The ideal time for a pt to get their flu shot is the last 2 weeks of Sept thru the first 2 weeks of Oct. Getting your flu shot during this time frame will help assure that the pt’s “blood titer” is as high as possible during what should be the peak flu season. Pts getting their flu shot this early when peak flu season comes around and/or it is a little later than normal. The chain pharmacists may start recommending that the pt get a second flu shot to boost their flu blood titers, to help protect the pt during the peak of the flu season. Of course, getting a booster will take ~ 2 weeks for the pt’s blood titer to peak again, and the protection that the pt has may be sub-therapeutic for 1+ weeks.

Retailers begin to roll out flu, RSV shot appointments

https://drugstorenews.com/retailers-begin-roll-out-flu-rsv-shot-appointments

Walgreens, Rite Aid and Bartell Drugs in the Pacific Northwest are just a few of the retailers who have begun offering the vaccines.

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We had our independent pharmacy for 20 yrs, we were not in a rural area but a small city/county seat with ~ pop of 30,000.  One very memorial day – at least for me – I had a regular pt & wife come in. He wanted his blood pressure taken.  That was before “free-standing blood pressure units” where the pt takes their own blood pressure. It was before digital blood pressure cuffs. I took blood pressure with a BP cuff and a stethoscope.  As I listened to his heart rate it was very erratic and I asked him if his heart rate was always very erratic?  NOPE!. I suggested that he go over to the hospital/ED -<1 mile away. He claimed that he would go home first and then go to the hospital – I knew him very well, that he would not follow thru.  I called Barb out of her office and got her to take the fellow and his wife over to the hospital. He didn’t push back, he knew I was right. A couple of days later, his adult Daughter – also one of our pts – came in and thanked me for saving her Dad’s life. He had been admitted and put in the cardiac care unit and lived to be discharged and sent home. Beside the pharmacy we were a very large home medical equipment (HME) vendor. We normally had 200+ respiratory/oxygen pts – many were home-bound, enteral feeding pts (tube feeding), home IVs, etc, etc. We had a well-trained, experienced staff and I am sure that collectively, we had helped many pts and their QOL health issues. Many I was indirectly involved with. I wonder how these PBMs & mail order pharmacies are going to help pts with their QOL issues?

Local Pharmacies Save Lives, While PBMs Don’t

https://www.realclearmarkets.com/articles/2024/08/01/local_pharmacies_save_lives_while_pbms_dont_1048679.html

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Who put those requirements in place?  The LOWEST COST FOR HEALTHCARE WILL PROVIDE THE BEST PT OUTCOME?

Mark Cuban’s big warning for employers

https://www.beckerspayer.com/workforce/mark-cubans-big-warning-for-employers.html

Mark Cuban is issuing a big warning to self-insured employers: If your company receives pharmacy rebates through employee benefits, prepare for an eventual lawsuit.

“It’s not a question of if, it’s a question of when,” he wrote on X on July 22. “The inevitable class action suit will dwarf the tobacco settlements.”

Mr. Cuban’s comments come as large employers are beginning to face lawsuits from their workers over claims of mismanaging health and pharmaceutical benefits and violating their fiduciary duties under the Employee Retirement Income Security Act. 

ERISA requires self-funded employers acting as health plan fiduciaries to make an effort to find the lowest costs for healthcare services. In 2021, the Consolidated Appropriations Act amended ERISA to create new requirements for consultants and benefits brokers to disclose to employers any direct or indirect compensation they receive. Price transparency requirements enacted the same year also means that employers have gained more tools and are under more pressure to fulfill their obligations to employees.

“But unlike employers who hold a fiduciary responsibility, consultants and brokers do not hold a fiduciary relationship with employees, thus there is no obligation to prioritize the employer’s interest over their own,” researchers wrote in an AJMC study published July 19, and cited by Mr. Cuban.

“In light of recent legal action, employers may wish to better understand the financial incentives of their consultants and brokers when accepting their recommendations for rebate contracting strategies and pharmacy benefit design.”

In the most recent example, Wells Fargo was sued by employees in July for allegedly paying inflated prices to its contracted pharmacy benefits manager, Express Scripts. 

