Day: 01/07/2015

6/2014, Drug Shortages: The Scary Reality of a World Without Meds

http://www.rd.com/health/healthcare/drug-shortages/

A Shocking Epidemic

It seems unfathomable in our high-tech medical system, but in 2007, 154 drugs were in shortage, a number that almost tripled to 456 in 2012, according to the U.S. Government Accountability Office.

Threatening medical-care options and patients’ lives, drug shortages have occurred in almost every pharmaceutical category. Antibiotics, cancer drugs, anesthesia, pain control, reproductive and gynecological drugs, cardiac medicine, psychiatric drugs, and intravenous-feeding solutions have all been in varying degrees of short supply or not available at all. Recently, nitroglycerin, an emergency room staple used to treat heart attack patients, has been in such severe scarcity that its sole U.S. manufacturer has restricted hospitals to 40 percent of their usual orders. A study published this March in the Mayo Clinic Proceedings attributed more than 15 documented deaths since 2010 to either lack of treatment or the switch to an inferior drug as a result of medication shortages…

Medicare reform imposed certain price controls on generic drugs, but, due to a loophole, these controls are lifted if a manufacturer stops making the drug for six months…

Predatory middlemen are making the situation even worse. A congressional investigation led by Rep. Elijah Cummings, a Baltimore Democrat, has found that shady secondary wholesalers buy up drugs in shortage and resell them, often at exorbitant prices. This explains, in part, the haphazard ebb and flow of the shortages that makes them particularly hard to handle: One day the medicine is just gone, but there’s plenty the next…

Shortages are leading hospitals and patients to get drugs from less regulated and potentially less safe sources, such as drug compounders…

In a recent study from the University of Pennsylvania presented at the 2013 annual meeting of the American Society of Clinical Oncology, 83 percent of oncologists and hematologists said they’ve faced cancer drug shortages, and of those, nearly all said their patients’ treatment had been affected by drug shortages…

Even the FDA has been boxed into a corner. After the cancer drug Doxil became unavailable in late 2011, the FDA made an emergency provision to allow an Indian generic-drug company, Sun Pharma Global, to temporarily export a similar generic drug, Lipodox, which is not approved in the United States. Although patients and doctors applauded the move, Sun Pharma has faced repeated past FDA sanctions for poor quality. (In 2009, U.S. marshals raided its U.S. manufacturing plant and shut down production.)…

Powerful painkiller shortage (FL)

http://www.actionnewsjax.com/videos/news/powerful-painkiller-shortage/vCM898/

An effort to crackdown on illegal prescription medicine is keeping necessary drugs away from those who need them

“Pharmacists recommend going back to your doctor and seeing if he can recommend another pain medication.”

1/7/2014, Crack down on pain killers forcing shortage at pharmacies

http://www.kvoa.com/news/crack-down-on-pain-killers-forcing-shortage-at-pharmacies/

Travis Howell, 26, is paralyzed from the waist down and confined to where his wheelchair can take him.

“I have 18 open bed wounds, five of which I can feel,” Howell said.

To cope with the daily pains, Travis depends on the roughly 200 Oxycodone pills he is prescribed by his doctor every two weeks.

“I know it’s a lot… Sounds like a lot. But there’s nothing else me and my doctor can do. We’ve tried everything from getting shots in my back to morphine — which I found out I’m allergic to,” Howell said.

On Monday, Travis tried to get his prescription filled at a nearby CVS Pharmacy but was rejected.

“All she could say was ‘I don’t feel comfortable’ and hung up the phone on me,” Howell told News 4 Tucson…

“There are patients out there not getting the medications they need because the supply is not there,” said Greg Rogan, of the Medicine Shoppe, a locally-owned pharmacy.

It’s a reality that all too obvious for Rogan, who said his shop has been cut off from its supplier of Oxycodone.

“We still get people calling everyday asking ‘can we get it?’ and can we fill their prescriptions… unfortunately, I had to stop taking any new pain patients on back in April,” Rogan told News 4 Tucson.

http://www.tucsonnewsnow.com/story/27559232/painkiller-abuse-more-likely-for-those-who-skip-college

12/6/2014, Painkiller abuse more likely for those who skip college

Nonmedical use of powerful narcotic pain drugs (for example, Oxycontin) was reported by 13.2 percent of those who did not graduate from high school, 13.1 percent of those with a high school diploma, and 11.3 percent of those in college…

The researchers also looked at abuse of prescription stimulants (such as Adderall) and found the opposite results: Stimulant misuse was more common among college students than among those who weren’t in college.

About 70 percent of all young adults in the United States enroll in some form of college education, while 30 percent do not…

http://www.medschat.com/Discuss/where-or-when-can-i-get-Oxycodone-in-Tucson-Az-240400_s2.htm

10/20/2014, Southern Nevada doctors change prescriptions after painkiller reclassification

http://www.reviewjournal.com/life/health/southern-nevada-doctors-change-prescriptions-after-painkiller-reclassification

Dr. Paul Michael, an oncologist with Comprehensive Cancer Centers of Nevada, wrote a new prescription this week for one such patient, an elderly woman who was turned down at her pharmacy when she tried to obtain her regular drug containing hydrocodone.

