Tagged Pharmaceuticals

Warren y Klobuchar dicen que pueden bajar precios de medicamentos sin ayuda del Congreso

Durante el debate demócrata, las dos mujeres que se postulan para la presidencia prometieron hacer, solas, lo que Washington hasta ahora no ha logrado: bajar los precios de los medicamentos recetados.

Hablando durante el último debate demócrata, la senadora por Massachusetts Elizabeth Warren y la senadora por Minnesota Amy Klobuchar dijeron que, si fueran elegidas presidentas, actuarían de inmediato para reducir directamente el costo de ciertos medicamentos.

Declaraciones importantes ya que provienen de dos senadoras que han patrocinado sus propios proyectos de ley para controlar el aumento vertiginoso de los precios de las drogas recetadas. Y, además, después que el Congreso se pasó el año pasado debatiendo el problema, sin aprobar ninguna legislación significativa para solucionarlo.

“Necesitamos ayudar a la gente todo lo que podamos, lo antes posible”, dijo Warren.

Si bien no dieron detalles sobre qué poderes presidenciales usarían, Warren y Klobuchar dijeron que el presidente ya tiene la autoridad legal para controlar estos precios. De hecho, Klobuchar tiene una lista de 137 cosas que puede hacer como presidente y sin ayuda del Congreso.

Una encuesta de 2019 de la Kaiser Family Foundation halló que, por culpa del costo, cerca del 29% de los estadounidenses no habían tomado sus medicamentos recetados correctamente el año anterior.

Tras haber propuesto una legislación que empoderaría al gobierno federal para fabricar drogas, Warren dijo que actuaría para reducir el precio de la insulina y drogas que tratan el VIH/SIDA.

Su campaña envió por correo electrónico a los reporteros una lista de otras drogas específicas, incluido EpiPen, para ataques severos de asma; Humira, el medicamento contra la artritis reumatoide más vendido, cuyo fabricante ha sido criticado por abusar de las patentes para sofocar a la competencia; y naloxona, un medicamento que revierte los efectos de la sobredosis de opioides.

Klobuchar y el ex alcalde de South Bend, Indiana, Pete Buttigieg, también respaldaron el empoderamiento de Medicare para negociar precios más bajos con los fabricantes de medicamentos: la propuesta en el corazón del plan de medicamentos presentada el año pasado por Nancy Pelosi y otros líderes demócratas de la Cámara de Representantes.

Sin embargo, esa idea es profundamente impopular entre los republicanos del Congreso, quienes la describen como una interferencia del gobierno en el mercado libre. Mientras el proyecto de ley fue aprobado por la Cámara en diciembre, el senador por Kentucky y líder republicano Mitch McConnell, dijo que no permitirá que se vote en el Senado, eliminando sus posibilidades, al menos por ahora.

Klobuchar enfatizó que el verdadero problema es el número de cabilderos farmacéuticos en Capitol Hill, dos por cada miembro del Congreso, dijo.

“¿Cómo podemos realmente romper el dominio corporativo de nuestro gobierno para que podamos aprobar cualquiera de estas cosas?”, se preguntó Tom Steyer, el empresario que fue uno de los seis candidatos demócratas que calificaron para el debate.

Este debate, que se realizó en Des Moines, Iowa, le dio al ex vicepresidente Joe Biden y al senador por Vermont Bernie Sanders otra oportunidad para discutir, aunque sea brevemente, el costo del Medicare para Todos.

Al extenderse sobre cómo pagaría por la revisión de un solo pagador del sistema de atención médica de la nación, Sanders dijo que implicaría un impuesto sobre la renta del 4%, eximiendo los primeros $29,000 del ingreso de un contribuyente para aliviar la carga de la “familia promedio en Estados Unidos”.

“Ahora es el momento de atacar la avaricia y la corrupción de la industria del cuidado de salud, de las compañías farmacéuticas, y finalmente brindar atención médica a todos a través de un programa de pagador único de Medicare para Todos”, dijo Sanders. “No será fácil. Es lo que tenemos que hacer”.

“Puedes hacerlo sin Medicare para Todos”, rebatió Biden. “Puedes llegar al mismo lugar”.

Sin embargo, luego de seis debates dedicados a analizar los detalles del Medicare para Todos, Warren hizo referencia al primer desafío que tienen por delante: una elección general durante la cual el candidato demócrata que gane se postulará contra el presidente Donald Trump, que quiere revocar la Ley de Cuidado de Salud a Bajo Precio (ACA).

Warren dijo que impulsaría su plan para expandir la cobertura a través de un sistema de pagador único, pero también que defendería ACA.

“Y vamos a vencerlo en esto”, agregó.

El octavo debate está programado para el 8 de febrero, el primero de tres debates demócratas que se realizarán el próximo mes.

Related Topics

Elections Health Care Costs Health Industry Medicare Noticias En Español Pharmaceuticals

A Pharma Snapshot Of JP Morgan Conference: Bristol’s Love Story, Alzheimer’s Drugs’ Future, Gilead’s Crown Jewels

What Does An Opioid Crisis Look Like? More Than 100 Billion Pain Pills Shipped Through U.S. During 8-Year Span

Warren and Klobuchar Say They Can Lower Drug Prices Without Congress’ Help

On Tuesday, two Democrats running for president promised to do — each by herself — what Washington has so far proven unable to do: lower the prices of prescription drugs.

Speaking during the last Democratic debate before the Iowa caucus on Feb. 3, Sen. Elizabeth Warren of Massachusetts and Sen. Amy Klobuchar of Minnesota said, if elected president, they would each act immediately to directly reduce the cost of certain drugs.

