PBM executives are heading to Capitol Hill this week. Here are 4 things to watch

https://www.fiercehealthcare.com/payer/pbm-executives-head-to-hill-4-things-to-watch

Pharma CEOs went before the Senate last month, and now it’s PBMs’ turn to be on the hot seat. 

Executives at five pharmacy benefit managers will testify before the Senate Finance Committee on Tuesday in the latest hearing on solutions to drive down drug prices. Express Scripts, CVS Caremark, Humana, Optum and Prime Therapeutics will be represented on the panel. 

Drug rebates—and the Department of Health and Human Services’ plan to eliminate them—are likely to be center stage in the discussion around the role that PBMs play in rising drug prices. PBMs play a shadowy role in the pharmaceutical supply chain and have been a prime target for criticism, especially from drug companies, in the price debate. 

Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Ore., said in a statement upon inviting the PBMs to testify that “middlemen in the healthcare industry owe patients and taxpayers an explanation of their role.” 

RELATED: Pharma CEOs go after familiar target in drug hearings—insurers 

“There’s far too much bureaucracy and too little transparency getting in the way of affordable, quality healthcare,” Grassley and Wyden said. “We’ve heard from pharmaceutical companies, and it’s only fair that the committee has the opportunity to ask questions of other players in the healthcare supply chain.” 

Here are a few things to watch at Tuesday’s hearing: 

1. Breaking into the drug rebate ‘black box’ 

As Grassley and Wyden made clear in their invitation to the PBMs, one of policymakers’ key concerns about drug rebates is the lack of transparency around the negotiations and who gets a cut of the discounts. 

Azar echoed this concern when HHS announced the rebate rule, saying that shining light on this “hidden system of kickbacks to middlemen” is driving up drug costs. 

The central criticism lobbed at PBMs by drug companies is that, because these negotiations happen behind closed doors and are not provided directly to consumers, insurers use the savings to line their own pockets instead of driving down costs for plan members. 

RELATED: Express Scripts hits back at criticisms of PBMs, says it ‘would do just fine’ without drug rebates 

PBMs have hit back at this criticism. The Pharmaceutical Care Management Association launched an ad campaign called #OnYourRxSide to dispute the idea that pharmacy benefit managers are the key driver behind rising drug costs. 

“PBMs have an established and successful track record of implementing consumer-friendly, market-based tools, such as negotiating with drug manufacturers, to lower costs for consumers,” PCMA President J.C. Scott said. 

2. Will eliminating rebates bring down drug costs? Depends on who you ask 

HHS argues that its rule—which would eliminate the anti-kickback protections for rebates and instead provide those legal safeguards to point-of-sale consumer discounts—will drive down drug prices. Drug companies have said the same. 

However, insurers, as one might expect, have disputed that claim. PCMA issued a report on Thursday that analyzes the costs that might be associated with the end of rebates, and it suggests that it could drive up overall drug spending by nearly $200 billion over the next decade. 

RELATED: Winners and losers under bold Trump plan to slash drug rebate deals 

The Centers for Medicare & Medicaid Services Office of Actuary does, to some degree, back up this assertion. An analysis from the actuaries on the rule estimates (PDF) that if the rule were implemented it could drive up overall drug spending by $137 billion by 2029, and Part D spending by $196.1 billion. 

Expect this debate to be a hot topic during the hearing. Coincidentally, the comment period on HHS’ proposed rule ends Monday, so the rule could take effect in short order following the PBMs’ testimony. 

3. The blame game 

Finger-pointing has been the name of the game in this debate, and Tuesday’s hearing is likely to include more of that. At their hearing, drug companies deflected blame for rising drug costs by targeting insurers and PBMs. 

Expect PBMs to return the favor on Tuesday. Industry groups, including PCMA, America’s Health Insurance Plans and the American Hospital Association have had harsh words for drug companies and say that they—not PBMs and payers—are the source of rising costs. 

RELATED: CVS looks to begin rollout of new PBM contracting model in 2019 

“The drugmakers have a long tradition of finger-pointing,” said Erik Rasmussen, AHA’s vice president of advocacy and public policy. “They’ll say it’s everyone’s fault but mine.” 

Of note in this cross-sector blame game is that the hearing panel will be entirely made up of PBM executives, so drug companies will not have the opportunity to respond directly to criticisms of them made at the hearing, paralleling their own hearing where PBMs were unable to counter their claims. 

