The Insurance Companies’ Latest Target: Specialty Drugs

http://www.huffingtonpost.com/paul-alexander/the-insurance-companies-l_b_9772944.html

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http://www.cbsnews.com/news/60-minutes-heroin-epidemic-ohio-bill-whitaker/

 

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Montana’s ‘Pain Refugees’ Leave State For Treatment

http://mtpr.org/post/montanas-pain-refugees-leave-state-treatment#stream/0

Travel with a group of Montanans who have to leave the state every 90 days because they can’t find relief for their chronic pain here.

Over the past two decades, the rate of overdose deaths from prescription painkillers known as opioids has quadrupled in the United States. Federal authorities say 78 Americans die every day from an opioid overdose. Health care officials in Montana report that the abuse here is worse than the national average. But the casualties of the opioid epidemic are not all addicts and drug abusers.

The others call themselves pain refugees. They say that finding doctors willing to help them in Montana is almost impossible, and the only way they can get the treatment and relief they need is to fly out of state.

On a recent mid-afternoon flight out of Missoula, Gary Snook is among three chronic pain patients leaving in search of relief.

Before Snook drops into his seat, he pauses in the aisle, pressing his fingertips into his upper thigh. He bends his knees slightly and moves his hips side to side. He’s getting one final stretch in before takeoff.

“Had I stayed in Montana, I would have killed myself,” Snook says as the plane carries him west. “I just want humanitarian care, and I get that in California.”

Snook has been taking opioids since he had surgery on his spine for a ruptured disk 14 years ago.

After the surgery, he was in so much pain he couldn’t work. He’s done all kinds of things to try to get better.

“Well I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he says. “I’ve tried anything that anyone has ever suggested me to try. Unfortunately what I do right now is the only thing that works.”

Snook is desperate like an addict, which he says he’s not. He says he’s not craving a quick fix. He leaves his home for medical treatment because he has no confidence in the doctors in Montana. He wants to be healed.

“I believe pain control is a fundamental human right, or at least an attempt at pain control,” he says. “To deny someone with a horrible disease like me access to pain medications is the worst form of cruelty.”

It’s dark outside when Snook, his wife, and two other pain patients get off the plane in Los Angeles. They wheel their suitcases to a budget car rental and find a midsize SUV. When they get to the hotel they smile and greet the lobby clerk by name.

This whole trip has become routine. Every 90 days, they come here to see a doctor who gives them care and prescriptions they can’t get at home.
“We as physicians are terrified that we are going to go to prison, or lose our license over prescribing pain pills to patients,” Ibsen says.

Fear Among Montana Doctors

In the winter of 2015, Helena Doctor Mark Ibsen shut down his practice after being investigated by the State Board of Medical Examiners. The Board said he was over-prescribing narcotics.

“We as physicians are terrified that we are going to go to prison, or lose our license over prescribing pain pills to patients,” Ibsen says.

He says he’s done nothing wrong.

In March Ibsen testified before a state interim legislative committee about pain treatment and opioid access in Montana.

“It’s like turning the light on in the kitchen and the cockroaches have fled,” he said. “There is no one willing to prescribe opioids for patients who they don’t know, who they don’t trust.”

Ibsen says pain management has never been easy for a doctor or a patient, and it’s getting harder as the concern over opioid abuse grows.

“There is no objective measurement of pain,” Ibsen says. “If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship. No miracles happen between you and me as a patient and a doctor if I suspect that you’re a scumbag.”

In a recent meeting, a member of the Montana Board of Medical Examiners said one of the reasons doctors are declining pain patients is because they are afraid of being followed around by the federal Drug Enforcement Administration.

In the past several years the board has taken on several high profile cases of doctors they considered to be over-prescribing opioids. At least two Montana doctors have had their licenses suspended for irresponsible prescribing since 2014.
“If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship. No miracles happen between you and me as a patient and a doctor if I suspect that you’re a scumbag.”

Montana Board of Medical Examiners Executive Director Ian Marquand said he couldn’t say whether the board’s disciplinary actions on doctors had anything to do with them deciding to cut back on their opioid prescriptions.

“[The] Board doesn’t play favorites,” Marquand says. “The Board does not encourage particular kinds of doctors, it does not discourage particular kinds of doctors. The door is open in Montana for any qualified, competent physician to come in and practice.”

Ibsen has appealed the suspension of his license in state court. He says he will apply for medical licenses in other states if he ever can’t practice in Montana.

There’s a fear in Montana’s medical community around prescription painkillers.

Doctor Marc Mentel chairs the Montana Medical Association’s committee on prescription drug abuse. He acknowledges that there’s fear in Montana’s medical community around prescription painkillers.

“Patients are in pain. We don’t have great tools for them, and we need to recognize that this is usually going to be a chronic disease state,” Mentel says. “They may be in pain for the rest of their life. So, how do we address that, how do we treat them without actually harming them?

“It takes a lot of time, and it takes a lot of work, and it’s not something that you say, ‘here is some medicine, go off and do okay,'” Mentel says. “You need frequent follow up, frequent counseling, and you need a lot of tools in place to help manage their pain. So that is the one hand, and then there are other physicians who are afraid to prescribe these, or are starting to become fearful because of the backlash that has been out there.”

