Category Archives: Hepatitis

U.S. prescription drug spending rose 13 percent in 2014: IMS report | Reuters

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Twenty-dollar bill in a pill bottleU.S. spending on prescription medicines jumped 13 percent to $374 billion in 2014, the biggest percentage increase since 2001, as demand surged for expensive new breakthrough hepatitis C treatments, a report released on Tuesday showed.

Demand for newer cancer and multiple sclerosis treatments, price increases on branded medicines, particularly insulin products for diabetes, and the entry of few new generic versions of big-selling drugs also contributed to the double-digit spending rise in 2014, the report by IMS Health Holdings Inc found.

via U.S. prescription drug spending rose 13 percent in 2014: IMS report | Reuters.

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The Cost of a Cure: Medicare Spent $4.5 Billion on New Hepatitis C Drugs Last Year

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Twenty-dollar bill in a pill bottleBy Charles Ornstein
ProPublica.

This story was co-published with the Washington Post.

Medicare spent $4.5 billion last year on new, pricey medications that cure the liver disease hepatitis C 2014 more than 15 times what it spent the year before on older treatments for the disease, previously undisclosed federal data shows.

The extraordinary outlays for these breakthrough drugs, which can cost $1,000 a day or more, will be borne largely by federal taxpayers, who pay for most of Medicare’s prescription drug program.

The most-discussed of the new drugs, Sovaldi, which costs $84,000 for a 12-week course of treatment, accounted for more than $3 billion of the spending.

But the expenditures will also mean higher deductibles and maximum out-of-pocket costs for many of the program’s 39 million seniors and disabled enrollees, who pay a smaller share of its cost, experts and federal officials said.

The spending dwarfs the approximately $286 million that the program, known as Part D, spent on earlier-generation hepatitis C drugs in 2013, said Sean Cavanugh, director of Medicare and deputy administrator at the Centers for Medicare and Medicaid Services (CMS).

The most-discussed of the new drugs, Sovaldi, which costs $84,000 for a 12-week course of treatment, accounted for more than $3 billion of the spending. Spending on another drug, Harvoni, hit $670 million even though it only came on the market only in October. Bills for a third drug, Olysio, often taken in conjunction with Sovaldi, reached $821 million.

Medicare also spent $157 million on older hepatitis C drugs in 2014, bringing the total spending for the category to more than $4.7 billion.

The spending surge is unlike anything Part D has seen. The nine-year-old program has benefited in recent years from a slowdown in prescription drug costs as several blockbusters, including the cholesterol-lowering drug Lipitor and the blood thinner Plavix, have lost patent protection and have faced competition from generics. Continue reading

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Shellfish harvest in Portage Bay will be limited due to pollution

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Portage Bay Bellingham LumiThe state Department of Health has placed restrictions on shellfish harvesting for part of Portage Bay in Whatcom County due to high levels of bacteria.

Water tests show that at certain times, the shellfish area is affected by polluted runoff from the Nooksack River.

Portage Bay usually has good water quality, but during specific times of the year the Nooksack River carries higher levels of bacteria into the shellfish harvesting area.

As a result, state health officials have changed the classification of nearly 500 of the 1,300 commercial shellfish harvesting acres in the bay from “approved” to “conditionally approved.”

Harvesting in the conditionally approved area will be closed each year from April through June and again from October through December. Continue reading

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Vashon parents try to get along despite deep divide over vaccination | The Seattle Times

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Vashon island mapEvery few years, stories appear about Vashon Island and its high percentage of unvaccinated kids. It happened again a few weeks ago in the wake of reports of measles outbreaks nationwide. Then the temporary publicity fades and this island of 11,000 goes back to the same old, same old. Which is: a deep divide between the pro and con camps that in most other ways are so much alike. Except that this time it got pretty vitriolic.

Vashon parents try to get along despite deep divide over vaccination | The Seattle Times.

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Specialty drugs save lives, come with daunting price tags – AP

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$100-dollar bill inside a capsuleDoctors hail many of these therapies as breakthroughs, since they can conquer or control diseases that were once almost untreatable.

But they can cost more than $80,000 for a single course of treatment and bury patients in debt, even those with insurance.