A February lawsuit against Johnson & Johnson accuses the company of paying inflated costs for generic prescription drugs designated as specialty medications to Express Scripts, thereby harming employees through higher costs, premiums, deductibles, copays and lower or limited wage growth. J&J’s employee health plan paid more than $10,000 for a 90-day prescription of a generic drug used to treat multiple sclerosis, which is available for as little as $40 without insurance at retail pharmacies, according to the suit.

“No prudent fiduciary would agree to make its plan and beneficiaries pay a price that is two-hundred-and-fifty times higher than the price available to any individual who just walks into a pharmacy and pays out-of-pocket,” the plaintiff’s attorneys wrote.

With employers increasingly feeling the pressure, some have sued their health plan and third-party administrators directly in an effort to access complete medical claims data. 

In June 2023, Kraft Heinz alleged Aetna used its role as third-party health plan administrator “to enrich itself to Kraft Heinz’s detriment” through undisclosed fees and processing medical and dental claims without human review. The food manufacturer voluntarily dismissed the lawsuit in December and moved it to private arbitration.

But employers can’t always point the finger at third-party administrators, Christin Deacon, an attorney and principal owner at VerSan Consulting, previously told Becker’s. For example, if an employer signed a bad contract that allowed egregious behavior, the TPA could turn around and ask why the employer didn’t act upon that. 

“I think that definitely plays into the fear factor of employers not being more aggressive,” Ms. Deacon said. “There’s plenty out there that are going to get on the bandwagon of being more aggressive with their carriers. Nobody wants to be the first, but everybody wants to be a fast follower.”

“I think the first step is get a handle on all of your existing contracts and relationships and ask for your claims data. Document everything you’re doing to try to be a good fiduciary to the plan,” Ms. Deacon said. “Get your contracts, read your contracts, get your data and put processes in place that are going to help you protect yourself again from that fiduciary liability.”

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PBMs Overpay Their Own Pharmacies to the Detriment of Insurers, Taxpayers, FTC Says

https://www.medpagetoday.com/pharmacy/pharmacy/111338

You’re busier from open to close, but making less than you did the last year, every year

Cash crunch pushes independents to the brink, data shows PBMs the cause

Pharmacy benefit managers (PBMs) often reimburse their own affiliated pharmacies at higher rates than they do independent pharmacies, to the disadvantage of insurers as well as taxpayers, the Federal Trade Commission (FTC) said.

“We see evidence PBMs pay their own pharmacies inflated prices,” said Suzie Jing of the FTC’s Office of Policy Planning, who presented interim results from the agency’s report on PBMs at a commission meeting Thursday. For example, she said, in the case of generic abiraterone (Zytiga) for prostate cancer, “it costs $229 to buy the drug, but the big three PBMs pay their affiliated pharmacies about $6,000 per month on average. That’s double the price paid to unaffiliated pharmacies … This means that the PBM is overpaying itself at the expense of — first, private insurance plans, which can lead to higher patient insurance costs; and second, at the expense of taxpayers who pay for Medicare.”

Jing noted that the top six PBMs manage 94% of pharmacy claims. In addition, “based on our review to date, we find that there’s often no negotiation for contract terms,” she said. “The PBMs’ internal memos reference ‘unilateral’ or ‘passive’ contracts, which are more like notifications — often sent via fax — outlining terms that take effect automatically, without the need for affirmative consent or signature. Reimbursement rates in these contracts can be unfavorable and potentially untenable, especially for local community pharmacies.”

The FTC also found examples in which the PBMs’ rebate contracts with drug manufacturers “are designed to limit access to affordable drugs and will exclude generic drugs from formularies … this is disturbing,” Jing said.

The report was quickly criticized by an industry representative. “Unfortunately, the interim report falls far short of being a definitive, fact-based assessment of the PBM industry,” Austin Ownbey, spokesman for the Pharmaceutical Care Management Association, a trade group for PBMs, said during the meeting’s public comment portion. “It’s devoid of empirics and built entirely around unsupported assertions. It also overlooks the volume discounts provided by the PBMs that demonstrate the value that they provide to America’s healthcare system by reducing prescription drug costs and increasing access to medications.”