Mentel, who started practicing in the 1990s, says medical education when he was training didn’t include anything about treating chronic pain. He says America’s medical community is still experimenting with how to do it.

“The perfect tool, the perfect medicine that would take away a person’s pain and allow them to function normally does not yet exist,” he says. “So we are trying to use any tool, any means we can to help lessen the severity of their pain.”

The California Solution
For some Montanans who suffer from chronic pain, like Gary Snook, relief is found at a small strip mall clinic in suburban Los Angeles.
Credit Corin Cates-Carney

For some Montanans who suffer from chronic pain, like Gary Snook, relief is found at a small strip mall clinic in suburban Los Angeles.

“I see a lot of tragedy,” says the doctor who runs it, Forest Tennant. “But on the other hand, I’m a doctor who is supposed to help deal with that. That is part of my job.”

Tennant is a former Army physician who has consulted for the National Institute on Drug Abuse, the National Football League and NASCAR.

He carries about 150 patients; half local Californians, and half out-of-staters.

Tennant says there are some legitimate reasons to be concerned about opioids, but he says that’s why doctors need to specialize in pain management.

“Somebody said we have this opioid epidemic, I guess they are talking about the overdoses, which are up, there is no two ways about it,” Tennant says.
“… Are we just going to tell these people we are not going to help them. You see what I’m getting at?”

“Apparently there are states where too many opioids have gotten out on the street. And again, doctors can get conned, get the wrong patient,” he says. “So I think that it is true that we’ve had a lot of opioids that get out on the street, and people get them, whether they are teenagers or addicts. In other words, it has been known since I started doing addiction medicine 40 years ago, opioid addicts are going to go get opioids, whether it is heroin or a prescription opioid. And they are going to go where they can get them.”

But Tennant says, opioids can help people. And because of that, he says the drugs shouldn’t be stigmatized, but used responsibility.

“This morning I had a women in from Massachusetts,” Tennant says, “she’s got a rare cancer that is in her neck and in her chest, and she also had at one time a traumatic brain injury. So, yeah, she does take a lot of opioid drugs. She’s not going to live very long. But are we going to just tell these people we are not going to help them. You see what I’m getting at?”
Snook travels to California every three months, where a doctor writes him a prescription for pain killing opioids. Each trip lasts a couple of days, but Snook is often in too much pain to leave the hotel room.
Credit Corin Cates-Carney

Permission to Die

Pain has turned Lolo resident Gary Snook’s life into something that resembles a spectator sport. He spends a lot of time lying down, isolated in a feeling no one can see. Sometimes, he talks about his life like it was something he had once, then lost.

“I mean, that’s life and death in that bottle,” Snook says, gesturing to his pain medication, “at least it’s my life.”

His wife Kathy says, “it is the most horrible thing, because it is somebody you love.”

“I am terrified for him not to be able to get the opioids that he needs to even just kind of put a damper on the pain,” Kathy says. “It never gets rid of it entirely, but it makes it so he can cope, how he can have some semblance of life. And every day we live in fear that he may not be able to get his medication that he needs.

“I would never want to see him lay in bed with torturous pain, with no hope of getting better” she says, “and I have given him permission, if we’re ever in that situation, that I would understand if he chose suicide.”

Tomorrow we’ll hear the story of patients desperate to change the law to guarantee the treatment of chronic pain patients in Montana.

 

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Maine’s Gov. LePage vetoes lifesaving overdose drug bill—why ‘perpetuate’ addiction? he says

Maine’s Gov. LePage vetoes lifesaving overdose drug bill—why ‘perpetuate’ addiction? he says

Sometimes it’s hard to fathom just how pathetic a human being can be, but Maine’s Gov. Paul LePage offered yet another reminder Wednesday when he vetoed a bill designed to help save the lives of people who are addicted to opioids. The measure, which lawmakers rushed through in order to address the state’s growing epidemic, would have allowed pharmacies to sell a drug that swiftly counteracts opiate overdoses without a prescription. Kevin Miller reports on the ever-repugnant LePage and his justification for nixing the bill.

“Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote, repeating a contention that has caused controversy before. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

Pharmacy chains such as Rite Aid and CVS already dispense naloxone without a prescription in other states. About 30 states allow sales of the drug without a prescription.

CVS requested the bill in Maine after receiving a letter from U.S. Sen. Angus King of Maine asking the chain to expand the availability of the antidote. The bill got support from both law enforcement and health organizations during the legislative hearing.

Yep, you read that right—addicts’ lives aren’t worth saving ‘cuz they might overdose again. Seriously, what rock did they find this guy under? Everyone is rushing to save lives—Sen. King writes a letter, CVS jumps onboard, police and hospitals give a thumbs up, lawmakers pass it on a unanimous voice vote—and LePage strikes it, saying essentially, what’s the point? It’s just hard to find the words for such an unconscionably callous rationale. How in god’s name has such ignorance been visited upon the Maine governor’s office?

