“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
Louisville, KY has a population of 600,000 and already this year 1300 doses of Naloxone has been administered
LOUISVILLE, Ky. (WHAS11) — First responders said their use of the drug Narcan, the medication used to reverse the effects of a heroin overdose, has tripled over the last year.
As the demand for Narcan goes up, so does the price, and in 2016 alone it’s estimated it could cost taxpayers $44,000 more than 2015.
However first responders, and one former addict, tell WHAS Narcan is worth every penny.
“My first overdose I was 13 years old,” said Daniel Nolan. “I remember doing the dope, and I remember telling them I’m overdosing.”
October 12th, 2015 is a day Daniel Nolan will never forget because for the fifth and final time in his life he overdosed.
“It was terrifying,” said Nolan. “All it made me want to do in the end was just die. I went black, and then I came to in the hospital twenty or 30 minutes later.”
Daniel was saved thanks to a drug known as Narcan, which Diane Vogel of Metro EMS said is used to try and stop 9 overdoses per day in Louisville alone.
“Everybody’s administration of NARCAN is up because the use of recreational drugs that are in the area,” said Vogel. “It’s not an unusual finding at all, but we’ve given it in the community over 1,300 times already this year.”
“Thank god for Narcan,” said Nolan.
Vogel said the demand for NARCAN is on the rise because of the fillers being used to cut drugs such as Heroin.
“You never know what’s in it, and I didn’t even care,” said Nolan. “I really didn’t care. The more bad stuff that was in it the better it was.”
“If the person who is using the drug mixes it with another drug it makes the potency of the heroin even stronger which takes more medication to counter act that,” said Vogel.
The higher the demand, the higher the price. A single dose of Narcan costs $33 dollars.
However the drug is almost too effective.
“It is extremely dangerous, and I don’t think they realize the shape that they’re actually in because they feel so fine after the fact,” said Vogel.
“It was hard man, but it wasn’t nearly as hard as going out there and trying to get another high,” said Nolan.
When a doctor doesn’t end the provider-patient relationship properly, it could amount to malpractice.
Patient abandonment is a form of medical malpractice that occurs when a physician terminates the doctor-patient relationship without reasonable notice or a reasonable excuse, and fails to provide the patient with an opportunity to find a qualified replacement care provider.
In this article, we’ll look at the elements that typically define patient abandonment, and we’ll explore a few scenarios that could qualify as patient abandonment in the health care setting.
The Elements of Patient Abandonment
Let’s start by pointing out that whether or not patient abandonment has occurred is a very fact-specific issue, and a doctor’s potential legal liability can vary from state to state. Having said that, there are certain common elements among patient abandonment cases:
First, the doctor-patient relationship must be established. This means that the physician must have agreed to treat the patient, and treatment must be underway.
Second, the abandonment must take place when the patient is still in need of medical attention — this is known as a “critical stage” of the treatment process.
Third, the abandonment must have taken place so abruptly that the patient did not have enough time or resources to find a suitable replacement physician to take over treatment.
Finally, the patient must suffer an injury as a direct result of the patient abandonment.
Examples of Patient Abandonment
There are many real-world situations in which a doctor might terminate a relationship with a patient without a reasonable excuse.
For example, if a doctor intentionally refuses to treat a patient who has failed to pay his or her medical bill, that is often considered unjustified. And if a doctor is unavailable for an unreasonable amount of time when a patient needs medical care — and so is the backup (or “on call”) doctor — that could amount to patient abandonment if the patient ends up suffering harm as a result.
It should be noted that patient abandonment can also occur between other kinds of health care providers and the patient — not just between the physician and the patient. For example, if a nurse-patient relationship has been established, and the same legal elements we discussed above are present, then the patient may have a valid medical malpractice claim based on patient abandonment.
Patient abandonment can also occur when:
the hospital has inadequate staffing
the medical staff fails to reach out to a patient who has missed an important follow-up appointment
the medical staff fails to communicate an urgent question from the patient to the doctor, or
the medical staff schedules an appointment too far in the future, resulting in preventable harmto the patient as their condition worsens.
When It’s Not Patient Abandonment
Not every situation where a doctor stops treating a patient leads to an actionable claim for medical malpractice. Most don’t, in fact.
Valid reasons to end a doctor-patient relationship include:
the doctor has insufficient skills to provide adequate treatment to the patient
there are insufficient supplies or resources to provide adequate treatment to the patient
ethical or legal conflicts arise during the treatment process
the patient violates the physician’s policies
the patient has numerous cancelled or missed appointments
the patient refuses to comply with the physician’s recommendations, and
the patient demonstrates inappropriate behavior, such as making sexual advances or engaging in verbal abuse.