On the other side of the issue, several independent pharmacy owners testified that PBMs’ business practices had hurt their business or even forced them to close. “My wife and I were owners of four pharmacies in central Ohio, [but we] closed all four locations in February of this year,” said Joe Craft. “The interim report insights are exactly in line with what I’ve witnessed over my 29 years as a pharmacist.”

“To put it simply, PBM abuses, of which there are many, put us out of business,” he continued. “We owned four stores, and we were having the same problem at each location — we weren’t making enough to cover our cost of operations because of low reimbursement. The PBMs dictated what we were paid and stole from us so we could not succeed no matter how busy we were.” In three of the closed locations, there were no other pharmacies in that same ZIP code, so “the PBMs have created pharmacy deserts where we closed,” he added.

Mallika Kopalle, who operates four independent pharmacies in Utica and Syracuse in New York State, said she also was having financial difficulties. “As we speak, [one large PBM] is taking $21,000 from our small pharmacy,” she said, adding that the PBM’s explanation was that the action was a result of something that happened in 2021. “This is on top of hundreds of thousands of DIR [direct and indirect remuneration] fees which were charged to us. They won’t give us an explanation and they won’t give us any further markdown … We need PBM reform sooner rather than later.”

One speaker told a darker story. “We lost our 22-year-old son to the tactics and greed of PBMs,” said William Schmidtknecht of Windsor, Wisconsin. “My son went into a pharmacy to fill a routine prescription that he would have paid less than $70 for in 2023; 10 days into 2024 he went in there to get his prescription at a pharmacy, and his price was changed to over $500.“

His son was unable to fill the prescription due to the high cost; “he got rushed to the ER on the 15th of January with cardiac arrest due to asthma and died 6 days later,” Schmidtknecht said. “My son’s death is just one of many out there … The reality is the greed, the tactics, the deception, is killing people in this country. You guys can fix that. We need your help.”

On the other side of the issue, several business owners said PBMs had allowed them to offer good health benefits to their employees. “PBMs helped me offer top-notch prescription drug coverage for my employees and kept us competitive in the job market,” said Coby Cullins, a former business owner in Missouri. “The report completely ignores Big Pharma’s use of anticompetitive [tactics that cost] taxpayers billions of dollars in savings. By only focusing on PBMs, the FTC is shifting the blame away from the big drug companies and on to the only market entity successfully lowering the price of prescription medications.”

“PBMs are instrumental in helping employers like me be able to offer prescription drug benefits,” said Alicia Cantrell of Houston. “They provide us with the flexibility and options we need in order to design the best benefits for our business so our employees and their families can stay healthy.” Like Cullins, Cantrell also criticized pharmaceutical companies, saying that they “undermine competition in the prescription drug marketplace by constantly engaging in anticompetitive practices so they can extend the monopolies on drugs … They have engaged in baseless claims to encourage policymakers to narrowly focus on PBMs instead of others in the prescription drug supply chain.”

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IMO, it will end up being referred to as the “National Gold Mine Program”. After UHC gets a full complement of provider groups to sign on to the program. The providers will discover that UHC took all the “gold” out of the mine and left the provider groups with “THE SHAFT”

UnitedHealthcare launching national gold-card program

https://www.beckerspayer.com/payer/unitedhealthcare-launching-national-gold-card-program.html

UnitedHealthcare will launch its national gold-card program on Oct. 1.

The program will reward contracted provider groups that “consistently adhere to evidence-based care guidelines,” according to an Aug. 1 policy update from UnitedHealthcare. The program will apply to all UnitedHealthcare commercial, individual exchange, Medicare Advantage and community plans.

The payer said that details on how to determine whether a provider group has qualified for the program will be published Sept. 1. Additional details will be available on UHCprovider.com.

UnitedHealthcare first floated plans for a national gold-card in March 2023 when it also said it would cut 20% of its prior authorization requirements. The cuts took effect  in two phases, the first in September 2023 and the second in November 2023.

