitution’s Fourth Amendment, which bans unreasonable searches or seizures by police. “With tremendous power comes tremendous responsibility and also tremendous potential for abuse.”
Michelman will represent Pyle and Jones next month when their privacy lawsuit is argued in the Tenth Circuit Court of Appeals. The outcome could ultimately determine whether warrantless searches of prescription records will be considered legal or banned outright in six Western states.
DEA pushes hard for access
While privacy advocates have won important recent victories, the U.S. Drug Enforcement Administration has grown increasingly aggressive, pushing to circumvent privacy safeguards even when state legislatures put them in place.
In Oregon, privacy-focused lawmakers set up the state’s database in 2009 and required law enforcement to present a warrant in order to access prescription records in the state’s database. But despite the state’s law, the DEA claimed a separate federal law still allowed them warrantless access to Oregon’s data. The DEA wanted access using only an administrative subpoena — a document that does not require approval by a court. Alarmed, the State of Oregon sued to block the DEA’s attempts and the American Civil Liberties Union intervened in the lawsuit.
The court ruled in favor of Oregon and the ACLU, with the federal judge Ancer Haggerty concluding “the DEA’s use of administrative subpoenas to obtain prescription records from the (prescription drug monitoring program) violates the Fourth Amendment.”
The DEA has since appealed the ruling and the case is expected be heard this fall. But a legal defeat in Oregon did not stop the DEA from trying again elsewhere. In June, the DEA sued the State of Utah in an attempt to force that state to still comply with the DEA’s administrative subpoenas, despite Utah’s warrant requirements that were put in place by the legislature in the wake of the controversy involving the firefighters. The ACLU filed a motion in July to intervene in that case as well, warning that the federal government’s latest actions constituted a broad intrusion on the will of state lawmakers.
“Utah’s law was passed with overwhelming support by Utah legislators and the general public, who clearly appreciate the need to protect the privacy of all Utahns from warrantless government searches,” said John Mejia, legal director for the ACLU of Utah.
The DEA declined an interview, but in an email spokesperson Barbara Carreno wrote, “it’s up to each state how to manage law enforcement access to its (prescription drug monitoring programs), including our access. Access is determined by the state legislature; we have no influence over a state’s legislative process, nor do we attempt to have influence.”
The statement continued, “we have no position on the question of whether there should be a national standard” for law enforcement access to prescription drug monitoring programs.
The agency has not responded to follow up questions.
Vast differences in state privacy safeguards
Seventy-eight Americans die every day from opioid overdose, according to the Centers for Disease Control and Prevention, and the White House said that when “properly implemented” the state’s prescription monitoring programs are a key part of the push to curb opioid abuse, but it declined to address whether there should be a national policy to guide states on what privacy safeguards should be implemented.
“Each state develops laws or guidelines to ensure the information in those systems is used effectively and appropriately,” said Mario Moreno, spokesperson for the White House Office on National Drug Control Policy.
Of the 31 states that allow warrantless access, 15 confirmed to Scripps they give law enforcement direct or login access to the sensitive information contained in the prescription drug databases. This allows some law enforcement officers to access the database from their computers.
“All registered users have direct logins (usernames and passwords) to be able to make requests. No prior contact to our agency needs to be made,” Indiana authorities said in response to a Scripps inquiry. “They do not have to provide anything prior to a request, only the case number.”
In West Virginia, police must only promise they have an investigation to tap in. “No case number or other certification is required,” said Michael Goff, administrator of the controlled substance database for the West Virginia Board of Pharmacy.
“When that type of information can be rifled through …by law enforcement, with the power to prosecute, that’s a very scary thing and something that should give all of us pause,” said attorney Michelman.
Minnesota limits the amount of information police can access to the most recent two years, preventing them from digging through a lifetime of prescription records that might reveal older treatments for depression or other conditions an individual would not want revealed. New York goes back five years, and Virginia has information compiled dating back to 2003.
Among the states that provided numbers to Scripps, Texas, which doesn’t require law enforcement to present a search warrant first, leads the nation in the number of times police requested access to a state database. Between 2014 and 2015 law enforcement tapped into the database 57,477 times to review the prescription histories of Texans. That is more than three times the number of requests for access as what took place in California, a state that has both a warrant requirement and a population that is nearly 50 percent larger than Texas.
