Tagged Public Health

Eating Diets High In Fiber Linked To Lower Risk Of Dying From Cancer And Stroke, New Analysis Finds

The research analyzed over 180 observational studies and 50 clinical trials from the past four decades and also showed people developed fewer chronic diseases. “The health benefits of dietary fiber appear to be even greater than we thought previously,” explained co-author Jim Mann. Nutrition and weight news also focuses on bigger waists and smaller brains, and a new study on why exercise is a bust for some people.

Eating Diets High In Fiber Linked To Lower Risk Of Dying From Cancer And Stroke, New Analysis Finds

The research analyzed over 180 observational studies and 50 clinical trials from the past four decades and also showed people developed fewer chronic diseases. “The health benefits of dietary fiber appear to be even greater than we thought previously,” explained co-author Jim Mann. Nutrition and weight news also focuses on bigger waists and smaller brains, and a new study on why exercise is a bust for some people.

Drug Overdose Fatality Rate Soars 260% Among Women From 1999-2017, CDC Reports

“The stereotype is a man who’s addicted to drugs who’s ODing on the street, and we know that that stereotype is clearly not complete. It’s inaccurate,” said Dr. Georges Benjamin, executive director of the American Public Health Association. Other drug epidemic news looks at equipping police with naloxone; tracking doctors who over-prescribe opioids; puppy programs; childhood trauma and research on safe-injection facilities.

Drug Overdose Fatality Rate Soars 260% Among Women From 1999-2017, CDC Reports

“The stereotype is a man who’s addicted to drugs who’s ODing on the street, and we know that that stereotype is clearly not complete. It’s inaccurate,” said Dr. Georges Benjamin, executive director of the American Public Health Association. Other drug epidemic news looks at equipping police with naloxone; tracking doctors who over-prescribe opioids; puppy programs; childhood trauma and research on safe-injection facilities.

Powerful Chamber Of Commerce Pledges To Fight Any Efforts By Congress To Move Toward Single-Payer

“We’ll use all our resources to make sure that we’re careful there,” said Thomas Donohue, the president and CEO of the Chamber of Commerce. In other coverage and access news: insurer settles discrimination allegations over consumers who take HIV-prevention medication; a look at what happens when an insurer’s pricing tool gets it wrong; and trends for the coming year.

Powerful Chamber Of Commerce Pledges To Fight Any Efforts By Congress To Move Toward Single-Payer

“We’ll use all our resources to make sure that we’re careful there,” said Thomas Donohue, the president and CEO of the Chamber of Commerce. In other coverage and access news: insurer settles discrimination allegations over consumers who take HIV-prevention medication; a look at what happens when an insurer’s pricing tool gets it wrong; and trends for the coming year.

Federal Shutdown Mostly Spares Health Coverage, But Other Issues Loom

As the partial government shutdown drags on, about 800,000 federal employees who work for the shuttered agencies — and their families — are facing the reality of life without a paycheck.

And those workers need to consider a host of other related issues as they attempt to make ends meet.

For starters, what will happen to their health insurance?

For the most part, federal employees needn’t worry about that, according to the Office of Personnel Management (OPM) in an FAQ blog post.

Both the online FAQ and the health insurance industry’s trade association confirm that coverage through the Federal Employees Health Benefits (FEHB) program will continue even if some federal agencies affected by the shutdown aren’t issuing those paychecks or paying premiums.

“The shutdown should not impact their coverage,” said Kristine Grow, spokeswoman for America’s Health Insurance plans, the trade group that represents insurers, including those that offer coverage through the federal program. “It’s business as usual.”

Once the shutdown ends and those payments resume, workers should expect that their usual share of premiums plus some of the accumulated amount that wasn’t deducted during the missed pay periods will be taken out.

“Procedures may vary somewhat by payroll office, but the maximum additional deduction allowed under regulations is one pay period’s worth of premiums (in addition to the current pay period’s premium),” said an OPM spokeswoman.

What about government contract workers?

Less clear is what happens to workers under contract with the affected federal agencies — including some people working as analysts, administration assistants and janitorial staff — who are mostly excluded from the FEHB program.

Many companies that contract with the federal government offer workers insurance. The federal Office of Personnel Management recommends these contracted employees consult the human resources office at their company for answers regarding the shutdown.

“In 95 percent of cases, even if it’s not required by law, I would think most everyone would continue that coverage,” said Rachel Greszler, a senior policy analyst and research fellow at the Heritage Foundation who studies economics, budget and labor issues.

For contract workers who buy their own coverage and are struggling to pay bills without their paychecks, it’s a different story. One strategy may be to ask their insurers for a grace period in paying their premiums, similar to how the government has suggested workers seek accommodation from mortgage lenders and other creditors. But there is no requirement that insurers grant such a request.

“We are concerned about the disruption that this shutdown has caused our members and their families,” noted a corporate statement from CareFirst BlueCross BlueShield. “We are currently exploring how to best address this issue should the shut-down continue.”

What else could be affected?

Depending on how long the shutdown lasts, dental, vision and life insurance programs may start sending bills directly to workers.

