Myth 8: Overprescribing
Over prescribing: Dr. Thomas Kline, MD, PhD: Medical Myths Revealed
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Myth 8: Over prescribing: Dr. Thomas Kline, MD, PhD: Medical Myths Revealed
Posted on January 8, 2020 by Pharmaciststeve
Are CHRONIC PAIN PTS the only group not involved in suing someone over the opiate crisis.
Posted on January 8, 2020 by Pharmaciststeve
Major Pharmacy Chains Claim Doctors, Other Providers Are Responsible For Opioid Crisis In New Lawsuit
“The pharmacist is not supposed to be second guessing the medical necessity of the doctor’s prescription,” said Timothy Johnson, an attorney for
Discount Drug Mart. Walgreens, CVS, Rite Aid, Walmart and others who have found themselves in the cross hairs over who was responsible for curbing the opioid crisis filed their own suit against providers.
when “deep pockets” start suing each other… then perhaps we really have some sort of crisis.. how much long before the insurance/PBM industry gets sued… after all they did PAY FOR ALL THE OPIATES … so how much of a stretch is it that the law firms start suing them because after all they did pay for most/all of those opiates. ?
could all of these legal activity cause some/many healthcare corporations to “just say no ” when it comes to dealing (prescribing, filling, paying ) with opiates. The financial liabilities could prove to be just too costly.
Of course, throwing tens of millions of chronic pain pts into untreated/unrelenting pain… may end up being NOT THEIR PROBLEM
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Managing Hypertrophic and Keloid Scars With Silicone Scar Tape
Posted on January 7, 2020 by Pharmaciststeve
A scar іѕ simply whеrе thе skin hаѕ hаd tо heal аftеr bеіng injured іn particular wау. Thе skin саnnоt heal bасk tо іtѕ original state аnd thеrеfоrе creates fibrous tissue іn thе place оf thе wound. Aѕ a result оf thіѕ, a scar forms. Scar treatment іѕ оftеn called fоr.
Thеrе аrе mаnу wауѕ thаt people саn gеt scarred. Sоmе scarring аlwауѕ happens frоm certain surgery, ѕuсh аѕ wіth breast cancer surgery. Acne саn саuѕе thе face аnd оthеr parts оf thе bоdу tо bе scarred. Different types оf injuries саn аlѕо create scarring оn thе skin. You can get anesthesiamore info about anesthesia right before surgery, do your research.
Whеn a hypertrophic scar forms, іt stays wіthіn thе immediate area оf thе wound. Thеѕе scars саn bе treated wіth a variety оf treatments successfully. Keloid scars оn thе оthеr hаnd spread past thе area аnd оftеn hаvе a tumor-like appearance. Keloid scars саn bесоmе ѕо severe thаt surgery іѕ merited.
Thеrе аrе types оf scar treatment available today frоm rubbing creams аnd oils оn thеѕе scars tо having surgery dоnе оn thеm. Sоmе оf thе creams аnd oils work wеll аnd ѕоmе don’t dо thе job аt аll. Scars аrе seldom removed completely еvеn thrоugh plastic surgery; thеіr appearance саn bе minimized, thоugh.
Laser treatments аrе оftеn dоnе оn scars today. Thіѕ does hаvе certain ѕіdе effects thоugh, so you can consider Touch Up Laser as thе skin wіll stay rеd fоr ѕеvеrаl days following treatment. Women саn hide thіѕ redness thrоugh using makeup, but men can’t ѕо thіѕ mіght bе аn issue.
Onе оf thе best treatments today іѕ thе uѕе оf Silicone Scar Tape оn thе scars. Wearing a Silicone Scar Tape оvеr a scar stimulates thе skin tо heal itself, thеrеfоrе thе scar’s appearance іѕ nоt аѕ pronounced. Thіѕ usually takes ѕеvеrаl weeks tо accomplish maximum results. Thіѕ scar treatment саn bе used оn scars thаt аrе old tоо. Thе older scars саn bе successfully minimized. The Law Office of Daniel Deng is where you will find the top legal advisers whose help you can seek.