Alabama, Georgia, Maine and New Jersey declined to provide the number of law enforcement searches of their respective prescription drug monitoring databases.
Thirty-four of the 49 state programs responding to the survey say they have never conducted an audit of their programs. Twenty-three of the 31 states that allow warrantless access have never audited their prescription monitoring programs.
Balancing privacy with law enforcement
Mike Unthank, superintendent of the New Mexico Regulation and Licensing Department. (Scripps News photo by Matt Anzur, National Investigative Photographer)
New Mexico has had one of the highest drug overdose rates in the nation for the past two decades, and officials there say the prescription drug monitoring program is an important tool to help combat the problem.
“We have an opportunity to make certain law enforcement, pharmacists, doctors themselves can accurately obtain the information that would lead them to believe a person is being over-prescribed or that they’re gaming the system,” said Mike Unthank, head of New Mexico’s Regulation and Licensing Department.
Unthank also acknowledges New Mexico officials have largely not wrestled with privacy issues bubbling up in other parts of the country. The state allows warrantless access for police and is among the states that give law enforcement direct log-in access to data. It also has never conducted an audit of its program.
He said he “absolutely, at this point certainly” has faith in police agencies to keep a close watch on any officers entrusted with direct access to the database.
The Albuquerque Police Department, one such agency, told Scripps it steers clear of the database altogether.
“We have never requested access to that database and don’t see any need to gain access to the database,” Tanner Tixier, a spokesperson for the Albuquerque Police Department, wrote in an email to Scripps. “We believe it would be a violation of HIPPA.”
Yet, records released to Scripps from the State of New Mexico show at least two individuals from the Albuquerque Police Department have been accessing the database in all three years from 2014 and 2016. One Albuquerque police officer made 35 requests for patient data in 2015 alone.
Unthank had no explanation for the discrepancy, but he acknowledged it is a sign New Mexico might want to audit its program and begin placing privacy safeguards above the state’s desire to increase utilization of its database.
“I am glad you brought this to my attention,” he said. “Privacy rights would trump anything. The rights of the citizen, I think, are absolutely critical as a first consideration.”
Unthank, who is a direct appointee of the governor, said he does see the “potential” for privacy intrusions under the current setup of New Mexico’s system.
“The timing is good to attempt to balance these two. I think you could put both together. The rights of the public being protected and also the utilization by law enforcement,” he said.
It’s this balance that privacy advocates want to ensure is met in every state across the country.
“We’re not objecting to the collection of the information. It’s the accessing of the information by law enforcement without judicial approval of any kind,” said attorney Michelman. “This issue is so important because of the depth of the privacy interest at stake.”
This story is the result of a five-month Scripps News investigation led by Mark Greenblatt, senior national investigative correspondent, and Angela M. Hill, national investigative producer. You can email Greenblatt at mark.greenblatt@scripps.com and Hill at angela.hill@scripps.com. You can follow them on Twitter at @greenblattmark and @AngelaMHill. National investigative producer Aaron Kessler created the interactives, and intern Maren Machles contributed to the report.
Nearly a third of the nation’s counties look likely to have just a single insurer offering health plans on the Affordable Care Act’s exchanges next year, according to a new analysis, an industry pullback that poses a major challenge to the health law.
The new study, by the Kaiser Family Foundation, suggests there could be just one option for coverage in 31% of counties in 2017, and there may be only two in another 31%. That would give exchange customers in large swaths of the U.S. far less choice than they had this year, when 7% of counties had one insurer and 29% had two.
At least one county—Pinal in Arizona—is at risk of having no insurers offering marketplace plans next year, despite talks between regulators and insurers aimed at filling the void.
The Kaiser study is the most comprehensive look at competition in the ACA marketplaces since several big insurers announced withdrawals from at least some of the exchanges. In many places, the retreats threaten to undermine the premise of the marketplaces, which were supposed to foster competition among insurers, holding down prices and expanding the offerings available to consumers buying their own health plans; the government subsidizes premiums for many of those individuals.