 

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In the last Presidential election 126 million votes were cast… FIVE MILLION separated the winner from the loser… 106 MILLION of eligible voters – DID NOT VOTE ! Strangely, that is the same number of estimated CHRONIC PAIN PTS.

Today on the TV.. I heard Bernie Sanders state “POOR PEOPLE DON’T VOTE “.. a recent survey stated that those people with chronic pain that the disease itself and/or the cost of treating the disease had a serious financial impact on 92% of the families…  Suggesting that 92% of the chronic pain pts and their families are POOR…  and DON’T VOTE ?

A form of VOTER SUPPRESSION ?

In case you haven’t been paying attention, the NATIONAL CONVERSATION is about substance abuse – NOT ALCOHOL OR TOBACCO – but opiate products.  Even though Alcohol and Tobacco use/abuse will kill about TWENTY TIMES the illegal use of opiates EVERY YEAR.

I am closing in our four years of writing this little blog. I have tried to get CPP to advocate for themselves.. the most I see is dozens or hundreds of new FACE BOOK pages dedicated to chronic pain in one form or another and a lot of whining, bitching and moaning between those on the pages. I see some “closed pages” that has HUNDREDS of members and maybe a couple of dozens who ever bother to make a post or a remark.  ADVOCACY takes more than reading FACE BOOK POSTS !   It takes more than whining, bitching, moaning to each other.

Congress has a collective approval rating in the single digits, but 90%+ will get re-elected EVERY YEAR… If you were them, would you change what/how you are doing things ?  Their approval rating must be the collection of their family, friends and employees votes of approval, even car salesmen get a HIGHER APPROVAL RATING  than Congress !

If case you haven’t noticed, apparently politicians believe that raising money and running political ads… will get them elected to office…. so does $$$ buy votes ? Last presidential election, 106 million  apparently didn’t get paid enough to even bother to vote ?

How has your pain management or access to pain care changed over the last 4-8 yrs ?  With the national discussion focused on opiate abuse.. do you think the direction is going to change in a positive direction for you moving forward ?

By the end of July all official candidates will be in place and by the time that Labor Day gets here “election season” will be in “fast forward”.  IMO, unless the appropriate treatment of ALL CHRONIC DISEASES becomes part of the national discussion. We are going to see an increase in suicides and unnecessary premature  deaths.. one of them could be YOU !

How do we get the proper treatment of all chronic diseases to be part of the national discussion ? Each candidate will have a website, a FACE BOOK PAGE and TWITTER account.  National and local media have the same.. Make comments on their wrong-headed articles about treating all chronic disease issues.  Copy statements from pts on various Face Book pages – without names – that points out how badly chronically ill pts are being treated… If you see/know of suicides because of lack of healthcare….share… across the political and media spectrum.

These politicians track just about data point that is floating around… there is at least 106 million people of voting age… what would be the politicians’ response if there was a HUGE increase in registered voters… particularly if they registered as INDEPENDENT.  UNCLEAR of who they would vote for.. it could make their HEADS SPIN…  Remember last presidential election only FIVE MILLION separated the winner from the loser..  at the same time.. there is a huge influx of comments about lack of the treatment of chronic diseases.

If you are not registered to vote … DO SO THIS WEEK !  You should be able to do it by mail.. and when Nov comes… you can vote by mail…  If you are too busy or too poor to make a phone call, fill out a voter’s registration form and mail it in.  There is NO ONE who can do it for you and you are the only one that can benefit from doing it.  I can assure you that if there is a  sudden surge of 5 -10 -20 million new independent registered voters.. it will SCARE THE SHIT OUT OF THE POLITICIANS. They like nothing less than such unpredictable things… especially if they can see no real reason behind them.

Finally, I would hope that this post will go VIRAL. Registering to vote is an anonymous act… voting is an anonymous act..  while making tweets and Face Book posts are not quite anonymous, hopefully the volume of posts and tweets will be so large that the volume will have a larger impact than what is being said.. and when November comes and the national conversation has not changed.. then it may be time to VOTE THE BUMS OUT.. since it will be very clear that they are not listening to their constituents and it may be time to share your pain with them and put them in the unemployment line come Jan 2017.

Likewise, if I see little/no action by the chronic pain community. I am going to have to question my personal advocacy for the chronic pain community that would seem to be in an irreversible  catatonic state.

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Diabetes: Delaware’s Billion-dollar crisis

http://www.delmarvanow.com/story/news/2016/04/23/diabetes-delaware-costs-healthcare-insurance-sussex-maryland-prmc-beebe/83430538/

Delaware has a $1 billion time bomb strapped to its back. It’s called Type 2 diabetes.

Today, one in three Delawareans has higher-than-normal blood sugar levels because they can’t efficiently produce and use insulin. Left unchecked, prediabetes and full-blown Type 2 diabetes can disrupt every organ system in the body, leading to blindness, amputated limbs, heart disease, stroke and kidney failure.

Type 2 diabetes, linked to excess weight and a sedentary lifestyle, disproportionately impacts minorities and the poor.

“It’s like a tornado,” said Carrie Holmes, a Dover diabetes educator. “It just keeps getting bigger and bigger.”