Their declarations, coming from two senators who have sponsored their own bills to control skyrocketing drug prices, stood out after Congress spent last year debating the problem — and failed to pass significant legislation to fix it.

“We need to get as much help to people as we can, as soon as possible,” Warren said.

While they did not elaborate on which presidential powers they would use, Warren and Klobuchar said the president already has the legal authority to rein in drug prices. (Klobuchar actually has a list of 137 things that she could do without Congressional action that include but are not limited to action on drug pricing.)

A 2019 poll from the Kaiser Family Foundation found that, due to cost, about 29% of Americans had not taken a prescription as directed in the previous year.          

Having proposed legislation that would empower the federal government to manufacture drugs itself, Warren said she would act to lower the price of insulin and drugs that treat HIV/AIDS.

Her campaign emailed reporters a list of other targeted drugs, including the EpiPen; Humira, the top-selling rheumatoid arthritis drug whose maker has been criticized for abusing patents to stifle competition; and Naloxone, a drug that reverses the effects of opioid overdose.

Klobuchar and former Mayor Pete Buttigieg of South Bend, Ind., also endorsed empowering Medicare to negotiate lower prices with drugmakers — the proposal at the heart of the drug plan unveiled last year by Speaker Nancy Pelosi and other House Democratic leaders.

However, that idea is deeply unpopular with congressional Republicans, who describe it as government interference in the free market. While the bill passed the House in December, Sen. Mitch McConnell of Kentucky, the Republican leader, has said he will not allow it to get a vote in the Senate, killing its chances, at least for now.

Klobuchar said the real problem is the number of pharmaceutical lobbyists on Capitol Hill — two to every member of Congress, she said. PolitiFact rated this claim Mostly True last year.

“How do we actually break the corporate stranglehold on our government so we can get any of these things passed?” said Tom Steyer, a businessman who was one of the six Democratic candidates to qualify for the debate.

The debate, which took place in Des Moines less than three weeks before voting begins, gave former Vice President Joe Biden and Sen. Bernie Sanders of Vermont another opportunity to spar over the cost of “Medicare for All,” albeit only briefly.

Elaborating on how he would pay for his single-payer overhaul of the nation’s health care system, Sanders said it would involve a 4% income tax, exempting the first $29,000 of a taxpayer’s income to ease the burden on “average family in America.”

“Now is the time to take on the greed and corruption of the health care industry, of the drug companies, and finally provide health care to all through a Medicare for All single-payer program,” Sanders said. “It won’t be easy. It’s what we have to do.”

“You can do it without Medicare for All,” Biden said. “You can get to the same place.”

After six debates spent parsing the details of Medicare for All, though, Warren referenced what comes next: a general election during which the Democratic nominee will run against President Donald Trump, a Republican who wants to repeal the Affordable Care Act.

Warren said she would push her plan to expand coverage through a single-payer system — but also that she would defend the Affordable Care Act.

“I’ll take our side of the argument any day,” she said. “We’re going to beat him on this.”

The eighth debate is scheduled for Feb. 8, the first of three Democratic debates next month.

Related Topics

Elections Health Care Costs Health Industry Medicare Pharmaceuticals

Sanders Targets Health Industry’ Profits. Are His Figures Right?

At the January Democratic debate, Vermont Sen. Bernie Sanders zeroed in on the question of profits in the health care industry.

Under “Medicare for All,” he said, “We end the $100 billion a year that the health care industry makes.”

It’s a huge number, and one that Sanders has cited before. So we decided to look closer.

The Math

The Sanders campaign shared its math, and it’s comprehensive. 

The $100 billion total comes from adding the 2018 net revenues — as disclosed by the companies — for 10 pharmaceutical companies and 10 companies that work in health insurance. 

We redid the numbers. Sanders is correct: The total net revenues, or profits, these companies posted in 2018 comes to just more than $100 billion – $100.96 billion, in fact. We also spoke to three independent health economists, who all told us that the math checks out.

There are a couple of wrinkles to consider. Some of the companies included — Johnson & Johnson, for instance — do more than just health care. Those other services likely affect their bottom lines.

But more importantly, $100 billion is likely an underestimate, experts told us.

For one thing, there are more than just 10 pharmaceutical companies, and more than 10 insurance companies, noted Robert Berenson, a health economist at the Urban Institute. Many more exist — even if they are smaller and post smaller profits.

And this figure looks at pharmaceutical companies and insurance companies, but it doesn’t include the biggest source of health care profits: hospitals and physicians.

“You could ask the same questions of health systems and not-for-profit hospitals who are raising prices at a steady clip,” said Ellen Meara, a professor of health economics at the Harvard T.H. Chan School of Public Health. “If you’re going to go after industry, you need to go after the whole system and say prices are a problem everywhere.”

If anything, Berenson said, that makes Sanders’ point stronger. After all, $100 billion is a small proportion of the trillions spent annually via national health expenditures. When you factor in hospital margins, the number grows significantly.

So, Medicare For All?

Sanders suggested that Medicare for All would “end” the $100 billion per year profits reaped by the health care industry.

The proposal would certainly give Washington the power to do that. 

“If you had Medicare for All, you have a single payer that would be paying lower prices,” Meara said. 

That means lower prices and profits for pharmaceuticals, lower margins for insurers

and lower prices for hospitals and health systems. 

That could bring tradeoffs: for instance, fewer people choosing to practice medicine. But, Meara noted, the number supports Sanders’ larger thesis. “There’s room to pay less.”