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Appetite grows for mail-order pharmacies: Study

https://www.beckershospitalreview.com/pharmacy/appetite-grows-for-mail-order-pharmacies-study.html

Patients are becoming less satisfied with physical pharmacies as popularity rises for online and mail-order services, according to J.D. Power’s 16th annual U.S. Pharmacy Study.

Compared to the company’s 2023 study, customer satisfaction with mail-order pharmacies saw a six-point increase (on a 1,000-point scale). Chain drugstores, meanwhile, received satisfaction scores “far below the brick-and-mortar category average,” J.D. Power said in a July 30 news release. 

The overall patient satisfaction score for brick-and-mortar locations dropped 10 points.

The consumer insights and data company surveyed more than 13,000 pharmacy customers who filled a prescription between September and May. Customers cited long wait times, lower trust in pharmacists and difficulties in ordering prescriptions as common issues. 

Digital and mail-order pharmacies had their own issues. For online pharmacies, many consumers shared confusion on whether their insurance covers the service. For mail-order pharmacies, only 18% of these customers said their pharmacy offers a well-designed digital experience.

J.D. Power also asked customers about their preferred pharmacies. They voted Good Neighbor Pharmacy the No. 1 chain drugstore, Sam’s Club the best mass merchandiser, Publix the top supermarket and Amazon Pharmacy’s PillPack as the favorite mail-order option.

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My experience of average Rx prices back in the late 1960s and early 1970s makes me question this AI’s stated average Rx price in 1970. Back in the summer of 1967, I was working as a pharmacy student for a small local/regional chain pharmacy. I got assigned the task of calculating the average Rx cost/retail of 1000 new Rxs. The pharmacy stored Rxs on. I tried to find a graphic, but none were found, there were 1000 paper Rxs on each “wire storage unit” Being the pharmacy student, I was given the task of calculating the retail & cost of 1000 new Rxs. So I started with the most recent “full” storage unit.  I had to go thru each Rx in the file, pull the Rx bottle from the shelf, and calculate the medication cost for the particular Rx. No electronic calculators in 1967, but there were slide rules. I had been using a slide rule since I was in High School. The final results were in the $4-$5 range – I don’t remember the exact number. I do remember when I opened my independent pharmacy in 1976, I did all projected gross revenue and gross profit was calculated on an average of $5/Rx.  The chat states that in 1970 the average Rx price was $2.12, which seems to be out of sync with what I saw back then. I have often stated that today the average Rx was approaching $60/Rx. But the chat is quoting an average price from Medicare Part D data, which probably produces a higher average price because Medicare Part D Rxs is dealing with Rxs for the disabled and/or Seniors. Using a “back of napkin calculation”… $5/Rx in 1970 and 54 yrs later, an average CPI of 3% would suggest that Rxs today would be in the $40/Rx range, but that doesn’t take into consideration, that total Rx market has flipped from 90% brand name in 1970 to 85% generic in 2024. All things being equal, with the exception that the PBM industry is now in charge of determining the price of 80%-90% of all Rxs, maybe the average Rx price would be in the $30s today. So, one must ask, why are our Rxs at least $30 higher than would otherwise be expected? Could it be padding the bottom line of the PBM industry’s net profits?

What was the average prescription price in 1970 as compared to the average prescription price today and the percentage of generics of all Rxs for both time frames

To compare the average prescription price and the percentage of generics of all prescriptions between 1970 and today, we need to look at historical data and current statistics. Here is a detailed comparison:

1. High Launch Prices

Pharmaceutical companies set high initial prices for new drugs, which often increase over time. This is particularly evident in branded drugs, where launch prices have been rising significantly year over year.

2. Lack of Competition

The U.S. patent system grants manufacturers monopolistic control over the market for brand-name drugs, limiting competition and allowing prices to remain high. Even when patents expire, inadequate competition among generics can keep prices elevated.

3. Market Exclusivity and Patent Protection

Drug companies use patent protections and exclusivity programs to maintain high prices. These protections prevent generic competition, which would typically drive prices down. The practice of “evergreening,” where companies make slight modifications to extend patent life, exacerbates this issue.