Patient advocates expect the problem to worsen as insurance coverage shrinks and use of specialty treatments grows.

via News from The Associated Press.

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Why I love family-run restaurants: Insights from a food inspector

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cropped-eyob-in-idBy Eyob Mazengia, PhD, RS, Food Protection Program
Public Health – Seattle & King County

When I started as a food inspector, I was assigned to the International District. And I liked it. It was almost like walking into a new culture, a new era.

What fascinated me was that as a public health worker, I had permission to walk into people’s personal spaces. I liked the smells, the sounds of their languages, their wall hangings and the way things looked.

It was a privilege, really, to be allowed into their personal spaces. Going on food inspections in the I.D., it was like walking into 3-4 different countries every day, without traveling outside the neighborhood.

Over the years, I established good relationships with the restaurant establishments. They were no longer just restaurant operators—they were mothers, fathers, grown kids. They’re not just businesses—there’s a family behind every door, people who had often gone through difficult times to be here.

And as I got to know them, I could recognize the sacrifices they made to give their children better opportunities in the U.S., and what they left behind. Even those born and raised here, you could recognize the sacrifices they were making. Continue reading

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States with looser immunization laws have lower immunization rates

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By Christine Vestal
Stateline

The U.S. Centers for Disease Control and Prevention issued a health advisory  this month about an ongoing measles outbreak, with more than 102 cases in 14 states so far. The highly contagious disease can cause severe health complications, including pneumonia, encephalitis, and death.

By 2000, measles had been nearly wiped out in the U.S., with fewer than 60 cases per year – most connected with foreign travel. Public health officials declared victory, the result of effective state-based immunization campaigns requiring kids to be vaccinated before they enter public schools.

Since then, however, the number of cases has risen along with the number of parents who have received religious or philosophical exceptions to state rules. In 2014, there were at least 23 outbreaks and more than 600 cases.

Measles graphic 2

The federal government’s goal is to immunize at least 90 percent of all children before they enter school to keep measles and other childhood diseases at bay.  Although the national average immunization rate (91.1 percent) exceeds that number, several states fall below it.

“To have pockets where community immunity is below 90 percent is worrisome as they will be the ones most vulnerable to a case of measles exploding into an outbreak,” said Litjen (L.J) Tan, chief strategy officer of the Immunization Action Coalition, which advocates for higher levels of immunization.

State immunization rates vary widely, with generally lower rates of inoculation occurring in states that make it relatively easy to get an exception. Lawmakers in California, Oregon, and Washington state are trying to tighten their laws to allow fewer nonmedical exemptions.

Laws allowing religious exemptions have been around longer than those allowing philosophical or “personal belief” exemptions, said Joy Wilson, of the National Conference of State Legislatures.

In many but not all states, philosophical exemptions are easier to get than religious exemptions, which typically require parents to cite and explain the religious doctrine in question.  Overall, states with philosophical exemptions have 2.5 times the rate of opt-outs than states with only religious exemptions.

SLN_Feb09_vaccinationRates

Stateline logo Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Measles outbreak sparks bid to strengthen California’s vaccine law

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Boy gets shot vaccine injectionBy Jenny Gold
KHN

State lawmakers in California introduced legislation Wednesday that would require children to be fully vaccinated before going to school, a response to a measles outbreak that started in Southern California and has reached 107 cases in 14 states.

California is one of 19 states that allows parents to enroll their children in school unvaccinated through a “personal belief exemption” to public health laws. The outbreak of measles that began in December in Anaheim’s Disneyland amusement park has spread more quickly in communities where many parents claim the exemption.

State Sens. Dr. Richard Pan and Ben Allen have proposed eliminating the personal belief exemption altogether in California.

“Every year that goes by we are adding to the number of unvaccinated people and so that’s putting everyone at greater risk,” said Pan, who is also a pediatrician. “We shouldn’t have to wait until someone sickens and dies to act.”

The exemption isn’t new — it’s been around since the 1960s. But the number of parents taking the exemption went way up in the past decade. In some schools in California, more than half of children have an exemption.