If a valid reason exists, then the physician can take steps to terminate the relationship in an appropriate manner, and attempt to avoid liability. That means, the physician should provide the patient with written notice of the termination along with a valid reason for the decision. The physician should continue to treat the patient for a reasonable period of time to allow the patient to arrange for alternative care from another competent physician. The physician should also recommend another qualified physician. Finally, once the patient has secured another physician, and has signed an authorization, the physician must transfer the patient’s medical records to the new physician in a reasonable and timely manner.
WASHINGTON — The chronic fatigue syndrome community demanded stronger investment in scientific research, and greater accountability from public agencies to address their illness, at the recent “Millions Missing: A Global Day of Protest for ME/CFS.”
Chronic fatigue syndrome (CFS) is also known as myalgic encephalomyelitis (ME/CFS), and the protesters emphasized that their community has been ignored for decades.
“Millions Missing is dedicated to the millions of [ME/CFS] patients missing from their careers, schools, social lives and families due to the debilitating symptoms of the disease,” the protest organizers posted on a website. “At the same time, millions of dollars are missing from research and clinical education funding that ME should be receiving. And millions of doctors are missing out on proper training to diagnose and help patients manage this illness.”
The event took place in seven U.S. cities, including Atlanta, Dallas, Seattle, San Francisco, and Raleigh, N.C., as well as in London and Melbourne. In-person attendees laid out dozens of empty shoes to symbolize the 1.5 to 2 million people in the U.S. who they say have been largely absent from their own lives because of their illness.
“Clearly, if everyone knew just how many people were sick, and how many people were suffering, there would be a much stronger outcry for funding, and for medical care, and for attention than we have now … The problem is that people just don’t know, because so many of us are stuck in our homes and bedrooms,” said MEAction co-founder Jennifer Brea, a filmmaker and patient with ME/CFS, who attended one of the events, to MedPage Today in a phone interview. MEAction is a global online platform for connecting ME/CFS patients.
A Call for Change
Only about 15% of patients with ME/CFS are accurately diagnosed, according to Nancy Klimas, MD, director of the Institute for Neuro Immune Medicine at Nova Southeastern University in Ft. Lauderdale, Fla.
She said that “most doctors don’t know how to diagnose it; most medical schools teach absolutely nothing at all about [ME/CFS] — it’s not in the curriculum — and yet it’s an illness that is so disabling.”
Increasing funding to $250 million, a level “commensurate with the disease burden”
Designing and completing clinical trials for potential ME/CFS treatments
Approving potential treatments in the next 5 years (there currently are no FDA-approved drugs for the treatment of ME/CFS)
Replacing the CDC’s “misinformation” around diagnosing and treatment of ME/CFS with accurate guidelines
Identifying a core group of leaders at HHS committed to addressing the illness
The activists estimated that $250 million will be needed annually to adequately address the needs of the ME/CFS patients, a marked increase over the current $7 million earmarked by the NIH’s National Institute of Allergy and Infectious Diseases for the disease.
The higher level of funding will help attract researchers to the ME/CFS field, Klimas said, adding that training grants would be critical to spur a new generation of investigators.
The ME/CFS community has urged the NIH to fund five regional ME/CFS Centers of Excellence, and to aggressively scale up funding for requests for applications over the next 3 to 5 years. They also want funding for a research network to establish a unified ME/CFS research strategy.
Klimas, who has been involved with the Chronic Fatigue Syndrome Advisory Committee (CFSAC) to HHS, said its top recommendation has always been to establish these centers. “Three different Secretaries of Health and the current one — make that four — have been advised by the secretaries of all the [CFSAC] advisory committees to make that happen and it has not happened,” she stated. “So I can see the advocates’ frustration.”
Efforts to obtain an official reaction or comment from the NIH were unsuccessful.
Finally, activists want funding for an outreach plan geared towards drawing more academics, pharmaceutical companies, and biotech firms to conduct ME/CFS research and drug development.
Drug Approval
The community has called on HHS to invest in and incentivize clinical trials for establishing treatment options, setting a goal of seeing a minimum of five accelerated clinical trials completed in the next 5 years, with two FDA-approved drugs reaching the market in that same time frame.
The community has suggested that rintatolimod (Ampligen), rituximab (Rituxan), and antiviral medications be included in these trials. In 2013, the FDA required a new clinical trial of rintatolimod and more data before it would approve the drug for ME/CFS.
Klimas said there is also a great need for ME/CFS management guidelines.
“Doctors are hurting for guidelines that are evidence-based, and right now, the only types of studies that have been done that are evidence-based, are very ‘softball’: reconditioning, emotional coping with chronic illness … that’s important but it’s not enough,” she said.
Better Info
The community demanded the CDC scrap the “erroneous and outdated” information that is currently available about ME/CFS.
In spite of a 2015 Institutes of Medicine report that laid out new diagnostic criteria for ME/CFS, the CDC continues to cite information focused on psychologically-rooted theories of illness and treatment, such as recommendations related to graded exercise therapy and cognitive behavioral therapy, according to the statement.