Other health reform plans — including letting Medicare negotiate drug prices, or a government-sponsored public option, such as the plan backed by former Vice President Joe Biden and former South Bend, Indiana, Mayor Pete Buttigieg — could also have this effect. 

But, Berenson noted, having only one insurer, and having it be publicly funded, would likely have a greater impact.

“I could whack pharmaceutical companies, and I don’t need Medicare for All to do it, but I do need Medicare prices for All to deal with what the real profits are — whether you call them profits or not — which is hospitals.”

Our Ruling

Sanders said Medicare for All would “end the $100 billion a year that the health care industry makes.”

The math holds up. If anything, it’s an underestimate because it doesn’t include one of the largest sources of health care profits: hospitals, health systems and physicians. We rate it True.

Related Topics

Elections Health Care Costs Health Industry Pharmaceuticals

Administration’s Rule Requiring Drug Prices Be Shown In TV Ads Does Not Get Warm Welcome At Appeals Court

Team Trump Says Administration’s Action On Health Care ‘Is Working.’ Is It?

With the 2020 election months away, President Donald Trump’s reelection campaign is touting his health care record as a key reason voters should grant him another term.

Those talking points were distilled in a Dec. 31 social media post from Team Trump, the campaign’s official Twitter account, and again in a post on Monday from the president’s account. It represents messaging the president will likely repeat, especially as polls consistently show health care is a top concern for voters.

The December tweet advanced five specific achievements.

Trump reiterated those claims Monday, arguing that he was “the person who saved Pre-Existing Conditions in your Healthcare,” while “winning the fight to rid you of the … Individual Mandate.”

But a closer examination of the list of achievements suggests the claims are not as straightforward as the 260-odd characters would suggest. Let’s take a look at the big picture.

Access And Affordability

According to Team Trump, the specifics behind these claims include a range of actions, from steps designed to increase organ transplantation and access to HIV medication to loosening regulations around short-term limited-duration health care plans and association health plans as well as “more participation” in ACA insurance markets.

Critics dismissed this perspective.

“That tweet is so far inconsistent with the direction of their policy push,” said Linda Blumberg, a health policy analyst at the Urban Institute, a think tank. “It’s just astounding to me.”

The administration has attempted to or successfully undermined coverage, argued Blumberg and other policy analysts, pointing to the Affordable Care Act repeal effort, which the president championed and continues to prioritize, along with changes made to the individual marketplace, where people buy insurance.

Plus, the critics said, the administration has encouraged state-based experiments with Medicaid, the government health plan for low-income people. In particular, they pointed to the administration’s approval of some state plans to implement work requirements that, research suggests, would limit the program’s reach by introducing new layers of bureaucracy. These work requirements are controversial and the subject of legal challenges.

“Those policies haven’t always succeeded, but it is rather misleading, if not comical, for an administration that has pursued multiple policies that would reduce access to health care to claim that it has expanded such access,” said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill.

In fact, the number of Americans without health insurance has crept up under the Trump administration, according to data collected by the federal Centers for Disease Control and Prevention. Before Trump took office, the uninsured rate had been dropping since 2010, when the ACA took effect.

As for health care costs: Growth has slowed, but costs are still going up, said Robert Berenson, a health policy analyst at the Urban Institute who studies hospital pricing.

That’s largely because the price of hospital and doctor care continues to increase, he said, which makes health care more expensive.

There is one area in which prices appear to have dipped: In the 2019 and 2020 health insurance years, the rate of ACA premium increases slowed and, in some cases, declined, Blumberg said.

But context matters. In 2018, marketplace premiums rose dramatically. Experts attribute those increases to a general climate of uncertainty stemming from efforts to repeal the ACA, the elimination of the tax penalty for people who don’t have insurance coverage, and a White House decision to halt government subsidies to insurance companies that offered marketplace plans. Those payments were meant to make up for discounts that plans were required to give low-income customers.

What happened in 2019 and 2020 represented a course correction by insurers, in spite of administrative policy, marketplace analysts said. People who do not qualify for subsidies still faced very high rates.

“We would have been in a different place to begin with had they not caused all the disruption,” Blumberg said.

The administration argues otherwise.

“We are reporting that for the third year in a row enrollment in the Federal Exchange remained stable,” said Centers for Medicare & Medicaid Services Administrator Seema Verma in a Dec. 20 statement marking the end of 2020 open enrollment. “Far from undermining the Affordable Care Act — as some hysterical and inaccurate claims would have it — the Trump Administration is making the very best of what remains a failed experiment.”

Separately, the White House loosened regulations on other forms of coverage, such as short-term and association health plans, which are not required to comply with ACA regulations and carry lower premiums.

Health and Human Services Secretary Alex Azar described these plans as providing “a much more affordable option for millions of the forgotten men and women left out by the current system.” Conservatives say they also appeal to consumers who may not be interested in such a robust set of benefits.

“Giving people more choices of affordable options is better for consumers than giving them a take-it-or-leave-it plan that may cost too much and cover everything,” said Doug Badger, a visiting fellow at the Heritage Foundation, who previously worked in the George W. Bush administration.

Plus, he said, the Trump plans don’t get rid of marketplace plans for people who want them. They can still get the benefits of ACA regulations, if they choose.

“None of the Trump administration regulations took away the availability of coverage for people with preexisting conditions,” Badger said.

Others argued that these short-term plans — which can deny people coverage based on preexisting conditions — are a net loss. The lower premiums, they point out, are possible largely because they cover far less than an ACA plan would. Consumers drawn in by the low prices may be surprised later to learn how few of their health needs are covered.

