The federal health reform law has saved seniors and the disabled millions of dollars on their Medicare prescription-drug coverage, says the Centers for Medicare & Medicaid Services.
CMS said 65,040 Kentuckians have saved a total of $60.4 million in the first 10 months of 2013, an average of $928 per person in Medicare. CMS said Kentucky seniors have saved $180.9 million on the coverage, known as Part D, since the passage of the reform law.
Seniors will also be free to use more of their Social Security cost-of-living adjustment as they choose, because the Medicare Part B premium will not increase in 2014 as a result of the law’s cost restrictions, CMS noted. The deductible for standard Part D plans will decline by $15 in 2014, to $310.
The data also show that since the Patient Protection and Affordable Care Act took effect, more than 7.3 million seniors and people with disabilities who reached the prescription coverage gap, commonly known as the "donut hole," have saved $8.9 billion on their prescription drugs, an average of $1,209 per person.
The "donut hole" is the gap in coverage after the basic coverage and before the catastrophic coverage takes effect. Without rebates authorized by the law, Medicare beneficiaries would have to pay out-of-pocket for the entire cost of prescription drugs once they hit the hole, until they incur enough expense to reach catastrophic coverage.
Next year, Medicare Part D participants in the donut hole will save about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs, CMS says. These savings and Medicare coverage are to gradually increase until 2020, when the donut hole will be closed.
Showing posts with label prescription drugs. Show all posts
Showing posts with label prescription drugs. Show all posts
Wednesday, 27 November 2013
Monday, 28 October 2013
A Ky. guide to the Patient Protection and Affordable Care Act
By Molly Burchett
Kentucky Health News
Few laws have generated as much confusion, opposition or news coverage as the Patient Protection and Affordable Care Act. Despite the flood of news stories about the law widely known as Obamacare, there is still much confusion about it.
That's not surprising. The 906-page law is complex and is accompanied by 10,535 pages of regulations. This guide to the law is designed to clear up confusion and offer various perspectives about how the law may affect you, your family or your business.
What does the Affordable Care Act do?
The law is a set of reforms that impose many requirements on insurance companies and requires all Americans, with very few exceptions, to have health coverage or pay a penalty starting Jan. 1.
In addition to those mandates, the law created online health-insurance marketplaces and encouraged states to expand the federally subsidized Medicaid program for the poor and disabled. Gov. Steve Beshear expanded Medicaid and decided the state would run its own marketplace or exchange, Kynect, which launched Oct. 1.
Why did Congress pass the law?
The law is designed to extend health coverage, either through private insurance or Medicaid, to Americans without health insurance. More than 47 million Americans were uninsured in 2012, says the Kaiser Family Foundation, and about 640,000 of them were Kentuckians.
The law's rules for insurance will increase costs for many, so it provides Medicaid or subsidized coverage to help qualifying individuals pay for coverage. Those with incomes under 138 percent of the federal poverty threshold qualify for Medicaid, and those with incomes up to 400 percent of the poverty line get premium subsidies. The line for a family of four is $23,550, so such a family would qualify for subsidies if it makes less than $94,200 a year.
Who will be affected by the law?
Obamacare will affect almost everyone, but it will have less impact on people 65 and up because they're eligible for Medicare. Virtually everyone must have health insurance coverage by 2014 or pay a penalty. Beginning in 2015, employers of 50 or more full-time workers (defined as working at least 30 hours a week) must provide coverage for their employees.
Insurance companies can no longer deny coverage because of pre-existing conditions such as a disability, pregnancy, or chronic disease. Under one part of the law that took effect early, parents are able to keep their children on their insurance until the children turn 26.
The law aims to help people who can't get affordable insurance through an employer or who aren't ineligible for public coverage through Medicare or Medicaid. It also affects the self-employed, small businesses and employees of businesses that don't provide coverage.
Because the law is making fundamental changes in the health-insurance system, "In the long run, pretty much every American will be affected by Obamacare," reports Abby Hayes of The Dough Roller, a financial-advice site. "Next year, employer-sponsored insurance premiums are likely to fluctuate as insurance companies adjust their offerings."
Will the law lower health costs?
It's too soon to tell what impact the law will have on costs. Remember, there are two types of health costs: the country's overall cost and the cost that you feel in your pocketbook from the money your household spends on health services.
If you buy an insurance policy through the state exchange, www.kynect.ky.gov, your cost will depend on your individual situation, such as the size of your household and the number of smokers in it, and your income, which will determine your eligibility for subsidies or Medicaid.
Most people who buy coverage in the individual market will pay higher premiums in 2014, mainly because companies are required to cover people with pre-existing conditions and a broader range of services, such as prescriptions, than many people have been paying for.
Rates in the individual market will change yearly, as explained in a report from the Kaiser Family Foundation. It says the broader coverage, and limiting surcharges due to age, will spread the overall cost of care across the insurance marketplace, tending to lower premiums for people who are older and sicker and raise them for people who are younger and healthier. Thus, the trade-off for pre-existing coverage is the individual mandate, which requires everyone to purchase coverage to spread the cost.
Think of it this way: When you go out to eat with two grade-school children, they can order off the kids' menu, so you pay less for their smaller portions. The total bill is $30. Your kids' chicken finger platters are $5 each, and you and your spouse both have $10 items. However, if the restaurant must charge all patrons equally for the same meal, the $30 cost would be assessed differently. The cost for each individuals would be $7.50; the cost of your kids' meals would be higher and you and your spouse's meal would cost less.
Many Kentucky businesses have expressed concern about rising premiums for employee coverage. Some are moving to high-deductible plans that require employees to pay a larger share of their costs, and some may drop coverage, letting employees obtain insurance and subsidies through the government exchanges.
How do I get coverage from the exchange?
The Kynect website will determine your eligibility for Medicaid or subsidies, allow you compare plans and process the insurance application. If you don't have a computer, you can call toll-free to 1-855-459-6328 to apply or locate a local "Kynector."
Unless you qualify for a special enrollment period, you must enroll in a health plan by March 31, 2014. A "life-changing event," such as moving to a new state, major changes in income and changes in family size, can make you eligible for a special enrollment period, says Healthcare.gov, the federal website. (Kentuckians do not use the federal site because the state has its own site, Kynect.)
The date coverage starts depends on when you buy it. If you enroll before Dec. 15 and pay your first premium, your coverage starts Jan. 1. Likewise, in succeeding months, if you enroll between the 1st and 15th, your coverage starts on the 1st of the next month. If you enroll after the 15th, coverage starts the month after the next one.
What do the health plans cover?
Regardless of which plan you chose, the law requires all plans offered by any insurance company to cover these essential health benefits:
Premiums depend on individual circumstances, such as income and the level of coverage, such as the amounts of deductibles and co-payments. Kynect is connected to federal databases — including Internal Revenue Service databases — to determine whether you qualify for assistance in paying a premium. People on Medicaid do not pay premiums.
Plans on Kynect vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have a $6,300 deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy.
Let's consider a basic example. A 45-year-old Floyd Countian named John Smith earns $36,000 a year, which means he is eligible to buy subsidized insurance through Kynect.
The individual market in Floyd County is limited to two companies, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana Inc. isn't offering individual coverage there. Depending on the type of plan John chooses, his premiums will range from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).
John has several options. Let's say he decides that he needs to keep his premium payments below $250 per month because he just bought a house and is on a tight budget. He doesn't expect to have many doctor visits because he's pretty healthy, but he doesn't have enough money saved to afford a $6,300 deductible if things went south.
Considering his obligations, John decides to set aside 15 percent of his monthly income for health care. Based on this budget, he narrows his options down to three plans. The Kynect website displays them.
After eliminating the gold plan, John decides he would prefer to pay an additional $40 per month to reduce his deductible to $2,000, so he purchases the cooperative's PPO Silver plan. About 7 percent of his income each month will go toward the premium. He will save the other 8 percent ($240) to apply to his deductible, prescription drug costs and co-pays for office visits.
A $2,000 deductible means that John must pay all of his medical costs, excluding certain preventive services like immunizations and screening, until he reaches this threshold. Co-payments and premiums cannot count toward the deductible.
John really likes his family doctor, whom he's been seeing for 20 years, and the doctor is in the cooperative's network. This plan has a $30 co-pay for primary care and mental health services, and he feels comfortable paying this amount for an office visit. If he were to see an out-of-network doctor, he would pay co-insurance: 60 percent of the doctor's full charge for the visit. For prescription drugs, there is a $500 deductible, and John will pay $20 per prescription for generic drugs after reaching this amount.
John has peace of mind knowing that he's covered if he were to have an accident. The total amount he may have to pay each year is his out-of-pocket limit of $6,350, and since he has purchased this plan during the enrollment period, he will not face a penalty for not having coverage.
As he navigates the site, John sees that he qualifies for a payment assistance in the form of a tax credit that will either reduce the amount John will pay in taxes or increase his refund, depending on his personal situation; or it will reduce his monthly premiums, if he so chooses.
What happens if I don't get covered?
The penalty for 2014 will be the larger of either $95 per adult and $47.50 per child under 18, up to a total of $285 per family or 1 percent of household income in excess of $10,000 for an individual or $20,000 for a family.
For example, let's say an individual making $40,000 per year doesn't buy health insurance in 2013. This person would would pay 1 percent of $30,000, or $300, in 2014. What about a family with a $50,000 household income? It would pay a penalty of 1 percent of $50,000, or $500.
The initial penalties are much less than the cost of health insurance, but will go up each year. The minimum penalty may increase to as much as $695 per person by 2016.
What if I'm on Medicare or Medicaid?
Almost nothing will change if you have coverage through Medicaid, but there are some changes for Medicare beneficiaries. The law doesn't require Medicare beneficiaries to buy more insurance and won't force beneficiaries to see different doctors, reports Andrea Adleman of U.S. News.
Obamacare does, however, increase premiums or prescription-drug costs for some Medicare beneficiaries, and it mandates $716 billion in Medicare payment reductions over the next 10 years. These cuts are made by changing payment formulas for hospitals, nursing homes, home-health agencies, hospice agencies and Medicare Advantage plans, says the Congressional Budget Office.
The law already affects higher-income Medicare beneficiaries. Those who earn more than $85,000 ($170,000 for a couple) are paying higher Part B premiums, which cover physician and outpatient services, and for Part D, which covers prescription drugs, says Kaiser Health News. As a result of this sliding scale, about 5 percent of Medicare beneficiaries are paying more for premiums and prescription drugs.
It is projected that by 2019, 7.8 million beneficiaries will be paying the higher Part B premiums and of that group, 4.2 million will pay the higher Part D premiums. Kaiser estimated the combined premium in 2019 would be $299 to $683 a month, depending on income.
However, typical Medicare beneficiaries, those below the $85,000/$170,000 income threshold, will pay less for their premiums since the the law closes the "doughnut hole," the coverage gap in prescription benefits, by 2020. The National Council on Aging estimates the savings could reach $1,800 for some beneficiaries.
Also, both Medicaid and Medicare beneficiaries will qualify for more free preventive care, such as a yearly wellness visit, vaccinations and colorectal screenings, starting Jan. 1.
What if my employer covers me?
About 57 percent of Americans have health insurance through an employer with fewer than 200 employees, and those who are covered do not have to purchase a new plan on Kynect. If your employer’s plan covers less than 60 percent of allowed medical expenses, or costs you more than 9.5 percent of your household income, you can shop on the exchange.