“This perpetuates medical confusion and puts ME/CFS patients at significant risk of harm,” advocates wrote.
They also said the CDC needs to publish revised clinical guidelines based on more recent scientific literature and input from ME/CFS experts.
Finally, the community said it wants a “serious commitment” from HHS that is open, collaborative, and accountable to ME/CFS patients and advocates. They are calling for a “senior-level cross-agency leader (‘czar’)” to coordinate and oversee a response to the disease.
Brea told MedPage Today that protesters in Boston and San Francisco met with HHS officials, and that a meeting has been promised with Karen DeSalvo, MD, MPH, acting assistant secretary of health. “But that might take months to schedule,” Brea acknowledged.
A meeting at the CDC with Atlanta-based advocates is also in the works.
WASHINGTON — After years of relentless growth, the number of opioid prescriptions in the United States is finally falling, the first sustained drop since OxyContin hit the market in 1996.
For much of the past two decades, doctors were writing so many prescriptions for the powerful opioid painkillers that, in recent years, there have been enough for every American adult to have a bottle. But for each of the past three years — 2013, 2014 and 2015 — prescriptions have declined, a review of several sources of data shows.
Experts say the drop is an important early signal that the long-running prescription opioid epidemic may be peaking, that doctors have begun heeding a drumbeat of warnings about the highly addictive nature of the drugs and that federal and state efforts to curb them are having an effect.
“The culture is changing,” said Dr. Bruce Psaty, a researcher at the University of Washington in Seattle who studies drug safety. “We are on the downside of a curve with opioid prescribing now.”
IMS Health, an information firm whose data on prescribing is used throughout the health care industry, found a 12 percent decline in opioid prescriptions nationally since a peak in 2012. Another data company, Symphony Health Solutions, reported a drop of about 18 percent during those years. Opioid prescriptions have fallen in 49 states since 2013, according to IMS, with some of the sharpest decreases coming in West Virginia, the state considered the center of the opioid epidemic, and in Texas and Oklahoma. (Only South Dakota showed an increase.)
Decline in Opioid Prescriptions
Prescriptions per capita
1.4
1.2
1.0
0.8
0.6
Ohio
Rhode Island
Pennsylvania
Texas
Oklahoma
South Dakota
New York
New Hampshire
West Virginia
California
Alabama
2013
2015
So far, fewer prescriptions have not led to fewer deaths: fatal overdoses from opioids have continued to rise, taking more than 28,000 lives in 2014, according to the most recent federal health data. That number includes deaths from both prescription painkillers, like Percocet, Vicodin and OxyContin, and heroin, an illegal opioid whose use has been rising as access to prescription drugs has tightened.
While experts agree that the decline is real, they differ on what it means for patients. Some say opioid prescribing has been too loose for too long, and that it must be tightened, even if that means extra hurdles for patients in pain.
“The urgency of the epidemic, its devastating consequences, demands interventions that in some instances may make it harder for some patients to get their medication,” said Dr. Nora Volkow, the director of the National Institute on Drug Abuse. “We need to set up a system to make sure they are covered. But we cannot continue the prescription practice of opioids the way we have been. We just can’t.”
Others argue that efforts to rein in prescribing have gone too far and are penalizing patients who take the medicines responsibly and need them for relief.
“The climate has definitely shifted,” said Dr. Daniel B. Carr, the director of Tufts Medical School’s program on pain research education and policy. “It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”
Photo
Dr. Jeanmarie Perrone, a professor of emergency medicine at the University of Pennsylvania, spoke on Friday to William Gates, who was seeking treatment for an infected thumb.Credit Mark Makela for The New York Times
Opioid painkillers present a uniquely difficult public policy puzzle, in part because they became so essential to so many Americans and health officials remained deadlocked for years over how to handle them.
In the past, prescribing of opioids was limited, often aimed at the pain that comes after surgery or with terminal illnesses like cancer. But it took off in the 1990s, as drug companies and medical experts argued that opioids could be used to treat chronic conditions like back pain without addicting patients. Medical residents began learning that pain was the “fifth vital sign” — a body function to be assessed after temperature, heart rate, respiration rate and blood pressure — and that opioids could help mitigate it safely. Sales of the drugs exploded, rising to nearly $10 billion in 2015, from $1 billion in 1992, according to IMS.
But recently, some doctors say they have detected a shift in the attitudes of some patients toward opioids.
“It used to be that people would come in and sometimes be quite insistent” about receiving opioids, said Dr. Wanda Filer, the president of the American Academy of Family Physicians. But in the past year or two, she said, “I think we’ve seen some dampening of that effect. It’s all anecdotal, but I’m hearing it state by state, all around.”