“That’s not generally a positive for consumers. It’s not a positive for the markets,” Blumberg said.

The Individual Mandate And Preexisting Conditions

In its New Year’s Eve tweet, the Trump campaign also highlighted repealing the individual mandate — which required all Americans to have insurance or pay a penalty — and the still-intact protection for people with preexisting medical conditions to get coverage without a higher price.

Technically, though, the individual mandate is still on the books. What no longer exists — through the Tax Cuts and Jobs Act of 2017 — is the penalty for not having coverage, rendering the mandate more or less meaningless.

Axing the penalty opened the door to a legal challenge to the ACA. A group of Republican state attorneys general and governors are suing to have the whole ACA overturned, arguing that the individual mandate’s penalty was central to the Supreme Court’s 2012 decision upholding the law. Without it, they say, the entire law — including protections for people with preexisting conditions and other popular provisions — must be thrown out. The Department of Justice has chosen not to defend the law, and experts predict the case will eventually reach the Supreme Court.

The White House hasn’t revealed any replacement or contingency plan in the event the ACA is struck down.

“Not only did President Trump have nothing to do with covering preexisting conditions, he and congressional Republicans tried in 2017 to pass legislation repealing the ACA that would have eroded those consumer protections,” Oberlander said.

Generic Drugs And The Drug-Pricing Debate

The point touting a “record number of generic drugs approved” is true and fits into a larger policy concern — escalating prescription drug prices — which voters have called one of their top health care issues.

How much relief this push means for consumers at the pharmacy counter is still unknown.

According to research published this fall, most of the new generics greenlighted because of the administration’s efforts are for drugs that already have competition. For consumers, the problem of high drug prices is most acute when brands don’t have two or more generic alternatives. In that category, the number of approvals for generics didn’t increase.

Plus, the approval of new generics doesn’t translate to consumer access. Last February, a KHN review of FDA data suggested that nearly half of the newly approved drugs weren’t for sale in the United States — meaning they weren’t helping lower prices. This November, an analysis in The Wall Street Journal reiterated those findings.

Generics manufacturers may not sell their new drugs for a host of reasons, including, some experts have suggested, anti-competitive behavior and patent lawsuits by bigger pharmaceutical companies.

“Approval doesn’t mean launched or available on the market,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University. Addressing the other pipeline issues, she said, would take “a lot” of policy legwork.

On the pharmaceutical subject, Team Trump argued that a number of administrative actions have brought down prices. But evidence supporting their position is scant.

“They want to take credit … on having a prescription drug bill that purportedly does something but it hasn’t passed,” Berenson said. The administration’s proposed rule changes and regulations have been similarly lackluster, he said.

Related Topics

Cost and Quality Elections Health Care Costs Insurance Pharmaceuticals Uninsured

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! In things I’ve learned today that I can’t stop thinking about: We apparently carry fat in our tongues? And you can lose it like any other fat on your body. This feels like something I should have known as a human, and yet I somehow managed 30-plus years without this information. Anyway, now that everyone is thinking too much about their tongues, let’s head to the news.

Democrats have asked the Supreme Court to expedite the case on the constitutionality of the health law, pushing for a ruling on the case during this term. This might seem paradoxical — as the lower courts have ruled against the ACA — but, as you Breeze readers know, the move is politically savvy. The health law is more popular than ever, and Democrats have been owning that advantage. If they can keep the Republicans’ attack on the legislation in the front of voters’ minds heading into the 2020 elections, there could be a repeat of the blue-wave midterms.

SCOTUS gave the Trump administration and Republicans until today to respond. (As of press time, they haven’t yet.)

The New York Times: Democrats Ask Supreme Court for Quick Decision on Obamacare


In a pretty harsh reality check, a new study this week found that a popular idea for cutting health spending doesn’t pan out when you look at the data. The strategy is based on identifying the hardest-to-treat, most expensive patients and better coordinating their care. But, despite the hype, the method didn’t cut hospital readmissions for those patients. The study highlights once again what we all know: Health care is complicated. And hyped-up promises to cut costs that sound too good to be true too often are.

Kudos to the evangelists of the method, though, for acknowledging it doesn’t work. “We could have coasted on the publicity we were getting,” said Dr. Jeffrey Brenner, a family physician in New Jersey who founded the program that was studied. “It’s my life’s work. So, of course, you’re upset and sad.”

The New York Times: These Patients Are Hard to Treat

The administrative costs of running a single-payer system in Canada come in at $551 per person per year. That seems like a lot, right? That’s what I thought, too, until I saw the total for Americans, which is *drum roll* $2,497 per year.

Los Angeles Times: U.S. Health System Costs Four Times More to Run Than Canada’s


California Gov. Gavin Newsom has proposed that California get into the drug-selling business — generic drugs, that is. The theory behind it is to increase competition and drive down prices. But despite generics accounting for 90% of the prescriptions filled in the country, they aren’t really the problem when talking high drug prices. It’s uncommon for those types of meds to only have one player in the marketplace, so pricing already tends to be competitive. For the average person, Newsom’s plan wouldn’t make much of a dent.

Los Angeles Times: Q&A: What You Need to Know About Gov. Newsom’s Drug Plan for California

But a strategy some people are hoping would make a difference is the VA model. The troubled federal agency might not have many bright spots these days, but patients who get prescriptions through Veterans Affairs are less likely than other insured Americans to skip doses and less likely to delay filling prescriptions because they were unable to afford them. What’s more, the program seems to curb racial disparities in accessing meds.

