Category Archives: News

Medicare’s drug-pricing experiment stirs opposition

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By Julie Appleby
Kaiser Health News

A broad proposal by Medicare to change the way it pays for some drugs has drawn intense reaction and lobbying, with much of the debate centering on whether the plan gives too much power over drug prices to government regulators.

One of most controversial sections would set up a nationwide experiment, scheduled to start in 2017, to test a handful of ways to slow spending on drugs provided in doctor’s offices, clinics, hospitals and cancer infusion centers. The proposal would not affect most prescriptions patients get through their pharmacies.

The aim, the government says, is to maintain quality while slowing spending in Medicare Part B by more closely tying payments to how well drugs work, using methods drugmakers, insurers and benefit managers are already trying in the private sector.

One of the approaches included in the proposal would allow Medicare to earmark “therapeutically similar” drugs and set a benchmark, or “reference price,” that it would pay for all drugs in that category.

That amount might be the cost of the drug the agency considers the most effective in the group, or some other measure. It’s aimed at narrowing the wide variability — often hundreds or thousands of dollars a year — in what is paid for similar drugs. Continue reading

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To combat disease, states make it harder to skip vaccines

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Vaccine SquareBy Sarah Breitenbach
Stateline

When Jennifer Stella’s two children were babies, she made sure they got all the usual vaccines.

But when one started having seizures and the other developed eczema after they’d gotten immunizations, the Vermont woman decided her kids would no longer get shots required to attend school.

Stella, a co-founder of the Vermont Coalition for Vaccine Choice, is among a growing number of parents who are opting out of childhood vaccinations because they’re worried about their safety. Public health experts say the movement is leading to outbreaks of nearly eradicated dangerous diseases, such as measles and whooping cough, among clusters of unvaccinated kids.

All states require children to get vaccinated to attend school, and immunization rates across the nation remain high, with 92 percent of children between 19 months and 35 months getting the shots to protect against potentially deadly measles, mumps and rubella (MMR).

But even a small number of unvaccinated people can undermine the immunity of the larger population, which is leading public health officials and vaccine advocates to push for changes.

Some want to educate parents about the risks of forgoing vaccines and fight what they say is misinformation about the risks posed by the vaccines.

Others have pushed lawmakers to eliminate exemptions from state vaccine requirements and sought to make it more difficult for families to qualify for the exemptions that remain. Continue reading

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FDA considering pricey implant for opioid addiction

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Tablet Thumb BlueBy Martha Bebinger, WBUR
Kaiser Health News

Amid a raging opioid epidemic, many doctors and families in the U.S. have been pleading for better treatment alternatives.

One option now under consideration by the Food and Drug Administration is a system of implanted rods that offer controlled release of buprenorphine — a drug already used in other forms to treat opioid addiction.

Because it’s implanted in the skin, this version of the drug can’t easily be sold on the illegal market, proponents say — a key treatment advantage. The FDA is expected to decide whether to approve the device — called Probuphine — within a week.

The implant system includes four rods, each about the size of a match stick, explained Dave, a paramedic in a small town outside of Boston; he was one of the patients recruited to test the device last year. Dave’s worried about reprisal if co-workers find out he is addicted to opioid pain pills, so NPR agreed to use only his first name.

“My implants were placed in my left arm, just above my elbow on the inside,” he explained. He’s been in recovery for four years — previously with the help of daily buprenorphine pills. Last year, he agreed to be part of an experiment that delivered regular doses of the drug to him via an implant instead. He’s sold on the new approach.

“I felt completely normal all the time,” he said. Continue reading

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CVS MinuteClinic: A cure for long wait times for veterans?

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SANTA CLARITA, CA/USA - MARCH 1, 2015: CVS/pharmacy store front and sign. CVS Pharmacy is the second largest pharmacy chain in the United States.
By Barbara Feder Ostrov
Kaiser Health News & NPR

Struggling with long wait times, the Veterans Affairs Health Care System is trying something new: a partnership with the CVS Pharmacy chain to offer urgent care services to more than 65,000 veterans.

The experiment begins today at the VA’s operations in Palo Alto, California.

Veterans can visit 14 “MinuteClinics” operated by CVS in the San Francisco Bay area and Sacramento, where staff will treat them for conditions such as respiratory infections, order lab tests and prescribe medications, which can be filled at CVS pharmacies.

The care will be free for veterans, and the VA will reimburse CVS for the treatment and medications. Whether the partnership will spread to other VA locales isn’t yet clear.