Nationally, some of the biggest declines have been in the prescribing of hydrocodone, according to IMS and Symphony Health. These drugs, which include brands like Vicodin and Lortab, remain the most broadly prescribed opioids, often given after routine dental work or other minor procedures. Prescriptions for OxyContin declined, but those for generic oxycodone went up, IMS data showed. The data measures numbers of prescriptions, not pills, but is a rough proxy for Americans’ use of opioids.
One important development that may have helped propel the decline came in 2014, when the federal government tightened prescribing rules for one of the most common painkillers: hydrocodone combined with a second analgesic, like acetaminophen. In the first year after the measure took effect, dispensed prescriptions declined by 22 percent, and pills by 16 percent, according to an analysis in JAMA Internal Medicine. Refills — which the change made much more difficult — accounted for 73 percent of the decline.
Over the past few years, medical schools have stepped up efforts to impress upon students the dangers of opioid prescribing. Dr. Jeanmarie Perrone, a professor of emergency medicine at the University of Pennsylvania’s Perelman School of Medicine, predicted the next generation of doctors would be appropriately “much more sparing” in their use of opioids.
“When I was a resident, treating patients’ pain as a vital sign was assumed,” said Dr. Branson Page, an emergency medicine doctor in Raleigh, N.C., who finished his residency in 2008. “Now, more of us are aware that even prescribing a small number of opioids to a patient who’s never taken them before is rolling the dice on whether that patient will become addicted.”
Still, Dr. Perrone, who helped review new federal guidelines on prescribing opioids for chronic pain, said there was some risk in making young doctors “too cautious.”
“Sometimes now I will see a patient with a resident who says, ‘I don’t want to give them opioids,’” she said. “But of course they need opioids — they have lung cancer and worsening pain.”
The ever-noisier public debate is changing minds in other medical practices, too. Dr. Mitchell Stark, an oral surgeon in Rockville, Md., said he cut his opioid prescribing this year after reading an article about teenagers getting addicted after having their wisdom teeth removed. Now he tells even patients recovering from multiple extractions to try prescription-strength ibuprofen first.
“I don’t want to be the person who gets a call from someone saying, ‘My kid had an overdose with the Vicodin he had left from getting his wisdom teeth out,’” Dr. Stark said.
State prescription drug monitoring programs, online databases that let doctors check whether a patient is getting prescriptions from other doctors, have also helped drive declines.
Tennessee tried hard to get doctors to consult the database it set up in 2006, to no avail — the number of doses prescribed rose by 12 percent from 2010 to 2012, state officials said. So in 2013, the state made checking the database mandatory, and the number of doses declined by 14 percent from 2012 to 2015.
Many experts say that the drop in prescribing is at best a half victory, in light of the rise of deaths from heroin and illicit fentanyl, a powerful synthetic painkiller. Some addicts who started with prescription painkillers are merely turning to such street drugs or getting their hands on prescription drugs by other means.
“We are seeing, in our area, many more pharmacies being robbed,” said Dr. Richard Vaglienti, the director of outpatient pain services at WVU Medicine, a health system in West Virginia.
Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, urged caution.
“It’s a tide turning, but you have to put it into perspective,” he said. The current level of prescribing, he added, “still leaves us in very dangerous waters
1. Opioid prescriptions have fallen in 49 states since 2013, according to data published in a recent New York Times article. West Virginia, Texas, and Oklahoma had some of the most significant declines. According to the article, experts indicate the decline may be a result of doctors becoming more aware about the “highly addictive nature of the drugs and that federal and state efforts to curb them are having an effect.” The article notes that each year from 2013 to 2015 the number of prescriptions have dropped, based on a review of several data sources. For instance, IMS Health reports a 12% drop in opioid prescriptions nationally since 2012. Symphony Health Solutions found a decline of approximately 18% during those years. A contributing factor to the decline, The New York Times notes, was after US Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products from Schedule III to Schedule II. In the year after the DEA rescheduling, 26.3 million fewer hydrocodone combination product prescriptions were written and 1.1 billion fewer hydrocodone combination product tablets were dispensed, according to a study published in JAMA Internal Medicine. Refills accounted for 73.7% of the decline and were “essentially eliminated by March 2015,” indicates the JAMA study. DEA’s final rule rescheduling hydrocodone combination products, while prohibiting refills, can permit patients to receive multiple prescriptions that can provide up to a 90-day supply. State prescription drug monitoring programs have also contributed to the decline, reports The New York Times. Although the number of opioid prescriptions has declined, fatal overdoses from opioids have increased, according to the most recent federal health data. Over 28,000 deaths in 2014 were from both prescription painkillers and heroin. The New York Times states some people who are addicted to prescription painkillers turn to street drugs like heroin and illicit fentanyl or obtain prescription drugs by other means
Are we headed towards the “battle of the Titans”.. we have seen when the Prescription Benefit Managers (PBM) have acquired the dominate share of the market.. they force pts to use particular pharmacies or their own mail order facilities. As the generic industry consolidate and now have an estimated 88% of the the market place.. we have seen pricing of generics go thru the roof. The next major consolidation is of the insurance industry. IMO, we have a estimated 30%-40% of all healthcare dollars being consumed by the infrastructure overhead and profits of many middlemen… All of these middlemen have evolved over the last 30-40 years under the pretense of saving the system money. Our country spends about $8000/person (2.5 TRILLION) on healthcare. Perhaps ONE-THIRD is spend on “saving money” by middlemen.. some 800 BILLION/yr. And who is picking up this healthcare tab? A larger and larger share is done by Federal/State governments. Some estimates have the government paying over 50% of all healthcare costs. At some point, be it 60%-70%-80% of Uncle Sam paying the tab… Congress is going to have to realize that many/most/all of those infrastructures and profits are largely a waste and their original goal of saving money has not only not been met, but has increased the overall cost of healthcare. Even with ACA/Obamacare we have 10%-15% of the population that is under/uninsured, could that 800 Billion in middleman costs be better devoted to providing care to those in our society? As all of these middlemen consolidate are they laying the ground work for Uncle Sam to be the one with all the bargaining power and take the position of dictating what infrastructure and profits these middlemen are going to be allowed.. Just like these middlemen had dictated to healthcare providers what they are allowed to charge for their services.