4. Research and Development Costs

The high costs associated with research, development, and regulatory approval of new drugs are often cited as justifications for high prices. Pharmaceutical companies need to recoup these substantial investments, which contributes to the high cost of medications.

5. Lack of Price Transparency

The opaque nature of drug pricing, involving confidential negotiations and rebates among manufacturers, insurers, and pharmacy benefit managers, makes it difficult for consumers to understand and compare prices. This lack of transparency can lead to higher prices and less informed decision-making.

6. Limited Bargaining Power

Unlike many other countries, the U.S. does not have a central negotiating body to leverage lower prices from pharmaceutical companies. Instead, negotiations are fragmented across numerous health plans, resulting in weaker bargaining power and higher prices.

7. Mergers and Acquisitions

Consolidation within the pharmaceutical industry through mergers and acquisitions reduces competition. This consolidation can lead to monopolistic practices and higher drug prices.

8. Insurance Benefit Designs

Insurance plans with significant patient cost-sharing provisions can increase out-of-pocket costs for patients, making medications less affordable. Additionally, the design of these benefits often lacks incentives to control drug prices effectively.

9. Regulatory Delays

Delays in the approval process for generic drugs by the FDA can also contribute to higher prices, as fewer generics are available to compete with brand-name drugs.

10. Lobbying and Political Influence

The pharmaceutical industry spends billions on lobbying efforts to influence drug pricing policies. This lobbying power can hinder regulatory and legislative reforms aimed at reducing drug prices.

Conclusion

The rising cost of prescription drugs in the United States is driven by a combination of high launch prices, lack of competition, market exclusivity, high R&D costs, lack of price transparency, limited bargaining power, industry consolidation, insurance benefit designs, regulatory delays, and significant lobbying efforts. Addressing these issues requires comprehensive policy reforms and increased transparency to ensure medications are affordable and accessible to all.

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7 payers exiting Medicare Advantage markets in 2025

https://www.beckerspayer.com/payer/5-payers-exiting-medicare-advantage-markets-in-2025.html

Seven insurers are exiting Medicare Advantage markets in 2025, a number that is likely to grow in the fall.

There are 3,959 Medicare Advantage plans available nationwide in 2024. The average number of plans available to beneficiaries is 43, unchanged from 2023. 

Seven insurers exiting Medicare Advantage markets in 2025: 

BCBS Arizona will not offer MA prescription drug plans in Arizona in 2025, Becker’s confirmed.

Centene will exit a handful of unspecified Medicare Advantage markets, CEO Sarah London said July 26. 

Clear Spring Health will withdraw its Medicare Advantage prescription drug plans from South Carolina and Virginia, Becker’s confirmed. The company will still offer plans in Illinois, Georgia (MAPD), and Colorado.

BCBS Kansas City is exiting the Medicare Advantage market at the end of 2024, citing increasing regulatory requirements and financial headwinds. 

Aetna is bracing to lose up to 10% of its 4.2 million Medicare Advantage members next year as it prioritizes profitability and exits an unknown number of counties where it believes it can’t be profitable, executives said in May.

Humana expects to exit unspecified Medicare Advantage markets in 2025 and see a membership decline, company executives told investors in April.

Cigna Group reached a deal to sell its Medicare business to Health Care Service Corp. for $3.3 billion in January. The deal is expected to close in the first quarter of 2025 and includes 596,977 MA members, 450,000 Medicare supplement members and 2.5 million members in part D plans. 

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Have President Roosevelt was re-elected for his FOURTH TERM, Congress imposed term limits on our Presidents.  How President Biden wants term limits of 18 yrs on the SCOTUS. Who has Congress never considered imposing term limits on? – CONGRESS THEMSELVES. Just look at how many members of Congress are in their 80’s!  Airline pilots MUST RETIRE at 65 y/o Congress wants to raise it to 67 y/o but the FAA response: FAA tells Congress not to raise the mandatory retirement for pilots until it can study the issue

Commercial airplanes are so highly automated these days, that the challenges of flying a plane are a lot less taxing than 20-30 yrs ago. Back in the 70’s, I got my pilot license and eventually got an instrument rating (could fly “in the clouds”) as well as certified to fly a high-performance plane & retractable gear and was a partner in a plane. I have not flown in years, but I am confident that – at my age – I could “dust off” my pilot skills and safely fly again.