Stat: The VA Approach to Buying Drugs Means Patients Are Less Likely to Skip Medications Due to Cost

Mark your calendar: The annual J.P. Morgan Healthcare Conference runs through next week, and, as it nears, Stat looks back at the past 20 years of the event and how it has shaped the health care world. What emerges is a story of heroes and villains, booms and busts, sensational scandals, drinks and deals, flaring tempers and foolish predictions, and far more drama than anyone could expect from health care industry executives.

Stat: The Ghosts of JPMs Past: How 20 Years of Deals Have Shaped Health Care


In the latest sign that red-state resistance against Medicaid expansion is fading, Kansas Democratic Gov. Laura Kelly fulfilled a campaign promise by reaching a deal with Kansas Senate Republican Leader Jim Denning after a years-long impasse between the state’s two parties. Denning is eyeing a tough reelection race for next year — which could make the decision all the more notable.

The Wichita Eagle: Kansas Governor Kelly, Senate GOP Leader Reach Medicaid Deal


In a rare glimpse of good news, cancer death rates plummeted dramatically over a one-year period in the largest drop ever seen in national cancer statistics dating to 1930. The reason? Advancements in lung cancer treatments.

The Associated Press: Cancer Group Finds Biggest One-Year Drop in U.S. Death Rate

The back-and-forth over whether baby powder can be linked to ovarian cancer is the debate that launched 1,000 lawsuits (plus a couple of thousand more). A big study, however, tries to put the matter to rest. Research — that was deemed “overall reassuring” — now shows there is no strong connection between the two.

The Associated Press: Big Study Finds No Strong Sign Linking Baby Powder & Cancer


In the never-ending finger-pointing game that signals a reckoning in the opioid crisis, major drugstore chains like CVS and Walgreens are saying, “Nuh-uh, not our fault!” Instead, they say, doctors are to blame. Who are pharmacists to question doctors’ orders? The counter-argument, of course, is that when you’re filling prescriptions that equate to thousands of pain pills per person in a town you’re serving, it might be expected that someone would raise a red flag. Just maybe.

Experts say that by bringing up the doctors and providers, the drugstore chains could also be trying to complicate the case further, in hopes of mitigating some damage to themselves.

The Washington Post: Major Drugstore Chains Sue Doctors in Sprawling Federal Opioid Case


In the miscellaneous file for the week:

— You’ve heard of ambulance-chasing lawyers, but what about ambulance-chasing doctors? It’s becoming a growing practice for doctors to promise plaintiffs in personal-injury cases free upfront care with the hope of cashing in when the settlement comes. While the strategy is legal and doesn’t technically violate any ethical rules, it still seems a little off — and can also leave patients with big bills if their lawsuits don’t go as planned.

The Wall Street Journal: Who Wins in a Personal-Injury Lawsuit? It Can Be the Doctor

— Public health experts are warily watching the development of a pneumonia-like illness in China, with echoes of the SARS outbreak not distant enough not to draw comparison and concern.

The New York Times: China Identifies New Virus Causing Pneumonia-Like Illness

— As we continue to watch suicide rates skyrocket, experts scramble to figure out what can be done to halt the disturbing rise. Now, research suggests hope could come from an interesting strategy: raising the minimum wage by just $1.

NPR: For Suicide Prevention, Try Raising the Minimum Wage, Research Suggests

— A truism that has emerged for me over my decade-plus in journalism is that where there’s a catastrophe or disaster, there is someone who stands to gain something. In this case, it’s the windfall that will come to hospitals if the flu season is as bad as predicted.

Bloomberg: Record 2019-2020 Flu Season May Be Good for Hospitals


On that cheerful note, that’s it from me. Have a great weekend!

Related Topics

Cost and Quality Elections Health Care Costs Health Industry Insurance Medicaid Pharmaceuticals Public Health The Health Law

Viewpoints: Lessons On Why Opposition To Medicaid Expansion Lost Ground In Even Red States; In The U.S., Expensive Breakthrough Therapies For Certain Cancers Have Vastly Improved Life

Experts Skeptical That Newsom’s Plan For California To Sell Its Own Generic Drugs Will Actually Lower Prices

Family Doctors In Rural America Tackle Crisis Of Addiction And Pain

Dr. Angela Gatzke-Plamann didn’t fully grasp her community’s opioid crisis until one desperate patient called on a Friday afternoon in 2016.

“He was in complete crisis because he was admitting to me that he had lost control of his use of opioids,” recalled Gatzke-Plamann.

The patient had used opioids for several years for what Gatzke-Plamann called “a very painful condition.” But a urine screening one week earlier had revealed heroin and morphine in his system as well. He denied any misuse that day. Now he was not only admitting it, but asking for help.

Gatzke-Plamann is the only full-time family physician in the central Wisconsin village of Necedah, population 916. She wanted to help but had no resources to offer. She and the patient started searching the Internet while still on the phone, trying to find somewhere nearby that could help with addiction treatment. No luck.

Here was a patient with a family and job who had spiraled into addiction because of doctor-prescribed pain pills, yet the community’s bare-bones health system left him on his own to find treatment — which he later did, 65 miles away. If that situation was going to change in Necedah, it was up to Gatzke-Plamann.

“That weekend I went home and I said, ‘I’ve got to do something different,’” she recalled.

In many ways, rural communities like Necedah have become the face of the nation’s opioid epidemic. Drug overdose deaths are more common by population size in rural areas than in urban ones. Amid a nationwide decline in prescribing rates since 2012, rural doctors prescribe opioids more often by far. Rural Americans have fewer alternatives to treat their very real pain, and they disproportionately lack access to effective addiction medication such as buprenorphine.

