Feeds:
Posts
Comments

Archive for January, 2011

One might think that a report entitled  Potential Federal and State-by-State Savings if Medicaid Pharmacy Programs Were Optimally Managed could contain useful information for cash-strapped states and the federal government.  When the report was released last month by author The Lewin Group, the consulting firm issued a press release stating that

States, Federal Government Could Save $30 Billion by Managing Medicaid Pharmacy Like Part D, Medicaid MCOs and Commercial Sector Programs.

But when the National Community Pharmacists Association reviewed the report, they found many reasons to be concerned both about  transparency  and COI issues with Lewin and the contents of the report itself.   NPCA’s Associate Director John Norton enumerated these problems in his recent blog post  entitled Lewin Group/PBMs’ Medicaid Pharmacy Report Misses the Mark; Recommendations Threaten Patient Health and Access.  Among the concerns highlighted  are:

  • ….the Lewin Group’s website touts itself as an “independent” consultant for clients, including the PBMs’ trade group, which commissioned this study. In this instance, that independence claim is undermined by the fact that the Lewin Group is owned by United HealthCare, a health care conglomerate whose holdings include Prescription Solutions— a PBM that serves over 10 million people.
  • PBMs have a record of questionable business practices, including in the states which they now purport to “save.”
  • By law, Medicaid programs must get the manufacturer’s best price for a particular drug. PBMs simply cannot negotiate better prices for drugs than Medicaid. Moreover, PBMs are notorious for not adequately sharing rebates from manufacturers.
  • The Lewin Group focuses on the savings that could be realized by moving a specific disability category—the blind and disabled—into managed care, citing the fact that this population experiences a high per-capita pharmacy cost. However, the Center for Health Care Strategies rejected this idea….
  • PBMs would charge the states massive administrative costs as compared to existing state Medicaid programs, which are run more efficiently through fiscal intermediaries. This means that states would spend more money on bloated PBM middlemen rather than patient care.
  • The study ignores the potential loss of jobs and tax revenues to the state by driving Medicaid prescription revenues to out-of-state PBMs;
  • PBMs seek to also achieve massive savings by reducing access to prescription drugs and services provided by community pharmacies.

NPCA  issued its own analysis of the findings:  Lewin’s Medicaid Pharmacy Managed Care Report: Bought and Paid for by PBMs .

The Michigan Pharmacists Association also spoke out against the misleading report, debunking its claims that

$146 million, or 10 percent of total costs, could be saved over the next 10 years if Michigan moved more of its fee-for-service Medicaid recipients to managed care programs.

What’s been the response in your state to this report ?  Readers, please let me know.

Read Full Post »

The article Efforts to Undermine Public Health:  Health Advocacy Organizations and the Pharmaceutical Industry: An Analysis of Disclosure Practices in the Jan.13 issue of  American Journal of Public Health focuses some much-needed attention on a serious and growing problem , which directly impacts the creation of rational health policy.  It’s also good to see the wide media attention being given to the study, which has been flagged by venues across the spectrum, including  healthcare sector analysis and investigative reporting blogs to mainstream  business media and news reports.

It’s been interesting too,but not surprising to see, that a number of people are also sending identical comments to multiple venues  which covered the story, some to decry the findings of the study, or  to make  off-topic remarks. The comments from the National Health Council , for example emphasized that it has a policy of requiring member groups to have internal disclosure policies regarding industry support received. The NHC itself  has a listing of funding received in 2009 from its  many “Corporate Partners.”   However, just like with payments to physicians, merely acknowledging industry funding doesn’t mean that it does not influence the actions of the recipient, nor not create conflicts of interest.  Unlike the significant body of research on the topic of influences on the prescribing practices of doctors (which have found that while many  state that they themselves are not influenced by pharma gifts and perks, they believe that their colleagues are) , much less attention has been paid in the US to the phenomenon of  industry support of HAGs and its impact on public policy.