Federal workers pay the premiums for these benefits themselves, according to Dan Blair, who served as both acting director and deputy director of the OPM during the early 2000s. He is now a senior counselor and fellow the Bipartisan Policy Center.

Because workers’ checks are not being processed, the amounts usually sent to these carriers each pay period also aren’t being paid. If the shutdown lasts longer than two or three pay periods, workers will get premium bills directly from these firms and should pay them “on a timely basis to ensure continuation of coverage,” the OPM says in its FAQ. Blair agrees.

There also may be a delay in processing claims for flexible spending accounts. These are special accounts in which workers use pretax money deducted from their paychecks to cover certain eligible medical expenses, such as eyeglasses, braces, copayments for doctor visits or medications, including some over-the-counter products. With no paychecks going out, these deductions are not being made and transferred into FSAs. Once paychecks start up again, the amount deducted will be adjusted so the worker will get the annual total they had requested.

During the shutdown, though, reimbursement claims to these accounts also won’t be processed, the OPM says. Blair suggests holding off on big-ticket purchases during the shutdown, if possible, and always keeping paperwork on the purchases.

Another consideration: Those who changed plans before the furlough may find their paperwork wasn’t processed in time.

In those cases, the OPM says to stick with the old health plan until the shutdown ends and the new plan is processed. The new plan will pick up any claims incurred.

How will workers know if their change was processed? The OPM’s FAQ says workers who receive an ID card in the mail are enrolled.

“The new policy will be what applies and pays benefits, but there could be some administrative burdens and hassles on the part of workers if the shutdown continues much longer, if the initial bills are not going to the right insurance company,” Greszler said.

Overall, Blair says workers should continue to monitor news media sites, particularly those that focus on federal workers and issues, looking for any updates.

“We’re getting into uncharted territory and there are always things that pop up that no one has planned for,” said Blair, who did not face any shutdowns during his tenure at OPM.

Study Finds Link Between Increase In Bullying In Trump Country And President’s Inauguration

“It is obviously difficult to demonstrate a causal link between statements by a public figure and schoolyard bullying. Nevertheless, there are incidents in which youth made threats and jeering statements that closely matched language used by President Trump,” the study found. Other mental health news comes out of New Hampshire, Texas and Louisiana.

Innovative App Would Detect Opioid Overdoses, Developers Say. Would People Turn It On, Though?

Researchers tested the experimental gadget at North America’s first supervised injection site in Vancouver, British Columbia, and found it correctly identified breathing problems. Other news on the opioid crisis focuses on a call for more federal funding, a dismissal of lawsuits against Purdue Pharma, attempts to measure pain, a deadly new mix of drugs and more.

Flurry Of Movement On Capitol Hill On Drug Pricing May Signal Possible Rough Waters Ahead For Pharma

Sen. Chuck Grassley (R-Iowa) was one of a handful of lawmakers who have introduced legislation to curb high drug costs in the first few weeks of Congress being back in session. The topic is seen as one of only a few bipartisan issues that may get addressed by a divided Congress this year. In other pharmaceutical news, government officials are worried that drugmakers are using scare tactics to keep competition out of the marketplace.

Some States Mull A Medicaid ‘Buy In’ As More Palatable Solution To Politically Polarizing ‘Medicare For All’ Plans

States have begun exploring the possibility of a Medicaid “buy in” as an attractive option for people who are struggling to find affordable coverage. With the strategy comes a plethora of questions, though, such as, who would be eligible and what benefits would be offered.

Extreme Temperatures May Pose Risks To Some Mail-Order Meds

Take a look at your prescription bottles. Most say “Store at room temperature” or “Keep refrigerated.”

But what happens when drugs are delivered by mail? Were those instructions followed as the medicine wended its way from the pharmacy to your doorstep?

Those questions haunt Loretta Boesing, who lives in Park Hills, a small town in the hills of eastern Missouri, where the weather varies dramatically from season to season.

“It’s crazy,” Boesing said. “We sometimes experience temperatures like they would feel in Arizona. Sometimes we experience temperatures like they would feel up north.”

In 2012, when son Wesley was 2 years old, he got so sick from the flu that he needed a liver transplant.

The transplant surgery went well, but just a few months later, lab tests showed Wesley’s body appeared to be rejecting the organ.

Boesing felt both devastated and guilty.

“I feel the extra duty of not just protecting his life, but the life that lives on inside him,” she said.

Wesley didn’t lose his new liver, but during his weeks in the hospital, Boesing’s mind raced, thinking about what might have gone wrong.

She remembered that when his anti-rejection medications were last delivered to their house, the box had been left outside by the garage, where it sat for hours.

Temperatures that day were well over 100 degrees, well beyond the safe temperature range listed on the drug’s guidelines.

At the time, she hadn’t worried about it.

“Even though I see plainly on the bottle that it says, ‘Store at room temperature,’” Boesing said, “I still thought, ‘Ah, someone’s making sure it’s safe.’”