After nearly losing a foot to gangrene, Sharon Childress, of Seaford, can’t ignore the signs of a “sugar shake” when her blood sugar levels plummet and convulsions rattle deep in the center of her chest.

Childress developed gestational diabetes when she was pregnant in 1975. More than two decades later, in 1997, she was diagnosed with Type 2 diabetes.

“I really keep an eye on it because I don’t want to lose my eyesight I don’t want to lose my feet,” explained the 59-year-old. “I want to live today. And you can live with diabetes.”

Not only can you live with diabetes; if caught early enough, life-altering changes can be avoided. That’s not the case with most chronic diseases. And it all starts with a simple blood test.

Once diagnosed, patients willing to overhaul their diet and exercise regimens can lower high blood sugar, high cholesterol and high blood pressure. Yet roughly a quarter of those who have diabetes don’t even know they have it.

The average person is diagnosed with Type 2 five to seven years after living with prediabetes, according to Christiana endocrinologist James Lenhard. Some patients experience no symptoms warning them of trouble ahead.

Faced with an aging population and widening waistlines, Delaware spends more on diabetes than either heart disease or cancer. The cost is a staggering $1.1 billion a year — the second-highest health care expenditure behind mental health — for screening, treatment, lost worker productivity and death. The national tab is more than $245 billion, threatening to bankrupt Medicare if current trends continue.

Nearly half of American adults have diabetes or prediabetes, according to a startling study published last year in the Journal of the American Medical Association. And those statistics don’t include the growing number of teens diagnosed with prediabetes, who don’t yet qualify as Type 2 diabetics.

Being overweight is the number one risk factor for youth. Children from African American, Hispanic, Asian and Native American families are twice as likely to develop diabetes as those from Caucasian families.

Delaware deals with diabetes dilemma

Type 2 used to be a disease associated with forty-somethings and retirees, said C.J. Jones, associate executive director for the Delaware Diabetes Coalition.

“In the last 10 to 15 years, the age keeps coming down lower,” she said. “It scares the living daylights out of me.”

The demand for diabetes treatment has spawned a more than $24 billion global insulin industry, with some brands raising their prices by 160 percent over the last five years. Patients, meanwhile, must bankroll a growing list of medications and supplies while negotiating higher insurance premiums and deductibles.

“It’s an insidious disease,” said Marianne Carter, a Delaware State University dietitian. “If it’s not under control, the complications can be devastating.”

Blame an aging population, spiraling obesity rates, behavioral economics, children sequestering themselves indoors to blow up virtual worlds, infrequent blood tests, or the absence of a coordinated outreach campaign.

Or just blame being set in your ways.

Type 1 diabetes is an autoimmune response typically diagnosed in children. But the more prevalent Type 2 is driving the uptick in cases. The nation’s overall diabetes rate has more than doubled over the past two decades in tandem with the obesity rate. Today, diabetes is the seventh-leading cause of death in the U.S.

The News Journal spent months interviewing people on the front lines of diabetes education, including doctors, local and national public health experts, community advocates and nutritionists. We also talked to Delawareans with prediabetes and Type 2 diabetes who radically changed their way of life to stop the disease in its tracks.

National data show that prediabetics who lost 5 to 10 percent of their body weight and exercised regularly lowered their risk of developing Type 2 diabetes by nearly 60 percent. Those who only took medicine lowered their risk by 31 percent.

Yet, in the race to contain an epidemic, prevention is a relatively new area of focus for state and national public health officials. It takes years to test programs to prove their efficacy, along with navigating the complex web of insurers, physicians, advocacy groups, federal regulators and legislators, according to Ann Albright, who heads the Division of Diabetes Translation for the Centers for Disease Control and Prevention.

“If this were a drug, it would already be in people’s hands,” she said.

CHAPTER 2

After an infected hair follicle nearly killed him, Gary Stumpf doubled down on managing his Type 2 diabetes.

The Dover retiree had a family history of the disease, but that didn’t stop him from scarfing down two orders of McDonald’s hash browns for breakfast or a Wendy’s hamburger for lunch.

Diagnosed with Type 2 more than two decades ago, Stumpf’s real complications began with what masqueraded as a nasty flu in 1998.

Doctors advised him to rest for a week. The next day, Stumpf noticed swelling the size of a grapefruit in the scrotum area around his testicles.

He was diagnosed with Fournier’s gangrene, an extremely rare condition caused by an infection in the genital region that destroys the body’s tissues. People with diabetes are at higher risk of contracting the disease, because high blood sugar impedes blood circulation, making it harder for the body to repair sores and wounds.

“In the last 10 to 15 years, the age keeps coming down lower. It scares the living daylights out of me.”

C.J. JONES, DELAWARE DIABETES COALITION

Type 2 diabetes is a chronic, progressive condition that affects the pancreas, an organ roughly the size of a hand. The pancreas makes enzymes that aid digestion and insulin, a hormone that helps the body store or break down sugar, or glucose, from the food we eat and convert it to energy.

Excess weight, eating habits and genetics play a role in how quickly the disease progresses. Being overweight, particularly in the midsection, interferes with the body’s ability to break down glucose in the blood, hamstringing the pancreas.