4. Expect the grilling to be bipartisan

As evidenced by the joint statement, addressing drug prices is of bipartisan interest, and in the Senate Finance Committee’s series of hearings so far, both Democrats and Republicans have been tough on industry players who may have a role in rising costs. 

Though a divided Congress is not likely to undertake a major legislative overhaul, industry experts have noted that action on drug prices is one issue that draws interest from both sides of the aisle. 

It’s an issue that’s also of particular interest to Grassley, who became chairman of the committee this year, as evidenced by the hearings. 

In the statement, the two senators said that “every part of the industry” has a role to play in driving down drug prices, and said they hope PBMs come to the hearing armed with “real information” and will discuss “real solutions.” 

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War on opioid abuse is striking the wrong target

Prescription drugs help people in pain. They aren’t to blame for the rise in opioid deaths.

http://www.aei.org/publication/war-on-opioid-abuse-is-striking-the-wrong-target/

Patients in pain have become collateral damage in the war on opioids.

That’s the message of a letter from more than 300 medical professionals, including three former White House drug czars, to the Centers for Disease Control. In 2016, the CDC issued guidelines to discourage doctors from overprescribing opioids. The signatories believe that those guidelines are being misapplied in a way that keeps many patients in agony.

Among policymakers, however, the focus is still on cracking down on prescriptions. Thirty-three states had imposed some type of limit on opioid prescriptions by last October. Democratic Senator Kirsten Gillibrand of New York and Republican Senator Cory Gardner of Colorado are pushing for a federal limit. Under their legislation, initial prescriptions for acute pain could cover no more than seven days and include no refills.

In the senators’ press release, Gardner says: “As I’ve met with Coloradans impacted by the opioid epidemic, the recurring story is clear. Oftentimes, the first over prescription spurs the devastating path of addiction.”

Gillibrand concurs: “One of the root causes of opioid abuse is the over-prescription of these powerful and addictive drugs.”

The bipartisan pair of senators have the same mindset that led then Attorney General Jeff Sessions to recommend last year that people in pain “tough it out” with aspirin rather than opioids. President Donald Trump, too, has called for reducing opioid prescriptions. “It’s so highly addictive,” he has said. “People go into a hospital with a broken arm; they come out, they’re a drug addict.”

This understanding of the opioid crisis has less and less grounding in reality. Illicit drugs, rather than prescription medications, have accounted for an increasing proportion of deaths from opioids.

The CDC reports 47,600 opioid overdose deaths for 2017. Heroin was involved in 15,500 of them. A drug category that mainly represents manufactured fentanyl and similar drugs was involved in 28,500.

Pain medications, meanwhile, were involved in 14,500: too many, but a minority of all cases. In some of these cases, illicit substances were also present. (The numbers for each category add up to more than the total because many overdoses include more than one drug.) The heroin- and fentanyl-related deaths have been rising much faster than the medication-related ones.

Other research suggests that prescription opioids are acting less and less as a “gateway drug” for opioid abuse. More and more opioid abusers are starting with heroin. Between 2005 and 2015, the percentage of opioid abusers who started with heroin grew from 9 percent to 33 percent.

Pain patients, contrary to a common view, have a low rate of addiction to opioids when you look closely at the research. A study of nearly 570,000 people who took opioids after surgery received attention when it was published last year for concluding that prescription refills were associated with a “large increase” in rates of misuse.

But the overall rate was low, including less than 1 percent of the sample. My American Enterprise Institute colleague Sally Satel reviewed some of the other research for Politico last year.

The campaign against over-prescription of opioids has succeeded in affecting medical practice. The prescription rate peaked in 2012 and has fallen steeply in recent years.

One might have hoped that by reducing the number of addicted patients and keeping excess medicines from being available for diversion into the street market, reducing prescriptions would dent the death toll from opioids. But during this period, the overdose-death rate has kept climbing: Those 47,600 deaths in 2017 set a new record.

It’s to Gardner and Gillibrand’s credit that their bill does not apply to prescriptions for chronic pain. The pleas of physicians and patients about the costs of the prescription crackdown may be starting to be heard.

But the record of recent years raises the question of whether a federal crackdown is a good idea in the first place. It misidentifies the root of the problem: It mostly has to do with people who are seeking out opioids for abuse, not who got addicted from prescriptions.

It is accompanied by a lot of counterproductive political rhetoric that discourages people from getting safe treatment for pain by telling them they will become addicts. And it does not seem to be succeeding in its fundamental aim of saving lives.