The collaboration comes amid renewed scrutiny of the nation’s troubled VA health system, which has tried without much success to improve long wait times for veterans needing health care. Continue reading

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The hefty price of ‘study drug’ misuse on college campuses

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Three red and white capsules

By Lina Begdache, Binghamton University, State University of New York
TheConversation.com

Nonmedical use of Attention Deficit Hyperactivity Disorder (ADHD) drugs on college campuses, such as Adderall, Ritalin, Concerta and Vyvanse, has exploded in the past decade, with a parallel rise in depression disorders and binge drinking among young adults.

These ADHD drugs act as a brain stimulant that are normally prescribed to individuals who display symptoms of ADHD. These stimulants boost the availability of dopamine, a chemical responsible for transmitting signals between the nerve cells (neurons) of the brain.

But now a growing student population has been using them as “study” drugs – that help them stay up all night and concentrate. According to a 2007 National Institutes of Health (NIH) study, abuse of nonmedical prescription drugs among college students, such as ADHD meds, increased from 8.3 percent in 1996 to 14.6 percent in 2006.

Besides helping with concentration, dopamine is also associated with motivation and pleasurable feelings. Individuals who use these ADHD drugs nonmedically experience a surge in dopamine similar to that caused by illicit drugs which induces a great sense of well-being.

My journey with investigating the effect of the stimulant use nonmedically on college campuses started with a question from a student seven years ago. The question was about the long-term effect of misuse on brain and physical health. Continue reading

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Most Texans and Floridians want Medicaid expansion, survey

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200px-Flag-map_of_TexasBy Carrie Feibel, Houston Public Media
Kaiser Health News

Americans who live in the two biggest states that haven’t expanded Medicaid have more complaints about health care costs and quality, according to a new survey released by the Texas Medical Center Health Policy Institute in Houston. They’d also like their states to expand Medicaid.

The survey, conducted by marketing research firm Nielsen, assessed attitudes about the health care system, and possible solutions, in five populous states: Texas, California, Florida, New York and Ohio.

“Both Texas and Florida, the residents there are hurting and are turning to the idea of Medicaid expansion.

The 5,000 respondents were also asked about their party affiliation and insurance status — and height and weight. Those measurements were used to estimate the rates of obesity, for questions about interventions.

320px-Flag_of_Florida.svgThe Affordable Care Act allowed states to expand Medicaid to cover more poor adults, but 19 states still have not done so.

In California, New York and Ohio, politicians took advantage of federal funding in the law to expand Medicaid. The survey showed most residents in those three states approved of that decision.

The Republican leaders of Texas and Florida refused to expand Medicaid. However, the survey showed two-thirds of people in those two states wanted them to do it anyway.

“Both Texas and Florida, the residents there are hurting and are turning to the idea of Medicaid expansion,” said Dr. Tim Garson, the director of the Health Policy Institute. Continue reading

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Doctor yearns for a return to the time when physicians were ‘artisans’

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stethoscope doctor's bag chest x-rayBy Michelle Andrews
Kaiser Health News

In his recent book, “The Finest Traditions of My Calling,” Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.

Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and practices on the adult inpatient psychiatric unit there. I recently spoke with him and this is an edited transcript of our conversation.

Q. Your book is in some ways a lament for times gone by, when physicians were “artisans” who had more time for their patients and professional independence. But you’re a young doctor and you must have known at the outset that wasn’t the way medicine worked anymore. Why do you stick with it?

A. The first thing I’d say was that I didn’t know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling. Continue reading

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New rules set limits for financial incentives used by employee wellness programs

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Twenty-dollar bill in a pill bottleBy Julie Appleby
Kaiser Health News

Employers seeking to get workers to join wellness programs and provide medical information can set financial rewards – or penalties – of up to 30 percent of the cost for an individual in the company’s health insurance plan, according to controversial rules finalized by the Equal Employment Opportunity Commission Monday.

Although such penalties or incentives could run into the hundreds or even thousands of dollars, the programs are considered voluntary — and therefore legal, the commission said.

The rules seek to ensure “wellness programs actually promote good health and are not just used to collect or sell sensitive medical information about employees and family members or to impermissibly shift health insurance costs to them,” the EEOC said.

But the final rules drew immediate concern from some groups.

Employers can set financial rewards – or penalties – of up to 30 percent of the cost of health insurance plan

Jennifer Mathis, director of programs for the Bazelon Center for Mental Health Law, says the new rule rolls back protections in existing law.