Based on personal observations both as  patient and a healthcare professional , I believe that the “don’t bite the hand that feeds you”  phenomenon  relating to HAGs, contributes to  the present inaction on getting states and federal government to do something about the exorbitant and escalating price of medicines as a public health measure. Until the electorate actively protests what is going on, the lobbying power of the biopharma industry  on Congress will remain in effect. While it is becoming more common to find  media pieces highlighting  complaints by provider and  disease groups  about the price of Rx drugs, along with the unaffordable co-pays for those insured, almost never do we hear patient advocacy groups demand that something be done about the situation.  The only logical conclusions that seemingly can be made about the scenario is either that the public is incredibility naive about how the pharmaceutical  and insurance  industries  function, or else HAGs have been so influenced by their pharma benefactors that recipients actually believe that the prices are justified by R & D costs, and that patient assistance programs ( PAPs) are a genuine access solution.  Likely it’s some combination of factors.  More about this later.

Since a requirement that  HAGs disclose industry funding was dropped from Sunshine Act provisions incorporated in the ACA, it’s time start to address the problem by pressing the IRS to require that all 501(c)3 charities disclose their funders and amounts received from each. At the same time, much more public education  is needed about  “the ties that bind”, to paraphrase the title of a 1999  report on the topic  by Health Action International.

In the meantime, those interested in starting to research  industry links to patient and disease groups will find the following resources of independent organizations helpful:

Essential Action
Pharmafiles database: Patient and Health Groups and Their Corporate Funders
Patients, Patents and the Pharmaceutical Industry

Knowledge Ecology International
Medical professional and patient group funding by drug and medical device companies

Healthy Skepticism


Read Full Post »

The following two items arrived in my email inbox yesterday:

The Seattle Times reported yesterday that Health dept. delivers layoff notices; maternity services hardest hit, referring to the Seattle-King County Department of Health. The WA Global Health Alliance announced that  the 2011 Celebration for the Health and Dignity of Women will held in Seattle on March 8, sponsored by Americans for the UNFPA, the United Nations Population Fund.

The US ranks 33rd or 46th in rate of infant mortality among countries of the world, depending on source of data analysis, hardly a track record to be emulated.  Underlying the statistics of course are harsh disparities among and between  sociodemographic and racial/ethnic groups, reflecting the inexcusable results of the politics of health care.

Coincidentally, last week also marked the release of the first-ever CDC Health Disparities and Inequalities Report detailing racial disparities across a wide range of health conditions and diseases.  While none of the findings were news in the public health sphere,
the new official focus on the topic is significant.  Some readers may recall events during the Bush Administration , when the Executive Summary of the first Congressionally-mandated  HHS’ AHRQ  2003 National Healthcare Disparities Report was secretly altered  from its draft version, just before its pre-Christmas release, to omit a conclusion stating that health care disparities “are national problems” and other key changes.

Read Full Post »

I’m catching up on my reading now, so passing on links to a number of  important studies , some ongoing , published in late 2010, including:

Public Citizen
Pharmaceutical Industry Is Biggest Defrauder of the Federal Government Under the False Claims Act

MSF/Doctors Without Borders
Access to Essential Medicines: Ten Stories That Mattered in 2010

ProPublica
Dollars for Docs: What Drug Companies are Paying Your Doctor

American Medical Students Association
AMSA PharmFree Scorecard 2010 : Conflict of Interest Policies at Academic Medical Centers

and in the news Supreme Court Reviews Data Mining & Free Speech

Also of  note, the upcoming conference of the National Legislative Association for Prescription Drug Prices :NLARx Meeting on Drug Pricing & Affordability, Friday, January 21, 2011, Washington D.C.  


Read Full Post »

Beyond the challenges planned to overturn the Affordable Care Act in the US, we need to keep abreast of news  from around the world affecting access to care , such as these headline stories:

HIV Patients May Soon Face a Choice: Full Price Meds or No Meds At All

U.S. Backs Drug Firms in Lawsuit Over Prices

Deadly Spin Strikes a Chord

Firms fight move to obtain cheap anti-blindness drug Avastin

and from North America, illustrating that it’s not only quality control and manufacturing issues, but the profit motive that contributes to shortages of important drugs:

Report warns of medication shortages across Canada

A push to ease prescription drug shortages: Sen. Klobuchar to propose easing imports of medication from abroad

Darcy Malard-Johnson, a pharmacist at the University of Minnesota’s cancer clinic, said 13 of the 150 drugs on the current shortage list are cancer drugs. Most have been around for years, she said, and that may be one of the problems. Because they’re generic, they’re not as profitable to make or sell as newer drugs. And there’s no way of knowing when a company will simply decide to stop making it.

