Day: 11/23/2015

A Prescription for Sticker Shock Caused by Drug Costs

http://well.blogs.nytimes.com/2015/11/23/a-prescription-for-sticker-shock-caused-by-drug-costs/

During the current enrollment period, from Oct. 15 to Dec. 7, I decided to switch to another insurer. Since everyone with a computer is supposed to be able to do this, I gave it a try.

I am most happy to report that, despite the problems many consumers initially had signing up for insurance under the Affordable Care Act, the government did a great job with the website for Medicare Part D. Expecting the task to take hours, I enrolled with a new company in about 15 minutes. Here is the link:https://www.medicare.gov/find-a-plan/questions/home.aspx.

You start by entering your ZIP code and answering two questions about your Medicare coverage. (Be sure to have your subscriber number handy.) Type in the name of each prescription drug you take, up to 25, as well as the dosage, quantity and frequency, and whether you get it from a pharmacy or by mail order.

If you choose a pharmacy, you are given a list of those near your home (the distances vary depending on your ZIP code). You are then asked to select the desired type of Medicare and drug plan. For example, I selected “drug plan with original Medicare.”

You can then refine your search according to such options as “limit to the monthly premium” (up to $290), “limit to annual deductible” (up to $360) and the company’s rating (I chose one with four stars out of five, the highest among the companies that fit my criteria).

The next screen estimated my annual drug and health care costs. Nineteen Part D plans were found in my ZIP code, listed from least to most expensive. For each company, the website showed my estimated annual drug costs if purchased retail or by mail order (cheaper by mail); the monthly premium, which in my case is deducted from my Social Security benefit; the annual deductible, if any; the drug co-pay amount; whether all my drugs are in the company’s formulary; and the company’s star rating.

By the way, if you can get your prescriptions written for a 90-day supply, the cost is less than for a 30-day supply refilled twice.

I did a general search on the Medicare website and found 23 other Part D plans that are cheaper than the one I currently have. But my plan has a zero deductible and only one of my new options has that. The others have at least a $360 annual deductible. Now, I have to look at all of them and choose one… my head hurts…

Tale of Two Suicides; Lessons for Opioid Public Policy

http://www.pharmaciststeve.com/?p=12691

http://nationalpainreport.com/tale-of-two-suicides-lessons-for-opioid-public-policy-8828356.html

For one it was the best of times, for the other, the worst. At no time did the paths of their lives cross, but they shared the same fate, one most would consider a tragedy. Their legacies, for pain and public policy, could not have been more different…

 I knew one, only heard of the other; both dramatically affected my life.

Bob was a marine. He had valiantly served his country, and he was proud of it. His identity was so tied to his service that he could not handle the thought of being any less of a marine, a warrior… a man, whatever that means. His back injury robbed him of that identity, and he struggled in a futile attempt to regain that which he no longer was, or, at least thought he was. Perception is reality, and his perception was that he was no longer what he wanted to be, needed to be.

Surgeries and elixers, therapies traditional and non-traditional. All tried in a vain attempt to rid himself his pain. All failed. Some made his pain worse.

He used pain meds to numb the pain, but they couldn’t restore his manhood. In desperation, he kept taking more and more. After a while, he gave up the hope for a cure. He was a broken man, not just physically, but also mentally and spiritually. The meds gradually became a temporary reprieve from his painful reality.

I was his doctor. I never really saw that brave marine. Rather, I saw a broken, staggering man, subservient to the world his pain had created for him. Our goal for any treatment is to improve one’s function. For many, opioids accomplish that. Not for Bob…

I told him that I could no longer prescribe the medication for him as I saw it harming more than helping…

There were no candle-light vigils for Fred [Bob]. He was gone, and quickly forgotten…

Billy’s parents took to the legislature to exact vengeance. While few would ever be driven to action to help Bob, there were many who sought to vindicate Billy. There are few things more motivating than a grieving mother’s wailing, and the legislators were not immune. Soon, laws were being enacted in a vain attempt to “stop the carnage.” In a world fueled more by emotion than reason, the land of “feel-good law,” the law of un-intended consequences reigns supreme. Soon, laws were passed. Addicts still died. Those in pain struggled to find someone with the courage to defy those laws and care…and they died too, but their cries went unheard…

