Painkiller and heroin hospitalizations: which Pa. regions had the most?

http://www.pennlive.com/news/2016/01/overdoses_opioids.html#comments

The Pennsylvania region that includes Harrisburg, York and Lancaster experienced a 442 percent increase in hospitalizations for painkillers from 2010 to 2014, according to a new analysis.

That was the largest increase out of nine regions, and more than double the average statewide increase of 204 percent.

The southcentral region also experienced a 305 percent increase in heroin overdose hospitalizations. That was above the statewide average of 145 percent, but below the level of increase in the northwestern and northcentral regions, which saw increases of 426 percent and 509 percent.

The analysis was done by the Pennsylvania Health Cost Containment Council in an effort to shed further light on the crisis of painkiller and heroin overdoses. The epidemic is attributed to easy access to prescription painkiller and a historical cheap supply of heroin. Both drugs are opioids, which are highly addictive and cause addicts to feel severely without an opioid. The majority of heroin addicts first become addicted to a painkiller.

In the midstate, in another public event devoted to the crisis will take place Feb. 8 at 6:30 p.m. in the auditorium of Northern High School near Dillsburg. The session will include a presentation by a heroin task force established by York County.

In terms of sheer numbers of overdoses, the Philadelphia region led the state, with 16.5 heroin overdoses per 100,000 people, and 12.3 painkiller overdoses per 100,000 people, according to the PHC4 analysis.

The southcentral region, made up of counties including Dauphin, Cumberland, Perry, York and Lancaster, had 8 painkiller overdoses per 100,000 people, and 5.4 heroin overdoses.

That statewide average as 8.8 painkiller overdoses per 100,000 people, and 8.7 heroin overdoses.

The analysis found that in 2014, 7.5 percent of hospitalized heroin overdose victims died, as did 1.5 percent of painkiller overdose victims.

The report looked only at painkiller and heroin overdose victims who were hospitalized — not those brought to the emergency room who don’t end up hospitalized.

Joe Martin, the executive direct of the PHC4, said the agency lacks access to the hospital ER data.

Martin said he suspects there would be “many more” case if those who are treated and released from the hospital were counted.

According to the analysis, about 44 percent of the people hospitalized for painkiller overdoses were 40 or older. With heroin, the age skews younger, with 43 percent being younger than 40, and 22 percent being in their 20s.

Filed under: General Problems | 3 Comments »

Brandon denies police violated HIPAA

http://www.clarionledger.com/story/news/2016/01/25/brandon-denies-bpd-violated-hipaa/79313188/?from=global&sessionKey=&autologin=

The city of Brandon denied allegations that one of its police investigators violated the Health Insurance Portability and Accountability Act by accessing a man’s prescription history through a state database, according to court records filed Monday.

A lawsuit filed in federal court last month alleges Brandon Police Department Investigator Chris Bunch accessed Brandon Maddox’s prescription history without probable cause or a court order. Brandon’s response to the lawsuit, which names the city, Chief William Thompson and Bunch as defendants, maintains the department obtained the information lawfully — with probable cause and without violating HIPAA.

However, the lawsuit argues the Board of Pharmacy’s Mississippi Prescription Monitoring Program, which monitors controlled substance prescriptions, violates the Constitution and individuals’ right to privacy by allowing law enforcement officials and licensing boards access without a court order.

“My opinion is Mississippi law … does not comply with United States constitutional requirements as far as them being able to access privileged medical information,” said Donald Boykin, who is representing Maddox in the lawsuit. “In other words, I think the Constitution protects people from unreasonable search and seizure, and in this case, just to go online and not have a court order based on probable cause doesn’t satisfy constitutional requirements.”

Last January, Maddox received a prescription for pain medication from an emergency room doctor, who told him to visit his own physician the next day if he needed more medication. The next day, Dr. Kurt Johnson wrote Maddox a prescription for oxycodone.

About six months later, Bunch used the Prescription Monitoring Program to view Maddox’s prescription history. He spoke with Johnson, who told the investigator he hadn’t known about Maddox’s other prescription at the time.