Over the past 10 years, employers have been shifting more health costs to employees. Worker contributions increased 89 percent during the decade, and are 14 percent higher than in 2009, Kaiser Health News reports. So, while the nature of your work plan may be changing, this is not a direct result of the health law.
If you aren't covered by your employer or if your employer decides to drop your coverage, you must obtain coverage or face a penalty. Religious conscience and hardship exemptions to this mandated coverage exist, and you will need to complete an application to request such an exemption.
What if I'm an employer?
Steve Wilson, senior vice president of Benefit Insurance Marketing in Lexington, said in an email that employers with fewer than 50 employees are facing 2014 premium increases that may lead them to drop coverage for their employees.
Wilson said unless companies act quickly to renew early based on 2013 underwriting rules, the average 2014 renewal for his company's small business clients will increase 63 percent. He said his clients represent a broad range of industries that will, on average, pay $3,508 more per employee for coverage next year.
On the other hand, a study by the RAND Corp. says Obamacare could alleviate some of the difficulties for small employers by putting their employees into a single risk pool. The study predicts that the number of workers offered coverage will increase after the reform, mainly because more small businesses will offer coverage.
If you have a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance.
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Kentucky Health News
Few laws have generated as much confusion, opposition or news coverage as the Patient Protection and Affordable Care Act. Despite the flood of news stories about the law widely known as Obamacare, there is still much confusion about it.
That's not surprising. The 906-page law is complex and is accompanied by 10,535 pages of regulations. This guide to the law is designed to clear up confusion and offer various perspectives about how the law may affect you, your family or your business.
What does the Affordable Care Act do?
The law is a set of reforms that impose many requirements on insurance companies and requires all Americans, with very few exceptions, to have health coverage or pay a penalty starting Jan. 1.
 |
| Kynect home page |
Why did Congress pass the law?
The law is designed to extend health coverage, either through private insurance or Medicaid, to Americans without health insurance. More than 47 million Americans were uninsured in 2012, says the Kaiser Family Foundation, and about 640,000 of them were Kentuckians.
Who will be affected by the law?
Obamacare will affect almost everyone, but it will have less impact on people 65 and up because they're eligible for Medicare. Virtually everyone must have health insurance coverage by 2014 or pay a penalty. Beginning in 2015, employers of 50 or more full-time workers (defined as working at least 30 hours a week) must provide coverage for their employees.
Insurance companies can no longer deny coverage because of pre-existing conditions such as a disability, pregnancy, or chronic disease. Under one part of the law that took effect early, parents are able to keep their children on their insurance until the children turn 26.
The law aims to help people who can't get affordable insurance through an employer or who aren't ineligible for public coverage through Medicare or Medicaid. It also affects the self-employed, small businesses and employees of businesses that don't provide coverage.
Because the law is making fundamental changes in the health-insurance system, "In the long run, pretty much every American will be affected by Obamacare," reports Abby Hayes of The Dough Roller, a financial-advice site. "Next year, employer-sponsored insurance premiums are likely to fluctuate as insurance companies adjust their offerings."
Will the law lower health costs?
It's too soon to tell what impact the law will have on costs. Remember, there are two types of health costs: the country's overall cost and the cost that you feel in your pocketbook from the money your household spends on health services.
If you buy an insurance policy through the state exchange, www.kynect.ky.gov, your cost will depend on your individual situation, such as the size of your household and the number of smokers in it, and your income, which will determine your eligibility for subsidies or Medicaid.
Most people who buy coverage in the individual market will pay higher premiums in 2014, mainly because companies are required to cover people with pre-existing conditions and a broader range of services, such as prescriptions, than many people have been paying for.
Rates in the individual market will change yearly, as explained in a report from the Kaiser Family Foundation. It says the broader coverage, and limiting surcharges due to age, will spread the overall cost of care across the insurance marketplace, tending to lower premiums for people who are older and sicker and raise them for people who are younger and healthier. Thus, the trade-off for pre-existing coverage is the individual mandate, which requires everyone to purchase coverage to spread the cost.
Think of it this way: When you go out to eat with two grade-school children, they can order off the kids' menu, so you pay less for their smaller portions. The total bill is $30. Your kids' chicken finger platters are $5 each, and you and your spouse both have $10 items. However, if the restaurant must charge all patrons equally for the same meal, the $30 cost would be assessed differently. The cost for each individuals would be $7.50; the cost of your kids' meals would be higher and you and your spouse's meal would cost less.
Many Kentucky businesses have expressed concern about rising premiums for employee coverage. Some are moving to high-deductible plans that require employees to pay a larger share of their costs, and some may drop coverage, letting employees obtain insurance and subsidies through the government exchanges.
How do I get coverage from the exchange?
The Kynect website will determine your eligibility for Medicaid or subsidies, allow you compare plans and process the insurance application. If you don't have a computer, you can call toll-free to 1-855-459-6328 to apply or locate a local "Kynector."
Unless you qualify for a special enrollment period, you must enroll in a health plan by March 31, 2014. A "life-changing event," such as moving to a new state, major changes in income and changes in family size, can make you eligible for a special enrollment period, says Healthcare.gov, the federal website. (Kentuckians do not use the federal site because the state has its own site, Kynect.)
The date coverage starts depends on when you buy it. If you enroll before Dec. 15 and pay your first premium, your coverage starts Jan. 1. Likewise, in succeeding months, if you enroll between the 1st and 15th, your coverage starts on the 1st of the next month. If you enroll after the 15th, coverage starts the month after the next one.
What do the health plans cover?
Regardless of which plan you chose, the law requires all plans offered by any insurance company to cover these essential health benefits:
- Ambulatory patient services (outpatient care)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse services (including behavioral health treatment)
- Prescription drugs
- Rehabilitative and habilitative services/devices
- Laboratory services
- Preventative, wellness, and chronic disease management services
- Pediatric services (including oral and vision care)
Premiums depend on individual circumstances, such as income and the level of coverage, such as the amounts of deductibles and co-payments. Kynect is connected to federal databases — including Internal Revenue Service databases — to determine whether you qualify for assistance in paying a premium. People on Medicaid do not pay premiums.
Plans on Kynect vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have a $6,300 deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy.
Let's consider a basic example. A 45-year-old Floyd Countian named John Smith earns $36,000 a year, which means he is eligible to buy subsidized insurance through Kynect.
 |
| Kynect shows selected plans' ranges of premiums, deductibles and out-of-pocket limts. |
Considering his obligations, John decides to set aside 15 percent of his monthly income for health care. Based on this budget, he narrows his options down to three plans. The Kynect website displays them.
A $2,000 deductible means that John must pay all of his medical costs, excluding certain preventive services like immunizations and screening, until he reaches this threshold. Co-payments and premiums cannot count toward the deductible.
John really likes his family doctor, whom he's been seeing for 20 years, and the doctor is in the cooperative's network. This plan has a $30 co-pay for primary care and mental health services, and he feels comfortable paying this amount for an office visit. If he were to see an out-of-network doctor, he would pay co-insurance: 60 percent of the doctor's full charge for the visit. For prescription drugs, there is a $500 deductible, and John will pay $20 per prescription for generic drugs after reaching this amount.
John has peace of mind knowing that he's covered if he were to have an accident. The total amount he may have to pay each year is his out-of-pocket limit of $6,350, and since he has purchased this plan during the enrollment period, he will not face a penalty for not having coverage.
As he navigates the site, John sees that he qualifies for a payment assistance in the form of a tax credit that will either reduce the amount John will pay in taxes or increase his refund, depending on his personal situation; or it will reduce his monthly premiums, if he so chooses.
What happens if I don't get covered?
The penalty for 2014 will be the larger of either $95 per adult and $47.50 per child under 18, up to a total of $285 per family or 1 percent of household income in excess of $10,000 for an individual or $20,000 for a family.
For example, let's say an individual making $40,000 per year doesn't buy health insurance in 2013. This person would would pay 1 percent of $30,000, or $300, in 2014. What about a family with a $50,000 household income? It would pay a penalty of 1 percent of $50,000, or $500.
The initial penalties are much less than the cost of health insurance, but will go up each year. The minimum penalty may increase to as much as $695 per person by 2016.
What if I'm on Medicare or Medicaid?
Almost nothing will change if you have coverage through Medicaid, but there are some changes for Medicare beneficiaries. The law doesn't require Medicare beneficiaries to buy more insurance and won't force beneficiaries to see different doctors, reports Andrea Adleman of U.S. News.
Obamacare does, however, increase premiums or prescription-drug costs for some Medicare beneficiaries, and it mandates $716 billion in Medicare payment reductions over the next 10 years. These cuts are made by changing payment formulas for hospitals, nursing homes, home-health agencies, hospice agencies and Medicare Advantage plans, says the Congressional Budget Office.
The law already affects higher-income Medicare beneficiaries. Those who earn more than $85,000 ($170,000 for a couple) are paying higher Part B premiums, which cover physician and outpatient services, and for Part D, which covers prescription drugs, says Kaiser Health News. As a result of this sliding scale, about 5 percent of Medicare beneficiaries are paying more for premiums and prescription drugs.
It is projected that by 2019, 7.8 million beneficiaries will be paying the higher Part B premiums and of that group, 4.2 million will pay the higher Part D premiums. Kaiser estimated the combined premium in 2019 would be $299 to $683 a month, depending on income.
However, typical Medicare beneficiaries, those below the $85,000/$170,000 income threshold, will pay less for their premiums since the the law closes the "doughnut hole," the coverage gap in prescription benefits, by 2020. The National Council on Aging estimates the savings could reach $1,800 for some beneficiaries.
Also, both Medicaid and Medicare beneficiaries will qualify for more free preventive care, such as a yearly wellness visit, vaccinations and colorectal screenings, starting Jan. 1.
What if my employer covers me?
About 57 percent of Americans have health insurance through an employer with fewer than 200 employees, and those who are covered do not have to purchase a new plan on Kynect. If your employer’s plan covers less than 60 percent of allowed medical expenses, or costs you more than 9.5 percent of your household income, you can shop on the exchange.
Over the past 10 years, employers have been shifting more health costs to employees. Worker contributions increased 89 percent during the decade, and are 14 percent higher than in 2009, Kaiser Health News reports. So, while the nature of your work plan may be changing, this is not a direct result of the health law.
If you aren't covered by your employer or if your employer decides to drop your coverage, you must obtain coverage or face a penalty. Religious conscience and hardship exemptions to this mandated coverage exist, and you will need to complete an application to request such an exemption.
What if I'm an employer?
Steve Wilson, senior vice president of Benefit Insurance Marketing in Lexington, said in an email that employers with fewer than 50 employees are facing 2014 premium increases that may lead them to drop coverage for their employees.
Wilson said unless companies act quickly to renew early based on 2013 underwriting rules, the average 2014 renewal for his company's small business clients will increase 63 percent. He said his clients represent a broad range of industries that will, on average, pay $3,508 more per employee for coverage next year.
On the other hand, a study by the RAND Corp. says Obamacare could alleviate some of the difficulties for small employers by putting their employees into a single risk pool. The study predicts that the number of workers offered coverage will increase after the reform, mainly because more small businesses will offer coverage.