Thе regimen іѕ usually tо start оut wearing thе silicone sheets fоr аbоut 30 minutes a day. Thеn thе person ѕhоuld gradually increases thе length thе sheet іѕ worn untіl thеу аrе wearing іt аll day. Thе sheets аrе worn untіl thе maximum results аrе reached. At thаt tіmе, thе scar wіll bе minimized аѕ muсh аѕ іt саn bе. Thе Silicone Scar Tape produce amazing results оn mоѕt scars.
Thе silicone sheets usually hаvе tо hаvе ѕоmе tape applied оvеr thеm tо allow thеm tо bе secure оn thе skin. Thеу ѕhоuld оnlу bе worn durіng thе day; thе skin ѕhоuld bе allowed tо breathe аt night. Thеѕе Silicone Scar Tape саn work оn hypertrophic аnd keloid scars bоth. Thе best results wіll bе seen оn thе hypertrophic scars thоugh.
If оnе suffers frоm scarring оf аnу kind, thеу ѕhоuld try thеѕе silicone sheets fіrѕt bеfоrе оthеr kinds оf treatments. Thеу mау fіnd thаt nо оthеr kind оf scar treatment іѕ necessary. It wоuld bе better thаn having tо hаvе surgery dоnе оn thе scars. Mоѕt people аrе vеrу satisfied аftеr using thе sheets оf silicone tо remove оr minimize thеіr scars.
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Novo Nordisk to offer free insulin to U.S. patients in immediate need
Posted on January 6, 2020 by Pharmaciststeve
Novo Nordisk to offer free insulin to U.S. patients in immediate need
Novo Nordisk said on Thursday it would offer free, one-time supply of insulin to people in immediate need and at risk of rationing the medication, the rising price of which has attracted fierce criticism from lawmakers and regulators.
Novo said prn.to/36kkhaq patients with prescription can get a free, one-time supply of up to three vials or two packs of pens of its insulin, after which they should find a longer-term solution from its other affordability offerings.
The drugmaker said in September U.S. patients can buy three vials or two packs of pens of its analog insulins for $99, following similar moves by rivals Sanofi SA and Eli Lilly and Co.
The cost of insulin for treating type 1 diabetes in the United States had nearly doubled from 2012 to 2016, leading some patients to put their health at risk by rationing the medication.
Last year, following heavy criticism over the prices, Eli Lilly started selling a half-price version of its Humalog insulin and Sanofi said it would cut the cost of its insulin products to $99 per month for some patients.
Novo on Thursday also announced the launch of cheaper versions of its heavily prescribed insulin drug, Novolog.
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Monday 8 PM EDT: communication campaign to end government overreach
Posted on January 5, 2020 by Pharmaciststeve
Monday Webinar:
The Communication Campaign
Link: https://join.me/sevenpillars
How do we get information to the legislators and President that they can’t ignore and dismiss with a form letter? Through coordinated mass emails/FB posts/tweets from hundreds of constituents at the same time. DoctorsofCourage is spearheading such a campaign.
Major advocates in the work of stopping the attacks on patients and pain management providers met on the webinar Monday, June 24. We put our heads together, discussed what has been tried, but hasn’t worked, and are working on a coordinated effort to design effective communication. This is a start. We will be working every Monday on a communication campaign that hopefully all will participate in. If you have any ideas to share, please send them to me at lindacheek@doctorsofcourage.org. I will share with the group. If you are interested in becoming an active advocate in the campaign, please join us next Monday at 8:00 EDT.
To dial in by phone:
United States – Camden, DE
+1.302.202.5900
United States – Denver, CO
+1.720.650.5050
United States – Los Angeles, CA
+1.213.226.1066
United States – New York, NY
+1.646.307.1990
United States – Tampa, FL
+1.813.769.0500
United States – Washington, DC
+1.202.602.1295
Conference ID:
848-079-407 #
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Sudden, Unexpected Death in Chronic Pain Patients
Posted on January 4, 2020 by Pharmaciststeve
Sudden, Unexpected Death in Chronic Pain Patients
https://www.practicalpainmanagement.com/sudden-unexpected-death-chronic-pain-patients
Severe pain, independent of medical therapy, may cause sudden, unexpected death. Cardiac arrest is the cause, and practitioners need to know how to spot a high-risk patient.
Sudden, unexpected death may occur in a severe, chronic pain patient, and the terminal event may be unrelated to medical therapeutics. Fortunately, sudden death is not as commonly observed in pain patients as in past years most likely due to better access to at least some treatment. Sudden death still occurs, however, and practitioners need to know how to spot an “at-risk” patient.