That’s why many people with diabetes, like Stumpf, must take multiple oral prescriptions and shoot themselves with insulin several times a day to lower their sugar levels.

Dover resident Gary Stumpf points at bananas during a diabetes care program tour at the Dover Acme grocery store on April 9. Stumpf was diagnosed with Type 2 diabetes more than two decades ago.
(Photo: JASON MINTO/THE NEWS JOURNAL)

During his first month in the hospital, Stumpf recalled submitting to 24 major surgeries and laborious, painful cleanings to remove all the dead skin from his gangrene.

“I was given a 10 percent chance to survive,” the 65-year-old remembers. It took him nearly five months to relearn to walk and breathe on his own, followed by three months of in-home nursing care.

Since that time, the former U.S. Department of Defense analyst has faithfully tracked what he eats, and his weight has dropped to 266 pounds from a high of 415 pounds.

With ritualistic precision, Stumpf needle-pricks his middle finger, squeezes a drop onto a plastic matchstick and shoves it into his glucose meter. Bleep. The screen flashed 131 (milligrams per deciliter) on a recent weekday. Normal is 70 to 100.

“I figured it would be high,” Stumpf said, immediately regretting the patty melt he ate for lunch.

Stumpf hiked up his T-shirt and stabbed the right side of his stomach, where his Fournier’s scar, encircling his waist like a belt, cushioned the blow.

Between chuckles, he pledged to eat a very light dinner — perhaps a salad or just five strawberries.

Obstacles multiply

CHAPTER 3

Gary Stumpf of Dover holds his morning diabetes medications pills. Gary has had diabetes for 20 years.
(Photo: JASON MINTO/THE NEWS JOURNAL)

On most days, Christiana endocrinologist Lenhard feels a lot like Chicken Little, issuing doomsday diabetes forecasts to inspire action among his patients. Roughly a quarter of the health system’s beds are filled with diabetes patients.

“It’s a public health threat that could easily cause the bankruptcy of our public payers,” he intones. “Every prediction I’ve ever read about diabetes has been exceeded.”

Lenhard, who directs Christiana Care Health System’s Diabetes and Metabolic Disease Center, has listened to patients give lip service to changing their eating habits with no concrete results.

“That’s the job of the health care professional — to find out what motivates patients,” he said. “The very best diet is the one you stick to.”

Doctors can’t predict with certainty when prediabetes reaches a “point of no return,” Lenhard said.

If nothing is done, most people with prediabetes will develop diabetes within 10 to 20 years, on average, he said. That’s when the beta cells in the pancreas, responsible for producing and secreting insulin, hit a death spiral.

Dr. James Lenhard, a national diabetes expert at Christiana Care.
(Photo: JENNIFER CORBETT/THE NEWS JOURNAL)

Early symptoms of diabetes can be easy to miss. Telltale signs include frequent urination, thirst and hunger, blurry vision, fatigue and numbness in the hands or feet. Fifteen percent of those with Type 2 diabetes aren’t overweight.

Research shows that many primary care doctors don’t talk to their overweight patients about diet and behavior changes. One study found that only 1 in 4 doctors communicate blood sugar abnormalities to their patients.

Time-strapped doctors are accustomed to treating the most pressing symptoms and may overlook diabetes as a risk factor, said Lenhard. The state’s diabetes prevention program trains doctors to look for diabetes warning signs.

Recently, the American Diabetes Association urged a federal task force to adopt broader guidelines for screening patients. The United States Preventive Services Task Force recommends that doctors routinely screen obese and overweight patients ages 40 to 70. Diabetes association leaders want screening to begin at age 20.

The key to changing the tide in Delaware is to hold physicians more accountable, according to Jeffrey Burtaine, a medical director in clinical client relations for Highmark Blue Cross Blue Shield.

“We believe the answer is to put it back on the provider,” he said. Highmark evaluates providers based on positive patient outcomes for blood sugar and blood pressure. Participating doctors also must offer A1C blood tests used to diagnose diabetes and monitor patients’ eyes for deterioration and feet for potential nerve damage.

Some doctors argue that insurance companies and the pharmaceutical industry have stymied their efforts.

Dr. Anita Raghuwanshi, of Beebe Healthcare specializing in endocrinology, diabetes and metabolism, noted that physicians must fight insurance companies for diabetes medication a patient actually needs –– not just what is approved by the insurer. Prescription drug coverage can change within six months, she added, which is frustrating once a doctor finds a regimen that works. Innovative, new medications are also more expensive.

Dr. Anita Raghuwanshi, an endocronolgist with Beebe Healthcare in Lewes, consults with Portia Miller of Lewes about her type 2 diabetes on Monday afternoon. DOUG CURRAN/SPECIAL TO THE NEWS JOURNAL
(Photo: DOUG CURRAN/SPECIAL TO THE NEWS JOURNAL)

Pharmaceutical companies, especially those that manufacture generic diabetes drugs, should be transparent about how much they spend for production versus what they charge the consumer, Raghuwanshi said. Insulin doesn’t come in a generic form because regulatory approvals are so strict, but the cost of other generic diabetic drugs is increasing, she added.