The Lower Courts’ Disregard for Supreme Court Precedent in Ruan v. United States

hhhhttps://doctorsofcourage.org/the-lower-courts-disregard-for-supreme-court-precedent-in-ruan-v-united-states/

In a legal landscape where the judiciary is expected to uphold the law with consistency and integrity, recent events highlight a troubling trend: the lower courts’ apparent disregard for Supreme Court rulings. This phenomenon is vividly illustrated in the cases stemming from the landmark decision in Ruan v. United States. Despite the Supreme Court’s clear directives, the lower courts have continued to impose harsh sentences, seemingly rendering the high court’s decisions meaningless. The absurdity of such legal incongruities is exemplified by the contrasting fates of Dr. Michael Fletcher and Dr. Kendall Hansen.

In 2022, the Supreme Court partially overturned the convictions of Dr. John Patrick Couch and Dr. Xiulu Ruan, ruling that prosecutors must prove that a doctor knew their conduct was outside the scope of professional medical practice. This decision was expected to significantly impact similar cases, offering hope to many convicted under the ambiguous standards previously applied.

However, the Supreme Court’s decision did not result in the anticipated relief for Drs. Couch and Ruan. Despite the high court’s ruling, Senior U.S. District Judge Ginny Granade maintained their lengthy prison sentences. This blatant disregard for the Supreme Court’s directives underscores a troubling trend: lower courts snubbing the highest court’s authority, thus undermining the legal system’s integrity.

Dr. Michael Fletcher, an interventional pain medicine specialist from Crestview Hills, Kentucky, faced similar charges. Convicted of illegally prescribing opioids, his case reveals the inconsistencies and apparent disregard for judicial precedent that plague the lower courts. Despite being found guilty of prescribing legal opioids to his patients—a far cry from street corner drug dealing—the severity of his punishment starkly contrasts with that of his colleague, Dr. Kendall Hansen.

Dr. Hansen, indicted alongside Dr. Fletcher, was charged with writing prescriptions for employees and instructing them to give him the pills. Despite the serious nature of these accusations, Dr. Hansen was acquitted in February 2024, while Dr. Fletcher faced conviction. This discrepancy raises critical questions about the application of justice and the influence of legal representation in these cases.

One significant factor contributing to Dr. Fletcher’s conviction appears to be the disparity in legal representation. Dr. Hansen’s attorney, Ronald Chapman, had extensive experience in health-related criminal trials, contrasting sharply with Dr. Fletcher’s attorney, who likely lacked documented experience in this specific healthcare field of law. This difference in legal expertise likely played a pivotal role in the divergent outcomes of their cases, highlighting the importance of specialized legal defense in complex medical-legal cases.

The ongoing disregard for Supreme Court rulings by lower courts extends beyond individual cases, reflecting a broader crisis in the judicial system. The refusal to adjust sentences in light of new legal standards, as seen in the cases following Ruan v. United States, suggests a troubling autonomy among lower courts that undermines the consistency and predictability essential to the rule of law.

This not only disrupts the lives of the accused but also propagates a climate of fear among medical professionals, ultimately affecting patient care.  The cases of Dr. Michael Fletcher and Dr. Kendall Hansen starkly illustrate the absurdity and injustice that can result when lower courts ignore Supreme Court rulings. The legal system’s integrity depends on the consistent application of law across all judicial levels. The Supreme Court’s decisions should serve as definitive guides for the lower courts, ensuring fairness and uniformity in the administration of justice.