Maddox was arrested on a prescription fraud charge that was later remanded for lack of evidence, court records show. After Maddox’s arrest, Johnson and his nurse practitioner said in writing that they’d known that Maddox had received a prescription the day before his visit to their office.

The complaint alleges Thompson and Bunch received the statements but said they’d already submitted the case to District Attorney Michael Guest for presentation to a grand jury. The city, however, denies Brandon Police Department received the letters.

“As to why they’re denying that, I don’t know,” Boykin said. “Not only did I sent the letter to them, I discussed that with their city prosecutor. I talked to him and the chief of police, and let them both know about the incorrect information.

“And they both said, ‘It’s out of our hands. It’s already gone to the DA’s office. We can’t do anything about it.’”

The complaint also alleges Johnson gave Bunch records regarding Maddox’s treatment, but the city denies that claim, court records show. Boykin said Bunch showed a treatment-related document to Maddox during his investigation, but it’s unclear how the Brandon Police Department obtained it.

Thompson would not respond to questions about the lawsuit, and Brandon Mayor Butch Lee and Mark Fijman, an attorney representing the city, would not comment, citing policy to not discuss pending litigation.

Filed under: General Problems | 4 Comments »

Editorial: Meth bill would demand too much of pharmacists

http://www.heraldbulletin.com/opinion/editorial-meth-bill-would-demand-too-much-of-pharmacists/article_edb93e41-353b-50e6-9cbb-aabff1a3d774.html

Once again, legislators wants to force Pharmacists to “play doctor” without being able to do a physical exam or have the pt’s medical records. It is also outside/against the Pharmacy Practice Act. IMO.. so if this bill becomes a law.. every time that a Pharmacist sells PSE.. he/she will be required by law to diagnose the pt’s need for the PSE and could be in violation of the Practice Act.  My money is on the Indiana BOP will NEVER take any action against these Pharmacists for violating the practice act.

This one is fraught with landmines.

A bill approved this week by an Indiana Senate committee would enable pharmacists to diagnose a customer’s condition and determine whether to allow the customer to purchase medicine containing pseudoephedrine. Under current Indiana law, consumers need to show their driver’s license to buy such medicine.

The bill is an alternative to another proposal, rejected repeatedly by the Legislature, that would require a physician’s prescription to purchase medicine containing pseudoephedrine. Other states have found similar laws to be highly effective in reducing the making and use of the illegal and volatile drug methamphetamine. Pseudoephedrine is a main ingredient used in the manufacturing of meth.

But this new Indiana bill, and a similar one to be considered Monday by the House Public Health Committee, just doesn’t make sense.

It would empower a group of people who are not physicians to make snap judgments, based largely on appearance, about whether a customer really needs a certain kind of medicine, or whether they will use it illegally to make meth.

Such discretion does not belong with pharmacists, nor should they want it. It would take them away from their core responsibility, dispensing prescription medicine accurately, according to the orders of physicians. It would be impossible to assure that pharmacists applied this discretion consistently from store to store and day to day.

And think of the potential liability. Let’s say a well-meaning pharmacist decides that a customer really does need pseudoephedrine, so her or she allows the person to purchase it. Then the person uses it to cook a batch of meth. Now, let’s say, a person who uses that batch of meth suffers a heart attack and dies.

The pharmacist, potentially, could be held liable for the death of the meth user.

Perhaps the biggest pitfall of this bill, however, is that it is patently unfair to consumers. The ability to purchase a cold medicine that can make them feel better would depend upon the whim of a pharmacist. How could that be considered fair? It’s another lawsuit waiting to happen.

The same Senate committee has also approved the bill that would require convicted drug offenders to have a physician’s prescription to purchase medicine containing pseudoephedrine.

Now, that’s a sensible bill — one that would apply actual criteria to the decision of whether a consumer can buy the medicine.