The battle has only started, and it is not just in the legislatures, and not just in my state of New Hampshire. It is also in courtroom. In the chilling wake of a second degree murder conviction for Dr. Hsiu-Ying “Lisa” Tseng, accused of prescribing opioids in the course of her practice that led to the deaths of three patients, I, like many others feel lost and vulnerable…

Under comments:

Jackie
November 23, 2015 at 5:49 pm
Have you wondered if telling Fred you were taking away his medication (his main means of controlling his unrelenting pain) may have in fact been the catalyst for his suicide? As a chronic pain sufferer I know a few sufferers who have done so when no longer able to get the medication they need. It is a very frightening thing to face the kind of pain you know is going to come. My pain is managed by opiates, but my strength fortunately comes from somewhere else.. So it’s never an option I would take, but I certainly understand why others may not want to have to deal with unremitting pain for the rest of their lives.

Shari
November 23, 2015 at 4:34 pm
I have Chiari Malformation and EDS and several other chronic debilitating conditions. I am to the point that I have PTSD because of the treatment I have received due to patient profiling and being labeled a drug seeker. Because of this I am unable to go to any dr. and would rather die in my home than go to the ER because of severe anxiety just thinking about calling to make an appointment let alone actually go to it. I don’t drive and have been house bound since August ’14 and spend most of my days in bed or on the couch. That wasn’t the case when I was going to pain management. I actually engaged in life rather than waiting to die like I do now. I’m 43 I do not receive ssdi and live with family because I have a 9 year old daughter and I am unable to properly care for her! Physically or financially. The thought of living another 5 or 10 or 20 years like this is daunting to say the least! But as I hear far too often “it could be worse, at least you’re alive!”
REALLY??? I fail to see how that would be worse!

Why did I unfollow you?

Six months ago, there was something about my blog that caused you to click on the follow button. And even though it took me a month or so, I eventually followed you in return. I made numerous likes and comments on your blog, and you made a few on mine. Good times. 🙂

Then you became a ghost follower — no more likes and no more comments. Just silence. (Had I said something to offend?) But that didn’t stop me from continuing to like your posts. It was an uneven blogging relationship, but I was fine with it… for awhile…

It’s funny how I never run into anyone I know when I’m out and about in the real world, but after blogging for a year, I’m constantly running into familiar avatars — like yours. I’ve noticed the likes and comments you give other bloggers, and I began to wonder what it was about my blog that you’ve deemed so unworthy of your time. (Or even worse, boring.)

Perhaps I’m doing us both a favor by unfollowing you. After all, if there was anything about my blog that you still liked, I’m sure you would’ve been able to show it by now.

I have no regrets, dude. Thanks for making me laugh and happy blogging. 🙂

Why did you unfollow me?

In the beginning, you liked a few of my posts and I happily reciprocated. I hadn’t seen you around the WordPress community before, but even with a fairly new blog, you already had a handful or two of likes on each post.

But the only thing our blogs had in common was a love of photography, so I began to wonder why you liked all of my posts. I mean, c’mon, I think I post more than any other blogger. (For those who are new to my blog, the reasons I post so much include distraction from pain, to escape isolation, and, of course, boredom.)

As time went on, I noticed that you binge-liked my posts, obviously not reading them. To me, likes don’t mean very much when they’re given out of self-interest or duty instead of genuine interest. But I liked visiting your blog, and it’s not like I could tell you that you didn’t have to like all of my posts for me to like each of yours.

I began frequently seeing your avatar liking posts on other blogs, and I watched as the traffic on your blog increased. For someone who hasn’t been blogging for very long, you’ve gained an impressive following. I’m happy for you. 🙂  If I had the same goal for my blog, I might even be jealous. 😀

With your increased following, I’m guessing that you reached a point where you didn’t have to waste time liking any of my posts anymore, so you unfollowed me. Is that what happened? Did you become overwhelmed (or was it boredom)?

I don’t know how bloggers with so many likes on each post are able to keep up with that kind of audience.  How can one person read so many different blogs?  Don’t you think it makes the whole process a little… I dunno…  less intimate and fake?

No one likes to get dumped, but I just wanted to say that I understand. And since you no longer have any interest in my blog, I’m sorry to say that the feeling is mutual. After all, even with insomnia, there’s only 24 hours in every day. Anyway, I prefer to have followers who actually read my posts (and hopefully interact with me), not ghosts who abuse the like button.

In WordPress time, a five-month relationship is nothing to sneeze at. We had a good run, didn’t we?