If their law passes, all of those children would be required to get fully vaccinated in order to go to school. Pan says the most parents in the state would support that. Continue reading

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Washington scores four out of 10 on key indicators related to preventing and responding to infectious disease outbreaks

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From Trust for America’s Health and the Robert Wood Johnson Foundation 

Washington scored only four out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks, like Ebola, Enterovirus and antibiotic-resistant Superbugs.

Some key Washington findings include:

No. Indicator Washington Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding: Increased or maintained level of funding for public health services from FY 2012-13 to FY 2013-14. N 28
2 Preparing for Emerging Threats: State scored equal to or higher than the national average on the Incident & Information Management domain of the National Health Security Preparedness Index. Y 27 + D.C.
3 Vaccinations: Met the Healthy People 2020 target of 90 percent of children ages 19-35 months receiving recommended ≥3 doses of HBV vaccine. N 35 + D.C.
4 Vaccinations: Vaccinated at least half of their population (ages 6 months and older) for the seasonal flu for fall 2013 to spring 2014. N 14
5 Climate Change: State currently has completed climate change adaption plans – including the impact on human health. Y 15
6 Healthcare-acquired Infections: State performed better than the national standardized infection ratio (SIR) for central line-associated bloodstream infections. N 16
7 Healthcare-acquired Infections: Between 2011 and 2012, state reduced the number of central line-associated blood stream infections. N 10
8 Preparing for Emerging Threats: From July 1, 2013 to June 30, 2014, public health lab reports conducting an exercise or utilizing a real event to evaluate the time for sentinel clinical laboratories to acknowledge receipt of an urgent message from laboratory. N 47 + D.C.
9 HIV/AIDS: State requires reporting of all CD4 and HIV viral load data to their state HIV surveillance program. Y 37 + D.C.
10 Food Safety: State met the national performance target of testing 90 percent of reported Escherichia coli (E. coli) O157 cases within four days. Y 38 + D.C.
Total  4

 Read the full report here.

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Are vaccinations ‘Everybody’s Business’? – documentary and discussion

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A community conversation sponsored by the Northwest Biomedical Research Association

Are Vaccinations ‘Everybody’s Business?’

Discussion of the locally-made documentary, “Everybody’s Business,” by Laura Green, which examines the small, tight-knit community of Vashon Island that has become a reluctant poster child for the growing debate around childhood vaccinations. This portrait of an island community digs beneath the surface to investigate the tensions between individual choices and collective responsibilities.

Tuesday night’s conversation will be facilitated by Dr. Doug Opel, Seattle Children’s Research Institute.

WHEN:
Tuesday
December 9, 2014
From 5:45pm to 7:45pm

WHERE:
Macao Chocolate+Coffee
415 Westlake Ave N.
Seattle, WA 98109

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Hepatitis C patients may not qualify for pricey drugs unless illness is advanced

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Twenty-dollar bill in a pill bottleBy Michelle Andrews
KHN / October 28, 2014

In the past year, new hepatitis C drugs that promise higher cure rates and fewer side effects have given hope to millions who are living with the disease.

But many patients whose livers aren’t yet significantly damaged by the viral infection face a vexing reality: They’re not sick enough to qualify for the drugs that could prevent them from getting sicker.

An estimated 3 million people have hepatitis C. Faced with a cost per patient of roughly $95,000 or more for a 12-week course of treatment, many public and private insurers are restricting access to those who already have serious liver damage.

Many baby boomers who have hepatitis C contracted it years ago from blood transfusions at a time when blood was not screened for the virus.

Other strategies that limit access include restricting who can prescribe the drugs or requiring early proof the drug is working before continuing with treatment.

In addition, many state Medicaid programs require that patients be drug and alcohol free for a period of months before they can get the hepatitis C drugs. Continue reading

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Even before Ebola, hospitals struggled to beat far more common infections

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Clostridium difficile

Clostridium difficile

This KHN story also ran on NPR.

While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die from them each year.

 from themA Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention.

In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than national benchmarks the CDC set in at least one infection category, the KHN analysis found.