If you have a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance.
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Friday, 25 October 2013
FDA wants to limit number of hydrocodone refills available without another doctor visit; approves pure version of drug
"The Food and Drug Administration on Thursday recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers, changes that are expected to take place as early as next year," Barry Meier reports for The New York Times. "Drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab." (Associated Press photo by Toby Talbot)
"Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems," Meier writes. "The change would reduce the number of refills patients could get before going back to see their doctor. Patients would also be required to take a prescription to a pharmacy, rather than have a doctor call it in. The new regulations would reduce by half, to 90 days, the supply of the drug a patient could obtain without a new prescription."
On Friday, the FDA announced it had approved a stronger version of hydrocodone, Zohydro ER, for patients who require 24-hour, long-term pain medication. "The new version is the first pure hydrocodone drug approved in the U.S.," ABC News reports. "Hydrocodone is currently sold in combination pills like Vicodin to treat pain from injuries, surgery, arthritis and migraines." Activists against prescription-drug abuse criticized the decision.
U.S. Rep. Hal Rogers of Kentucky's 5th District "said on Friday that top FDA officials had recently assured him they would only approve new opioids like Zohydro if they were marketed in formulations intended to deter abuse," Meier and Eric Lipton report. "OxyContin is now formulated that way, but Zohydro, which is contains hydrocodone without acetaminophen, is not. Its producer, Zogenix, says it will closely monitor use of the drug." Rogers told the Times, “It is like the original OxyContin, so that is real problematical.”
On Friday, the FDA announced it had approved a stronger version of hydrocodone, Zohydro ER, for patients who require 24-hour, long-term pain medication. "The new version is the first pure hydrocodone drug approved in the U.S.," ABC News reports. "Hydrocodone is currently sold in combination pills like Vicodin to treat pain from injuries, surgery, arthritis and migraines." Activists against prescription-drug abuse criticized the decision.
U.S. Rep. Hal Rogers of Kentucky's 5th District "said on Friday that top FDA officials had recently assured him they would only approve new opioids like Zohydro if they were marketed in formulations intended to deter abuse," Meier and Eric Lipton report. "OxyContin is now formulated that way, but Zohydro, which is contains hydrocodone without acetaminophen, is not. Its producer, Zogenix, says it will closely monitor use of the drug." Rogers told the Times, “It is like the original OxyContin, so that is real problematical.”
More than 6.1 million Americans abuse prescription pills, and last year there were 22,133 prescription drug deaths. The problem is most rampant in Central Appalachia, including Eastern Kentucky.
In 2011, about 131 million prescriptions for 47 million patients, or about five billion pills, were written for medications containing hydrocodone, Meier notes. "Prescription drugs account for about three-quarters of all drug overdose deaths in the United States, with the number of deaths from narcotic painkillers, or opioids, quadrupling since 1999, according to federal data." (Read more)
In 2011, about 131 million prescriptions for 47 million patients, or about five billion pills, were written for medications containing hydrocodone, Meier notes. "Prescription drugs account for about three-quarters of all drug overdose deaths in the United States, with the number of deaths from narcotic painkillers, or opioids, quadrupling since 1999, according to federal data." (Read more)
Friday, 11 October 2013
Kentucky ranks high in prescription drug abuse, but also is a national leader in efforts to fight it, state-by-state analysis says
By Molly Burchett
Kentucky Health News
A new report finds many states do not have effective strategies in place to fight prescription drug abuse, but Kentucky scores high on most prevention measures, indicating that the state is working hard to combat the problem.
The Trust for America's Health report found that Kentucky, along with Massachusetts, New York and Washington, scored 9 out of 10 possible indicators of promising strategies to fight prescription drug abuse. Only two states, New Mexico and Vermont, scored 10 out of 10, while 28 states and Washington, D.C., scored 6 or less.
Prescription drug abuse has become a top national and state public health concern. Since 1999, rates have doubled in 29 states, tripled in 10 and quadrupled in four, including Kentucky. The state has the third highest drug-overdose death rate in the country, with 236 people per million people suffering overdose fatalities in 2010.
"Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response - starting with prevention and education all the way through to expanding and modernizing treatment," said Dr. Jeffrey Levi, executive director of Trust for America's Health, in a news release. "There are many promising signs that we can turn this around - but it requires urgent action."
To develop scores for the report, the organization worked with public-health, clinical, injury-prevention, law-enforcement and community organization experts to review a range of national recommendations and examine the 10 indicators. Kentucky received 9 out of 10 points because it:
"We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis," said Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, in a news release. Click here for a full description of the indicators, state scores and the full report.
Kentucky Health News
A new report finds many states do not have effective strategies in place to fight prescription drug abuse, but Kentucky scores high on most prevention measures, indicating that the state is working hard to combat the problem.
The Trust for America's Health report found that Kentucky, along with Massachusetts, New York and Washington, scored 9 out of 10 possible indicators of promising strategies to fight prescription drug abuse. Only two states, New Mexico and Vermont, scored 10 out of 10, while 28 states and Washington, D.C., scored 6 or less.
The only indicator Kentucky lacks is a Good Samaritan law, which would provide a degree of immunity from criminal charges or mitigation of sentencing for individuals who seek to help themselves or others experiencing an overdose, says the report. Such laws are in place in 17 states and D.C.
"Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response - starting with prevention and education all the way through to expanding and modernizing treatment," said Dr. Jeffrey Levi, executive director of Trust for America's Health, in a news release. "There are many promising signs that we can turn this around - but it requires urgent action."
To develop scores for the report, the organization worked with public-health, clinical, injury-prevention, law-enforcement and community organization experts to review a range of national recommendations and examine the 10 indicators. Kentucky received 9 out of 10 points because it:
- Has an active prescription drug monitoring program
- Requires utilization of monitoring program by prescribers
- Is participating in Medicaid expansion, which helps expand coverage of substance abuse services and treatment
- Has a "doctor shopping" law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider
- Requires or recommends prescriber education
- Has a rescue drug law to expand access to and use of naloxone, a prescription drug that can help counteract an overdose
- Has a law requiring health care providers to physically examine patients (or have a bona-fide physician-patient relationship) before prescribing a controlled substance
- Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance
- Has a pharmacy lock-in program under the state's Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy.
Although a cause-and-effect relationship cannot be determined, there are indications these efforts and strategies may be having a positive impact on reducing prescription drug abuse. A recent survey found fewer Kentucky teenagers said last year that they used prescription drugs without a doctor's direction, and this report indicates steps forward in the fight against abuse. There is still much more work to be done.
"We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis," said Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, in a news release. Click here for a full description of the indicators, state scores and the full report.
Middle- and high-school students invited to create 30-second videos discouraging prescription drug abuse, win prizes in contest
Attorney General Jack Conway and his Keep Kentucky Safe partners invite Kentucky middle- and high-school students to compete in the annual Prescription Drug Abuse Prevention Public Service Announcement contest.
Contestants create a PSA to warn Kentucky kids about the dangers of prescription drug abuse. "I want our young people to know that it is never okay to take a prescription pill that was not prescribed to them by their doctor," Conway said in a press release. "These are some of the most addictive substances on the planet, and if taken in the wrong combination, or with other substances, they can kill you."
Participating students should produce a 30-second video showing the perils of prescription drug abuse and submit it by Dec. 6. Winners will be announced Dec. 13. The first place winner will receive an Apple iPad, donated by the National Association of Drug Diversion Investigators, and the runner-up will receive a $100 Amazon.com gift card donated by the Kentucky Pharmacists Association.
Other partners in the contest are the Kentucky Office of Drug Control Policy, Operation UNITE and concerned parents, Dr. Karen Shay and Mike Donta.
Instructions for submission can be found here. Examples of winning videos can be found by clicking here for the 2012 winning video and here for the 2012 second place video.
Contestants create a PSA to warn Kentucky kids about the dangers of prescription drug abuse. "I want our young people to know that it is never okay to take a prescription pill that was not prescribed to them by their doctor," Conway said in a press release. "These are some of the most addictive substances on the planet, and if taken in the wrong combination, or with other substances, they can kill you."
Participating students should produce a 30-second video showing the perils of prescription drug abuse and submit it by Dec. 6. Winners will be announced Dec. 13. The first place winner will receive an Apple iPad, donated by the National Association of Drug Diversion Investigators, and the runner-up will receive a $100 Amazon.com gift card donated by the Kentucky Pharmacists Association.
Other partners in the contest are the Kentucky Office of Drug Control Policy, Operation UNITE and concerned parents, Dr. Karen Shay and Mike Donta.
Instructions for submission can be found here. Examples of winning videos can be found by clicking here for the 2012 winning video and here for the 2012 second place video.
Monday, 7 October 2013
Fewer teens report using tobacco and abusing prescription drugs, but some attribute latter trend to increase in heroin use
By Melissa Patrick and Melissa Landon
Kentucky Health News
Fewer Kentucky teenagers said last year that they used prescription drugs without a doctor's direction, or tobacco, than in the last such survey. But some addiction experts worry that prescription-drug abuse has dropped since 2010 because young people are using heroin instead.
According to a state survey of young people in 88 percent of Kentucky's school districts, their improper use of prescription drugs has declined steadily since 2004, with the greatest decrease between 2010 and 2012.
In 2012, prescription-drug abuse among high-school seniors dropped almost a third, to 9 percent from 13.1 percent in 2010. Among sophomores, it dropped to 7.6 from 11.3 percent; among eighth graders, to 2.9 from 5.3 percent; and among sixth graders, to 0.7 from 1.8 percent.
Some feel there's a disconcerting reason for the decline in prescription-drug abuse. "My concern is the unintended consequence is that people have switched to heroin," Karyn Hascal, president of The Healing Place recovery program in Louisville, told Laura Ungar of The Courier-Journal. "The problem is addiction, not the drug of the day." Hascal said The Healing Place has seen addicts who started out using other types of drugs but eventually turned to heroin as a cheaper option.
Although the survey didn't measure heroin use among teens, it asked if any of their four best friends had used illegal drugs in the past year. The results showed a continued slow decline, to 12.2 percent and 15 percent, respectively, among high-school sophomores and seniors.
"Over the past four years we have significantly stepped our efforts to address prescription-drug abuse," Connie Smith, manager of the Substance Abuse Prevention Branch of the state Division of Behavioral Health, said in a news release. "All of our regional prevention centers have been working very hard with their local coalitions to plan and implement effective programs to reduce illegal use of prescription drugs among youth."
The federally funded survey measures use of drugs, tobacco and inhalants; mental health; school safety issues; and gambling. The division said 153 of the 174 school districts at the time took part, with 122,718 students participating. The survey also measures concerns such as school safety issues and gambling. The report said that almost every other area studied had lower numbers in 2012 than in 2008
The survey asked several questions about tobacco. Among high-school seniors, 25.6 percent reported smoking in the previous 30 days, down from 29.4 percent in 2010. Among sophomores, smoking dropped to 18 percent from 21.7 percent; among eighth graders, to 8.7 from 10.7; and among sixth graders, to 2 percent from 2.5 percent in 2010.
Use of smokeless tobacco by high-school students declined in 2012, after rising in each survey from 2006 to 2010. Among seniors, it fell to 15.7 percent from 17.5 percent in 2010; among sophomores, it dropped to 13.4 percent from 15.9 percent. Among younger students, an eight-year decline continued, but at a sharper rate since 2010.