Unexpected, sudden death due to severe pain is poorly appreciated, since many observers still view severe pain as a harmless nuisance rather than a potential physiologic calamity. In many cases, just prior to death, the patient informs their family that they feel more ill than usual and seek relief in their bed or on their couch. Unfortunately, some of these patients don’t awaken. Other patients die, without warning, in their sleep or are found collapsed on the floor. Modern medicine’s aggressive toxicology and forensic procedures after death have contributed to the poor understanding of pain’s death threat. In some cases, a pain patient that was being treated appropriately with an opioid or other agent with overdose or abuse potential has suddenly and unexpectedly died. Drugs were found in body fluids after death, and in my opinion a coroner wrongly declared the death to be an “accidental overdose” or “toxic reaction” to drugs rather than implicate the real culprit, which may have been an “out-of-control” pain flare.
This article is partially intended to call attention to the fact that the mere finding of abusable drugs at autopsy doesn’t necessarily mean that the drugs caused the death. In fact, the drugs may have postponed death. Some physicians have been falsely accused of causing deaths due to drug overtreatment when, in fact, undertreatment of pain may have caused the death. Additionally, opioid blood levels assessed at autopsy of a patient who died suddenly are all too often wrongfully considered accidental overdoses because the pathologist is unaware that chronic pain patients on a stable dose of opioids can be fully functional with serum levels of their prescribed opioids that far exceed lethal levels in opioid-naïve patients.1
Given here are the mechanisms of sudden, unexpected death in pain patients and some protective measures that practitioners must take to keep from being falsely accused of causing a sudden, unexpected death. More importantly, given here are some clinical tips to help identify the chronic pain patient who is at high risk of sudden, unexpected death so that more aggressive pain treatment can be rendered.
A Brief Anecdotal History
As a senior medical student at Kansas University in the early 1960s, I was required to take a rural preceptorship with a country doctor. In making our rounds one day to the county’s nursing home, I heard a farmer’s wife declare, “pain killed my mother last night.” Since then, I’ve repeatedly heard that pain killed a loved one. Folklore frequently mentions that people die “from,” as well as “in” pain. There is, however, little written detail of these events.
In the early years of my pain practice, which I began in 1975, I had several patients die suddenly and unexpectedly. This rarely happens to me today as I’ve learned to “expect the unexpected” and to identify which patients are at high risk of sudden death. In recent years, I’ve reviewed a number of litigation and malpractice cases of sudden, unexpected death in chronic pain patients. In some of these cases, physicians were accused of over- or misprescribing and causing a sudden, unexpected death, even though the patient had taken stabilized dosages of opioids and other drugs for extended periods. Also, the autopsy showed no evidence of pulmonary edema (a defining sign for overdose and respiratory depression). In cases where the physician was falsely accused, the post-death finding of abusable drugs in body fluids caused a family member, regulatory agency, or public attorney to falsely bring charges against a physician.
Setting and Cause
Unexpected deaths in chronic pain patients usually occur at home. Sometimes the death is in a hospital or detoxification center. The history of these patients is rather typical. Most are too ill to leave home and spend a lot of time in bed or on a couch. Death often occurs during sleep or when the patient gets up to go to the toilet. In some cases, the family reports the patient spent an extraordinary amount of time on the toilet just prior to collapse and death. Sudden and unexpected death, however, can occur anywhere at any time, as pain patients who have died unexpectedly and suddenly have been found at work or in a car.
Coronary spasm and/or cardiac arrhythmia leading to cardiac arrest or asystole is the apparent cause of death in the majority of these cases, since no consistent gross pathology has been found at autopsy.2-5 Instant cardiac arrest appears to account for sudden collapse or death during sleep. Perhaps constipation and straining to pass stool may be cardiac strain factors as some pain patients die during defecation. Acute sepsis due to adrenal failure and immune suppression may account for some sudden deaths.