Filed under: General Problems | 4 Comments »

Fight To Lower Drug Prices Forces Some To Switch Medication

http://www.npr.org/sections/health-shots/2016/01/25/463809474/fight-to-lower-drug-prices-forces-some-to-switch-medication

Steve Miller has some customers on offer. Millions of them in fact.

The chief medical officer at Express Scripts, the largest pharmacy benefit manager in the U.S., has been essentially auctioning off his 80 million customers to the drug companies that will give him the best deal.

“Who wants my market share?” Miller says. “Whoever will give me the best price, I will reward you with an enormous amount of market share.”

Miller is the most vocal leader in what has become a war on drug prices.

Express Scripts and its rivals including CVS/Caremark and OptumRX manage prescription drug coverage for insurers and employers. They’re trying to spark price wars among drugmakers by refusing to pay for some brand-name medications unless they get a big discount.

The result is that average costs for many drugs are falling. At the same time, consumers are being forced to change medications, sometimes to brands that don’t work as well for them.

Tim Kilroy is a father of five who runs a business out of his home in Arlington, Mass. Kilroy has attention deficit hyperactivity disorder — ADHD — and he is dependent on his medications to keep his mind, and therefore his business and family life, in order.

“I had tried several drugs,” he recalls. “I had tried Concerta; I had tried Adderal. Finding the right dosage can be really challenging.”

He spent six years trying medications, adjusting doses, switching and starting over before he and his doctor settled on a long-acting form of Ritalin. He’d finally landed on the drug that worked for him. But about a year ago he switched insurance and the new pharmacy benefit company — United Health Care’s Optum subsidiary — refused to pay.

“I thought, ‘How dare you,’ ” Kilroy says. “How dare this company that I pay money to tell me how to manage my health care. I was really, really angry.”

He paid for the Ritalin once, but it cost more than $120 a month on top of his insurance premiums. So he asked his doctor to move him to another medication that was covered. Kilroy says it does a good job controlling his ADHD, but the side effects include a swollen prostate that makes it difficult to urinate. So now he’s switching insurers again so he can get back on Ritalin.

Kilroy is just one of millions of people affected by this battle between drug companies trying to make as much money as possible and insurers trying to drive down those prices. This year, more than half of all people with insurance will have some medications excluded from coverage, says Ronny Gal, a drug industry analyst at investment firm Alliance Bernstein in New York.

“Drug companies have been pricing their drugs largely along the lines of, you know, whatever you can get away with and still have the patient get the drug,” he says. “This year exclusion will become a standard feature of the industry, which is actually quite a shocker for a lot of patients.”

Express Scripts pioneered the strategy two years ago, when it announced it would no longer pay for 48 brand-name drugs. Right out of the gate it took on some big-name products, such as Advair — the blockbuster asthma drug made by GlaxoSmithKline, now known as GSK.

Advair’s price had risen more than 20 percent in 2013, according to data from SSR Health, a New Jersey-based investment research firm. Then on Jan. 1, 2014, Express Scripts tossed Advair off its drug list and moved its customers to rival asthma drug Symbicort.

The results were immediate. Sales of Advair dropped $1.8 billion that year. The prices of both Advair and Symbicort fell 20 percent in 2014 and are still falling. GSK spokeswoman Jenni Ligday said in a statement that Advair was restored to Express Scripts’ formulary last year.

Filed under: General Problems | Leave a Comment »

We know the cure to the opioid epidemic

http://www.huffingtonpost.com/deborah-hersman/we-know-the-cure-to-the-o_b_9073208.html

Deborah Hersman is president and chief executive officer of the National Safety Council, an organization focused on saving lives and preventing injuries at work, in homes and communities and on the roads. Prior to joining the Council, Ms. Hersman served as chairman of the National Transportation Safety Board. Among her many initiatives as chairman, Ms. Hersman focused attention and actions on distracted driving, child passenger safety and helping victims and their families.

https://www.linkedin.com/in/deborah-hersman-6b821295

According to Ms Hersman’s LinkedIn profile.. she has ZERO experience in any medical field. Yet her post claims that  WE KNOW THE CURE TO THE OPIOID EPIDEMIC. How presumptuous with her background in TRANSPORTATION INDUSTRY.  IMO… another example of PSEUDO EXPERTS regurgitating what they have read from others who are in lockstep with the DEA/CDC/White House and the rest of the alphabet soup of various State/Federal agencies.