The missteps Texas Health Presbyterian Hospital made this month in handling an Ebola patient echo mistakes hospitals across the nation have made in dealing with homegrown infections. Continue reading

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Vaccination rates lower among US adults born abroad

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Vaccine SquareBy Milly Dawson
Health Behavior News Service

Nationality at birth appears to play a significant role in whether or not adults in the United States are routinely vaccinated for preventable diseases, a new study in the American Journal of Preventive Medicine finds, reflecting a risky medical lapse for more than one in ten people nationwide.

Foreign-born adult U.S. residents, who make up about 13 percent of the population, receive vaccinations at significantly lower rates than U.S.-born adults.

Foreign-born adult U.S. residents make up about 13 percent of the population.

This gap poses special risks for certain groups of people who are vulnerable to many serious and sometimes deadly diseases that vaccines can prevent.

The study’s lead author, Peng-Jun Lu, MD, PhD, a researcher at the Center for Disease Control and Prevention, noted the rise in the foreign-born population in the United States, which stood at only five percent in 1970.

“As their numbers continue to rise, it will become increasingly important to consider this group in our efforts to increase vaccination and eliminate coverage disparities,” he said. Continue reading

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States negotiate for better drug prices

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Because of skyrocketing prescription drug prices, some state Medicaid programs and prison systems are limiting certain drugs to only the sickest patients. Some states are negotiating better pricing.

By Michael Ollove
Stateline

Twenty-dollar bill in medicine bottleThe new hepatitis C drug Sovaldi promises a cure rate of well over 90 percent, compared to 45 percent (at best) for older drugs. But when Sovaldi went on the market earlier this year for as much as $84,000 for a single course of treatment, critics blasted the cost as “exorbitant” and “gouging.”

It is estimated that between 3.2 million and 5.2 million Americans have hepatitis C, an infectious illness that can eventually compromise the liver.

The disease falls disproportionately on the poor and the incarcerated, which makes it a particular challenge for Medicaid, the federal-state health plan for the poor, and for state prison systems.

One study by Express Scripts, a drug benefits management company, estimated it would cost states $55 billion to provide Sovaldi to all prisoners and Medicaid beneficiaries with hepatitis C.

Because of its high cost, some state Medicaid programs and prison systems are refusing to provide Sovaldi to any but the sickest patients. Most recently, Oregon last month threatened to limit access to the drug unless it can get Sovaldi at a deeply discounted price.

“Sovaldi is a seminal event,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It’s clear that states are not equipped to handle this. They simply do not have the tools to maintain control.”

But Sovaldi is only the beginning. Expensive new treatments for certain cancers, rheumatoid arthritis and other conditions also have rattled Medicaid officials, patients and health care providers.

What can states do to hold down drug costs? Drug pricing is a complicated and opaque process. Here are some of the basics.

Question: Is each state Medicaid program on its own when it comes to drug pricing?

Answer: Not completely. The federal Omnibus Budget Reconciliation Act of 1990 mandates that drug makers give all Medicaid programs a 23 percent rebate off the Average Manufacturers Price (AMP) for all prescription drugs purchased, or the difference between the AMP and the best price given to a private payer. (Prisons aren’t covered by this discount provision and have to negotiate drug prices as any retailer does.)

In return for the rebates, Medicaid programs must carry all drugs approved by the U.S. Food and Drug Administration on their “formularies,” which is the list of the medications each health plan will pay for.  That guarantee means that the drug makers get access to substantial markets in all 50 states and the District of Columbia. Continue reading

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County receives $6m grant to improve hepatitis C care

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Hepatitis C by the numbersKing County has received a four-year, $6 million grant to improve testing, treatment and cure rates of people with chronic HCV infection.

Hepatitis C virus (HCV) affects large numbers of people in King County, but it often goes unnoticed until it’s too late.

“Thousands of people in King County have chronic HCV, but many don’t know they have it,” said Dr. Jeff Duchin, Chief of Communicable Disease & Epidemiology at Public Health – Seattle & King County. “This grant will allow us to make sure that patients with chronic HCV are not just identified, but also seen by a provider, receive follow-up testing, and get the care they need.”

The grant will fund the Hepatitis C Test & Cure Project, which will provide training for clinicians on the diagnosis, evaluation, and treatment of HCV and connect them to specialists. Continue reading

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