Marijuana use among high-schoolers declined slightly after increasing in 2008 and 2010. The survey also showed a steady decrease in the risk that teenagers associate with occasional use of marijuana. For the full report, click here.
Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Kentucky Health News
Fewer Kentucky teenagers said last year that they used prescription drugs without a doctor's direction, or tobacco, than in the last such survey. But some addiction experts worry that prescription-drug abuse has dropped since 2010 because young people are using heroin instead.
According to a state survey of young people in 88 percent of Kentucky's school districts, their improper use of prescription drugs has declined steadily since 2004, with the greatest decrease between 2010 and 2012.
In 2012, prescription-drug abuse among high-school seniors dropped almost a third, to 9 percent from 13.1 percent in 2010. Among sophomores, it dropped to 7.6 from 11.3 percent; among eighth graders, to 2.9 from 5.3 percent; and among sixth graders, to 0.7 from 1.8 percent.
Some feel there's a disconcerting reason for the decline in prescription-drug abuse. "My concern is the unintended consequence is that people have switched to heroin," Karyn Hascal, president of The Healing Place recovery program in Louisville, told Laura Ungar of The Courier-Journal. "The problem is addiction, not the drug of the day." Hascal said The Healing Place has seen addicts who started out using other types of drugs but eventually turned to heroin as a cheaper option.
Although the survey didn't measure heroin use among teens, it asked if any of their four best friends had used illegal drugs in the past year. The results showed a continued slow decline, to 12.2 percent and 15 percent, respectively, among high-school sophomores and seniors.
"Over the past four years we have significantly stepped our efforts to address prescription-drug abuse," Connie Smith, manager of the Substance Abuse Prevention Branch of the state Division of Behavioral Health, said in a news release. "All of our regional prevention centers have been working very hard with their local coalitions to plan and implement effective programs to reduce illegal use of prescription drugs among youth."
The federally funded survey measures use of drugs, tobacco and inhalants; mental health; school safety issues; and gambling. The division said 153 of the 174 school districts at the time took part, with 122,718 students participating. The survey also measures concerns such as school safety issues and gambling. The report said that almost every other area studied had lower numbers in 2012 than in 2008
The survey asked several questions about tobacco. Among high-school seniors, 25.6 percent reported smoking in the previous 30 days, down from 29.4 percent in 2010. Among sophomores, smoking dropped to 18 percent from 21.7 percent; among eighth graders, to 8.7 from 10.7; and among sixth graders, to 2 percent from 2.5 percent in 2010.
Use of smokeless tobacco by high-school students declined in 2012, after rising in each survey from 2006 to 2010. Among seniors, it fell to 15.7 percent from 17.5 percent in 2010; among sophomores, it dropped to 13.4 percent from 15.9 percent. Among younger students, an eight-year decline continued, but at a sharper rate since 2010.
Marijuana use among high-schoolers declined slightly after increasing in 2008 and 2010. The survey also showed a steady decrease in the risk that teenagers associate with occasional use of marijuana. For the full report, click here.
Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Fighting prescription drug abuse? Save your spot for 'The Difference Faces of Substance Abuse' conference Jan. 28-29
The conference, to be held Jan. 28-29 at the Griffin Gate Marriott in Lexington, will address all aspects of substance abuse and misuse, and provide opportunities for networking and professional development. Continuing education credits are available for alcohol and drug counselors, social workers, licensed professional counselors and marriage and family therapists.
Topics for Jan. 28 include faces and voices of recovery, children of substance abuse, and drug-use trends and updates. Michael Barry, CEO of People Advocating Recovery, will be the keynote speaker and will talk about combating the stigma of substance abuse.
On Jan. 29, Jennifer Havens, epidemiologist for the University of Kentucky's Center on Drug and Alcohol Research, will discuss her research about the effect of prescription painkiller use in Eastern Kentucky, followed by a session during which stories of recovery will be shared. Participants can also attend three of the following nine breakout sessions:
Registering early guarantees participants one spot among the 250 available. If registration is received by Nov. 1, it costs $100 per person; after Nov. 1, if space remains, the fee increases to $150 per person. Click here to register.
The conference is a partnership of UK's Cooperative Extension Service and state drug abuse prevention gaencies, says its website. Part of its mission is to plan and implement an educational conference for community partners combating drug abuse problems to improve strategies for minimizing and preventing drug abuse in Kentucky counties.
Tuesday, 1 October 2013
Conway says ruling in his Oxycontin lawsuit means he will seek settlement of $100 million or more
Attorney General Jack Conway says he wants Purdue Pharma to settle for $100 million or more after it missed a deadline to respond to his arguments in his lawsuit over the marketing of Oxycontin, Nick Strom reports for cn|2, a news service of Time Warner Cable. After Purdue Pharma failed to respond to a court motion, "all the admissions the commonwealth sought in the case were deemed admitted" by the circuit judge hearing the case in Pike County.
"Judge Steven Combs ruled Monday that Purdue could not withdraw those admissions which include that the drug maker: misrepresented and/or concealed the addictive nature of OxyContin, knew OxyContin was being abused and wasn’t being used for its stated purpose, continued to market and promote OxyContin despite knowing that, and encouraged physicians to overprescribe the drug," Storm reports. Conway told him, "I expect that a jury would be very very harsh on Purdue Pharma. I’m not going to be really negotiating much less or below nine figures. I want to see something well into nine figures.” (Read more)
Purdue Pharma has been blamed for starting, in Central Appalachia, the national epidemic of prescription-painkiller abuse and deaths. More than 1,000 Kentuckians die each year from prescription overdoses, the sixth highest rate in the country. Forbes ranked the Kentucky as the fourth most medicated state, according to Conway's office. More Kentuckians die from overdoses than in traffic accidents. (Read more) Map by Kentucky Justice and Public Safety Cabinet:
"Judge Steven Combs ruled Monday that Purdue could not withdraw those admissions which include that the drug maker: misrepresented and/or concealed the addictive nature of OxyContin, knew OxyContin was being abused and wasn’t being used for its stated purpose, continued to market and promote OxyContin despite knowing that, and encouraged physicians to overprescribe the drug," Storm reports. Conway told him, "I expect that a jury would be very very harsh on Purdue Pharma. I’m not going to be really negotiating much less or below nine figures. I want to see something well into nine figures.” (Read more)
Purdue Pharma has been blamed for starting, in Central Appalachia, the national epidemic of prescription-painkiller abuse and deaths. More than 1,000 Kentuckians die each year from prescription overdoses, the sixth highest rate in the country. Forbes ranked the Kentucky as the fourth most medicated state, according to Conway's office. More Kentuckians die from overdoses than in traffic accidents. (Read more) Map by Kentucky Justice and Public Safety Cabinet:
Wednesday, 4 September 2013
As heroin use increases in Kentucky, new report shows its strong connections to abusers of prescription pain medicines
Kentucky's law-enforcement agences, policymakers and public-health advocates have taken serious measures to curb the state's rampant prescription drug abuse problem, and recent state and national news stories suggest that the reduced supply of these painkillers, at least the ones in a non-crushable form, has driven pill abusers to heroin. Now there's research to support this theory.
Non-medical use of prescription pain medication may raise the risk of heroin use, says a new report by the Substance Abuse and Mental Health Services Administration. SAMHSA says people aged 12 to 49 who previously used prescription pain relievers non-medically were 19 times more likely than non-abusers to have started using heroin over the past year.
Proving the connection, the converse was true: Almost 80 percent of those who started to use heroin over the past year had abused prescription pain relievers. These findings are part of a larger effort to identify some risk factors of heroin use, and also to understand the "dependence and initiation that have occurred in the past few years," says a SAMHSA news release.
Heroin use, which had already become a problem in Northern and Central Kentucky, has been spreading to the Southern and Eastern Kentucky. The drug is becoming more popular throughout the state and nation because it is cheaper and easier to get than prescription painkillers, specifically opioid medications.
The number of U.S. heroin users has increased by about 60 percent from 2007 to 2011, says the 2011 National Survey on Drug Use and Health. And while some can argue for the benefits of prescription medication, that same risk-benefit analysis doesn't apply to heroin, which has only risk.
The SAMHSA report offers another risk of prescription drugs: “Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “This report shows that it can also greatly increase an individual’s risk of turning to heroin use – thus adding a new dimension of potential harm.”
The number of U.S. heroin users has increased by about 60 percent from 2007 to 2011, says the 2011 National Survey on Drug Use and Health. And while some can argue for the benefits of prescription medication, that same risk-benefit analysis doesn't apply to heroin, which has only risk.
The SAMHSA report offers another risk of prescription drugs: “Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “This report shows that it can also greatly increase an individual’s risk of turning to heroin use – thus adding a new dimension of potential harm.”
Wednesday, 28 August 2013
Kentucky expands list of permanent locations for safe disposal of unneeded or expired prescription medications
Gov. Steve Beshear announced today that Kentucky now has 149 permanent prescription drug disposal locations in 97 counties where Kentuckians can safely dispose of unused or expired medications in order to help curb the state's prescription drug abuse problem.
“The effects of prescription drug abuse are devastating to our families and our communities,” Beshear said in a news release. “Medications, once they are no longer needed for their prescribed purposes, should be disposed of properly to reduce their risk of being diverted and abused . . . "
Counties with permanent disposal boxes are shown on the map below in green. The boxes are monitored to ensure safe drug disposal and are located in law enforcement buildings. There are two pending locations, one in Ohio County and one in Franklin County, as shown in light blue. The 23 counties in white do not have permanent disposal locations.
“One in five of our Kentucky teens has abused prescription medication for an off-label purpose, and that abuse is starting in the home when children have access to their parents’ unused or expired pain medications,” Attorney General Jack Conway said in the news release.
The disposal boxes are funded by Kentucky Agency for Substance Abuse Policy, Operation Unite, Kentucky League of Cities and state and local law enforcement agencies, says the release. Click here for a complete listing of locations and hours of operation.
“The effects of prescription drug abuse are devastating to our families and our communities,” Beshear said in a news release. “Medications, once they are no longer needed for their prescribed purposes, should be disposed of properly to reduce their risk of being diverted and abused . . . "
Counties with permanent disposal boxes are shown on the map below in green. The boxes are monitored to ensure safe drug disposal and are located in law enforcement buildings. There are two pending locations, one in Ohio County and one in Franklin County, as shown in light blue. The 23 counties in white do not have permanent disposal locations.
“One in five of our Kentucky teens has abused prescription medication for an off-label purpose, and that abuse is starting in the home when children have access to their parents’ unused or expired pain medications,” Attorney General Jack Conway said in the news release.
The disposal boxes are funded by Kentucky Agency for Substance Abuse Policy, Operation Unite, Kentucky League of Cities and state and local law enforcement agencies, says the release. Click here for a complete listing of locations and hours of operation.
Tuesday, 30 July 2013
Obama and allies tout preventive-services and drug benefits of health-reform law to Medicare beneficiaries in Ky.
The federal health-reform law has made drugs more affordable for seniors, broadened coverage for preventive services and made Medicare more solvent, the Obama administration and its allies are pointing out today, the 48th anniversary of the enactment of the Medicare program.