The shortage of oncology drugs in particular was also highlighted in NCI Cancer Bulletin in an article entitled Continued Shortage of Chemotherapy Drugs Causing Concern.

The FDA’s Drug Shortages  website includes current shortages, status updates, and a list of drugs to be  discontinued, per the following terms:

Companies are required under 21 CFR 314.81(b)(3)(iii) to provide FDA with a six month advance notice of the discontinuation of sole source products that are life-supporting, life-sustaining or for use in the prevention of a debilitating disease or condition. From time to time, FDA also receives notification for other products. These discontinuations are provided below for informational purposes only.

Health Canada currently does not conduct such monitoring or provide information on drug shortages, actions that the Canadian Pharmacists Association has urged the government to take on quickly to address the serious and growing problem.

Read Full Post »

The end of the year with its annual holidays found many  of us here in Washington State feeling anything but in a festive mood, given the imminent decimation of core health and human services, as part of  the Governor’s proposal for balancing of the state’s  budget in the new year and for the biennium.  On September 13th, Governor Gregoire’s Executive Order 10-04 instructed all state agencies to make reductions in their allotments from the State General fund in order to meet the requirement for a balanced  budget. On September 29, DSHS issued its initial plan of how the 6.3% across-the-board budget cuts would be applied to Department programs to meet this mandate. The proposed cuts were aimed at every program and service (included some entirely state-funded and other linked to Medicaid)  not technically defined as “mandatory,” affecting the state’s most vulnerable populations in all age-groups from pre-cradle to grave, and including  primary care delivered at community health centers.

By December, a supplemental budget proposal with even worse news was issued, containing further  proposals for achieving the needed $4 billion in savings to balance the budget. The drastic cuts to almost every aspect of civic life, was driven by outcomes of  ballot measures  from the November elections, which dashed any hopes even of short-term new revenue generation  from snack sales, rejection of a first-ever state income tax to have been levied only on the wealthiest among us, and hamstrung future legislative efforts to raise taxes with the 2/3 majority approval stipulation.  By December 30, the Governor released the latest list of planned budget cuts,and the timeline for their elimination. While some of the worst of the cuts have been staved off or delayed temporarily, it still remains to be seen whether the remaining services will be funded, even in vastly reduced mode, and how many human beings affected by the cuts will even survive.

While at this stage in my life nothing surprises me any more, the discrepancy between what is happening to these most basic of services and the treatment of the high-profile, socially attractive high tech sector by state government should be a wake up call to all of us who value a decent society. While the majority of Washingtonians have not misbehaved, it seems like the most vulnerable among us are being singled out for punishment.

State Dollars > Private Venture

During exactly same time period that the budget cuts were first announced in October, another state agency, the Life Sciences Discovery Fund, gave a grant of $5 million to a private, for-profit business, the Omeros Corporation, a Seattle biopharmaceutical company, for  research into speculative personalized medicines. The grant to Omeros was rolled into a package deal for the firm, that included $25M from Paul Allen’s Vulcan Capital. Even Xconomy: Seattle‘s biotech reporter Luke Timmerman expressed great surprise at this development in his Dec. 14 article entitled Life Sciences Discovery Fund Debunks Perceptions with Omeros Deal, Shows State Can Bankroll Companies. If the research ever pans out, then there is the possibility of financial returns to the state at some unknown time in the future.

A bit of background: Washington’s Life Sciences Discovery Fund was established by the Legislature in 2005 to disburse the tobacco settlement funds allocated to the state. While the the fund originally had been allocated $350M for a 10-year period, when the State’s budget crisis threatened to shut down the program in 2009, it survived with a budget cut of 41% or $39M in funds for FYs 2009-2011. The LSDF’s  stated mission is as follows:

The Life Sciences Discovery Fund supports innovative research in Washington state to promote life sciences competitiveness, enhance economic vitality, and improve health and health care.

which the  program website further explains as intending to “foster growth of the state’s life sciences sector and improve the health and economic wellbeing of its residents.”