Two Mechanisms of Cardiac Death
Severe pain is a horrific stress.6,7 Severe pain flares, acute or chronic, cause the hypothalamic-pituitary-adrenal axis to produce glucocorticoids (cortisol, pregnenolone) and catecholamines (adrenalin and noradrenalin) in an effort to biologically contain the stress.8,9 Catecholamines have a direct, potent stimulation effect on the cardiovascular system and severe tachycardia and hypertension result.10 Pulse rates may commonly rise to more than 100 beats per minute and even rise to more than 130 beats per minute. Blood pressure may reach more than 200 mmHg systolic and more than 120 mmHg diastolic. In addition to adrenal catecholamine release, pain flares cause overactivity of the autonomic, sympathetic nervous system, which add additional stimulation to catecholamine-induced tachycardia and hypertension. Physical signs of autonomic, sympathetic overactivity, in addition to tachycardia and hypertension, may include mydriasis (dilated pupil), sweating, vasoconstriction with cold extremities, hyperreflexia, hyperthermia, nausea, diarrhea, and vomiting.
The combined physiologic effects of excessive catecholamine release and autonomic, sympathetic discharge may put such strain on the heart to cause coronary spasm, cardiac arrhythmia, and sudden death.11 Pain patients who have underlying arteriosclerosis or other cardiac disease are at higher risk of sudden death. For example, a patient with angina or generalized arteriosclerosis is at high risk, and should be aggressively treated. Anecdotal reports have been made in which a patient whose pain was well controlled on opioids died unexpectedly with an underlying cardiac disease. In one report, a 40-year-old pain patient on opioids was found dead and the autopsy revealed previously unrecognized coronary artery disease, which was determined to be the cause of death. Some patient deaths may be due to other comorbid conditions, whether known or not known, and may not be related to the pain problem.
Case Example #1
A 60-year-old male with severe pain due to Lyme’s disease–related arthritis has generalized arteriosclerosis. When his pain flares, he has hypertension, tachycardia more than 100 beats per minute, and angina. On numerous occasions, he had been hospitalized for chest pain and he regularly requires nitrates for emergency coronary relief. He was treated with a long-acting opioid for baseline pain and a short-acting opioid for breakthrough pain. This regimen has controlled his angina and has prevented hospitalizations for more than 2 years.
The second mechanism, which may produce sudden death, is adrenal insufficiency. The hypothalamic-pituitary-adrenal axis may acutely and suddenly deplete during episodes of severe pain resulting in a life-threatening drop in cortisol, aldosterone, and possibly other adrenal hormones (Figure 1).12 With a precipitous drop in adrenal hormone production, there can be a severe electrolyte imbalance (eg, low sodium, high potassium), which may produce cardiac arrhythmia and death. Although undocumented, some sudden deaths may likely be a simultaneous result of excess sympathetic stimulation and electrolyte imbalance.
Identification of the At-risk Patient
An active, ambulatory pain patient who has mild to moderate, intermittent pain is not at high risk for sudden death. The patient at high risk for sudden death is a severe pain patient who is functionally impaired and has to take a variety of treatment agents, including opioids and neuropathic drugs, to control pain. In all likelihood, the patient who has centralized pain and who has central nervous system inflammation due to glial cell activation is the patient who will likely have flares severe enough to affect the endocrine and cardiovascular systems. Acute pain severe enough to cause cardiac overstimulation and death is usually only seen with severe trauma. Pain as a result of modern-day surgery is well controlled by analgesics, so perioperative sudden death due to surgically induced pain, per se, is essentially a thing of the past. Accidents, trauma, and war wounds are exceptions. In these situations, a patient in excruciating pain who shows signs of excess sympathetic discharge needs progressive emergency pain treatment to control excess sympathetic discharge.13,14 Excess sympathetic discharge signs that can be discerned at the bedside, emergency room, or accident site include mydriasis, diaphoresis, hyperthermia, tachycardia, hypertension, and hyperreflexia.15,16
The chronic pain patient who is at high risk for sudden death can usually be spotted at a clinical visit (Table 1). Patient and family will give a history of functional impairment. The most typical history will be one in which the patient will have constant, daily pain intermixed with severe flares, which cause a bed or couch-bound state. Even though medication dosages may be high, they may not be effective enough to prevent pain flares and sudden death. The patient will likely demonstrate excess sympathetic discharge. By history, this includes waves or episodes of allodynia, hot and cold flashes, hyperalgesia, and severe insomnia. Physical exam may reveal excess sympathetic discharge by any or all of the following signs: tachycardia, hypertension, vasoconstriction (cold hands/feet), mydriasis (dilated pupil), and hyperreflexia.