The art of the deal? Cigna and Anthem are spending big to push regulators to approve a giant merger — one that could drive premiums up and limit treatment and coverage options.
Is bigger necessarily better? That age-old question is no abstraction when it comes to your healthcare premiums, as Cigna and Anthem Blue Cross Blue Shield are pushing to merge into the largest health insurance company in America. With consumer groups, physicians and hospital officials insisting that the consolidation threatens to limit medical care and jack up insurance prices for millions of Americans, regulators in one small state, Connecticut, are positioned to play a pivotal role in determining whether the companies get the approval they need.
The state is home to Cigna and has long been friendly to the industry, building up a reputation as the insurance capital of America. But some watchdog groups say that with a recent personnel move inside the state government, the friendship has gotten too close for comfort.
When Anthem’s plan to acquire Cigna was being negotiated in early 2015, Connecticut’s Democratic Gov. Dannel Malloy appointed Katharine Wade as his state’s insurance commissioner: She was a longtime Cigna lobbyist whose father-in-law works at a law firm that lobbies for the company, whose mother and brother previously worked at Cigna, and whose husband still does. She was also a top official of the major lobbying group for the state’s health insurance industry. As commissioner, she appointed a top deputy who worked at Cigna and she had a former longtime Cigna employee serve as an agency counsel in the merger review. As Wade continues to oversee Connecticut’s review of Cigna’s merger, she recently secured a position chairing a healthcare policy committee for insurance commissioners across the country. Malloy’s decision to appoint Wade to such a powerful regulatory post on the eve of the merger was not made in a vacuum. It came after employees of Cigna, its lobbying firm Robinson & Cole and Anthem delivered more than $1.3 million to national and state political groups affiliated with Malloy, including the Democratic Governors Association (DGA), the Connecticut Democratic Party, Malloy’s own gubernatorial campaign and a political action committee supporting Connecticut Democrats.
International Business Times reviewed campaign finance data dating back more than a decade. Since Malloy’s first successful run for governor in the 2010 election cycle, donors from the insurance companies and the lobbying firm have given more than $2 million to Malloy-linked groups, according to the figures compiled by PoliticalMoneyLine and the National Institute on Money In State Politics. Almost half that cash has come in since 2015, the year the merger was announced.
Continue Reading Below
Malloy had previously served as a finance chairman of the DGA, was named DGA chair-elect in 2014, and assumed control of the organization as of late last year. In the 2016 election cycle, Cigna and Anthem have become among the largest donors to the group, according to the nonpartisan Center for Responsive Politics. In the midst of the merger push, Anthem has also hired public relations firm SKDKnickerbocker — the samefirm that helped run Malloy’s first successful campaign for governor.
Connecticut’s Democratic Gov. Dannel Malloy (pictured) appointed Katharine Wade as his state’s insurance commissioner. She was a longtime Cigna lobbyist.Photo: Christopher Capozziello/Getty Images
Anthem and Cigna have touted the deal as one that will help consumers. They both have a lot on the line in getting the merger approved: The former could be forced to pay $1.8 billion in termination fees to Cigna if the deal is blocked, and the latter’s executives and shareholders could miss out on a potential jackpot from a successful sale. In light of that, Cheri Quickmire of the Connecticut branch of Common Cause said that the campaign cash and the Wade appointment are not happenstance — and that consumers should question whether the insurance industry is unduly tilting the merger review in its own favor.
“This looks like a conflict of interest, not a mere coincidence,” said Quickmire, whose group aims to reduce the influence of money in politics. “Hiring a lobbyist for the industry to be the regulator of that industry does not seem appropriate. She should not be in charge of the review, and people should definitely be worried that if she doesn’t recuse herself, the review will not be impartial.”