“Voluntary inquiries can now come with steep financial penalties, according to the EEOC, for choosing not to answer,” she said. “That’s a troubling precedent for the application of civil rights laws.” Continue reading

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Kreidler files for re-election as Washington’s insurance commissioner – Puget Sound Business Journal

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MKreidlerPhotoWashington state Insurance Commissioner Mike Kreidler Monday officially filed for re-election for what would be his fifth term in office.

Kreidler was first elected in 2000 and has played a central role in implementing health reform in the state.

He announced in September he would seek re-election.

Source: Kreidler files for re-election as Washington’s insurance commissioner – Puget Sound Business Journal

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Supreme Court sends health law birth control case back to lower courts

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U.S. Supreme CourtBy Julie Rovner
Kaiser Health News

When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.

In an unsigned opinion issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.

At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to  provide no-cost contraception for women.

The government made several changes to the rules over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage.

But dozens of religious nonprofit employers sued anyway, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful. Continue reading

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Where drinking, drugs and Alzheimers’s are disproportionately fatal

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Compass_4By Tim Henderson
Stateline

Drinking is more likely to be the cause of death in much of the Southwest than in other parts of the country. In parts of Appalachia and New England, it’s a drug overdose. Suicide by gun stands out as disproportionately lethal in parts of the Upper Midwest and Alaska.

Although the top causes of death are similar for most states, many states have their own peculiar hard cases —types of deaths whose rates are higher than the national norm, a Stateline analysis of 2014 data from the Centers for Disease Control and Prevention shows.

The analysis, which relies on a method similar to one used in a CDC journal, shows some understandable disparities in the causes of death in some regions. The South, the epicenter of the nation’s obesity epidemic, has high rates of heart-related deaths. New Mexico and Arizona, where American Indian reservations have struggled with alcohol for decades, have high rates of alcohol-related deaths.

Some are more puzzling. Why, for instance, are falls disproportionately killing people in Northern states such as Iowa, Minnesota and Wisconsin? Why is Alzheimer’s disease causing relatively more deaths in Washington state?  Continue reading

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Increased physical activity associated with lower risk of 13 types of cancer

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Running shoes full shotFrom the National Institutes of Health

A new study of the relationship between physical activity and cancer has shown that greater levels of leisure-time physical activity were associated with a lower risk of developing 13 different types of cancer.

The risk of developing seven cancer types was 20 percent (or more) lower among the most active participants (90th percentile of activity) as compared with the least active participants (10th percentile of activity). Continue reading

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Five health issues presidential candidates aren’t talking about, but should be

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USA America buttonBy Julie Rovner
Kaiser Health News and USAToday

References to the Affordable Care Act — sometimes called Obamacare — have been a regular feature of the current presidential campaign season.

For months, Republican candidates have pledged to repeal it, while Democrat Hillary Clinton wants to build on it and Democrat Bernie Sanders wants to replace it with a government-funded “Medicare for All” program.

But much of the policy discussion stops there. Yet the nation in the next few years faces many important decisions about health care — most of which have little to do with the controversial federal health law. Here are five issues candidates should be discussing, but largely are not:

1. Out-of-pocket spending:

Millions more people — roughly 20 million, at last count — now have health insurance, thanks to the new coverage options created by the ACA. But most people are also paying more of their own medical bills than ever before. And they are noticing. A recent Gallup survey found health costs to be the top financial problem faced by adults in the United States, outpacing low wages and housing costs. Continue reading

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In Prince’s age group, risk of opioid overdose climbs

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Prince - Photo: imieye from flickr.com

Prince – Photo: imieye from flickr.com

By Kristin Espeland Gourlay, RINPR
Kaiser Health New

Evidence is mounting that opioid pain medication may have played a role in the death of pop legend Prince.

While the medical examiner hasn’t yet released the results of the autopsy and toxicology tests in this case, opioid overdose in middle age is all too common.

In 2013 and 2014, according to the The Centers for Disease Control and Prevention, people ages 45 to 64 accounted for more than 40 percent of all deaths from drug overdose.

Prince died on April 21 at his home and music studio Paisley Park in Minneapolis. He was 57.

Experts say there are a number of scenarios that increase risk of overdose, which is often accidental, for people over 55.

Imagine you are in that age group and you injured your shoulder a while back. It just hasn’t gotten better, so you take prescription painkillers — an opioid like OxyContin — to help with the pain. Let’s say you’ve been taking it for a couple of years. Your body has built up a tolerance to the drug, and now, you need to change it up to get the same amount of relief.

When it comes to the potential for overdose, said Boston Medical Center epidemiologist Traci Green, this is one of the most dangerous crossroads. Continue reading

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