But given the crisis situation we now face–in context of course of the ongoing national recession–emergency measures are needed.  It hardly seems the time for state government to be investing in private companies, purely ethical issues aside for the moment. Obviously, it’s going to take more than redirecting the “mere” $5M given by the LSDF to a private venture to save public health services in Washington State, but those funds certainly could have turned things around for a good number of the axed programs, such as the Basic Health Program insurance plan and so many Medicaid services.  While research is important, without access to care, medical innovations are meaningless.  What good is research, if there is no safety net? Given the LSDF’s mission, it should be part of the logical solution needed  now: making sure that all Washingtonians can benefit from the medical knowledge available today. And the state government can take a leadership role too in education on the need for investment in our human capital. Despite laments over the election outcomes,and grim prognostics, the official ChooseWashington.com website continues to highlight the array of attractive tax incentives, some of which I had commented on previously, for certain types of companies to set up shop here, along with the absence of a personal income tax.

Another part of the Governor’s plan to balance the budget, announced December 14, is to eliminate Boards and Commissions. No mention was made in this announcement, however, about the status of  a brand-new board, the Global Health Technologies Competitiveness Board established in July 2010, after SB 6675 Creating the Washington global health technologies and product development competitiveness program and allowing certain tax credits for program contributions, was approved by the Legislature and signed into law by Gov. Gregoire. Per RCW 43.374.010, among the Board’s charges are seeking funding from the private sector, foundations, and the federal government in order to issue grants to local enterprises …to stimulate our economy and foster job creation in the emerging field of global health while improving the health of people in our state and the world. The program is required to be administered by a 501(c)6 tax-exempt nonprofit organization, which contracts with the Dept. of Commerce for administrative services.

The Global Health Technologies Competitiveness Program (GHTCP) was awarded $1M by the Legislature (evidently not subject to the budget cuts) and issued its first RFP in mid-November, with awards expected to be announced early in the new year, along with a second RFP announcement, according to the Washington Global Health Alliance.

Think Globally, Act Locally ?

These new developments beg the question of just exactly what these specific state-funded programs are doing to improve the health  of Washington residents in the here and now. I write these words from the perspective of understanding full well how domestic and  international health are inextricably linked, whether regarding diseases rapidly transcending national borders or concerning the impact of international trade agreements on availability of medicines for US Medicaid programs, just to name a few examples. I myself am alive today partly as a result of medical advances developed here in Seattle, and I am also directly involved with both local and global health equity work, which makes me even more appalled at what is going on. Global health has been described as Seattle’s “next hot industry,” but few are the public voices applying critical thinking skills to analyze what this actually means for local folks. One of the exceptions is that of Seattle journalist Tom Paulson, who now offers insights on his Humanosphere blogsuch as a November 2010 story on a still-vague, 5-year  $1M  Swedish Medical Center pilot project called Global to Local targeting two low-income communities in  South King County.  Tom pointed out the irony  of this program being rolled out at the very same time that well-established and proven-effective, public health services are being slashed. According to the article, G2L is based on a concept that the “best practices” used by local actors in overseas health programs can be applied here at home too, while structural reasons for domestic health and healthcare inequalities are not addressed. And another observer, Steve Gloyd, MD of Health Alliance International and the UW Dept. of Global Health, has opined that there can be an upside to calling global health an “industry”:

“Maybe using the word will shock people into recognizing that when a local biotech firm says it is working on a vaccine to help people in Africa, some will see it is actually just trying to make a few people in Seattle rich.”

Next year, a new nonprofit called Global Health Nexus will commemorate the 50th anniversary of the Seattle World’s Fair with a major conference and exhibition showcasing the region’s global-health advancements. One has to wonder if anyone working to improve health at the local level will be invited to present, or if we’ll be able to afford the registration fees. Perhaps advocates can submit an abstract for a session there featuring real-life Washingtonians sharing first-hand accounts of the outcomes of state budget cuts on preventable health problems, such as  a child who has  been experiencing asthma attacks since elimination of the Children’s Health Program; an adult with diabetes who had to get their leg amputated due to lack of non-emergency podiatry care;  or the relative of a patient who died due to a wrong diagnosis resulting from lack of a medical interpreter;  or we could show  videos of overflowing ERs full of patients bumped from the Basic Health Program and unable to be seen at community clinics. Then maybe we could pass the hat among the rich and famous to take to up a collection for local health.

Read Full Post »

Follow

Get every new post delivered to your Inbox.