The woman has other pain relievers to control chronic pain associated with her cancer treatment, Michael said, but the hydrocodone pills were effective when she experienced breakthrough pain, a more severe flare-up with a sudden onset that normally lasts from 30 minutes to an hour.

Because the woman faced the prospect of having nothing extra for her breakthrough pain, Michael prescribed methadone.

“This problem is especially severe in the cancer world because our patients need these medications so long term,” Michael said. “Our patients might need these medications for months or years.”

Federal regulators say there is no shortage of actual product. Jeff Ventura of the U.S. Food and Drug Administration said Friday that any delays in patients receiving their medications can be attributed to logistics behind the rescheduling rules.

The Nevada Board of Pharmacy has received calls from all over the state from people unable to fill their prescriptions, David Wuest, deputy executive secretary of the Nevada Pharmacy Board, said…

The situation is worse than at any time in the nearly 40 years Forman has been practicing medicine in Southern Nevada.

Forman was told one pharmacy chain in Southern Nevada arbitrarily reduced its inventory of hydrocodone products by 30 percent to lessen the risk of being caught up in any regulatory action…

mcarlton • 3 months ago

First, what I’m about to say should not be construed as a call for gun control. But I find it ironic that we live in a country where over 31,000 people are killed with misused guns each year while, at the same time, some bureaucrat can make it much more difficult and expensive, if not impossible, to buy needed medications because less than half that number of people die from opiate misuse.

Iraq Veteran, Now a West Point Professor, Seeks to Rein In Disability Pay

http://www.nytimes.com/2015/01/08/us/iraq-veteran-now-a-west-point-professor-seeks-to-rein-in-disability-pay.html?_r=0

As he paced back and forth in front of the soldiers, some of them leaning on crutches, Colonel Gade said that too many veterans become financially dependent on those monthly checks, choose not to find jobs and lose the sense of identity and self-worth that can come from work.

“People who stay home because they are getting paid enough to get by on disability are worse off,” he said. “They are more likely to abuse drugs and alcohol. They are more likely to live alone…

Unum and IBM

http://www.postonline.co.uk/post/news/2081254/risk-management-software-aids-solvency-ii-compliance

6/23/2011

Unum is using IBM Open Pages software to assess all internal and external risks and ensure it has sufficient cover for them. The software, which combines risk data self-assessments, end user surveys, loss events, scenario analysis and key risk indicators provides an automated workflow and dashboards to provide the visibility, control and decision support to analyse, manage and mitigate risk.

Why Disability Testing For Fibromyalgia Is Often Misleading

http://www.fmnetnews.com/coping-resources/disability-issues

The Functional Capacity Evaluation, or FCE, is the most common disability test used, and it only collects data during the test period itself, and ignores pain and other symptoms that flare later…

Michael’s long-term disability carrier asked him to take a functional capacity evaluation (FCE) to “see” if he could work. This was a series of light exercises that included toe-touching, carrying a ten pound weight, crawling, walking, and sitting. The evaluation lasted about two hours. Michael’s attorney, who has fibromyalgia herself, felt that this FCE testing protocol was, by its very nature, misleading, and would drastically underestimate Michael’s true disability. How, she asked, could two hours of testing reveal how Michael would handle an eight hour a day job, for 40 hours every week? She also complained that the FCE would not reflect any information in its report about how Michael felt and functioned that night, or through the next day, when his symptoms were most likely to flare…

Those who administer the FCE seem to believe that the current test really does predict everything. However, this faith is almost certainly wrong. I have searched the scientific literature and have not found a single scientific paper that even attempts to measure the accuracy of the FCE for predicting the long-term work capability of people with fibromyalgia…

Sensibly, the FDA requires that we routinely collect data on symptoms and performance for one week before as well as one week after each time we do an exercise stress test on a patient…

12/2/2012, Insider tells how some insurance companies rig the system

http://www.postandcourier.com/article/20121202/PC16/121209871

In 2009, led by New York and Illinois, state insurance regulators began the first multi-state examination of how an insurance company uses a software tool to handle claims…

“A part of this story is the failure of state insurance regulators to police insurance companies’ conduct,” added Jay Feinman, a law professor at Rutgers University and author of “Delay, Deny, Defend,” a book that says insurers try to avoid paying claims.

Robert Hunter, a director with the Consumer Federation of America, was blunter: “It was weak.” If the investigation was so thorough, he asked aloud, why had the regulators failed to talk with Allstate’s official Colossus expert, Mark Romano?