Cortisol, pregnenolone, or corticotropin (adrenocorticotropic hormone) serum levels may be subnormal indicating that the immune and healing systems are impaired, leaving the patient subject to infections and interference with opioid effectiveness.
When high-risk indicators are found, therapeutic adjustments in type, quantity, and quality of pain treatment must be implemented to minimize or eliminate risk factors. In particular, there should be attempts to normalize hypertension, tachycardia, and hormone levels.
Methadone Administration And Sudden Death
Other than overdose and respiratory depression, the opioid methadone has been associated with a cardiac conduction defect (prolonged QT interval) called “torsades de pointes,” which may cause an unexpected, sudden death.17,18This defect may cause sudden death by cardiac arrests. No other opioid has been credibly associated with cardiac conduction defects. In addition to the problem of QT prolongation, many methadone-related deaths occur during the first few days of use, making the deaths in these instances more likely due to the prescriber’s unawareness of methadone’s long half-life and, therefore, accumulation in the bloodstream because the dose was titrated too quickly.
However, the recognition of QT prolongation has caused considerable controversy and many experts believe that an electrocardiogram should be done to screen for a prolonged QT interval before and/or during methadone administration.17 The occurrence of “torsades de pointes” with methadone is usually dose related and associated with concomitant use of antidepressants or benzodiazepines. If a patient who takes methadone suddenly dies due to cardiac arrhythmia, there will be no gross pathology at autopsy, which is typical of sudden death in a pain patient. The prescribing physician may, however, be accused of overprescribing methadone. Due to this risk, many physicians have made a choice to shun methadone and avoid the risk of being falsely accused for overprescribing. From a clinical perspective, the use of antidepressants and benzodiazepines should be restricted if methadone is prescribed, since these ancillary agents appear to facilitate methadone deaths.
Risk of Sepsis
Although not well documented, acute sepsis and sudden death probably occur in some severe, chronic pain patients. The mechanism is probably initiated by subnormal serum levels of cortisol or other hormones due to adrenal depletion. Chronic subnormal adrenal hormone levels severely compromise the protective immune system in the body, rendering the patient susceptible to virulent bacteria and other pathogens.19,20 The author has frequently found extremely low levels of cortisol (fewer than 1.0 mg/dL) in undertreated intractable pain patients. One can only wonder as to how many pain patients have suddenly died from acute sepsis. Although documentation of this pathologic event is scant, practitioners should be aware that extremely low serum levels of adrenal hormones are known to be associated with a compromised immune system and sepsis.
Death Following Sudden Opioid Cessation
There is the misguided notion among some addiction and mental health practitioners that withdrawal from opioids is an innocuous procedure that is risk free. This school of thought says that only withdrawal from alcohol and benzodiazepines is risky. This is generally true unless the patient who is dependent upon opioids has severe underlying pain and is taking opioids solely for pain control. In some patients, opioids may mask underlying pain so well that a practitioner may not even believe that pain recrudescence is a possibility once opioids are stopped.
Patients who have severe pain that is well controlled by opioids may be sudden-death candidates if their opioids are precipitously stopped. If opioids in a severe pain patient are precipitously stopped, the masked pain may flare causing severe autonomic, sympathetic discharge and overstimulation of the adrenals to produce excess catecholamines with subsequent cardiac arrhythmia and arrest. Malpractice suits have occurred when opioids have been precipitously stopped in a pain patient. Here are two examples known to the author.
Case Example #1
A 45-year-old woman with fibromyalgia and severe pain was well controlled with extended release morphine for baseline pain and short-acting hydrocodone for breakthrough pain. She entered an in-patient detoxification program where she was told that fibromyalgia only required psychotherapy and no opioids. The detoxification program precipitously stopped all her opioids and placed her in isolation for punishment because she was using opioids as a “crutch” rather than “facing her problems.” She died suddenly about 36 hours after all opioids were stopped.