“That’s just pure greed,” Raghuwanshi said. “It’s a huge problem… that we are putting profits above our nation’s well-being – both our financial well-being and the nation’s health.”

Kristin Rogers, an AstraZeneca spokeswoman, said the drug manufacturer prices its medications to “remain competitive, but more importantly so that we can invest in bringing new medicines to market to address unmet patients’ needs.”

Last year, patients saved $617 million through an AstraZeneca program that offers free or reduced medicine to qualifying patients, she said.

Still, patients with Type 2 diabetes spend an average of $6,000 annually visiting specialists, filling prescriptions and stocking up on supplies. That’s 2.3 times higher than the annual health care costs for those who don’t have diabetes.

Stumpf’s bathroom counter is lined with miniature plastic cups, three for each day, 24 pills in all. They treat his blood sugar, cholesterol, stomach acid and more.

One vial of insulin costs him $55 and he needs two over 90 days. Medicare doesn’t cover insulin, insulin pens, syringes, needles, alcohol swabs or gauze unless the use of an insulin pump is deemed “medically necessary.”

Chrissy Nelson, of Seaford, also has piles of supplies. But she occasionally rations her medicine.

Chrissy Nelson, of Seaford, talks about discovering she had diabetes after she had her gallbladder removed in 2007.
(Photo: JASON MINTO/THE NEWS JOURNAL)

Diagnosed with Type 2 diabetes in 2007 after she had her gallbladder removed, the 46-year-old subsists on her $769 monthly disability check, which also supports her unemployed husband. The couple pays $400 a month to rent a room with a mini fridge and microwave in a friend’s house.

A local pharmacy has helped Nelson, a peer center volunteer, cover her co-pays of $30 or more. Some days, she wishes she didn’t have to deal with diabetes. It’s just one more thing to manage.

But after watching both her diabetic parents die before they could settle into retirement, Nelson won’t ignore it.

She sticks to a fixed eating schedule, even if she can’t afford frequent snacks or fresh fruit.

“I’m a stressed person,” she said, softly.

Burtaine, of Highmark, admits that insurers place limits on how much medication and supplies a person with diabetes can purchase. If a doctor authorizes additional blood sugar test strips for a patient, the patient can appeal to increase the coverage allowance, he said.

“The real issue I see in America with diabetes is one of compliance and adherence,” he said. “It’s maddening. You look at this and go, ‘there’s no reason for this.'”

The slow pace of prevention

CHAPTER 4

Health experts seize on prevention programs as the most effective tool in reversing alarming rates of diabetes worldwide. More than 400 million people are diagnosed each year and 1.5 million die from the disease.

“As a country, if we were devoting all our resources to prevention rather than treating after the fact, we would be much healthier and richer,” said Carter of DSU.

But public awareness campaigns have been slow to coalesce.

The American Diabetes Association closed its Delaware office, among others, at the end of 2014 due to funding gaps, according to Jones, who shares a part-time position with one other Delaware Diabetes Coalition staffer. The state contributes less than $30,000 a year to the coalition to pay for operations, an annual wellness expo and distribution of a diabetes resource guide to medical professionals.

For the last three years, Delaware’s diabetes rate has hovered around 11 percent.

Don Post, director of the state Division of Public Health’s Diabetes Program, is hopeful that the state’s diabetes numbers will decline over time. The state program offers free six-session training programs for people with Type 2 diabetes. Roughly 3,000 people have participated in the lessons, which target medication adherence, nutrition, mood and physical activity. About one-quarter of enrollees drop out, which is in line with the national average.

The program falls under a $500,000 annual budget funded by state and federal governments to tackle both diabetes and heart disease prevention.

More needs to be done, Lenhard said: “We haven’t scratched the surface in education.”

He praised England for recently rolling out the world’s first nationwide program aimed at at-risk individuals for Type 2 diabetes. Covering 26 million people, or half of the country’s population, the program will test different prevention models as part of a larger campaign to curb obesity rates.

In the U.S., which doesn’t have single-payer national health insurance, it takes longer to build a prevention infrastructure, enlist all the stakeholders and complete clinical trials to determine the most successful approaches, said Albright of the CDC. Only in the last few years has the nation initiated a conversation about prediabetes.

“We have got to work to get most of the players to the table,” Albright said. “This is an incredibly serious issue in our country.”

The CDC has certified more than 850 diabetes programs. Slightly more than half have reported the number of patients helped, totaling about 40,500 people. Nationally, the CDC estimates that more than 86 million U.S. adults have prediabetes and nearly 30 million live with diabetes.

In recent years, insurance companies, employers, the American Diabetes Association, the national YMCA and the American Medical Association have joined with government health officials in investing in wellness strategies to curb one of the costliest diseases in the U.S.

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(Photo: KAREN OKAMOTO/TNJ)

Highmark, for instance, employs nurse educators who call non-compliant or very sick diabetic patients to discuss their treatment plans; prediabetic patients can access wellness coaches. If employers opt in, Highmark also offers discounts to help workers lower out-of-pocket costs for diabetes and other diseases, Burtaine said.