Like many others, Bill suffered lower back pain. He was prescribed hydrocodone and then methadone, and an overdose killed him at age 33.

Lance was prescribed opioids for a root canal, after which the Army veteran became addicted. He died in a Texas hotel room of an overdose at age 26.

Michael was prescribed hydrocodone for Crohn’s Disease when he was 18 and, after almost three years of escalating dosages, he took his own life with a shotgun after being unable to find a treatment program.

The stories of Bill, Lance, and Michael are horrifying ones, all of them beginning with a seemingly benign prescription from a doctor. The painful details of these tragedies reveal the depth of the problem. But the scope of the problem has been growing for decades as revealed in autopsies, mortality statistics and epidemiological research.

Last November, a study was released saying that white adults, ages 45 to 54, were seeing their death rate rise as a result of a substantial increase in prescription drug overdoses. The New York Times has published two articles in the last week, calling attention to the steady increase in prescription drug overdoses which has raised the death rates for white adults 25 to 34, and showing that drug overdose deaths have jumped in nearly every county in the nation.

The downward trend lines reflect the progress medical science has made in impacting threats like heart disease, cancer and HIV, extending the lifespans of thousands. The lines climbing upward reflect how the overprescribing of opioid painkillers has virtually wiped out that progress, shortening tens of thousands of lives every year.

In sum, our medical science is helping people live longer, but medicines are helping people die.

Every day in the United States, 52 people die from an overdose of prescribed opioid painkillers. In 2014, there were more overdose deaths from opioids than from heroin and cocaine combined. Most agree on the causes behind the problem, citing uneven prescribing guidelines, marketing of the drugs by the pharmaceutical industry, few limitations on access to the drugs, economic factors and an inadequate number of treatment facilities for drug misuse, abuse and dependence.

The causes behind these trends are complex and intertwined, varying from place to place and from person to person. The solutions are far more straightforward though.

The National Safety Council has joined the Centers for Disease Control and Prevention and other national organizations in calling for broader and more consistent use of state Prescription Drug Monitoring Programs to reduce the availability of opioid painkillers. We also are supporting the publishing of clear guidance for prescribing opioid painkillers for a simple reason: the risks of opioids are outweighing the benefits.

Over-the-counter medicines such as ibuprofen, naproxen and acetaminophen can be as effective or more effective than opioid painkillers, but without the risks of abuse or addiction. Opioids are more expensive, can delay recovery from injury or surgery, and have side effects that pose a safety risk in a work place or on the road. Further, research indicates 80% of new heroin users started with prescription painkillers.

These are good reasons to be thoughtful, if not outright resistant to using opioid painkillers. Opioids are killing more than 18,000 people every year, so asking your doctor, nurse or pharmacist about the alternative options for pain relief and whether opioids are necessary.

At the National Safety Council, we know if we are going to eliminate preventable deaths in our lifetime, people like Bill, Lance and Michael might be alive today if they had known to ask these questions and had the opportunity to make informed decisions about managing their pain.

Filed under: General Problems | 10 Comments »

Teen can’t get chemotherapy drug due to CVS issue

http://www.wowt.com/home/headlines/Teen-Cant-Get-Chemotheraphy-Drug-Due-To-CVS-Issue-366368741.html?ref=741

An Iowa family is furious. Their daughter is battling cancer. She is on a very strict drug maintenance program.

When they went to pick up her chemotherapy drugs, they ran into one hurdle after another.

“She asked me if she was going to die. That was the hardest,” said Makayla Umphreys, Gracie’s mom.

Makayla recalls day one-when she learned her 15-year-old daughter, Gracie, had Leukemia.

Doctors put Gracie on a nine cycle treatment plan that would stretch over several months.