It used to be rare for primary care physicians outside big cities to take on the challenges of opioid misuse, according to Dr. Erin Krebs, a professor of medicine at the University of Minnesota who researches chronic pain management. Now, Krebs said, it’s becoming increasingly common “out of necessity.”

“We just have a lot of people who need this kind of care, and they need it where they are,” Krebs said.

Both pain management and addiction treatment are specialties, calling for advanced training that many family physicians don’t have. Specialists tend to practice in larger towns and cities, said Dr. Alan Schwartzstein, speaker of the American Academy of Family Physicians Congress of Delegates, “so they’re not as accessible.”

For rural physicians, the burden of responding to the opioid epidemic falls squarely on their already loaded shoulders. And for Gatzke-Plamann, there was no question that she wanted to rise to the challenge.

Downtown Necedah, Wisconsin, population 916(Coburn Dukehart/Wisconsin Watch)

The Necedah Family Medical Center(Coburn Dukehart/Wisconsin Watch)

Reducing Pain Pill Prescriptions

When Gatzke-Plamann came to Necedah in 2010, U.S. opioid prescriptions were peaking. She estimates she inherited 25 to 30 patients with monthly opioid prescriptions. Soon she, like many of her peers around the country, noticed a rise in overdose and misuse.

Around 2012, she stopped taking on new patients using chronic opioid medications to focus on current opioid patients. She weaned many off opioids and tracked how many pills she prescribed for acute issues, like surgeries. Instead of defaulting to prescribing a month’s worth of pills for a patient who underwent a cesarean section, for example, she might prescribe only three to five pills.

“Most of the time those patients really only have that much pain for a couple of days,” Gatzke-Plamann said. “We don’t need to have those pain medications sitting in their medicine cabinets.”

Gatzke-Plamann helped shape her community’s wider discussion about opioids. That included joining the county’s substance abuse prevention coalition and educating her peers.

Today, the hospital Gatzke-Plamann is affiliated with sends her a monthly report of how many of her patients have opioid prescriptions. It varies each month, she said, but usually ranges from seven to 10.

Managing Chronic Pain Patients

For 62-year-old Necedah resident Michael Kruchten, the chronic pain he suffers stems from chemotherapy and radiation therapy treatments he received for lung cancer in 2011.

Kruchten is cancer-free now, but the treatments left him with permanent and severe nerve damage in his hands and feet.

“Sometimes it’s a burning — a continuous burning,” Kruchten said. “Sometimes it’s just like a sharp jolt of pain. And then sometimes it’s just pain, pain, pain.”

The pain was so bad he had to stop working at the ethanol plant in Necedah. Daily chores became challenging. The pain would keep him awake at night, leaving him pounding his pillow in frustration.

Michael Kruchten, a patient of Gatzke-Plamann, takes prescription opioids for chronic pain. “Dr. Gatzke has been a big plus and incentive for me. … She’s one of the main factors why I’m still here. She pulled me through it,” he says.(Coburn Dukehart/Wisconsin Watch)

One reason there are more opioid prescriptions in the rural United States is that Americans living in those areas report more chronic pain. Rural communities skew older, meaning they disproportionately deal with painful conditions related to aging, such as arthritis. Injuries also appear to be more common in communities more dependent on physically demanding jobs, such as mining and logging.

For patients with chronic pain like Kruchten, Gatzke-Plamann tries to avoid prescribing opioids when she can, but alternatives are limited. Though evidence shows that physical therapy, exercise, psychotherapy or some combination of these techniques can help reduce the need for opioids, it’s not easy to get these treatments. The nearest physical therapy is in Mauston, a 17-mile drive south. Treatments such as cognitive therapy for pain require drives to Madison, Marshfield or La Crosse, each at least an hour away.

She first tried prescribing Kruchten two non-opioid medicines: gabapentin and then duloxetine. Neither helped enough. Eventually, she prescribed the opioid hydrocodone, finally allowing him to sleep.

“Without the sleep, I was a couch potato,” Kruchten said. “Once I started to get to sleep [at night], I got rid of my TV and the couch and started becoming more active.”

Agreements For Long-Term Opioid Patients

Gatzke-Plamann’s efforts to carefully manage opioid use with chronic pain patients is supported by other efforts in the community.

Around 2016, Mile Bluff Medical Center — the hospital in Mauston with which Gatzke-Plamann is affiliated — standardized a medication treatment agreement with patients, laying out rules for opioid prescriptions.

Patients such as Michael Kruchten must agree to stipulations before getting a new prescription. That includes getting pills from only one doctor and filling prescriptions at just one pharmacy while also submitting to random pill counts and urine screenings. Kruchten is something of a model patient in that regard, according to Gatzke-Plamann.

“You come in for appointments regularly and you’re always on time and you’re respectful with the staff,” she told him as they reviewed the contract at an appointment in November.

Gatzke-Plamann in her office at the Necedah Family Medical Center with medical assistant Laurie Kenke. She says it’s challenging to make room for a buprenorphine practice as well as a family practice, but she considers it an important responsibility for her community. “There isn’t another me just down the road. I’m the only one here. So if I can fulfill that need, then I should do that.”(Coburn Dukehart/Wisconsin Watch)

Gatzke-Plamann can stop prescribing opioids to patients who violate the agreement. But the contracts aim less to punish than to keep communication open. Reviewing the contract with a patient allows them to revisit the risks and warning signs of addiction.

On his recent visit, Kruchten told the doctor he took only one hydrocodone pill instead of his usual two the previous night, saying it was “satisfactory” in curbing the pain.