UnitedHealthcare partnered with the CDC, the AMA and others on a national diabetes prevention campaign that began in 2010. The AMA recently determined that prediabetes and hypertension were critical areas to target improving patient outcomes.

No more mayo sandwiches

CHAPTER 5

Maybelle Diane Delaney is borderline wistful when she describes the white bread-and-mayo sandwiches she inhaled as a kid sitting on her mother’s lap.

Maybelle Diane Delaney
(Photo: BETSY PRICE/THE NEWS JOURNAL)

Until recently, nobody told her how many carbs were in that sandwich. Or in a tomato for that matter.

Diagnosed with Type 2 diabetes more than two decades ago, the quick-witted New Castle resident began the routine of pills and insulin. She had been warned of prediabetes — Type 2 runs in her family — but no one mentioned a food pyramid.

Delaney watched her mother, a Type 2 diabetic, lose one toe after another. Then her entire leg.

Her mother never complained, Delaney remembers, but she also never left the house, feeling too insecure to confront the outside world after losing her sight and hearing.

Type 2 diabetes also claimed Delaney’s older brother, who died of a massive heart attack in 1998. His final words to his sister: “Leave that candy alone.”

A retired bank worker who wears a tight curl in her hair, Delaney found her current Christiana Care specialist, James Hays, in the phone book.

During her first appointment, Hays studied Delaney’s long list of medications. “We’re getting off that,” she remembered him saying. “And we’re getting off that.”

“He was stern,” Delaney said. “He was what I was looking for. Like going to the sergeant.”

Hays ordered a lifestyle makeover for his patient. Delaney, 65, stopped drinking her neighbor’s syrupy lemonade and eating broccoli flavored with a stick of butter.

She got off the breathing machine she used for five years and the twice-daily insulin injections. She lost 50 pounds and she’s down to a single pill, three times a day.

For exercise, she’ll walk the aisles of grocery stores, decrying how a Weight Watchers frozen entree can pack more than 500 mg of sodium.

Delaney cheats, too. With a cupcake. OK, maybe two.

But she finds sustenance in lean meats, frozen vegetables and her doctor’s annoyingly practical advice.

“I listen,” she said, “because I want to live.”

Imagine Delaware: Combating Diabetes

CALL TO ACTION

On Thursday beginning at 5 p.m., The News Journal will host “Combating Diabetes,” an Imagine Delaware event at Cab Calloway School of the Arts in Wilmington, which is serviced by public transportation.

Following a vendor fair featuring preventive strategies and treatment solutions, a panel discussion will begin at 7 p.m. with health leaders from the American Medical Association, Christiana Care and the state Department of Health.

ShopRite will provide diabetic friendly snacks for the event.

“Diabetes is a huge problem in Delaware and getting bigger,” said Susan Leath, president and publisher of The News Journal. “But we can help slow it down if people understand the danger of high blood sugar, and do what they can to monitor it.

“We hope our journalism and Wednesday’s forum, sponsored by Christiana Care, will serve as a call to action for people to become better educated about this debilitating disease.”

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In search of fair drug prices

http://www.latimes.com/business/la-fi-lazarus-20160422-column.html

When CVS Health in February began taking over pharmacy operations at more than 1,600 Target stores, CVS Pharmacy President Helena Foulkes called the changeover “an important milestone.”

“Our heart is in every prescription we fill, and providing accessible, supportive and personalized healthcare is part of our DNA,” she said.

Accessible, supportive, personalized — those are all good things. But noticeably missing from Foulkes’ list of consumer-friendly DNA components was this: affordable pricing.

Riverside resident Jerry Good was accustomed to paying between $40 and $50 at his local Target for a vial of sildenafil, which is generic Viagra and thus not covered by most insurance plans unless prescribed for heart failure.

Good, 70, doesn’t use it for heart failure, so he pays cash, along with a discount card from the price-comparison website GoodRX.

Last month, he went in for a refill and was astonished to learn that, with CVS now running the Target pharmacy, he was being charged $241 for the same 60 little white pills.
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“I’m all for people making a reasonable profit,” Good told me. “But this is just price gouging.”

He asked to see the manager. He wanted to know why a prescription refill that had cost about $50 in December was 380% more expensive just three months later.

“The manager said he’d been hearing complaints from a number of people,” Good recalled. “He said it was because they were now using CVS’ pricing schedule.”

Good promptly switched his prescription to a nearby Vons pharmacy, where he was charged just $45 for sildenafil.

His experience with cash-only purchases highlights the wide range that can exist in healthcare pricing — a crazy situation that’s often hidden from consumers because insurers pick up the bulk of the tab.

It’s important to remember, though, that higher prices paid by insurers ultimately means higher premiums for policyholders. So when charges for prescription meds reach ridiculous levels, everyone ends up suffering.

To see what happened in Good’s case, I first contacted Target. A spokeswoman for the chain declined to comment, telling me to take up the matter with CVS.

Mike DeAngelis, a CVS spokesman, said the drugstore wasn’t to blame.