According to the Department of Health and Human Services, Medicare beneficiaries in Kentucky have saved nearly $141 million on prescription drugs because of the Patient Protection and Affordable Care Act. Last year, 72,391 Kentuckians saved more than $51 million, or an average of $703 each, on prescriptions because those in the “donut hole” of Medicare Part D got a 50 percent discount on covered brand-name drugs and a 14 percent discount on generic drugs. The law will keep expanding coverage for both types of drugs until it closes the donut hole, the gap in coverage between modest and huge prescription needs.
The law also eliminated deductibles and co-payments for screening and other preventive services for seniors and people with disabilities. Last year, 485,843 Kentuckians with traditional Medicare used one or more free preventive service.
"The health care law extends the life of the Medicare Trust Fund by 10 years," said a news release from U.S. Rep. John Yarmuth, D-Louisville. From 2010 to 2012, Medicare spending per beneficiary grew 1.7 percent a year, much more slowly "than the per capita rate of growth in the economy," the release said. "And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology."
Earlier, the administration noted that Americans received $504 million in rebates from insurance companies because of the law's requirement that a certain percentage of premiums paid must be used for health care. In Kentucky, the rebates totaled $14.4 million to 206,771 consumers (slightly more than half, totaling almost $11 million, in the individual market) and averaged $100 per family. For other data on the effects of the law in Kentucky, click here.
According to the Department of Health and Human Services, Medicare beneficiaries in Kentucky have saved nearly $141 million on prescription drugs because of the Patient Protection and Affordable Care Act. Last year, 72,391 Kentuckians saved more than $51 million, or an average of $703 each, on prescriptions because those in the “donut hole” of Medicare Part D got a 50 percent discount on covered brand-name drugs and a 14 percent discount on generic drugs. The law will keep expanding coverage for both types of drugs until it closes the donut hole, the gap in coverage between modest and huge prescription needs.
The law also eliminated deductibles and co-payments for screening and other preventive services for seniors and people with disabilities. Last year, 485,843 Kentuckians with traditional Medicare used one or more free preventive service.
"The health care law extends the life of the Medicare Trust Fund by 10 years," said a news release from U.S. Rep. John Yarmuth, D-Louisville. From 2010 to 2012, Medicare spending per beneficiary grew 1.7 percent a year, much more slowly "than the per capita rate of growth in the economy," the release said. "And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology."
Earlier, the administration noted that Americans received $504 million in rebates from insurance companies because of the law's requirement that a certain percentage of premiums paid must be used for health care. In Kentucky, the rebates totaled $14.4 million to 206,771 consumers (slightly more than half, totaling almost $11 million, in the individual market) and averaged $100 per family. For other data on the effects of the law in Kentucky, click here.
Friday, 26 July 2013
Beshear, Stumbo credit law for reducing prescription-drug deaths, but reduction was far outnumbered by rise in heroin fatalities
Deaths from prescription-drug abuse in Kentucky declined last year for the first time in a decade, and top state officials are crediting a law passed by that year's General Assembly.
However, passage of the law has prompted many drug users to switch to heroin, and the increase in heroin deaths (121) was much larger than the decline in prescription-drug fatalities (19).
"Autopsied overdose deaths attributed to the use of heroin increased 550 percent over the previous year, from 22 in 2011 to 143 cases in 2012," a release from Gov. Steve Beshear's office said. The decline in prescription-drug deaths was 1.9 percent, from 1,023 to 1,004, but the release said nothing else about the new problem and did not link it to the 2012 law that cracked down on abuse of prescription drugs.
“The impact of this bill can’t be measured just in the numbers of pills we’ve kept off the streets,” Beshear said in the release. “This bill, I believe, has literally saved lives in Kentucky.”
House Speaker Greg Stumbo, D-Prestonsburg, said, “I’m proud of the results, and the fact that other states are following our lead. Our goal now is to build on these gains and to improve access to treatment, so that abusers can truly escape this deadly cycle once and for all.”
The first quote in John Cheves' Lexington Herald-Leader story came from Van Ingram, executive director of the state Office of Drug Control Policy, which the new law required to begin publishing annual reports on drug overdose fatalities in the state: "There's no great victories here. I'm glad that we're at least seeing a leveling off and some small decline. I've been in this job for nine years and have watched a steady rise in numbers that whole time."
The law, known as House Bill 1 before Beshear signed it, required pain-management clinics to be owned by a licensed medical provider, required all drug prescribers to register with a state monitoring system, and reduced the number of prescriptions for heavily abused controlled substances, a release from the governor's office said.
"Since the law was passed, 20 non-physician-owned pain management facilities have closed," the release said. The "Cabinet for Health and Family Services has issued cease-and-desist letters to another four pain management facilities operating outside the scope of state regulations."
"Of the 1,004 overdose fatalities in 2012, 888 were found to be unintentional, 59 were suicides and 57 remain undetermined," the release said. "Alprazolam (Xanax) remained the most-detected controlled substance in overdose deaths, present in 41 percent of all autopsied cases. Morphine was found in 32 percent of autopsies, followed by hydrocodone at 26 percent and oxycodone at 24 percent."
"Autopsies often found more than one drug present," Cheves notes. "The youngest overdose fatality was 16; the oldest was 72. Slightly more than half of the victims were men. Leslie County (population 11,170) reported the state's top per-capita rate of an annualized 85 fatal overdoses for every 100,000 people. The county had 11 overdose deaths in 2012, up from eight the previous year. In descending order, the other leading counties were Clinton, Clay, Estill, Floyd, Nicholas, Perry, Whitley, Monroe and Magoffin." (Read more)
However, passage of the law has prompted many drug users to switch to heroin, and the increase in heroin deaths (121) was much larger than the decline in prescription-drug fatalities (19).
"Autopsied overdose deaths attributed to the use of heroin increased 550 percent over the previous year, from 22 in 2011 to 143 cases in 2012," a release from Gov. Steve Beshear's office said. The decline in prescription-drug deaths was 1.9 percent, from 1,023 to 1,004, but the release said nothing else about the new problem and did not link it to the 2012 law that cracked down on abuse of prescription drugs.
“The impact of this bill can’t be measured just in the numbers of pills we’ve kept off the streets,” Beshear said in the release. “This bill, I believe, has literally saved lives in Kentucky.”
House Speaker Greg Stumbo, D-Prestonsburg, said, “I’m proud of the results, and the fact that other states are following our lead. Our goal now is to build on these gains and to improve access to treatment, so that abusers can truly escape this deadly cycle once and for all.”
The first quote in John Cheves' Lexington Herald-Leader story came from Van Ingram, executive director of the state Office of Drug Control Policy, which the new law required to begin publishing annual reports on drug overdose fatalities in the state: "There's no great victories here. I'm glad that we're at least seeing a leveling off and some small decline. I've been in this job for nine years and have watched a steady rise in numbers that whole time."
 |
| Top counties: Leslie, Clinton, Clay, Estill, Floyd, Nicholas, Perry, Whitley, Monroe (Herald-Leader) |
"Since the law was passed, 20 non-physician-owned pain management facilities have closed," the release said. The "Cabinet for Health and Family Services has issued cease-and-desist letters to another four pain management facilities operating outside the scope of state regulations."
"Of the 1,004 overdose fatalities in 2012, 888 were found to be unintentional, 59 were suicides and 57 remain undetermined," the release said. "Alprazolam (Xanax) remained the most-detected controlled substance in overdose deaths, present in 41 percent of all autopsied cases. Morphine was found in 32 percent of autopsies, followed by hydrocodone at 26 percent and oxycodone at 24 percent."
"Autopsies often found more than one drug present," Cheves notes. "The youngest overdose fatality was 16; the oldest was 72. Slightly more than half of the victims were men. Leslie County (population 11,170) reported the state's top per-capita rate of an annualized 85 fatal overdoses for every 100,000 people. The county had 11 overdose deaths in 2012, up from eight the previous year. In descending order, the other leading counties were Clinton, Clay, Estill, Floyd, Nicholas, Perry, Whitley, Monroe and Magoffin." (Read more)
Tuesday, 23 July 2013
As prescription painkillers become harder to get and abuse, heroin replaces them in Eastern and Southern Kentucky
Heroin use, which has been a problem in Northern and then Central Kentucky after the state began cracking down on prescription painkillers last year, has been spreading to the Southern and Eastern parts of the state. Heroin is becoming more popular throughout Kentucky because it is cheaper and easier to get than prescription painkillers, specifically opioid medications, reports Valarie Honeycutt Spears of the Lexington Herald-Leader.
While an 80-milligram OxyContin costs between $60 to $100 a pill on the black market, heroin costs $45 to $60 for a multiple-dose supply, reports The Partnership at Drugfree.org. With national and state efforts to curb prescription drug abuse, including the reformulation of OxyContin that makes the drug more difficult to crush and snort, heroin can also be easier to obtain and abuse.
As drug users turn from prescription drugs to heroin to get their high, Northern Kentucky and major cities like Lexington and Louisville are struggling to address the problem, says an Operation UNITE press release. Operation UNITE is a regional anti-drug coalition fighting substance abuse in Southern and Eastern Kentucky counties (map).
Most Southern and Eastern Kentucky counties are just beginning to see the signs of heroin use, says the release. Dan Smoot, CEO of Operation Unite, told Spears that heroin’s spread throughout Kentucky was inevitable. “We knew it was coming. We just didn’t know when it would hit,” he said.
Rowan County was hit before most Eastern Kentucky counties, said Smoot; the most recent example of increased heroin use occurred July 9, when Operation UNITE agents arrested a known prescription drug trafficker attempting to bring a large quantity of heroin into Beattyville, says the release.
Uncertainty about what heroin users are actually getting makes the drug especially dangerous, says Paul Hays, law-enforcement director for Operation UNITE. “You don’t know the purity of the heroin,” he said in the release. “Dealers will often ‘cut’ the drug with other substances in order to boost their profits. There’s no way the public knows what they’re shooting up.”
This increased risk can be deadly, and although there's no evidence of an increase in heroin overdose deaths in Eastern Kentucky, a task force has been created to address this fatal problem in Lexington. There have been 29 heroin overdose deaths in Fayette County so far this year, seven more than the amount of overdose deaths in all opf 2012, Fayette Coroner Gary Ginn told the newspaper.
While an 80-milligram OxyContin costs between $60 to $100 a pill on the black market, heroin costs $45 to $60 for a multiple-dose supply, reports The Partnership at Drugfree.org. With national and state efforts to curb prescription drug abuse, including the reformulation of OxyContin that makes the drug more difficult to crush and snort, heroin can also be easier to obtain and abuse.
As drug users turn from prescription drugs to heroin to get their high, Northern Kentucky and major cities like Lexington and Louisville are struggling to address the problem, says an Operation UNITE press release. Operation UNITE is a regional anti-drug coalition fighting substance abuse in Southern and Eastern Kentucky counties (map).Most Southern and Eastern Kentucky counties are just beginning to see the signs of heroin use, says the release. Dan Smoot, CEO of Operation Unite, told Spears that heroin’s spread throughout Kentucky was inevitable. “We knew it was coming. We just didn’t know when it would hit,” he said.
Rowan County was hit before most Eastern Kentucky counties, said Smoot; the most recent example of increased heroin use occurred July 9, when Operation UNITE agents arrested a known prescription drug trafficker attempting to bring a large quantity of heroin into Beattyville, says the release.