Each year, nearly as many Americans are dying from opioids as died in the entire Vietnam War. Increased interdiction of drugs at the border and funding for drug courts and treatment may help reduce those harrowing numbers. A continued bipartisan focus on prescriptions, though, will guarantee that too much of the war on opioid abuse will keep being fought on the wrong front.

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Emergency Department Program Aims At Reducing Opioid Use Disorder

https://www.news-line.com/PH_news28523_enews

Alabama hospital emergency departments have become all too familiar with patients suffering from opioid overdose.

The state leads the nation in opioid prescriptions, according to the Centers for Disease Control and Prevention, and Jefferson County alone saw 98 deaths from heroin and 104 from fentanyl use in 2017. Opioid abuse, whether street drugs or prescriptions, is rampant.

“Emergency departments are the tip of the spear where societal problems meet healthcare,” said Erik Hess, M.D., vice chair for research for the University of Alabama at Birmingham Department of Emergency Medicine. “The nation’s opioid epidemic plays out every day in our emergency departments.”

The UAB Department of Emergency Medicine is launching a new initiative to help patients with opioid use disorders get appropriate therapy and referral for further assistance in an effort to put a dent in the epidemic. The program, called the ED MAT, or Medication Assisted Treatment Protocol, is funded by a $1.5 million grant from the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services. Telehealth can provide individuals with a number of different services including: specialist referral services, patient consultations, and remote patient monitoring. Specialist referral services involve both a doctor and a specialist, who work together to come up with an accurate diagnosis for the individual. Patient consultations use video and audio in order to come up with a diagnosis and an effective treatment plan. Remote patient monitoring is where devices are used remotely to collect data that is sent to a monitoring station and is interpreted by a health professional. This helps professionals to come up with an effective treatment plan and to spot any changes in condition quickly. Telehealth can be used to measure and monitor and measure a number of different areas and these include: blood pressure, blood glucose levels, oxygen levels and weight. These systems can be beneficial because they can reduce the number of visits that an individual needs to make to their doctor or to the hospital. You can get more information about Telehealth.

Program partners include the UAB Center for AIDS Research and the Jefferson County Department of Health, which has undertaken a county-wide effort to coordinate care for persons with opioid use disorder.

The Jefferson County Department of Health helped establish the Recovery Resource Center, a referral hub at Cooper Green Mercy Health Services that assesses the severity of an individual’s opioid addiction, determines the intensity of treatment that is required, and coordinates referral to appropriate treatment centers, including the UAB Addiction Recovery Program, the Fellowship House, and the Beacon Addiction Treatment Center, among others.

The program has several components. The ED MAT program consists of the use of buprenorphine/naloxone in the ED to treat the symptoms of opioid withdrawal and to decrease cravings, followed by a short-term prescription of buprenorphine/naloxone if appropriate and a take-home naloxone kit.

Buprenorphine/naloxone, also known as Suboxone, is used to treat opioid use disorder. It can reduce withdrawal symptoms for 24 hours.

“It helps to lessen withdrawal so that a person feels more like their usual self, more normal,” says Hess, who is principal investigator on the project. “As they return to normalcy, they become more capable and willing to engage in treatment, which is an important first step to recovery. Studies show that Suboxone is very effective in getting patients into treatment and getting them clean.”

Patients will also be connected face-to-face with a peer navigator while in the emergency department.

“This is a hard handoff to a peer navigator – an individual in sustained recovery from opioid use disorder who has ‘been there,’ who can help the patient understand the options for continued therapy and how to maneuver through the system to access those options,” Hess said. “The emergency department is our window of opportunity to treat these patients, as many don’t tend to see medical providers outside of emergency situations.”

The navigator will assist patients with referrals to follow up treatment through the Recovery Resource Center of Jefferson County at Cooper Green Mercy Services.

“I’m elated to see that Dr. Hess and his team are able to start this innovative program,” said Mark Wilson, M.D., health officer for the Jefferson County Department of Health. “It fills a critical gap for people who are desperately seeking effective treatment for their opioid addiction or who have just survived an overdose. It will definitely save lives. I hope it can become a model that other emergency departments can replicate.”

Another component of the program will be to increase the number of physicians licensed to administer Suboxone. The Drug Addiction Treatment Act of 2000 provides a waiver for physicians who have undergone the DATA 2000 training to prescribe Suboxone. The program goal is to have 75 percent of UAB emergency physicians receive DATA 2000 waiver training. Currently only about three percent of Alabama physicians have received that training.

Program administrators anticipate enrolling 550 patients with opioid use disorder over the three years of the program.