As Dr. Fletcher continues to fight his conviction, his case stands as a poignant reminder of the need for judicial accountability and the protection of medical practitioners from unjust legal persecution. The fight for justice, as highlighted in these cases, is far from over. It is imperative for the legal community and society at large to scrutinize and challenge these judicial inconsistencies to restore faith in our legal system. https://x.com/DrLizaMD/status/1816865615086518506

Why do we dismiss women’s pain so easily? I am calling on family doctors and gynecologists to provide a small amount of actual pain medication- yes *GASP* a small amount of opioid pain medication to be used for IUD placement and removal. Even women who have just delivered babies think it’s excruciating. Thanks to “The Retrievals” podcast by @NewYorkTimes_official for reminding me about this. And now that i know that my fav tik tok feminist @hope_peddler and fav tik tok addiction medicine doc @Taylor Nichols, MD are friends too, I’m gonna tag them to get their thoughts too! 

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All one has to look at to get the validity of the overall answer from this AI chat is the 5 citations at the bottom of the text. FOUR were from the CDC and ONE from the Medical Board of CALF.

Many consider healthcare a HUMAN RIGHT, so the “so-called experts” that put the two versions of the CDC opioid dosing guidelines together, must not share that idea of what is considered basic human rights

## Impact of CDC Opioid Dosing Guidelines on Chronic Pain Management

The CDC’s opioid dosing guidelines, initially released in 2016 and updated in 2022, were designed to improve the safety and effectiveness of pain management while addressing the opioid crisis. These guidelines have had a mixed impact on chronic pain patients.

### **Positive Outcomes**

1. **Improved Safety and Communication**:
– The guidelines emphasize the importance of careful assessment before initiating opioid therapy, selecting appropriate dosages, and conducting regular follow-ups. This has led to better communication between clinicians and patients about the risks and benefits of opioid therapy, ultimately improving the safety of pain management practices[1][3].

2. **Reduction in Opioid Prescriptions**:
– The 2016 guidelines contributed to a decline in the overall number of opioid prescriptions. This was achieved by encouraging the use of non-opioid therapies and safer prescribing practices, which helped reduce the risk of opioid use disorder and overdose[2][3].

3. **Emphasis on Non-Opioid Therapies**:
– Both the 2016 and 2022 guidelines recommend maximizing the use of non-opioid therapies when appropriate. This shift has encouraged healthcare providers to explore and integrate alternative pain management strategies, potentially improving patient outcomes and quality of life[5].

### **Challenges and Negative Outcomes**

1. **Undertreatment of Pain**:
– The guidelines have been criticized for inadvertently leading to the undertreatment of pain. Misinterpretation and rigid application of the guidelines by some healthcare providers and institutions resulted in patients experiencing inadequate pain relief, withdrawal symptoms, and psychological distress[2][4].

2. **Disruption in Care**:
– The implementation of the guidelines led to the abrupt closure of several pain management centers, leaving many chronic pain patients without proper referrals or treatment plans. This disruption in care has had potentially dangerous consequences for these patients[2].

3. **Inflexibility and Misapplication**:
– The initial guidelines were sometimes applied as rigid standards rather than flexible recommendations. This misapplication led to issues such as rapid tapering or abrupt discontinuation of opioid therapy, which can be harmful to patients[5].

4. **Health Inequities**:
– The guidelines highlighted disparities in pain management, with evidence showing that certain patient populations, such as Black patients, are less likely to receive appropriate pain care. The updated 2022 guidelines aim to address these inequities by emphasizing individualized, patient-centered care[4].

### **Conclusion**

While the CDC’s opioid dosing guidelines have contributed to safer prescribing practices and a reduction in opioid misuse, they have also presented challenges in chronic pain management. The guidelines have sometimes led to the undertreatment of pain and disruptions in care due to their misapplication. The updated 2022 guidelines aim to rectify these issues by promoting flexibility, individualized care, and the use of non-opioid therapies. Ongoing efforts are needed to ensure that chronic pain patients receive compassionate, effective, and equitable pain management.

Citations:
[1] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[2] https://www.mbc.ca.gov/Download/Publications/pain-guidelines.pdf
[3] https://www.cdc.gov/media/releases/2022/p1103-Prescribing-Opioids.html
[4] https://www.cdc.gov/media/releases/2022/t1109-prescribing-opioids.html
[5] https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/healthcare-admin-applying-guidelines.html

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