Uncertainty about what heroin users are actually getting makes the drug especially dangerous, says Paul Hays, law-enforcement director for Operation UNITE. “You don’t know the purity of the heroin,” he said in the release. “Dealers will often ‘cut’ the drug with other substances in order to boost their profits. There’s no way the public knows what they’re shooting up.”
This increased risk can be deadly, and although there's no evidence of an increase in heroin overdose deaths in Eastern Kentucky, a task force has been created to address this fatal problem in Lexington. There have been 29 heroin overdose deaths in Fayette County so far this year, seven more than the amount of overdose deaths in all opf 2012, Fayette Coroner Gary Ginn told the newspaper.
Sunday, 21 July 2013
Kentucky, insurance companies are applying lessons learned in state's hurried transition to managed-care Medicaid
By Molly Burchett
Kentucky Health News
Gov. Steve Beshear rushed to transplant Medicaid into a new bed called managed care, hoping the new medium would save money and improve health, but his administration didn't take time to condition the soil, fertilize the ground or oil the machinery in 2011. This month, managed-care company Kentucky Spirit proved to be the self-plucking bad weed, fleeing the state as it cited unbearable costs.
Kentucky’s hurried transition to Medicaid managed care has been anything but smooth for many doctors, hospitals and other health-care providers. They have complained about late payments and burdensome reimbursement processes.
It's also not been smooth for the state or the managed-care firms, which are subsidiaries of insurance companies. There have been court battles, tension-filled negotiations, dropped contracts, allegations of a contract breach and now the departure of Kentucky Spirit, pushing its 125,000 clients to one of the other two companies operating outside the Louisville region.
Most important, patients have suffered from the rapid switch and ensuing wrangles. They complain that prescriptions previously covered by the old "fee for service" system are now denied as not being"medically necessary" by managed-care firms, which the state pays a set fee per person. Patients in rural areas complain because they must drive long distances to find providers in their Medicaid company's network.
But there have been improvements in delivery of health care, particularly in the areas of vaccinations and other preventive services, says the state Cabinet for Health and Family Services. Those include a 33 percent increase in flu vaccinations and an increase in immunizations for children, more well-child visits, increased smoking-cessation consultation, and more than a 50 percent increase in diabetes testing, cabinet spokeswoman Jill Midkiff said.
State and companies made some missteps
Amid those encouraging signs for the future, most of the news about managed care in the past 10 months has been about Kentucky Spirit's potential departure which occurred July 6. The cabinet is preparing legal action to seek damages from Kentucky Spirit for abandoning its contract; the company, a subsidiary of St. Louis-based Centene Corp., says it didn't break the contract and took every step possible to make a smooth and orderly transition. The state Court of Appeals ruled that Kentucky Spirit could end its contract without a two-month transition period for patients because the state had plenty of time to make arrangements for the company's departure.
It's not clear that the state can recoup damages, or lost taxpayer money, from Kentucky Spirit, though it is having to pay the other two companies more because Kentucky Spirit was initially the low bidder for a managed-care contract. CoventryCares and WellCare of Kentucky are paid an average of about $100 more per month per Medicaid patient.
When Kentucky Spirit first threatened to leave in October 2012, it said it was losing money due to "faulty data" the state provided during the bid process. The two other companies received the same information.
"There were no flaws in the state's data book," CoventryCares CEO Michael Murphy told Kentucky Health News. But he said the companies miscalculated because the data book didn't refer to retroactive payments. That led to a loss of $50 million for Coventry in the first quarter of 2012, he said. Now, he added, the company has a greater understanding of the system.
WellCare, asked if the state provided faulty data, did not answer as definitively. "Medicaid programs are expansive and complex, and it is not unusual for any state to provide data during a RFP [request for proposals] process that may have anomalies or other issues that could negatively impact rates if left unaddressed over time," said Mike Minor, president of the firm.
Schedule seemed politically influenced
Both companies said the state's transition to managed care was rapid and taught difficult lessons. That raises questions about whether haste made waste. Kentucky Spirit blames the state for its losses, and providers blame managed care companies for reimbursement issues, but evidence continues to clearly indicate two problems: too little time and money.
The state has been using managed care in the Louisville region through the not-for-profit Passport Health Plan since the late 1990s, and had long considered expanding it to other parts or all of the state to save money as Medicaid costs burgeoned, especially during the Great Recession.
Gov. Steve Beshear proposed statewide managed care in the budget he gave the General Assembly in early 2011, called a special legislative session to authorize it in March 2011, and signed the legislation on March 25 of that year. The state requested proposals from managed-care companies two weeks later, and bids were due less than two months later.
Contracts were finalized July 8 but implementation was not scheduled until Oct. 1. It was delayed until Nov. 1 "at the insistence of the Kentucky Hospital Association," which "asserted more time was needed for hospitals to negotiate contracts with plans," says a University of Kentucky report published last year and funded by the Foundation for a Healthy Kentucky.
"Several informants told us that they believed that the upcoming election for Kentucky’s race for governor was a primary contributing factor in the rapid implementation timeline," the report says. "Beshear’s office saw the closing of this gap as a major issue that needed to be addressed before the November election," which was held Nov. 8. That effectively delayed most publicity about complaints regarding implementation until after the election.
"There is no doubt that the commonwealth’s rapid transition from a Medicaid fee-for-service program to a managed-care program raised a number of unforeseen challenges," said Minor, of WellCare.
"Certainly, the short timeframe . . . made for a difficult transition," said Midkiff. "Despite the negative portrayal of the managed-care companies, much progress has been made . . . and we expect that progress will continue."
In October 2012, the managed-care companies continued to be dissatisfied with their fees, claiming they were inadequate to provide quality care, says the UK report. In January 2013, the state gave CoventryCares and WellCare 3 to 5 percent rate increases.; Kentucky Spirit asked for 21 percent, Murphy said, but got only 1 percent.
Murphy said the state had reduced rates below those established by the federal Centers for Medicare and Medicaid Services. "We want to establish base rates for primary care services that we hope the state will continue," he said.
Minor said, "While there were legitimate prompt-pay issues during the first six months of implementation of Medicaid managed care, we are now well past those issues."
Looking ahead
Murphy said some of CoventryCares' initial failures were due to the company's lack of understanding, and it has found Health and Family Services Secretary Audrey Haynes and her actuaries very cooperative and transparent, helping improve the system. "CoventryCares had to first figure out the problems going on with providers and payments. We had to understand the risks we had, and things have settled down quite a bit, especially regarding the pre-authorization process," he said. "We've stopped the bleeding."
Murphy said health-care providers will bear the burden of Kentucky Spirit's departure. To resolve issues faced by providers even before that, the cabinet has held regional forums across the state. Reception at the forums has been positive, and providers have been grateful for the opportunity to address any problems or complaints they have with the cabinet and Medicaid staff, said Midkiff.
Some providers still complain, saying that they should not have to meet with managed-care and state officials to receive payment for services already provided to Medicaid patients.
Starting in January 2013, primary care providers were supposed to be paid Medicare rates for Medicaid services over a two-year period, but some providers have yet to see that rate increase. Murphy said Coventry is planning to pay the increased rates as soon as the state's application is approved by federal officials.
Murphy said managed care should not be about the money, but about the member. He said primary care is at the core of improved health outcomes. Minor said WellCare has also made it a goal to establish relationships with primary-care providers.
But for those primary-care providers facing financial difficulties in wake of payment cuts, it is about the money because they need it to keep their practices open.
One of providers' latest complaints is CoventryCares' recent limit on dispensing certain prescription pain killers, to a 15-day supply. The move was made "to curb the manipulations going on with opioid painkillers," said Russell Harper, the company's director of government relations.
Murphy said, "It's not everybody, but there are physicians that don't want to engage in health care." He acknowledged that the prior-authorization process between doctors and pharmacists can be a hassle, but it's just another facet of managing the health care of Medicaid patients. That, and saving money, are what managed care is all about.
Kentucky Health News
Gov. Steve Beshear rushed to transplant Medicaid into a new bed called managed care, hoping the new medium would save money and improve health, but his administration didn't take time to condition the soil, fertilize the ground or oil the machinery in 2011. This month, managed-care company Kentucky Spirit proved to be the self-plucking bad weed, fleeing the state as it cited unbearable costs.
Kentucky’s hurried transition to Medicaid managed care has been anything but smooth for many doctors, hospitals and other health-care providers. They have complained about late payments and burdensome reimbursement processes.
It's also not been smooth for the state or the managed-care firms, which are subsidiaries of insurance companies. There have been court battles, tension-filled negotiations, dropped contracts, allegations of a contract breach and now the departure of Kentucky Spirit, pushing its 125,000 clients to one of the other two companies operating outside the Louisville region.
Most important, patients have suffered from the rapid switch and ensuing wrangles. They complain that prescriptions previously covered by the old "fee for service" system are now denied as not being"medically necessary" by managed-care firms, which the state pays a set fee per person. Patients in rural areas complain because they must drive long distances to find providers in their Medicaid company's network.
But there have been improvements in delivery of health care, particularly in the areas of vaccinations and other preventive services, says the state Cabinet for Health and Family Services. Those include a 33 percent increase in flu vaccinations and an increase in immunizations for children, more well-child visits, increased smoking-cessation consultation, and more than a 50 percent increase in diabetes testing, cabinet spokeswoman Jill Midkiff said.
State and companies made some missteps
Amid those encouraging signs for the future, most of the news about managed care in the past 10 months has been about Kentucky Spirit's potential departure which occurred July 6. The cabinet is preparing legal action to seek damages from Kentucky Spirit for abandoning its contract; the company, a subsidiary of St. Louis-based Centene Corp., says it didn't break the contract and took every step possible to make a smooth and orderly transition. The state Court of Appeals ruled that Kentucky Spirit could end its contract without a two-month transition period for patients because the state had plenty of time to make arrangements for the company's departure.
It's not clear that the state can recoup damages, or lost taxpayer money, from Kentucky Spirit, though it is having to pay the other two companies more because Kentucky Spirit was initially the low bidder for a managed-care contract. CoventryCares and WellCare of Kentucky are paid an average of about $100 more per month per Medicaid patient.
"There were no flaws in the state's data book," CoventryCares CEO Michael Murphy told Kentucky Health News. But he said the companies miscalculated because the data book didn't refer to retroactive payments. That led to a loss of $50 million for Coventry in the first quarter of 2012, he said. Now, he added, the company has a greater understanding of the system.
WellCare, asked if the state provided faulty data, did not answer as definitively. "Medicaid programs are expansive and complex, and it is not unusual for any state to provide data during a RFP [request for proposals] process that may have anomalies or other issues that could negatively impact rates if left unaddressed over time," said Mike Minor, president of the firm.
Schedule seemed politically influenced
Both companies said the state's transition to managed care was rapid and taught difficult lessons. That raises questions about whether haste made waste. Kentucky Spirit blames the state for its losses, and providers blame managed care companies for reimbursement issues, but evidence continues to clearly indicate two problems: too little time and money.
The state has been using managed care in the Louisville region through the not-for-profit Passport Health Plan since the late 1990s, and had long considered expanding it to other parts or all of the state to save money as Medicaid costs burgeoned, especially during the Great Recession.