“It is essential for there to be a robust marketplace with multiple competitors offering different products,” said Leemore Dafny, a professor at Harvard Business School. “The whole thing was framed around it.”
Research by Dr. Dafny and others has shown that premiums tend to be lower when there are more insurers competing.
Insurance-industry executives say premiums reflect the cost of enrollees’ care, but in some markets they worry about a cycle of rising prices that might encourage the consumers who need health care least to opt out. Dr. Dafny says federal subsidies will blunt the impact of premium increases for many consumers.
Most of the likely one-insurer counties are predominantly rural, according to the Kaiser analysis, which updates one it did in May, But several urban areas, such as Charlotte, N.C., Philadelphia and Oklahoma City, also face a lack of competition. The analysis suggests that about 19% of current exchange enrollees could have just one option next year, while another 19% would have two.
“It’s terribly concerning,” said Julie Mix McPeak, Tennessee’s commissioner of insurance. “I feel like we don’t have enough choices in the market.” In most of her state, there will likely be just one exchange insurer next year, after the withdrawal of UnitedHealth Group Inc. ; consumers throughout the state had at least two options in 2016.
The number of counties with limited competition is likely to change between now and late September, when insurers have to lock in their plans, and in some states exact insurer footprints aren’t yet available, so the analysis includes estimates. Since Aetna Inc. said earlier this month that it would withdraw from 11 of the 14 state exchanges where it markets plans, other insurers have been reassessing their situation, worried they will get stuck with more of the sickest enrollees.
“All the other carriers say, ‘what does that mean for me?’ ” said Paul Rooney, a vice president at eHealth Inc., a major seller of individual plans.
“A number of steps remain before the full picture of this year’s marketplace competition is known, but the ACA has greatly expanded the insurance options available to consumers in the individual marketplace,” said Marjorie Connolly, a spokeswoman for the Department of Health and Human Services.
President Barack Obama has called for the creation of a new public insurance option to bolster competition in areas where it is limited.
States including Alabama, Alaska, Missouri, Arizona, Florida, North Carolina, Mississippi, Oklahoma and Tennessee are likely to move next year to having one insurer in all or a majority of counties, Kaiser’s analysis found. Regulators in those states confirmed the findings, except in Florida and Missouri, where officials said they didn’t yet have counts.
In many states, the decline in exchange competition stems largely from the pullbacks of UnitedHealth, Aetna and Humana Inc., which have all said they are seeking to stem growing losses on their ACA business. Some states that lost insurers, like Kansas and North Carolina, were able to attract new ones.
Next year will bring “a major shift in insurer participation,” the biggest decrease since the start of the exchanges in 2014, said Cynthia Cox, an associate director at the Kaiser foundation.
In some markets, the high-profile withdrawals of big companies come atop the retreat of smaller insurers, including the closure of 16 of the 23 nonprofit cooperatives that launched operations under the health law.
Where Insurers are Leaving
Net change* in the number of participating insurers, 2016-2017 estimate
*Net changes represent insurer entries and exits disclosed through 8/26/16; where exact county footprints not available, estimates used.
Source: Kaiser Family Foundation
UnitedHealth’s planned withdrawal from Oklahoma came after two regional insurers bowed out, according to the state’s regulator. Aetna, meanwhile, canceled plans to join the state’s exchange.
The upshot: Only one remaining exchange insurer statewide. “Let’s face it, there’s no competition,” said Mike Rhoads, Oklahoma’s deputy insurance commissioner.
Joseph Devoy, a 31-year-old construction worker who lives in Arizona’s Pinal County, said he had to switch insurers to UnitedHealth this year after his previous provider, the co-op Meritus, stopped selling plans. Now, with UnitedHealth leaving Arizona, Mr. Devoy, who has to purchase coverage through the ACA marketplace to qualify for a federal subsidy, isn’t sure if any insurer will be offering a plan he can buy for next year. Without coverage, he fears he could face a penalty under the law.
“I don’t know what to do now,” Mr. Devoy said. Even if an insurer does come into Pinal, “at that point, it’s a monopoly.”
Sen. Joe Manchin backs suit by addicts who say docs and Big Pharma conspired to hook them on opioids