“And that’s good that you don’t take it to just put yourself to sleep,” Gatzke-Plamann said. “Because it’s not a sleep medicine. You understand that. We’ve talked about that one before.”

“Yep,” Kruchten agreed.

Addressing The Rural Addiction Treatment Gap

The Friday call for help in 2016 made Gatzke-Plamann realize Necedah was missing a crucial resource in solving the pain puzzle: addiction treatment.

“We don’t have as many resources here,” Gatzke-Plamann said of the surrounding Juneau County, one of the poorest and least healthy in the state. “When I see that there’s a need for something, it’s on me to do something about that.”

She said that’s why she decided to get the required training to prescribe the addiction medicine buprenorphine.

Research shows buprenorphine effectively treats addiction, but the medicine is particularly scarce in rural America. More than 10 million rural Americans — more than one-fifth of the country’s rural population — live in counties without a single clinician licensed to prescribe the drug. (The rural-urban disparity in access has, however, shrunk since 2017.)

In Wisconsin, 18 of 72 counties lack a buprenorphine provider, and 14 of those unserved counties are rural.

Gatzke-Plamann is one of only two people in Juneau County licensed to prescribe buprenorphine. The other is a physician assistant she supervises.

Catina Stoflet has been prescribed the addiction medicine buprenorphine for seven months, being supervised by Gatzke-Plamann. “I probably would have died of a heroin overdose if I didn’t do this program. It’s changed my life,” says Stoflet.(Coburn Dukehart/Wisconsin Watch)

Catina Stoflet is among the buprenorphine patients who benefit.

Stoflet, 35, got addicted to prescription opioids as a 16-year-old in 2001, during the first wave of the nation’s opioid epidemic. She started getting kidney stones in high school. She’s had many surgeries to remove the painful obstructions.

That first prescription was for Tylenol 3, a combination of acetaminophen and the opioid codeine. Doctors soon escalated her to stronger drugs: Vicodin, Percocet, oxycodone.

“It was right around the time that people didn’t know what [opioids were] doing to you,” Stoflet said.

Stoflet said she spent years in recovery beginning in 2007. But she relapsed in 2014, progressing to heroin and methamphetamine. Last year, she decided to quit for good. Stoflet said her primary care doctor introduced her to Gatzke-Plamann, who had recently begun prescribing buprenorphine.

Just like Gatzke-Plamann’s opioid patients, buprenorphine patients must sign contracts, agreeing to participate in a treatment program that includes counseling.

Stoflet works with a counselor and community recovery specialist at the Roche-A-Cri Recovery Center in Friendship, about 20 miles from Necedah. The center opened in September 2018. Without its additional resources, Gatzke-Plamann said, she would not feel comfortable prescribing buprenorphine.

“I am just one part of their treatment plan,” Gatzke-Plamann said. “They need the counseling. They need the psychosocial support. They need the group meetings.”

Doctors like Gatzke-Plamann have an important role to play in the opioid crisis by treating patients where they live, said Erin Krebs of the University of Minnesota. But, she added, funding models don’t always encourage this kind of work.

“I’m not sure we’ve done all we can do to really support small practices taking on this effort,” said Krebs. “There’s hope for people with opioid problems, and we have treatments that work. And so I think the more we can hear about clinicians who are tackling these problems in their own communities and having success the better.”

This story is part of a partnership that includes Wisconsin Watch, Wisconsin Public Radio, NPR and Kaiser Health News.

Related Topics

Mental Health Pharmaceuticals States

Walgreens’ Quarterly Earnings Plummet Amid Increased Competition, Shrinking Prescription Drug Profits

Major Pharmacy Chains Claim Doctors, Other Providers Are Responsible For Opioid Crisis In New Lawsuit

Questions Remain About Marijuana-Cased Psychosis Among Teens, But One Thing’s Very Clear: Treatment Severely Lags Behind Need

VA Could Provide Drug-Buying Model That Helps Patients Stick With Taking Doses, Reduces Racial Disparities

The Financial Impossibilities Of Making Antibiotics: Why Drugmakers Are Going Bust Even In Era Of Superbugs

Doctors are prescribing the drugs sparingly and patients only need to take them a week or two at a time. In a world where pricey million-dollar cancer drugs are king, drugmakers producing modest antibiotics are crashing just when the country needs them the most. In other pharmaceutical news: pay-to-delay deals, blockbuster treatments and a failed promise.

Effort To Control Opioids In An ER Leaves Some Sickle Cell Patients In Pain

India Hardy has lived with pain since she was a toddler — ranging from dull persistent aches to acute flare-ups that interrupt the flow of her normal life.

The pain is from sickle cell disease, a group of genetic conditions that affect about 100,000 people in the U.S., many of them of African or Hispanic descent.

Sitting in the afternoon heat on her mom’s porch in Athens, Georgia, Hardy recollected how a recent “crisis” derailed her normal morning routine.

“It was time for my daughter to get on the bus, and she’s too young to go on her own,” Hardy recalled. “I was in so much pain I couldn’t walk. So, she missed school that day.”

Sickle cell disease affects red blood cells, which travel throughout the body carrying oxygen to tissues. Healthy red blood cells are shaped like plump and flexible doughnuts, but in people with sickle cell disease, the red blood cells are deformed, forming C-shaped “sickles” that are rigid and sticky.

These sickle-shaped cells can cause blockages in the blood vessels, slowing or even stopping normal blood flow. An episode of blockage is known as a sickle cell “crisis” — tissues and organs can be damaged because of lack of oxygen, and the patient experiences severe spells of pain.