Gov. Steve Beshear proposed statewide managed care in the budget he gave the General Assembly in early 2011, called a special legislative session to authorize it in March 2011, and signed the legislation on March 25 of that year. The state requested proposals from managed-care companies two weeks later, and bids were due less than two months later.
Contracts were finalized July 8 but implementation was not scheduled until Oct. 1. It was delayed until Nov. 1 "at the insistence of the Kentucky Hospital Association," which "asserted more time was needed for hospitals to negotiate contracts with plans," says a University of Kentucky report published last year and funded by the Foundation for a Healthy Kentucky.
"Several informants told us that they believed that the upcoming election for Kentucky’s race for governor was a primary contributing factor in the rapid implementation timeline," the report says. "Beshear’s office saw the closing of this gap as a major issue that needed to be addressed before the November election," which was held Nov. 8. That effectively delayed most publicity about complaints regarding implementation until after the election.
"There is no doubt that the commonwealth’s rapid transition from a Medicaid fee-for-service program to a managed-care program raised a number of unforeseen challenges," said Minor, of WellCare.
"Certainly, the short timeframe . . . made for a difficult transition," said Midkiff. "Despite the negative portrayal of the managed-care companies, much progress has been made . . . and we expect that progress will continue."
 |
| Implementation timeline from UK's Medicaid managed care report |
Murphy said the state had reduced rates below those established by the federal Centers for Medicare and Medicaid Services. "We want to establish base rates for primary care services that we hope the state will continue," he said.
Minor said, "While there were legitimate prompt-pay issues during the first six months of implementation of Medicaid managed care, we are now well past those issues."
Looking ahead
Murphy said some of CoventryCares' initial failures were due to the company's lack of understanding, and it has found Health and Family Services Secretary Audrey Haynes and her actuaries very cooperative and transparent, helping improve the system. "CoventryCares had to first figure out the problems going on with providers and payments. We had to understand the risks we had, and things have settled down quite a bit, especially regarding the pre-authorization process," he said. "We've stopped the bleeding."
Murphy said health-care providers will bear the burden of Kentucky Spirit's departure. To resolve issues faced by providers even before that, the cabinet has held regional forums across the state. Reception at the forums has been positive, and providers have been grateful for the opportunity to address any problems or complaints they have with the cabinet and Medicaid staff, said Midkiff.
Some providers still complain, saying that they should not have to meet with managed-care and state officials to receive payment for services already provided to Medicaid patients.
Starting in January 2013, primary care providers were supposed to be paid Medicare rates for Medicaid services over a two-year period, but some providers have yet to see that rate increase. Murphy said Coventry is planning to pay the increased rates as soon as the state's application is approved by federal officials.
Murphy said managed care should not be about the money, but about the member. He said primary care is at the core of improved health outcomes. Minor said WellCare has also made it a goal to establish relationships with primary-care providers.
But for those primary-care providers facing financial difficulties in wake of payment cuts, it is about the money because they need it to keep their practices open.
One of providers' latest complaints is CoventryCares' recent limit on dispensing certain prescription pain killers, to a 15-day supply. The move was made "to curb the manipulations going on with opioid painkillers," said Russell Harper, the company's director of government relations.
Murphy said, "It's not everybody, but there are physicians that don't want to engage in health care." He acknowledged that the prior-authorization process between doctors and pharmacists can be a hassle, but it's just another facet of managing the health care of Medicaid patients. That, and saving money, are what managed care is all about.
Wednesday, 15 May 2013
Could Medicare Part D be an inadvertent enabler of prescription drug abuse?
By Molly Burchett
Kentucky Health News
An examination of the Medicare Part D program that Congress established a decade ago, dedicating billions of dollars to subsidizing prescription drug purchases for 35 million elderly and disabled Americans, uncovers the program's risky lack of oversight -- and suggests that it might be contributing to Kentucky's prescription-drug abuse epidemic.
An analysis of Medicare prescription records by ProPublica, an independent, nonprofit newsroom, found that the program has failed to properly monitor safety, ProPublica's Tracy Weber, Charles Ornstein and Jennifer LaFleur write in The Washington Post. And despite their findings that many providers prescribe antipsychotics, narcotics and other drugs known to be dangerous for older adults, Medicare officials told them it's not their job to monitor for unsafe prescribing or to stop doctors with criminal histories.
The largely unchecked prescribing habits of Medicare providers and the increased availability of prescription drugs suggests that Part D has inadvertently enabled prescription drug abuse, by making drugs available for abuse by Medicare patients, their friends, acquaintances and family members, particularly teenagers. A 2010 national survey by the U.S. Department of Health and Human Services found that 65 percent of teens who report that they have abused prescription medicine got them from friends, family and acquaintances rather than illegal drug dealers.
In Kentucky, drug overdose, mostly from prescription drugs, is the leading cause of death, and the widespread availability of drugs and easy access to drugs are some reasons for this trend, says the 2012 combined report from the Kentucky Justice & Public Safety Cabinet. In addition to taking the lives of loved ones, drug overdose takes a huge financial toll on the state, and a recent study shows that the Medicare program bankrolls the single largest percentage of drug overdose inpatient hospitalizations.
Medicare alone was billed for 30 percent of all inpatient hospitalizations for drug overdoses in Kentucky from 2000 through 2010, totaling over $440.7 million, says a report by the Kentucky Injury Prevention Research Center. During those 11 years, the number of unintentional drug-overdose hospitalizations of Medicare beneficiaries increased 222 percent.
The fact that almost a third of overdose hospitalizations involve Medicare patients is concerning, said Van Ingram, executive director for the Kentucky Office of Drug Control Policy. In addition to these alarming statistics, Medicare and Medicaid incurred nearly $4 million worth of charges for drug-overdose visits to emergency rooms in 2010, which represents 41 percent of the total charges, says the KIPRC report. Also, during the period from 2008 to 2010, the number of unintentional Medicare drug-overdose emergency visits increased almost 44 percent.
Among prescription drugs, opiates and similar narcotics are most likely to be abused and most likely to lead to death. Since Medicare Part D began covering prescription drugs in 2006, drug overdose deaths involving opiates have increased almost 80 percent in Kentucky, says the KIPRC report.
ProPublica's Prescriber Checkup database shows that 30 percent of Medicare Part D patients have filled at least one narcotic prescription. The most common drug provided by Part D in Kentucky is hydrocodone-aceteminophen, which is an opiate painkiller known commercially as Lortab, Lorcet or Vicodin. Part D paid more than $12.6 million on 958,933 claims for hydrocodone-aceteminophen from 2007 to 2010.
Medicare officials told ProPublica that the government isn't responsible for monitoring these types of prescriptions because that is the duty of private health plans administering the program. Yet, health plans aren't given the tools to do so, the reporters write, and no one party has been slated the task of ensuring safe medication-use. This complacent mentality suggests Medicare officials, who also say it's not the providers' duty to "prevent inappropriate prescribing for individual patients," could be passively contributing to the drug-safety issue of prescription medications covered by Part D.
In addition to indicating that providers should not industriously discourage dangerous prescription drug usage, ProPublica’s examination of Part D data showcases numerous examples of Medicare officials failing to act against providers with troubled prescribing backgrounds. Such examination initiates a worthwhile discussion about the program's role in encouraging, or well, at least not actively combating, prescription drug abuse. Click here to visit Kentucky's Medicare Part D Prescriber Checkup. Individual doctors can be looked up.
Kentucky Health News
An examination of the Medicare Part D program that Congress established a decade ago, dedicating billions of dollars to subsidizing prescription drug purchases for 35 million elderly and disabled Americans, uncovers the program's risky lack of oversight -- and suggests that it might be contributing to Kentucky's prescription-drug abuse epidemic.
An analysis of Medicare prescription records by ProPublica, an independent, nonprofit newsroom, found that the program has failed to properly monitor safety, ProPublica's Tracy Weber, Charles Ornstein and Jennifer LaFleur write in The Washington Post. And despite their findings that many providers prescribe antipsychotics, narcotics and other drugs known to be dangerous for older adults, Medicare officials told them it's not their job to monitor for unsafe prescribing or to stop doctors with criminal histories.
The largely unchecked prescribing habits of Medicare providers and the increased availability of prescription drugs suggests that Part D has inadvertently enabled prescription drug abuse, by making drugs available for abuse by Medicare patients, their friends, acquaintances and family members, particularly teenagers. A 2010 national survey by the U.S. Department of Health and Human Services found that 65 percent of teens who report that they have abused prescription medicine got them from friends, family and acquaintances rather than illegal drug dealers.
In Kentucky, drug overdose, mostly from prescription drugs, is the leading cause of death, and the widespread availability of drugs and easy access to drugs are some reasons for this trend, says the 2012 combined report from the Kentucky Justice & Public Safety Cabinet. In addition to taking the lives of loved ones, drug overdose takes a huge financial toll on the state, and a recent study shows that the Medicare program bankrolls the single largest percentage of drug overdose inpatient hospitalizations.
 |
| Inpatient hospitalizations for drug overdoses by percentage of total charges, among Kentucky residents treated in Kentucky acute-care hospitals, 2010 |
The fact that almost a third of overdose hospitalizations involve Medicare patients is concerning, said Van Ingram, executive director for the Kentucky Office of Drug Control Policy. In addition to these alarming statistics, Medicare and Medicaid incurred nearly $4 million worth of charges for drug-overdose visits to emergency rooms in 2010, which represents 41 percent of the total charges, says the KIPRC report. Also, during the period from 2008 to 2010, the number of unintentional Medicare drug-overdose emergency visits increased almost 44 percent.
Among prescription drugs, opiates and similar narcotics are most likely to be abused and most likely to lead to death. Since Medicare Part D began covering prescription drugs in 2006, drug overdose deaths involving opiates have increased almost 80 percent in Kentucky, says the KIPRC report.
ProPublica's Prescriber Checkup database shows that 30 percent of Medicare Part D patients have filled at least one narcotic prescription. The most common drug provided by Part D in Kentucky is hydrocodone-aceteminophen, which is an opiate painkiller known commercially as Lortab, Lorcet or Vicodin. Part D paid more than $12.6 million on 958,933 claims for hydrocodone-aceteminophen from 2007 to 2010.
Medicare officials told ProPublica that the government isn't responsible for monitoring these types of prescriptions because that is the duty of private health plans administering the program. Yet, health plans aren't given the tools to do so, the reporters write, and no one party has been slated the task of ensuring safe medication-use. This complacent mentality suggests Medicare officials, who also say it's not the providers' duty to "prevent inappropriate prescribing for individual patients," could be passively contributing to the drug-safety issue of prescription medications covered by Part D.
In addition to indicating that providers should not industriously discourage dangerous prescription drug usage, ProPublica’s examination of Part D data showcases numerous examples of Medicare officials failing to act against providers with troubled prescribing backgrounds. Such examination initiates a worthwhile discussion about the program's role in encouraging, or well, at least not actively combating, prescription drug abuse. Click here to visit Kentucky's Medicare Part D Prescriber Checkup. Individual doctors can be looked up.
Wednesday, 24 April 2013
Spring-clean the cabinet and dump your drugs Saturday, April 27
According to the Drug Enforcement Administration, the National Prescription Drug Take-Back Day aims to provide a safe and convenient way to throw away unwanted or unused drugs, keeping them out of the wrong hands while also educating the general public about the potential for abuse of these medications.