“We’ve set ambitious goals that we think are reachable,” Hess said. “We hope to have 75 percent of our MAT clients report abstinence from opioids at six months and we aim, along with our community partners, to decrease the number of deaths in Jefferson County from opioid overdose by 30 percent over three years.”

The UAB emergency department has extensive experience integrating public service programs into ED workflow, following the creation of universal testing for HIV and Hepatitis C virus in ED patients beginning in 2011.

“We already have the necessary systems in place to identify and track these patients while we link them to appropriate follow-up care,” said Ricardo Franco, M.D., an investigator in the UAB Center for AIDS Research and co-principal investigator. “There is considerable overlap between intravenous drug use and HIV or HCV infection. This program offers a unique opportunity to have an impact on reducing not only opioid use but also the incidence of HIV and HCV infection.”

According to SAMHSA, the number of admissions for heroin in Alabama increased 220 percent from 2014 to 2017. Jefferson County’s overdose rate of 48.75 per 10,000 population was significantly higher than the statewide average of 19.9 percent per 10,000. The Jefferson County Coroner’s office reports 269 illicit drug deaths in 2017.

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Pharmacists, state chamber at odds over prescription benefits

https://www.tulsaworld.com/news/pharmacists-state-chamber-at-odds-over-prescription-benefits/article_2f79d3b4-23c0-50de-b20b-f0bd11b889fb.html

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Local veteran says nationwide push against opioids is hurting some of those who served

https://kfor.com/2019/04/04/local-veteran-says-nationwide-push-against-opioids-is-hurting-some-of-those-who-served/

OKLAHOMA CITY – For 20 years, Don White bravely served our country and put himself in harm’s way.

“There’s two Purple Hearts,” White said, showing his accolades. “I could have had three but I didn’t want to argue about it. There’s the Bronze Star, Silver Star, Combat Infantry Badges on my hat.”

While a lot of pride comes from his time in the military, there has also been considerable pain.

“My right leg was shot almost off on March 12, 1969,” White recalled. “My ring finger had been shot completely off. They managed to sew it back on. I’ve been hit in the face a couple of times, friendly fire.”

Since leaving the service, White has worked as a realtor and written two books about his time in Vietnam.

He says with old injuries and a degenerating spine, the pain has always been a part of his life. However, things took a turn when he fell and broke several ribs in February.

The veteran, who is in his 80s, says he went to OU Medical Center for treatment and was sent home with some opioid pain medication.

When the pills ran out, he says the pain returned. He says he asked the VA for something to help with the pain, and he was given something that didn’t seem to make a dent in the suffering.

“You turn the TV on, you see how wonderful the veterans are,” White said. “Well, the veterans need something for pain.”

He says he believes a nationwide initiative to slow the prescription of opioids is affecting those who really need them.

News 4 reached out to the VA for a comment. We were told that White’s allegations are “not entirely accurate and missing key context,” adding that “publishing them would be irresponsible.”

“I don’t care what you publish,” White said. “I just told you the truth. They can’t stand the truth, well there it is.”

White says he doesn’t blame the local VA. In fact, he says his doctor at the clinic is one of the best he’s had.

Instead, he blames the national push to slow the prescriptions, saying while he’d never want a young person to die from misusing the drug, many elderly veterans need them.

“Those people have got to be able to stop some pain and Excedrin won’t get it done,” he said.

The Oklahoma City VA Health Care System declined to go on-camera but provided News 4 with this statement:

“Patient privacy laws prevent us from commenting on the care of individual Veterans, but please note that these allegations are not entirely accurate and are missing key context. Publishing them would be irresponsible. Our country’s opioid epidemic is a public health emergency and this national crisis demands a holistic approach.

VA is recognized by many as a leader in the pain management field for the responsible use of opioids, and the department is sharing its knowledge and experience with federal and local governments and across the nation’s health-care networks.  In 2017, VA released its top eight best practices for reducing opioid use. These best practices are invaluable tools for others working to balance pain management and opioid prescription rates.

In 2018, VA became the first hospital system in the country to publicly post its opioid dispensing rates.

Because some Veterans enrolled in the VA health care system suffer from high rates of chronic pain, VA initiated a multi-faceted approach called the Opioid Safety Initiative (OSI) to make the totality of opioid use among America’s Veterans using VA health care visible at all levels in the organization. From January 2017 through December 2018, the program has resulted in 117,981 fewer Veteran patients – a 26 percent reduction – receiving opioids

We expect even better management of pain medications for Veterans when VA and the Department of Defense roll out new, integrated electronic health records. The new records will give health care providers a full picture of patient medical history, enabling better treatment and better clinical outcomes. It will also help us better identify Veterans at higher risk for opioid addiction and suicide, so health care providers can intervene earlier and save lives.”