Asked about the faster pace of donations since the merger talks in 2015, a DGA official told IBT that “the donations have been consistent over the last few years — and equivalent with what the companies are giving the RGA,” a reference to the Republican governors’ group.
A spokesperson for Malloy, Christopher McClure, defended the governor’s appointment of Wade, telling IBT that she is “a person of integrity, one who is well regarded for her deep experience and knowledge of the industry, and also for her collaborative approach with stakeholders.” While prominent politicians such as Hillary Clinton have warned about potential negative consequences of the merger, Malloy — a top Clinton surrogate set to co-chair the national Democratic Party’s platform committee — has not called for Wade to recuse herself from the matter.
For her part, Wade has already proven to be merger-friendly: In January, her department approved a controversial deal to combine Connecticut-based Aetna with Humana. Wade’s agency only announced that move last week, and its approval came without Connecticut regulators holding a public hearing on the matter — a move that drew scathing criticism from consumer and physician groups.
As the separate Cigna-Anthem merger has progressed, Wade has resisted calls to recuse herself, asserting that she has no association with the company, even though she admitted such an association in her disclosure filings with Connecticut’s Office of State Ethics. That office, whose board is dominated by appointees of Malloy and other state Democrats, has declined to back calls for her to remove herself from the proceedings, and Wade says she will conduct an impartial review of the merger.
“I am following the Connecticut ethics statutes and I have taken the appropriate measures that allow me to carry out my duties as Insurance Commissioner,” Wade told IBT in a written statement. “I am confident that nothing in my professional background or in my family’s associations will adversely affect my ability to take action fairly, objectively and in the public interest. Consumer protection is first and foremost the mission of state insurance regulators and safeguarding the best interest of Connecticut consumers is a mission I take very seriously.”
Consumer watchdog groups say Gov. Malloy (left) may be compromised by campaign donations from Cigna and Anthem, and that Katherine Wade (right) should not be in charge of the merger review, given her past lobbying role and family ties within Cigna.Photo: Governor Dannel Malloy/Flickr/Creative Commons
Those arguments, though, have not allayed watchdogs’ worries.
“Americans are entitled to government where the key figures are genuinely distinct from the special interests we need them to regulate with a healthy skepticism,” said Jeff Hauser, who directs the Revolving Door Project, a nonpartisan ethics watchdog group. “When a decision-maker faces a decision where he or she has strong personal and familial ties to a corporation with millions or billions at stake, recusal isn’t just the best option; it is the only option.”
While criticism of her role mounts, Wade is taking a hands-on approach to the merger. Emails obtained by IBT make reference to her seeking biweekly conference calls with Cigna and Anthem about the companies’ progress on the merger with other state regulators. Visitor logs obtained by IBT show that during just the last eight months of 2015, Wade and her staff held 24 in-person meetings with officials from Cigna, Anthem or the companies’ lobbyists. Wade’s agency has also worked with Malloy’s office on pushing new legislation — backed by the health insurance industry — that would empower Connecticut officials to shield financial information about the companies from open records laws.
Former Connecticut Attorney General Richard Blumenthal, a Democrat who is now the state’s senior U.S. senator, is among those raising questions about the Cigna-Anthem merger. The state office he used to lead could be a regulatory counterweight in both reviewing the merger and serving as an impartial check on Wade. That office, though, is now run by George Jepsen, a Democrat whose wife was a Cigna executive. Jepsen had recused himself from the matter until his wife left the company late last year.
Many experts say that merged companies end up pocketing the recouped cash as profit.
Since the 2014 election cycle when Jepsen ran for a second term, Cigna and Anthem (and Wellpoint, as Anthem used to be named) have together delivered $175,000 to the Democratic Attorneys General Association — a group that supports Jepsen, and that Jepsen has said he has been “an active participant” in, including with fundraising. Last month, Jepsen’s aide blocked the release of any merger-related correspondence between the state attorney general’s office and Cigna and Anthem, saying it is exempt from Connecticut’s open records laws.
Though Connecticut is a small New England state, the effects of its regulatory decision on the merger could be felt across the country by those like Maureen Murphy, for whom insurance choice is a real issue. A 55-year-old data collector who moonlights as a waitress in Northern Virginia, she was only able to get the insurance policy she needed — and could afford on her $23,000 a year income — through the insurance exchange available to her. The Anthem-Cigna merger could reduce the options on that exchange to just two insurance plans, and could similarly reduce the choices on exchanges throughout the country.
“When you hear that there is going to be these mergers to create these monster insurance companies, you know it’s going to get worse,” Murphy told IBT after testifying at a regulatory hearing about the deal in Richmond, Virginia, last week. “They are going to be so big, you can’t negotiate with them, you can’t go to a different plan. They will control everything, and people like me will have no choice but to keep paying the higher premiums and get less coverage, which is already happening.”