This is a great opportunity for those who missed the previous events or those that have accumulated unwanted, unused prescription drugs since the last event to safely dispose of them. Click here to find the nearest collection site and here to learn more about the DEA initiative.
Tuesday, 16 April 2013
FDA requires OxyContin pills to be non-crushable to deter abuse
The Food and Drug Administration announced Tuesday that it would block generic, crushable versions of OxyContin from coming to the market and approve the reformulated, non-crushable OxyContin, which deters abuse of the powerful painkiller.
U.S. Senate Republican Leader Mitch McConnell applauded the move. “Given the public health epidemic of prescription drug abuse and the ravaging effects it has on families all across Kentucky, this announcement is great news and will prevent an influx of crushable, generic OxyContin from coming to market,” McConnell said in a release.
OxyContin is a potent drug designed to treat severe pain. Without abuse-deterrent formulas, addicts can crush the pills to get an immediate heroin-like high. The reformulated product has properties that make the tablet harder to crush, break, or dissolve and that prevent it from being injected in order to achieve a quick high, an FDA press release said.
Drug overdoses are now the leading cause of death in Kentucky, and law enforcement, lawmakers and health providers have expressed their concerns that crushable, generic versions would worsen the problem.
The FDA decision came on the same day manufacturer Purdue Pharma’s patent on the original drug was set to expire, and McConnell has been actively meeting with federal officials on behalf of those concerned. Rep. Hal Rogers, R-5th, also lobbied for it. (Read more)
In an editorial, the Lexington Herald-Leader points out that the move means a continued OxyContin monopoly and more profits for Purdue Pharma, which "paid $600 million in fines in 2007, and three of the company's executives paid a total of $34.5 million, after they pleaded guilty to misleading doctors and the public about OxyContin's addictiveness. . . . We wonder why Rogers and McConnell aren't calling for Purdue to voluntarily share its new formulation."
U.S. Senate Republican Leader Mitch McConnell applauded the move. “Given the public health epidemic of prescription drug abuse and the ravaging effects it has on families all across Kentucky, this announcement is great news and will prevent an influx of crushable, generic OxyContin from coming to market,” McConnell said in a release.
OxyContin is a potent drug designed to treat severe pain. Without abuse-deterrent formulas, addicts can crush the pills to get an immediate heroin-like high. The reformulated product has properties that make the tablet harder to crush, break, or dissolve and that prevent it from being injected in order to achieve a quick high, an FDA press release said.
Drug overdoses are now the leading cause of death in Kentucky, and law enforcement, lawmakers and health providers have expressed their concerns that crushable, generic versions would worsen the problem.
The FDA decision came on the same day manufacturer Purdue Pharma’s patent on the original drug was set to expire, and McConnell has been actively meeting with federal officials on behalf of those concerned. Rep. Hal Rogers, R-5th, also lobbied for it. (Read more)
In an editorial, the Lexington Herald-Leader points out that the move means a continued OxyContin monopoly and more profits for Purdue Pharma, which "paid $600 million in fines in 2007, and three of the company's executives paid a total of $34.5 million, after they pleaded guilty to misleading doctors and the public about OxyContin's addictiveness. . . . We wonder why Rogers and McConnell aren't calling for Purdue to voluntarily share its new formulation."
National Rx Drug Abuse Summit, a Kentucky product, seeks to make the nation face up to its problem
The second annual National Rx Drug Abuse Summit, organized by Eastern Kentucky's Operation UNITE, called for a national commitment to combating the country's drug-abuse problem
"People of great passion and perspective are here wanting to make an impact in their communities," said U.S. Rep. Hal Rogers, who first funded Operation UNITE. "The first step is we have to admit there is a problem. I don't think the country is there yet. We've got to face up to it. We've got to make this known ... and that we're not going to hide from it." Rogers was quoted in a news release.
UNITE (Unlawful Narcotics Investigations, Treatment and Education) serves 32 counties in Eastern Kentucky. It was created to fight illegal drug use through a comprehensive approach that includes educating youth and the public and coordinating substance abuse treatment while providing support for families affected by abuse.
In Kentucky, drug overdose is the leading cause of death and is more fatal than motor vehicle accidents, and the number of Kentucky drug-overdose deaths nearly quadrupling from 2000 to 2010. The nation has seen a similar trend, with the number of overdose deaths more than tripling over the decade.
“We can stop this epidemic,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said at the summit. “But we need everyone working together in an all-hands-on-deck approach.”
Themes highlighted at the summit included the need to provide better education about drug abuse, the need for greater use and seamless integration of state prescription-monitoring programs, the need to facilitate effective treatment and recovery programs, and the need for abuse-deterrent narcotic formulations.
“We were extremely pleased that so many individuals representing such a broad cross-section of interests shared their knowledge and expertise,” said Karen Kelly, who is leaving Operation UNITE to become district director on the Rogers congressional staff. To read more about the summit, click here.
 |
| U.S. Rep. Hal Rogers, R-5th District |
UNITE (Unlawful Narcotics Investigations, Treatment and Education) serves 32 counties in Eastern Kentucky. It was created to fight illegal drug use through a comprehensive approach that includes educating youth and the public and coordinating substance abuse treatment while providing support for families affected by abuse.
In Kentucky, drug overdose is the leading cause of death and is more fatal than motor vehicle accidents, and the number of Kentucky drug-overdose deaths nearly quadrupling from 2000 to 2010. The nation has seen a similar trend, with the number of overdose deaths more than tripling over the decade.
“We can stop this epidemic,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said at the summit. “But we need everyone working together in an all-hands-on-deck approach.”
Themes highlighted at the summit included the need to provide better education about drug abuse, the need for greater use and seamless integration of state prescription-monitoring programs, the need to facilitate effective treatment and recovery programs, and the need for abuse-deterrent narcotic formulations.
“We were extremely pleased that so many individuals representing such a broad cross-section of interests shared their knowledge and expertise,” said Karen Kelly, who is leaving Operation UNITE to become district director on the Rogers congressional staff. To read more about the summit, click here.
Tuesday, 9 April 2013
Poll shows health care costs are a burden for many Kentuckians
A recent statewide survey shows health-care costs are a burden for many Kentuckians, especially for those who are poor and don't have insurance and put off getting care they need because they can't afford it.
More than 60 percent of Kentucky adults in the poll said high costs forced them or a family member living in their home to delay getting care in the past year. Not surprisingly, almost 90 percent of uninsured respondents reported going completely without care in the past year.
The Kentucky Health Issues Poll also showed that 48 percent have relied on home remedies when they are sick instead of going to a doctor, 43 percent have postponed care they needed, 37 percent have not filled a prescription or skipped a dental visit or checkup, 36 percent skipped a recommended medical test or treatment, and 16 percent have cut pills in half or skipped doses of medicine for financial reasons. Overall, 64 percent answered "yes" to at least one of those questions.
“Although our economy is improving, many Kentucky families are still struggling financially. Our research shows healthcare costs have a significant impact on Kentuckians’ actions,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Timely access to quality, affordable healthcare is important to restore and maintain Kentuckians’ health and productivity. When we delay or go without care, illness severity and costs can escalate. Based on the KHIP results, many Kentuckians are taking risks with their overall health because of the expense.”
Rising costs of health care do not affect all Kentuckians in the same way; almost 40 percent of Kentucky adults reported that paying for health care and health insurance is not a financial burden. Those who did say costs were a burden said they were burdened equally by the costs of doctor visits, prescription drugs and insurance premiums or deductibles.
The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted Sept. 20 and Oct. 14 of last year by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or 2.5 points.
More than 60 percent of Kentucky adults in the poll said high costs forced them or a family member living in their home to delay getting care in the past year. Not surprisingly, almost 90 percent of uninsured respondents reported going completely without care in the past year.
The Kentucky Health Issues Poll also showed that 48 percent have relied on home remedies when they are sick instead of going to a doctor, 43 percent have postponed care they needed, 37 percent have not filled a prescription or skipped a dental visit or checkup, 36 percent skipped a recommended medical test or treatment, and 16 percent have cut pills in half or skipped doses of medicine for financial reasons. Overall, 64 percent answered "yes" to at least one of those questions.
“Although our economy is improving, many Kentucky families are still struggling financially. Our research shows healthcare costs have a significant impact on Kentuckians’ actions,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Timely access to quality, affordable healthcare is important to restore and maintain Kentuckians’ health and productivity. When we delay or go without care, illness severity and costs can escalate. Based on the KHIP results, many Kentuckians are taking risks with their overall health because of the expense.”
Rising costs of health care do not affect all Kentuckians in the same way; almost 40 percent of Kentucky adults reported that paying for health care and health insurance is not a financial burden. Those who did say costs were a burden said they were burdened equally by the costs of doctor visits, prescription drugs and insurance premiums or deductibles.
The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted Sept. 20 and Oct. 14 of last year by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or 2.5 points.
Wednesday, 20 March 2013
Most Kentucky adults don't know that drug overdose is the leading cause of death in the state, but those in the east do
Drug overdoses, driven largely by prescription drug abuse, overtook motor vehicle accidents as the leading cause of unintentional deaths in Kentucky back in 2010 and remain the state's leading cause of death. From 2000 to 2010, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent, highlighting the state's drug abuse epidemic that now kills more than 1,000 Kentuckians a year. But a recent poll suggests many Kentuckians are not fully aware of the state's drug problem.
In an effort to gauge awareness of the problem, the Kentucky Health Issues Poll asked Kentucky adults whether traffic accidents, falls, firearms or unintentional drug overdoses resulted in the highest dumber of deaths in the state each year. Only 44 percent of Kentucky adults correctly indicated that drug overdose is the leading cause of unintentional Kentucky deaths; 43 percent incorrectly identified traffic accidents as the leading cause.
Respondents from Eastern Kentucky, where the problem is most prevalent were more likely to correctly identify it as the leading cause of death, at 69 percent. However, only 29 percent of Louisville-area respondents did.
“Experts have reported significant prescription pain reliever abuse in eastern Kentucky,” said Susan Zepeda, presient of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “It is no surprise that the Kentuckians most aware of this issue are those who are living in this region. Awareness is the first step towards curbing this trend – it is up to all of us to get involved and take action to reduce the toll of this health crisis.”
The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by land line and cell telephones, and the poll's margin of error is plus or minus 2.5 percentage points.
In an effort to gauge awareness of the problem, the Kentucky Health Issues Poll asked Kentucky adults whether traffic accidents, falls, firearms or unintentional drug overdoses resulted in the highest dumber of deaths in the state each year. Only 44 percent of Kentucky adults correctly indicated that drug overdose is the leading cause of unintentional Kentucky deaths; 43 percent incorrectly identified traffic accidents as the leading cause.
Respondents from Eastern Kentucky, where the problem is most prevalent were more likely to correctly identify it as the leading cause of death, at 69 percent. However, only 29 percent of Louisville-area respondents did.
“Experts have reported significant prescription pain reliever abuse in eastern Kentucky,” said Susan Zepeda, presient of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “It is no surprise that the Kentuckians most aware of this issue are those who are living in this region. Awareness is the first step towards curbing this trend – it is up to all of us to get involved and take action to reduce the toll of this health crisis.”
The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by land line and cell telephones, and the poll's margin of error is plus or minus 2.5 percentage points.
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