Case Example #2
A 42-year-old male had a work injury and subsequently suffered reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS). His pain was reasonably well controlled with fentanyl transdermal patches (Duragesic) for baseline pain and short-acting oxycodone (OxyContin) for breakthrough pain. His workers’ compensation carrier had him evaluated by “experts” who claimed that pain couldn’t possibly exist for more than about 6 months after injury, and RSD and CRPS were not “legitimate diagnoses.” His workers’ compensation carrier, based on their “experts’” opinions, precipitously stopped all his opioids by refusing to pay for them. The man died suddenly 4 days after abrupt cessation of his opioids.
Value of Opioid Serum Levels
Patients who have severe chronic pain, take opioids, and demonstrate some high-risk signs and symptoms for sudden death as described above should have opioid blood levels done. Why? Legal protection. If a severe chronic pain patient who takes opioids suddenly dies, the practitioner may be accused of overprescribing and causing an overdose death unless he/she has pre-death opioid blood levels on the patient’s chart. Keep in mind that there will be no gross cardiac pathology at autopsy if the patient suddenly dies of a cardiac arrhythmia or arrest. And, the coroner will likely call the death a drug overdose and blame the prescribing physician. Here are two illustrative cases.
Case Example #1
A 28-year-old male, former football player had severe spine and knee degeneration. He died in his sleep and his death was brought under investigation by the coroner. At autopsy he had a methadone blood level of 400 ng/mL. The prescribing physician was about to be charged with negligence by the local district attorney, until the physician showed that, in life, the patient’s methadone blood levels ran between 500 to 650 ng/mL.
Case Example #2
A 58-year-old female with genetic porphyria had suffered from severe generalized pain for more than 20 years. She collapsed in her living room in sudden death. At autopsy she was found to be wearing three fentanyl dermal patches (100 mcg/hour). At autopsy she demonstrated a fentanyl blood level of 10 ng/mL and a morphine blood level of 150 ng/mL. Her prescribing physician was able to show the sheriff’s investigators that in pre-death treatment, she had fentanyl and morphine blood levels considerably above these found at autopsy. No charges were ever brought against the physician.
Summary
Although sudden, unexpected death in chronic pain patients appears to be declining in incidence due to greater access to treatment, practitioners need to be aware that sudden, unexpected death may occur independent of opioid administration. The precise mechanism of death is cardiac arrest or asystole due to coronary spasm, arrhythmia, and/or electrolyte imbalance. Severe chronic pain produces excess sympathetic discharge through the autonomic nervous system and overstimulation of the hypothalamic-pituitary-adrenal axis, which causes great output of adrenal catecholamines. The chronic pain patient who is at highest risk for sudden death is the patient whose uncontrolled pain and pain flares are so great as to cause a high degree of functional disability. Those pain patients who are ambulatory and active are not at high risk for sudden death. The attainment of opioid blood levels during treatment of patients who are at high risk for sudden death are advised as a medical-legal protection should opioids be present in blood after death. Patients who are identified as high risk should be monitored by regular clinic visits, and efforts should be done to control excess sympathetic discharge and adrenal deficiencies.
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Highway robbery is ILLEGAL … EXCEPT for (PBM) Prescription Benefit Managers
Posted on January 4, 2020 by Pharmaciststeve
Metformin ER (Glucophage XR)
Generic Glucophage XR
Metformin ER (Glucophage XR) is an inexpensive drug used to treat type II diabetes. It helps control blood sugar in combination with diet and exercise. This drug is slightly more popular than comparable drugs. It is available in brand and generic versions. Generic metformin ER is covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower. The lowest GoodRx price for the most common version of metformin ER (Glucophage XR) is around $3.00, 69% off the average retail price of $9.98.
This is apparently how the “PBM highway robbery game is played”.. The above is from www.goodrx.com This shows that the AWP (Average Wholesale Price) is $1667.77 and CVS/Caremark paid the pharmacy a total of $155.21 – $40 from the pt & Caremark $115.21 and in turn CVS/Caremark sent the pt’s insurance company a bill for $1212.33
And what did CVS/Caremark do to earn $1057.12 administrative fee ?
Not much more than what a Visa/MC/Amex/Discover does when a person uses them to pay a purchase. For which a charge card will charge the seller a 2%-3% service charge.
Is Anthem insurance that STUPID about the price or is there some “back door” kickback/rebate/discount from CVS/Caremark to Anthem…
Everyone – especially members of Congress – is complaining about the cost of Rx medication. Maybe the fact that the insurance/PBM industry has one of the largest pot of money to hire lobbyists has something to do with Congress’ lack of knowledge what is really behind the high cost of Rx meds ?