But after Wesley’s setback, Boesing swore off mail-order pharmacy altogether, and this year she started a Facebook group for patients who share her concerns about how extreme temperatures during shipping could affect the prescription drugs that many people receive by mail.

As of 2016, prescriptions fulfilled by mail accounted for nearly a quarter of total U.S. spending on prescriptions (before rebates and discounts), according to a report from IQVIA’s Institute for Human Data Science.

Health insurers typically contract with companies known as pharmacy benefit managers to handle the complex process of getting medicine to patients. PBMs negotiate with drugmakers on prices and rebates, help insurers decide which drugs to cover and handle mail-order shipping.

Mail order is a money saver for PBMs, and, in turn, they’ve touted the potential advantages for patients — such as 90-day refills for the cost of a 30-day copay, and the added convenience, especially for rural or housebound patients.

But Boesing wants insurers and their PBMs to reconsider these incentives and their practices in light of temperature concerns. She says they must ensure that their patients have easy access to retail pharmacies — unless the mail-order services can prove that drugs are getting to patients at the right temperatures.

The three biggest PBMs are Express Scripts, CVS Caremark and OptumRX. They insist they’ve got mail-order drug shipment down to a science.

Inside an enormous OptumRX warehouse in a Kansas City suburb, lines of orange prescription bottles fly along conveyor belts, while pharmacists scan bar codes and technicians refill bins of pills.

Lead pharmacist Alysia Heller explains that this shipping behemoth, which sends out as many as 100,000 prescriptions a day, includes a system to account for weather.

“If there’s an extreme heat situation where a product is going into 100-plus-degree weather, the system will tell the technician to add an extra ice pack,” Heller said, “because we’ve monitored the ZIP code and the weather in that area.”

But at OptumRX and across the industry, that level of temperature-controlled shipping is usually reserved only for a relatively small number of drugs — such as certain types of insulin, or hepatitis C drugs that have specific refrigeration requirements.

Standard, room-temperature medications (like most drugs for blood pressure or cholesterol, which make up the vast majority of prescriptions shipped) are typically sent in bubble mailers without any temperature monitors.

Stephen Eckel, a pharmacy professor at the University of North Carolina at Chapel Hill, said those practices can lead to some drugs being damaged.

“A lot of people enjoy the convenience of mail order, but there are some risks they’ve got to understand,” said Eckel. He said it’s possible that drugs in liquid form, such as the one Wesley was taking, could potentially be damaged by exposure to extreme heat or cold.

He predicts it’s just a matter of time before mail-order pharmacies will expand their use of temperature controls and add individual temperature monitors to all packages, so customers can see whether their medications got too hot or too cold in transit.

But Adam Fein, a consultant on pharmaceutical economics and drug distribution, called the temperature concerns overblown. He pointed out that many states already require insurance companies and/or PBMs to offer access to retail pharmacies if customers prefer.

“We have literally billions and billions of prescriptions that have been dispensed by mail over many years without evidence of widespread harm,” Fein said.

The Pharmaceutical Care Management Association is a national trade industry group for PBMs. In response to questions about temperature concerns and the safety of mail-order drugs, the association wrote in a statement: “Mail-service pharmacies adhere to all Food and Drug Administration rules, ship those prescription medications that may be adversely affected by extreme heat in refrigerated packaging, and notify patients to make sure those packages have been delivered properly.”

Some room-temperature drugs are approved to spend up to 24 hours in temperatures from as low as the upper 50s to as high as 104 degrees. But scientists just don’t know how a number of medications respond to more extreme temperatures — such as they might experience on a freezing porch or in the back of a sweltering truck.

A few studies suggest that some inhalers or antibiotics can lose potency over time.

Many industry experts think mail-order pharmacy is on the cusp of a boom driven by the development of new specialty drugs, especially biologics. Many of those often come with a hefty price tag and are generally not handled by retail pharmacies. These specialty drugs, many of which are injected, can be more vulnerable to temperature swings.

Competition in the mail-order drug industry is heating up, with Amazon’s acquisition last summer of online pharmacy PillPack, and the announcement in December that Walgreens would work with FedEx to offer next-day medication delivery.

Fein said more temperature controls and monitoring would do little more than drive up costs in an industry that’s been successful in large part because of its low operating costs.

But after collecting more than 76,000 signatures for an online petition on the issue, Loretta Boesing said she’s convinced a larger health problem is being shrugged off.

In Missouri, the Board of Pharmacy has decided to review its mail-order prescription policies and invited Boesing to testify.

Her son still needs prescriptions, but Boesing has stopped using Walgreens’ Specialty Pharmacy, which was shipping the drugs. She obtained a waiver that lets her fill Wesley’s prescriptions at a specialized pharmacy affiliated with a children’s hospital in St. Louis. She makes the two-hour round-trip drive every month to pick up the medicine.

After connecting with patients all over the country, she said, her advocacy is no longer just about keeping Wesley safe.

“I don’t want my son to have to receive special treatment,” Boesing said. “I want everyone to have access to safe medications.”

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


KHN’s coverage of these topics is supported by
Laura and John Arnold Foundation
and
Heising-Simons Foundation