These black boxes have a significant impact on what people in South Carolina receive for their claims, but state insurance regulators have no plans to study Colossus or other claim handling programs. They say they leave such analyses to states where insurance companies are based. Overall, said Robert Hartwig of the Insurance Information Institute, “these issues are dead and buried, and regulators don’t pay much attention to it. The fact of the matter, they’re satisfied with the methodologies and constantly review the models.” Twenty percent of the top 30 U.S. insurers, including Allstate, use Colossus today…

6/9/2012, Software Helps Auto Insurance Companies “Low-Ball” Claimants

http://www.pissd.com/2012/06/software-helps-auto-insurance-companies-low-ball-claimants/

A recent article in ComputerWorld, of all places, expresses some concerns about the use of such software in the evaluation of claims. Here are excerpts:

Claims software used by many large auto and homeowners insurance vendors in the U.S. has allowed the companies to manipulate claim payments and “low-ball” customers, according to a new report from the Consumer Federation of America.

Injury evaluation software, including CSC’s Colossus package, allows insurance companies to “tune” payment perimeters and reclassify injuries as less serious than the diagnosis from a doctor, said the report, by Mark Romano, a former Colossus expert at Allstate Insurance, and Robert Hunter, a former insurance commissioner for Texas.

The claims software, adopted by many U.S. insurance companies in the past 15 years, “has enabled many insurers to increase profits by reducing the amount paid to consumers who filed bodily injury liability claims,” the report said…

CSC originally marketed Colossus as a cost-savings product, but shifted to talking about the software as a way for insurance companies to achieve consistency in claims payouts, the report said. Some insurance companies were uncomfortable with the software marketing as a money-saving package, said the report, referencing CSC materials made public during a class-action lawsuit against the software vendor settled in 2009…

Insurers can also use the software to downgrade, en masse, the diagnosis of certain injuries, or pair the claims software with medical repricing software that reduces the “usual and customary” medical costs to be reimbursed, the report said.

The Consumer Federation of America called on state insurance commissioners to investigate claims software vendors and insurers for unfair business practices or unfair claims settlements.

10/15/2010, How to Discover Information about Prior Similar Claims

http://www.propertyinsurancecoveragelaw.com/2010/10/articles/bad-faith/how-to-discover-information-about-prior-similar-claims/

This week, I would like to address the importance of requesting information about prior similar claims filed by other insureds. When faced with these requests, insurers usually object, claiming the requests are overly broad and burdensome. In this day and age, however, it becomes increasingly difficult for a carrier to assert such objections when taking into consideration the advances in technology and software that enable businesses, to maintain and organize a tremendous amount of information and pull it up with a push of a button…

The Superior Court of Arizona in Maricopa County addressed this very issue in Stephen T. Russell v. UNUM Life Ins. Co. of America, et al (2001). In Russell, one of the interrogatories to UNUM, the insurer, sought information regarding UNUM’s handling of other insureds’ claims that were similar to Russell’s (the insured plaintiff) claim. UNUM objected as follows:

The information is not easily and readily available through the computer system…and that it [UNUM] did not have a central filing system of all lawsuits filed against it of computerized records containing the information requested.

UNUM added that in order to comply with the request, it would have to have someone manually review the files pertaining to each lawsuit in order to pull together the information requested. The Court appointed a special master who exercised his authority to retain a computer expert to access the insurer’s computer database and evaluate its capabilities. The special master and computer expert reported to the Court that UNUM had misled the Court with regard to UNUM’s computer system’s ability to provide the information at issue – information regarding other insureds’ similar claims.

UNUM argues that its computer systems could not have accurately and completely answered the interrogatory and all its subparts in 1996 (or even now); that its employees made “inartful” but not intentionally misleading statements to the Court and Discovery Master; that the Discovery Master and his computer expert should have tested UNUM’s system in situ; and that the “functional equivalents” analysis used by the Discovery Master was flawed. The Court rejects all such arguments for reasons which were developed and/or stated on the record at the hearing. UNUM’s conduct is and should be sanctionable…

The trial court ordered UNUM to produce the requested information and sanctioned UNUM for its conduct. When challenged by UNUM, the sanctions were upheld by an appellate court.
Based on the Superior Court of Arizona’s Minute Entry in Russell, Maricopa County, there are few things to keep in mind:

Policyholders’ attorneys should not be discouraged by carefully crafted objections asserted by insurers to discovery requests;

Information regarding other insureds’ claims was determined to be discoverable; and

The Court can and will impose sanctions against a carrier that improperly asserts meritless objections and misrepresents its ability to produce responsive, relevant and non-privileged information and/or documents.

Unum and Adobe

2011

Leading global workplace benefits provider standardizes on Adobe® Connect™ to deliver critical information about benefits programs to customers and workforce worldwide.

Click to access casestudy.pdf

“Adobe Connect offers more advanced capabilities like screen-sharing, the ability to upload and share large files, and live chat pods for ongoing dialogue. Add to that the ability to set up a web camera for direct interactions and the solution is a complete end-to-end platform for…”