Filed under: General Problems | 1 Comment »
chuckle of the day 01/04/2020
Posted on January 4, 2020 by Pharmaciststeve
Filed under: General Problems | 5 Comments »
PULL THE PLUG: she’s on a constant stream of painkillers, sedatives and paralytics
Posted on January 3, 2020 by Pharmaciststeve
Judge Rules Hospital Can Take Baby Off Life Support
https://blackamericaweb.com/2020/01/02/judge-rules-hospital-can-take-baby-off-life-support/
DALLAS (AP) — A Texas judge on Thursday sided with a hospital that plans to remove an 11-month-old girl from life support after her mother disagreed with the decision by doctors who say the infant is in pain and that her condition will never improve.
Trinity Lewis had asked Judge Sandee Bryan Marion to issue an injunction in Tarrant County district court to ensure that Cook Children’s Medical Center doesn’t end her daughter Tinslee Lewis’ life-sustaining treatment. Texas Right to Life, an anti-abortion group that is advocating for Tinslee, said the girl’s mother will appeal the judge’s decision.
Doctors at the Fort Worth hospital had planned to remove Tinslee from life support Nov. 10 after invoking Texas’ “10-day rule,” which can be employed when a family disagrees with doctors who say life-sustaining treatment should be stopped. The law stipulates that if the hospital’s ethics committee agrees with doctors, treatment can be withdrawn after 10 days if a new provider can’t be found to take the patient.
In a statement issued by Texas Right to Life, which opposes the “10-day rule,” Lewis said she was “heartbroken” over the judge’s decision. “I feel frustrated because anyone in that courtroom would want more time just like I do if Tinslee were their baby,” she said.
The hospital said in a statement Thursday that in order to keep Tinslee alive, she’s on a constant stream of painkillers, sedatives and paralytics. She currently has severe sepsis, which isn’t uncommon when patients require deep sedation and chemical paralysis, it said.
“Even with the most extraordinary measures the medical team is taking, Tinslee continues to suffer,” the hospital said.
Efforts to find another facility to take her have been unsuccessful. The hospital said it has reached out to more than 20 facilities. Texas Right to Life and Protect TX Fragile Kids have also been trying to find a facility to take her.
Prior to Thursday’s ruling, both sides agreed that if Marion denied the injunction request, the hospital would wait at least seven days before taking Tinslee off life-support. In her decision, Marion said the seven-day period would give the girl’s mother time to file a notice of appeal and a motion for emergency relief with a state court of appeals.
Tinslee has been at Cook Children’s since her premature birth. The hospital said she has a rare heart defect and suffers from chronic lung disease and severe chronic high blood pressure. She hasn’t come off a ventilator since going into respiratory arrest in early July and requires full respiratory and cardiac support.
Lewis testified at a hearing last month that despite her daughter’s sedation, she has a sense of the girl’s likes and dislikes, describing her as “sassy.” She said Tinslee likes getting her nails done but doesn’t like having her hair brushed.
“I want to be the one to make the decision for her,” Lewis said about removing her daughter from life support.
At the hearing last month, Dr. Jay Duncan, one of Tinslee’s physicians, described the girl’s complex conditions and Cook Children’s efforts to treat her, which have included about seven surgeries. The cardiac intensive care doctor said that for the first five months of Tinslee’s life doctors had hope she might one day at least be able to go home.
But Duncan said there came a point when doctors determined they had run out of surgical and clinical options, and that treatment was no longer benefiting Tinslee. Duncan said last month that the girl would likely die within half a year, and noted the hospital has made “extraordinary” efforts to find another facility for her.
“She is in pain. Changing a diaper causes pain. Suctioning her breathing tube causes pain. Being on the ventilator causes pain,” he said.
Duncan said there had been “many, many” conversations with Tinslee’s family about her dire condition.
Tarrant County Juvenile Court Judge Alex Kim issued a temporary restraining order to stop the removal of life support on Nov. 10. But Kim was removed from the case after the hospital filed a motion questioning his impartiality and saying he had bypassed case-assignment rules to designate himself as the presiding judge.