Take care, dude, and I’ll be seeing you around the blogosphere…

Email responses to alleged annual limit on decongestants

https://painkills2.wordpress.com/2015/11/19/fucked-by-the-dea-once-again/

Response email (11/19/2015 11:26 PM)

Hi ,

Thank you for contacting Walmart.com. We appreciate your feedback and we understand your concerns. We value you as a customer and thank you for taking the time to provide this feedback. We will definitely report your concerns. Would you mind providing your name and email address so that I can ensure your concern is fully documented?

If you have additional questions, please reply to this email and we will be happy to assist.

Sincerely,
Kenya P
Walmart.com Customer Care

Dear Kenya:

My name and email address have already been provided. Did you even read the email? Is this the only response I can expect to receive from Walmart?

Johnna Stahl
painkills2@aol.com

Sun, Nov 22, 2015 10:46 am

Re:  A response to your Walmart.com inquiry [Annual limit on decongestants]
From:  Walmart Customer Care, help@walmart.com
To:  painkills2@aol.com

Hi ,

Thank you for contacting Walmart.com. Your business and feedback is truly important to us. My name is Amy, I’m with tier 2 escalations at the corporate office for Walmart.com.

We apologize for the inconvenience you are experiencing, unfortunately this law is enforced through the Drug Enforcement Administration. We advise you to reach out to them directly for any further questions.

Sincerely,
Amy M.
Walmart.com Customer Care

Fri, Nov 20, 2015 9:32 am

RE:  Annual limit on decongestants
From:  ODLP@usdoj.gov
To:  painkills2@aol.com

Dear Johnna – Although the Combat Methamphetamine Epidemic Act of 2005 (CMEA) did establish sales limits, it did not establish an annual sales limit. See below.

The United States has experienced a significant problem with the abuse of methamphetamine and the clandestine laboratories that manufacture it. As a result, many states have enacted legislation to control the precursor chemicals used to illicitly manufacture methamphetamine. In March 2006, the CMEA was signed into law and established restrictions on the sale of over-the-counter (OTC) drug products that contain pseudoephedrine, ephedrine, and phenylpropanolamine. Ephedrine and pseudoephedrine are common ingredients in cough, cold, and allergy products, but are also used in the illicit manufacture of methamphetamine. As part of the CMEA, Congress statutorily placed daily sales limits and 30-day purchase limits on scheduled listed chemical products, to include OTC drug products that contain pseudoephedrine. The CMEA limits the amount of active ingredient that may be sold at retail, per person, to 3.6 grams per day, and a person may not purchase more than 9 grams, per 30-day period, based on a rolling calendar. As the sales limits are a statutory requirement, the Drug Enforcement Administration (DEA) does not have the authority to change them. Furthermore, to ensure the sales limits are not exceeded, the documentation of sales is also a requirement under the CMEA.

On September 26, 2006, the DEA published an Interim Final Rule, in the Federal Register, titled, Retail Sales of Scheduled Listed Chemical Products; Self-Certification of Regulated Listed Chemical Products, to implement the regulations governing the CMEA. (71 Fed.Reg. 56008). On page 56010 of the Interim Final Rule, there is a table that lists the daily sales limits and monthly purchase limits, according to the base quantity, of each listed chemical in OTC drug products. As the OTC drug product, Claritin D, mentioned in your e-mail, has an active ingredient of pseudoephedrine sulfate, the following excerpt of the chart in the Interim Final Rule, indicates the number of tablets that equal retail transaction limits (as base) for scheduled listed chemical products.

However, it is important to note that each state may have its own laws and regulations regarding the purchase of OTC products containing pseudoephedrine. To determine if the state of New Mexico has implemented any such laws or regulations that may be stricter than the CMEA, you may wish to contact the New Mexico State Board of Pharmacy. In accordance with Title 21, Code of Federal Regulations, Section 1307 .02 (21 C.F.R. § 1307.02), when federal and state law or regulation conflict, then the parties involved must adhere to the stricter aspects of each.

[The email was unsigned.]

Fri, Nov 20, 2015 8:53 am

RE:  Annual limit on decongestants
From:  Pharmacy.Board@state.nm.us
To:  painkills2@aol.com
Cc:  Ben.Kesner@state.nm.us

Your inquiry will be forwarded to our Director for follow-up.

[Another unsigned email.]