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Woman given Narcan for asthma attack now being treated for brain injury

http://www.fox8live.com/2018/10/31/woman-given-narcan-asthma-attack-now-being-treated-brain-injury/

CINCINNATI, OH (FOX19) – A wife and mother is being treated for a brain injury stemming from an asthma attack and now the family is blaming the Pierce Township Police Department.

The family says instead of responding to her respiratory issues they treated her for an overdose. Police Chief Jeff Bachman says his officers did nothing wrong, however. In fact, he says his officer’s actions likely saved the woman’s life.

Heather Matson is trying to put together the pieces of exactly what happened Oct. 14 that left her mother at Bethesda North Hospital fighting to recover from a serious brain injury. Louis Cione says around 1 a.m. he woke up after his wife Tammy — Maton’s mother — collapsed.

“I heard my wife fall. I woke up I grabbed her I called my son we laid her out on the floor. I told my son to call 911,” said Cione.

He says the 911 operator began giving them directions to do CPR until help arrived. He realized that he should soon find CPR and first aid courses in Brisbane to deal with such emergencies. When a responding officer asked what the woman may be on, Cione’s son said she was not on anything, adding she’d just collapsed.

Cione said that from there, the officer gave his wife Narcan.

“I just watched him and he was shaking her and shaking her and calling her name. I told Matt, my son, he’s not even doing CPR. He’s just calling her name and shaking her, so I stuck my head in and I said, ‘Excuse me do you know how to do CPR or do I need to help?’ I said I don’t know how, but I’ll help if I need to. He said, ‘I know what I’m doing, I’m getting a response, step out of the room sir,'” Cione said.

Cione says medics arrived about 10 minutes later and his wife was taken to the hospital. The family says she was diagnosed with an asthma attack, which led to respiratory failure causing cardiac arrest.

“The time that she went without oxygen actually caused the anoxic brain injury,” said Matson.

Chief Bachman says the officer used two rounds of Narcan and went on to do CPR for seven to eight minutes until the fire department arrived.

“If he would have done chest compressions instead of shaking her then I think she would have been okay,” said Cione.

Currently, the woman is still unresponsive and is being treated in the hospital.

The family doesn’t know what the future holds or if the woman will make a full recovery.

“I feel like because of the heroin epidemic they’re starting to make assumptions. I know she’s not the only one and I’m afraid she won’t be the last one. I think going into it with the assumption that it’s an overdose sets up failure for anything else,” said Matson.

The family says they aren’t sure what actions they plan to take next but most importantly they want first responders to review their policies and to make sure they are providing the best treatment to save lives.

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http://nymag.com/intelligencer/2017/05/republican-sick-people-dont-deserve-affordable-care.html

Republicans usually defend their health-care position with an array of buzzwords like choice, patient-centric, or competition. In a CNN interview, Representative Mo Brooks, an Alabama Republican, makes the case for Trumpcare in much starker terms: It will free healthy people from having to pay the cost of the sick. “It will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” explained Brooks. “And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.”

It is certainly true that the Republican health-care plan will spur insurance companies to charge more money to people with expensive medical needs, and less to healthier people. (It will also transfer hundreds of billions of dollars from the poor, who will get reduced Medicaid and tax credits to buy insurance, to the rich, who will receive a large tax cut.) The idea that morality dictates healthy people pay less, and sick people more, has been floating around the margins of conservative health-care thought. John Mackey, the libertarian owner of Whole Foods, made this case in a 2009 Wall Street Journal op-ed denouncing Obamacare:

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.

When Democratic Senator Tom Harkin in 2010 proposed that it was time to stop segregating Americans on the basis of health status, the conservative health-care analyst Jeffrey H. Anderson scoffed, “Having people pay their own way is apparently an injustice akin to segregating them by race or creed.”

Of course, you can’t pay your own way if you’re too poor or sick to afford your own projected medical costs. Indeed, sometimes people who are healthy at the moment find one day they are not, or they have a sick child, or maybe they simply want to have a baby. (The cost of bearing children is another one Republicans want to be borne entirely by those doing it.) The Republican plan expresses one of the core beliefs shared by movement conservatives, and utterly alien to people across the globe, right and left: that people who can’t afford the cost of their own medical care have nobody to blame but themselves.

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