After his removal, Judge Marion, who is chief justice of Texas’ Fourth Court of Appeals, was assigned to hear the request for an injunction in Tarrant County district court.
The case has become a rallying point for Republicans in Texas, with the attorney general stating his opposition to the “10-day rule” and GOP state Rep. Tan Parker saying it “doesn’t fit with Texas values.”
The 1999 law that shields from lawsuits doctors who follow the process of going through an ethics committee was crafted by a task force that included lawmakers, attorneys, doctors and anti-abortion groups. Supporters of the law passed when George W. Bush, a Republican, was governor include the Texas Alliance for Life, the Texas Catholic Conference of Bishops and the Texas Medical Association.
Supporters say the law provides a framework for doctors and hospitals to resolve differences and ensures that doctors can’t be forced to perform medical interventions that cause harm or suffering.
I have mixed emotions about this situation. “PAIN” is mentioned many times as the basis behind the decision and mentioned a few times of other meds – probably controlled substances – that she was receiving routinely.
It was not mentioned in this article but some others that I have read the current hospital had supposedly contact as many as 20 other hospital to take on the care of baby Tinslee going forward and none wanted to take on the care of this baby.
There is only a mention of Tinslee’s Mother in the picture… where is the Father ?
Is Trinity Lewis a single Mother ?
Is MONEY a underlying issue ? 11 months at $3000/day her care could hit ONE MILLION although most likely such high-touch, high-tech care could in the end the total cost to date could be multi millions.
No matter how this ends…. not everyone will be happy ….
Filed under: General Problems | 6 Comments »
If you didn’t check your Part D program before the end up the year – you may be getting $crewed
Posted on January 3, 2020 by Pharmaciststeve
We have been using Silver Scripts (part of CVS Health/Caremark) for years… I have always been rather lazy and not checking out Rx prices from various Part D programs until 2019… when I ran the program https://www.medicare.gov/plan-compare/#/?lang=en to find out what would be the least expensive annual out of pocket costs for us.
We use a local independent and had noticed over the last couple of years… our out of pocket costs for Rxs seem to be going up – dramatically !! Come to find out that Silver Scripts the only TWO PREFERRED PHARMACIES in the county of abt 85,000 population was the CVS Rx dept in Target and a new CVS store – these stores is one of the most congested roads in the entire county and about 1/2 mile apart and at least a 8 mile drive for us to go “into town” as opposed to the local indy that is abt ONE MILE from our house and will deliver if needed.
I took our new Part D cards to the pharmacy on Saturday with a refill that Barb needed and told them to fill it after the first of the year… since this year we have a $450 deductible with the new Part D prgm- but all Part D programs were going to have a deductible or higher premiums to collect the same copay over 12 months.
The prescription that I was to pickup today was suppose to be $55 but when I got there… .it was $92… Come to find out the staffer that I had talked to had filled in on Monday when I dropped it off and billed it to Silver Scripts.
The Pharmacist reversed the Silver Script and billed it to our new Part D program and the price came out as $56.. Keep in mind the Rx filled/billed to Silver Scripts …the $92 was a COPAY and the one filled/billed to our new Part D was FULL PRICE because we are in our DEDUCTIBLE PERIOD… and it is suppose to be $3 once the deductible is met.
So I went to print out all the Rxs filled with Silver Scripts for 2019 and while they don’t automatically show you this.. if you hit the down arrow on each claim it will show what they paid… and found out that they paid little to NOTHING on most of the Rxs that we had filled last year… One very notable Rx was I was charged $147.00 and THEY PAID $6.00
I just checked www.goodrx.com and the quoted prices was a range of $35 -$64 locally. So Silver Scrips (CVS) has been charging me – and everyone else that doesn’t have them filled at a CVS pharnacy ) – from 50% to nearly THREE TIMES the available CASH PRICE at local pharmacies. I was also paying Silver Scripts a MONTHLY PREMIUMS and normally the Part D/PBM gets a rebate/kickback/discount from the Pharma and I don’t know if they are getting any $$$ from the Feds/Medicare on a monthly basis.
Many scream & holler that Medicare should be negotiating prices with the pharmas… looks like they should start putting a mussel on some of their Part D prgms. Silver Scripts is one of the top three Part D providers.
Filed under: General Problems | 1 Comment »