‘It’s Like Torture’

Hardy tries to manage these crises on her own. She’ll take a hot bath or apply heating pads to try to increase her blood flow. Hardy also has a variety of pain medications she can take at home.

When she has exhausted those options, she needs more medical help. Hardy would prefer to go to a specialized clinic for sickle cell patients, but the closest is almost two hours away, and she doesn’t have a car.

So, Hardy often goes to the emergency room at nearby St. Mary’s Hospital for relief. Until recently, the doctors there would give her injections of the opioid hydromorphone, which she says would stop her pain.

Then, some months ago, the emergency room changed its process: “Now they will actually put that shot in a bag which is full of fluids, so it’s like you’re getting small drips of pain medicine,” Hardy said. “It’s like torture.”

It’s the same for her brother, Rico, who also has sickle cell disease and has sought treatment at St. Mary’s. The diluted medicine doesn’t give the same pain relief as a direct injection, they say.

Striking A Balance

St. Mary’s staffers explain that they’re trying to strike a balance with their new treatment protocol between adequate pain treatment and the risk that opioid use can lead to drug dependence.

It’s a local change that reflects a national concern. The U.S. is in the midst of an addiction and overdose crisis, fueled by powerful opioids like hydromorphone. That crisis has made medical providers more aware of the risks of administering these drugs. More than 47,000 Americans died in 2017 from an overdose involving an opioid, according to the Centers for Disease Control and Prevention.

That has prompted some emergency room leaders to rethink how they administer opioid medications, including how they treat people, such as Hardy, who suffer from episodes of severe pain.

“We have given sickle cell patients a pass [with the notion that] they don’t get addicted — which is completely false,” said Dr. Troy Johnson, who works in the emergency room at St. Mary’s. “For us to not address that addiction is doing them a disservice.”

Rico Hardy takes medication each day to manage his sickle cell disease at home. When his pain gets severe, he heads to the ER for extra help.(Johnathon Kelso for WABE)

Johnson proposed the ER’s shift to intravenous “drip delivery” of opioids for chronic pain patients because of personal experience. His son has sickle cell disease, and Johnson said he has seen firsthand how people with the disease are exposed to opioids when very young.

“We start creating people with addiction problems at a very early age in sickle cell disease,” Johnson said.

He brought his concerns to the director of the ER, Dr. Lewis Earnest, and found support for the change. Hospital officials say they also consulted national guidelines for treating sickle cell crises.

“We’re trying to alleviate suffering, but we’re also trying not to create addiction, and so we’re trying to find that balance,” Earnest said. “Some times it’s harder than others.”

St. Mary’s says the new IV-drip protocol is for all patients who come to the emergency room frequently for pain, and most of their sickle cell patients are fine with the change.

Caught In The Crossfire

The national guidelines cited by St. Mary’s also say doctors should reassess patient pain frequently and adjust levels of opioids as needed “until pain is under control per patient report.”

Some people who work closely with sickle cell patients, upon hearing about the new approach to pain management at St. Mary’s, called it “unusual.”

“When individuals living with sickle cell disease go to emergency departments, they are living in extreme amounts of pain,” said Dr. Biree Andemariam, chief medical officer of the Sickle Cell Disease Association of America.

It’s more common for ERs to give those patients direct “pushes” of pain medication via injection, she noted, not slower IV drips.

People with sickle cell disease aren’t fueling the opioid problem, Andemariam said. One study published in 2018 found that opioid use has remained stable among sickle cell patients over time, even as opioid use has risen in the U.S. generally.

“If anything, individuals with sickle cell disease in our country have really been caught in the crossfire when it comes to this opioid epidemic,” Andemariam said.

She suggested that ER doctors and nurses need more education on how to care for people with sickle cell, especially during the painful crisis episodes, which can lead to death.

“Sickle cell pain has a mind of its own,” says Anesha Barnes, who has had the disease since she was a baby. She says the longer she stays in a pain crisis, the harder it is to break out of it.(Johnathon Kelso for WABE)

A study of some 16,000 deaths from 1979 to 2005 related to sickle cell found that men in the group lived to be only 33, on average. Women didn’t fare much better, living to an average age of 37. The same study suggested that a lack of access to quality care is a factor in the short life spans of people with sickle cell disease.

Researchers who study sickle cell say the opioid epidemic has made it harder for patients with the condition to get the pain medication they need. The American College of Emergency Physicians is focusing on the problem, asking federal health officials to speak out about sickle cell pain and fund research on how to treat it without opioids.

“We in the physician community are looking for ways to make sure they get adequate pain relief,” said Dr. Jon Mark Hirshon, vice president of the group. “We recognize that the process is not perfect, but this is what we’re striving for — to make a difference.”

Considering A Move To Find Relief

In the meantime, India Hardy said she feels those imperfections in the process every time she suffers a pain crisis, and she’s not alone.

In addition to her brother, Hardy said she has another friend in Athens with sickle cell disease, and that friend has also reported difficulty in finding pain relief at the St. Mary’s emergency room.

“It’s just really frustrating, because you go to the hospital for help — expecting to get equal help, and you don’t,” Hardy said, her voice breaking. “They treat us like we’re not wanted there or that we’re holding their time up or taking up a bed that someone else could be using.”

Hardy filed a complaint with the hospital but said nothing has changed, at least not yet. She still gets pain medication through an IV drip when she goes to the St. Mary’s emergency room.

At this point, she’s considering leaving her relatives and friends behind in Athens to move closer to a sickle cell clinic. She hopes doctors there will do a better job of helping to control her pain.

This story is part of a partnership that includes WABE, NPR and Kaiser Health News.