She takes a combination of drugs on an intricate schedule.

“She has three chemotherapy drugs that she takes at various times throughout the cycle, and one cycle is 85 days,” said Makayla.

It was during cycle five-the Umphreys say-that their pharmacy they have used for years, CVS, dropped the ball.

It was on Gracie’s prescription for ATRA, or Tretinol. It’s the *main* drug in Gracie’s fight against Leukemia.

“I get a phone call from a pharmacist at CVS asking if I knew the prescription was going to be moved to their Specialty Pharmacy…no I didn’t of course. I didn’t even know they had such a thing I’d never even heard of it before,” said Makayla.

Makayla says a few days later, she got a call from that Specialty Pharmacy. In some sense it felt like the whole cancer fight was starting all over.

They started asking her all the basic questions again-her daughter’s birth date, height, her weight…

“It frustrated me at first because if anybody should know all this it should be her doctor and her pharmacy,” said Makayla.

But Makayla says she answered all the questions-and was told the ATRA would be called into her CVS.

The next day-on her lunch break-she went to pick it up.

“Over the course of an hour, they tell me that they can’t get it processed yet. They did verify they had the medicine at the pharmacy,” said Makayla.

“It just doesn’t make any sense to me,” said Gracie.

Makayla waited inside for one hour-she says only to be told the Specialty Pharmacy said she didn’t answer all of their questions.

This was news to her.

“We didn’t get cut off. No one tried to call me back,” Makayla said.

“I don’t get why they didn’t fill my prescription and give me my Atra,” said Gracie.

At this point, Makayla says she was frustrated but the pharmacy promised to sort it out and asked her to come back later that day.

Once again, she did.

“I went through the drive-thru because that’s all I needed and they told me they still didn’t have it,” she said.

Malorie Maddox asks, “And you were never given a reason as to what the hold up was?” “Nope. I still don’t know,” said Makayla.

Desperate-at this point-Makayla started calling around to find somewhere to fill her daughter’s chemotherapy prescription.

UNMC was immediately able to help.

“They even offered to meet me somewhere with it which was wonderful,” said Makayla.

Makayla is speaking out in hopes it helps others. She says there should never be an issue in getting chemotherapy drugs.

“I think at the very least for them to review their system,” she said.

WOWT 6 News reached out to CVS. They issued us this statement:

“We apologize to the Umphreys family for the delay they experienced in filling their daughter’s prescription. The dispensing of the medication in question was recently moved to our specialty pharmacy service, which handles medications that treat complex health conditions and provides patients with expert clinical support for complex drug therapies.

Our Specialty Connect program is designed to provide our retail pharmacy customers who require specialty medications with access to specialized clinical support and the flexibility to pick up their prescriptions in-store or have them delivered to their home.

Unfortunately, due to a miscommunication the registration process for the Specialty Connect program was not completed properly, which led to the delay in filling the prescription. We have contacted the family to apologize and to explain our specialty pharmacy service.

We are also addressing the miscommunication issue internally, and we are reinforcing the process our pharmacies should use to ensure that patients do not experience any delays in obtaining their specialty medications.”

Filed under: General Problems | 4 Comments »

Lawsuit: CVS ‘Knowingly and Intentionally’ Overcharging Customers

http://www.newsweek.com/lawsuit-cvs-knowingly-and-intentionally-overcharging-customers-359060

Filed under: General Problems | 1 Comment »

Cigna temporarily banned from new Medicare plans

http://www.usatoday.com/story/money/2016/01/22/cigna-medicare-sanctions/79160738/

U.S. regulators have temporarily banned health insurer Cigna from offering certain Medicare plans to new patients after a probe uncovered issues with current offerings.

The insurer disclosed late Thursday in a public filing that the U.S. Centers for Medicare and Medicaid Services (CMS), had suspended the company from enrolling new customers or marketing plans for Cigna Medicare Advantage and Standalone Prescription Drug Plan Contracts.