“This increase was caused by changes made by GoodRX, not by CVS Health,” he said. “Discount card programs are administered by third-party networks and these networks establish the discounted price, not the pharmacy. In addition, drug prices under discount card programs can fluctuate regularly and vary from network to network.”

True. Take a look at sildenafil costs on GoodRX’s website. For 60 pills with a 20-milligram strength, Wal-Mart, Kmart, Safeway and Kroger each charge about $45, using GoodRX’s discount card or coupon.

On the other hand, you’ll be charged nearly $1,000 at Rite-Aid. Walgreens charges more than $450.

Doug Hirsch, co-chief executive of Santa Monica-based GoodRX, said such huge differences are “the nature of pharmacy pricing.” Some drugstores are amenable to offering customers discounts, some aren’t, he said.

Yet since no pharmacy will sell drugs at a loss, it’s reasonable to assume that the discounted price of $45 for 60 sildenafil pills is something close to a fair price. Anything above that, Hirsch acknowledged, almost surely represents pure gravy for the drugstore.

“We don’t control the prices of drugs,” he said. “CVS has its own relationships with suppliers.”

In this case, however, it seems that the changeover from Target to CVS caused some drug prices to spike higher than CVS wanted. Hirsch said GoodRX has been in touch with the drugstore and with the pharmacy benefit manager that helps provide discounts to GoodRX cardholders.

In coming days, he said, the price of sildenafil at CVS should drop again to the roughly $45 that Good had been paying when it was still a Target pharmacy.

“This whole thing was kind of a blip,” Hirsch said.

You could say that. Or you could say it was an unintended pulling back of the curtain on all the hocus pocus that goes into healthcare costs. And consumers have every reason to be concerned as industry consolidation gives them fewer choices.

“Less competition usually means higher prices,” said Jason Doctor, as associate professor at USC’s School of Pharmacy. “We’ve seen that again and again.”

Mireille Jacobson, director of UC Irvine’s Center for Health Care Management and Policy, said the dwindling number of drugstore chains makes it harder and harder for consumers to know they’re being treated fairly.

“These are not highly competitive markets,” she said. “These are markets with a handful of big, big players, and with customers usually sticking with whatever drugstore is closest to them.”

Target was a relatively small player in the drugstore business — and apparently not that good at it. The company’s chief financial officer, John Mulligan, acknowledged last year that Target’s pharmacy business posted “modestly negative” results in the previous fiscal year despite generating $4 billion in sales.

The company chose to let CVS buy the business for nearly $2 billion.

“All this consolidation among drugstores means the remaining players have more market power and more economies of scale,” said Sean D. Sullivan, a pharmacy professor at the University of Washington.

“That could mean lower prices for customers. But what you usually see instead is higher prices because of monopoly-like power.”

I asked CVS’ DeAngelis how much a cash-only purchase of sildenafil would run without a GoodRX discount card. He replied that this information is “not relevant.”

It couldn’t be more relevant. Unless consumers know the true costs of healthcare, they’ll never know if they’re being fleeced.

As it happens, GoodRX says 30 sildenafil tablets, without a discount card, will cost $528 at CVS.

And with the card, it’ll soon be about $25. That’s some discount.

Shop around. Check sites like GoodRX to see which stores are charging lower prices and which ones are ripping you off. See what kind of savings can be found through mail-order pharmacies or discount programs.

Blips happen. And seldom in your favor.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to david.lazarus@latimes.com.

 

 

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http://thunderoverlouisville.org/

http://www.wdrb.com/

Starting about noon on 04/23/2016 is the start of what we know locally as the KY Derby Festival. Everyone knows that the KY Derby is the first Saturday in May.

Normally about two weeks before the Derby.. the TWO WEEKS prior the “kick off” for the derby is call THUNDER OVER LOUISVILLE…

Which will draw upwards of 800,000 to the banks of the Ohio River to watch the day’s festivities.

The finally of this day .. starts about 09:30 PM with abt a 30 minute massive fireworks shows that is matched to a music score.

As best as I can tell the local FOX channel WDRB is the designated channel to broadcast on line the entire day..

For those of you who like FIREWORKS… this is suppose to be the largest display in the entire country and it is put on by the premier fireworks company  http://www.zambellifireworks.com/ and takes some six major corporate sponsors to fund this huge party.

If you have a large HD TV… it is best viewed IN THE DARK on a big HD TV screen.. If you are into fireworks, get you a soda, pop some popcorn and take a 30 minute break on Saturday night and enjoy, and when it all over.. be glad you are not among the 800,000 that are trying to leave the area by car and trying to get home… because it makes normal rush hour look like a non-issue 🙂

 

 

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It has taken less than 24 hr for the various news channels to race each other as to who was going to be first to speculate on Prince’s death.. racing to reach the conclusion that his death was somehow related to a “drug overdose”.

Reportedly that he had “hip problems” .. so could he have been a chronic pain pt ?  Could he have “over done it” at a concert trying to meet his fans expectations and trying to “push the pain back” and took one dose too many ?

He appeared to be a very private introvert. Had the pressures of preforming and managing his pain become too much to deal with ?

We may never know the truth behind his demise.

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