A Debate Over the Effect of Mergers
Anthem and Cigna have presented a much cheerier view of what the future would look like if they receive regulatory approval for the merger deal they announced in July of 2015. The $48 billion transaction they proposed would create what the companies say is a conglomerate with more than 53 million members and more than $115 billion in annual revenues. On the basis of membership, the new firm would be the largest insurer in the United States. With premiumsanddeductibles rising, company officials say that size will benefit consumers by empowering the company to squeeze savings out of the healthcare system, and promote the kind of collaboration that can help physicians more effectively treat their patients.
“The combined companies will operate more efficiently to reduce operational costs and, at the same time, further our ability to manage what drives costs, helping to create more affordable healthcare for consumers,” said the companies in their joint website promoting the merger.
Last June, a spokesperson for America’s Health Insurance Plans, the major lobbying group for the health insurance industry, told CNN/Money, “There is little evidence that shows mergers in health insurance increase costs.”
Groups representing consumers, physicians and hospitals have said the opposite: that the merger may increase the companies’ profits but will ultimately hurt patients and the medical system.
“Mergers in the health insurance industry would have an immediate and profound negative impact on the availability and affordability of health insurance for millions of consumers,” said the American Academy of Family Physicians in a letter to federal regulators summarizing many of the concerns.
An analysis by researchers at Northwestern University, the University of Pennsylvania and UCLA found that the 1999 merger of Aetna and Prudential “raised premiums by roughly 7 percent.” A subsequent study of Nevada markets affected by the merger between United Health Group and Sierra found that premiums jumped nearly 14 percent. And just last month, a study by University of California, Berkeley, researchers found that in the last few years, premiums rose faster in parts of New York where there was less insurer competition. The same study found that consolidation did not have the same effect in California, but probably because state officials drove a harder bargain with insurers.
Insurance companies’ size, say experts, tracks their penchant for using market power to raise premiums, knowing it will be difficult for consumers to find alternatives. A recent analysis published in the Journal of Technology and Science found that “the largest insurance company in each state on average increased their rates 75 percent more than smaller insurers in the same state.”
An Anthem spokesperson told IBT that the merger would “benefit consumers by accelerating the move to value-based reimbursement models, which will provide improved health outcomes for members at a lower cost — achieving savings that can also be reinvested to benefit current and future customers.”
Anthem and Cigna officials predict $2 billion in cost savings from the deal. Many academic experts say that insurers can generate such savings by using their larger market power to reduce reimbursement rates to doctors and hospitals — but they also say merged companies end up pocketing the recouped cash as profit.
“Insurance consolidation will tend to lead to lower payments to healthcare providers, but those lower payments will not be passed on to consumers,” Northwestern’s Leemore Dafny told a congressional hearing on mergers a few months after the announcement of the Anthem-Cigna transaction.
Regulators in states and at the U.S. Justice Department are now charged with reviewing the proposed Anthem-Cigna merger, to make sure it does not squelch competition and harm consumers. That evaluation is taking place in an insurance economy that has already been consolidated by two decades of mergers. A 2014 study by the Government Accountability Office found that private insurance “was concentrated among the three largest insurers in most states.” In all, the report concluded, “the three largest insurers had at least 80 percent of the total enrollment in at least 37 states.” In more than half those states, “a single insurer had more than half of the total enrollees.”
Opponents of the deal say the trend is likely to become more pronounced if Anthem is permitted to acquire Cigna.
According to a recent analysis of market data by the American Medical Association, the merger would “raise significant competitive concerns” in Ohio, California, New York and Wisconsin, and further consolidate insurance markets in 10 other states where Anthem already operates. The American Hospital Association estimates that more than 800 local markets serving 45 million people would see the companies gain market power and would subsequently “lack sufficient local competitive alternatives.” In a separate study of the proposed merger, Edmund Haislmaier of the conservative Heritage Foundation noted that the main effect of the merger would be to enhance Anthem’s dominance of employer-based health insurance plans in the 14 states where it already operates.
In a recent earnings call with investors, Anthem CEO Joseph Swedish countered the notion that the merger would reduce competition: he suggested that the merger could increase competition on health insurance exchanges in states where the company has not had a large presence, by helping Anthem move into states where it has not had a large presence.
“Cigna will help us with future expansion beyond our 14 states, so that’s a story that’s not yet told,” he said, adding that there will specifically be “potential to expand to other markets relative to the public exchanges.”
The major questions facing state insurance commissioners is not merely whether the projected levels of concentration are legally permissible, but also whether such consolidation will ultimately benefit consumers, according to attorney David Balto, a former policy director at the Federal Trade Commission and the federal Department of Justice’s antitrust division.