In an enforcement letter, CMS accused Cigna of “widespread and systemic failures,” including the denial of health care coverage and prescription drugs to patients who should have received them.

The actions “create a serious threat to enrollee health and safety,” said CMS, which is requiring Cigna to appoint an independent monitor to audit its handling of the matter.

The sanctions, which took effect at the end of the day Thursday, do not affect patients who are already enrolled. CMS said could not provide an estimate for how many patients were affected.

Cigna had market share of 3% in Medicare Advantage plans in 2015, representing about 502,000 patients, according to the Kaiser Family Foundation.

“As a company committed to delivering quality products and services, we focus on putting customers first.  The findings in the audit are unacceptable and will be addressed in full partnership with CMS,” said Herb Fritch, president of Cigna-HealthSpring, in a statement.

“We have internal quality review processes in place that identified some of the areas in advance of the audit findings and we have already started working to remedy them. In other instances, we will implement the changes as quickly as possible to emerge a stronger organization further dedicated to those we serve.”

CMS also accused Cigna of maintaining inadequate documentation and failing to implement a risk assessment program, among other alleged violations.

“Cigna has had a longstanding history of non-compliance with CMS requirements,” the agency said. “Cigna has received numerous notices of non-compliance, warning letters, and corrective action plans from CMS over the past several years. A number of these notices were for the same violations discovered during the audit, demonstrating that Cigna has not corrected issues of non-compliance.”

The news comes several weeks after Cigna shareholders approved the company’s $48 billion sale to insurance giant Anthem. That deal must still win approval from regulators.

Cigna’s revenue from U.S. insurance plans in 2015 reached a projected $30.4 billion, representing total industry market share of 4.1%, according to IBISWorld.

Marianne Udow-Phillips, director of the University of Michigan Center for Healthcare Research & Transformation, said in an email that the issues “must be complex enough to require some substantial operational changes that cannot be done simply and probably did reflect some prior warnings by CMS that were not heeded.”

She added: “Medicare Advantage is a very small part of Cigna’s portfolio and is not the reason why Anthem was interested in merging with them.  They have always been stronger in the self funded/large employer market.  Whether or not these problems will affect Cigna’s other market segments is unclear.”

Filed under: General Problems | 2 Comments »

CDC Over-Counted Opioid Overdoses

http://www.painnewsnetwork.org/stories/2016/1/23/cdc-over-counted-opioid-overdose-deaths#commenting

The conclusion of the report was the same message the CDC has been promoting (as it has been tasked with by the White House) — to reduce the prescribing of opioids.

Do you think that this administration/White House/President Obama… is encouraging all Federal agencies to violate the Americans with Disabilities Act by reducing access to opiates… regardless of a pt’s medical necessity ?

We asked Rose A. Rudd, CDC health scientist and lead author of the report, about the over-counting of overdose deaths.

“Some deaths do include more than one type of drug,” responded Rudd in an email to ADAW. “In 2014, there were 12,159 deaths involving a natural or semi-synthetic opioid; 3,400 deaths involving methadone; 5,544 deaths involving a synthetic opioid (exclusive of methadone); and 10,574 deaths involving heroin. There were 28,647 deaths that involved any opioid: this number of deaths does not the sum to the other categories, as deaths do include more than one type of drug.”

That is not to discount the severity of the opioid epidemic, and the increase in heroin and illicit fentanyl use and overdose deaths. Heroin and illicit fentanyl (not the prescribed medication) were responsible for most of the increase, the report stated. There was a particularly sharp increase in deaths involving synthetic opioids (other than methadone), which, the report said, was in line with law enforcement reports of an increase in illicit fentanyl on the streets. However, pharmaceutical fentanyl cannot be distinguished from illicit fentanyl in death certificates.

Filed under: General Problems | 6 Comments »

Few Ohio pharmacies sell Narcan without a prescription after state law widens access

http://www.wcpo.com/news/insider/few-ohio-pharmacies-sell-narcan-without-a-prescription-after-ohio-law-widens-access

Filed under: General Problems | 4 Comments »