“Even if the Commissioner finds that a merger would not tend substantially to lessen competition, it would still be subject to disapproval if it would have other adverse effects on policyholders or the public,” he wrote in a memo distributed to state insurance regulators in 2015. That memo pointed out that in the last 15 years, state regulators have intervened in nine separate merger proposals, including moves that ended up fully blockingthreemergers on the grounds that they would harm consumers.
Physicians and the groups representing them have raised some of the strongest objections to Anthem’s proposed merger with Cigna. During a California hearing about the deal, physical therapist Dennis Langton testified that patients covered by both companies had experienced delays and retroactive denials for services deemed medically necessary by doctors.
“We are dealing with two companies that have failed to administer their specialty networks in a manner beneficial to the consumers,” said Langton, who has practiced for 43 years in San Diego. “Allowing two dysfunctional programs to combine forces seems like a recipe for disaster.”
Matthew Katz of the Connecticut Medical Society told IBT that doctors in his state will see their bargaining power eroded.
“If one mega company is now 60 percent of the market but is a bad actor in that market, the patient and the physician are stuck, and the company can limit their network, tier their network and limit access to care,” he told IBT. “A physician may look at a network that is making it difficult to deliver necessary care, but when that network is 60 percent of the market, they can’t walk away from it.”
With 68 pharmacy robberies during the first five months of 2015, Indiana has twice as many pharmacy robberies as California and more than five times more than Texas. In 2014, Indiana had 78 pharmacy robberies.
So far in 2015.. there has been more robberies in Indiana than the NEXT TWO STATES
Pence and Zoeller are running for re-election this November and on TV Pence’s campaign ads are focused on all the new jobs that have been created in Indiana during his first term. Apparently robbing pharmacies is a pretty profitable business… since it would appear that most robberies were done by DIVERTERS… that have a business plan. Besides any business that has a ZERO COST of product acquisition should be able to make a good profit.
This is the front page of a brochure that I received from our Medicare Part D program. All providers involved with Medicare are now subject to a STAR RATING SYSTEM.. If you are unhappy with your provider of services covered by Medicare and you don’t complain… they will continue to get HIGH RATINGS… if pts complain.. Medicare are suppose to take action and if enough complaints are filed… it is suppose to affect the reimbursements that the provider receives for services provided to ALL PATIENTS.
Silver Script is the second or third largest Part D provider.. so other Part D providers (PDP) may be sending out similar brochures. On the front page of this brochure they state:
We’re committed to working with you, your doctor and your Pharmacist to help you stay adherent to your medication
So if anyone from your PDP, doctor, pharmacist is involved with you – as a patient – interferes or hinders you being complaint with your necessary medication for your chronic disease… Medicare would appear to like to hear about how your proper care was interfered with.. That can be done at www.medicare.gov (800 MEDICARE) of if you believe that you where discriminated against under the Americans with Disability Act… you should contact the Office of Inspector General (OIG) of Health and Human Services ( HHS) 800.447.8477
If you are treated poorly, denied care and you say NOTHING.. they will keep their high star rating and they will continue to not provide the care that patients are entitled to
When you take away chronic pain pts’ necessary medication… they seek alternatives… not knowing what they are doing… they OVERDOSE… of course, when you talk to someone who runs an addiction facility… properly treating a pt’s chronic pain with opiates… is not an option.
Have you ever had someone tell you that you must do something or can’t do something only to find out later that they lied to you… but.. it was a area that your knowledge was rather limited and could not call them out at the time ?
It has been reported that Walgreen’s computer system and corporate policies allow a single Pharmacist to BLACK BALL a pt in their system and all Walgreen Pharmacists through out their 8500 stores are required to honor that BLACK BALL and that the only person that can remove that BLACK BALL FLAG is the Pharmacist first entered it.
Some chain stores will chose to BLACK BALL a single or group of prescribers and either direct their Pharmacists to reject all prescriptions from those prescribers or just all controlled medications from those prescribers.
I have been told of some rather inventive “reasons/excuses” why a Pharmacist cannot fill a prescription. I have even had stories related where when the Pharmacist was challenged latter by upper management… could not remember what was said, done or lied about what was said or done. One recent story, the Pharmacist stated that phone calls were made and when the corporation reviewed its phone records, no phone calls had been made to the number(s) the Pharmacist stated was made.
Some Boards of Pharmacy or corporate management may consider lying to pts unprofessional conduct. If you don’t have a video/audio recording of what was said/done… how are you going to prove it. There is a saying in “medicine” … “.. if it is not documented.. it did not happen …”
There are a dozen states that have “two-party” recording laws…but.. those states the laws were written when land-lines were the primary means of private communication. Who believes that standing at the Rx dept register has any hopes of privacy ? Besides, if you notice there are dozens of video cameras watching/recording your ever move in just about every retail outlet.
Remember… there is a WAR ON DRUGS going on since 1970 and those pts that have a valid medical need for controlled medications have become collateral damage of this war. Being a passive patient, will only assure that you will get “taken out”.
