The Official Medtipster Blog

www.Medtipster.com Source: The New York Times, 9.24.10 – by Lesley Alderman

About 11,500 cases of whooping cough, or pertussis, have been reported nationwide so far this year. In California, where the infections are nearing a record high, nine infants have died.

It is likely that some of those children had not received all their shots, experts say. But some of those deaths might have been prevented if more adults, too, had been immunized.

Though public health authorities have long recommended that adults get a pertussis booster shot, just half have done so. Without it, they risk passing this illness to vulnerable children.

“Almost everyone understands how important it is for children to be immunized,” said Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, “but adults need vaccines too.”

Far too few get them. The C.D.C. recommends that people 19 and older receive immunizations against as many as 14 infectious diseases. (Not all adults require every vaccine.) Yet most adults rarely think about getting the shots — until they step on a rusty nail or begin planning travel to a developing country.

Only 7 percent of Americans over age 60, for instance, have received the herpes zoster vaccine, which prevents shingles, a painful nerve infection. Just 11 percent of young women have received the vaccine against the two types of human papilloma virus that cause 70 percent of all cervical cancers.

Why are adults so behind on vaccinations? For one thing, the shots can be expensive (from $20 to $200 a dose for some, and some require three doses). But a bigger part of the problem is a lack of awareness. Doctors often fail to remind patients that they require booster shots, and consumers are not well informed about the need.

In a 2007 survey by the National Foundation for Infectious Diseases, 40 percent of respondents incorrectly stated that, if they had received vaccines as a child, they did not need them again; 18 percent said vaccines were not necessary for adults.

The new health care law should help get more adults to roll up their sleeves. Under the law, group and individual health plans, as well as Medicare, must provide preventive health services, including immunizations recommended by the C.D.C., free of charge. That means no co-payments, co-insurance or deductibles.

The hope is that since vaccines will be free, more doctors will suggest them and more patients will ask for them, said Jeffrey Levi, executive director of Trust for America’s Health, a nonprofit group that works to prevent epidemics.

Here’s the catch. If you are in a group or individual health plan, your plan must be new, or it must have undergone substantial changes, in order for the new requirements to apply. In addition, certain recent vaccine recommendations will not be covered right away. If you are uncertain, call your insurer.

Adult immunizations are not just an important way to prevent the spread of disease. Immunizations are also a phenomenally cost-effective way to preserve health.

“When you compare the cost of getting sick with these diseases to the cost of a vaccine, it’s a modest investment,” said Dr. Robert H. Hopkins, a professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences.

If you end up in the emergency room with a bad case of the flu or pneumonia, your bill could be thousands of dollars. A flu shot is just $20, or often free; the pneumonia vaccine is about $77.

Here is how to get up-to-date on your shots — whether you have a new insurance plan, an old plan or no plan at all.

THE VACCINES YOU NEED Tear out the immunization chart accompanying this article or print it out online. Note the vaccines you should be getting, based on your age and health status.

This year, for the first time, the C.D.C. recommends that everyone, regardless of age or health, get an influenza shot. Most people need only one. This year the flu shot provides protection against the H1N1 virus and two seasonal viruses.

Most other vaccines are intended for specific age groups or for those with particular risk factors. The zoster vaccine, for example, has been tested only in older people. There is little evidence that it could benefit younger people, whose immune systems are still strong.

Next, figure out which vaccines you have already received. Your doctor should be able to help. But if you have switched physicians a number of times, you may have to reconstruct your history on your own.

“When in doubt, get vaccinated,” said Dr. Hopkins. “There’s very little risk with getting a second dose of a vaccine.”

IF YOU HAVE INSURANCE Call your primary care physician and explain that you would like to get your vaccinations updated.

Some offices do not stock vaccines, so it is wise to tell the staff in advance what you will need. You may find that certain vaccines are not available right away; your doctor can tell you where to find them, or how long the wait will be.

Next, call your insurer and ask if they will cover vaccines free of charge. If not, ask how much they charge. If the fees are high, see below for alternate options.

IF YOU LACK COVERAGE You can still pay out-of-pocket for immunizations at the doctor’s office, of course. But the shots may be less expensive at other places.

YOUR HEALTH DEPARTMENT If money is tight, find out if your state or community health department provides vaccinations for adults. Unfortunately, there is no federally funded program for adult immunizations, only for children.

The C.D.C. Web site provides an interactive map to help locate the health department or immunization clinic in your area.

YOUR LOCAL PHARMACY Many retail clinics administer vaccines, including CVS MinuteClinics and Walgreens Take Care Clinics. MinuteClinics offer 10 vaccines for adults, including shots for hepatitis A ($117) and B ($102), meningitis ($147), pneumococcal disease ($77) and DTaP, which protects you from diphtheria, tetanus and pertussis ($82).

There are 500 CVS clinics across the country, and all are open seven days a week. No appointments or prescriptions are necessary. Walgreens clinics offer travel vaccines, like the one for typhoid fever, as well.

Even if your local pharmacy does not have a clinic, you may be able to get some of the shots you need there. In all states, pharmacists are licensed to give flu shots; in some states, they can administer other vaccines as well, like the one to protect against pneumonia.

Check with a local pharmacy and find out what shots they are licensed to provide and at what cost.

< Find a local pharmacy nearest your home that offers your vaccine at the lowest price at www.medtipster.com >

YOUR EMPLOYER Inquire at your company’s human resources or wellness office. Some companies provide free flu shots for employees, as well as their families. Few companies provide other vaccines, but it can’t hurt to ask.

Remember that when you get immunized, you are not only ensuring your own good health but the health of those around you.

www.Medtipster.com Source: The Washington Post – 9.21.2010

If you’ve ever seen a sale advertising 50 percent off, you might have wondered if the retail price was ratcheted up to make the discount possible.

Patient advocates are watching to see if a similar tactic undermines one of the most widely publicized benefits of the health-care overhaul that President Obama signed in March.

Beginning next year, at the expense of pharmaceutical companies, millions of senior citizens in the Medicare coverage gap known as the “doughnut hole” will receive 50 percent discounts off the price of brand-name prescription drugs.

The government does not control the underlying prices; the law leaves that to the market.

“There is legitimate concern that some manufacturers will steeply increase the price of drugs in order to offset the cost of the discount to the manufacturers at the expense of both consumers and the Medicare program itself,” the Center for Medicare Advocacy and the Medicare Rights Center said in a letter to the agency that oversees the federal health insurance program.

That agency, the Centers for Medicare & Medicaid Services, announced in August that the average monthly premium for Medicare prescription drug plans will rise next year by a dollar, to $30.

Officials at the agency and at the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry group, said the average premium increase indicates that there has been no spike in prescription drug prices.

Competition in the drug market will serve as a restraint, they said.

“I am confident we will continue to see very low price growth” for the Medicare drug program, said Jonathan Blum, deputy administrator of the government’s Center for Medicare.

But others are worried about the long-term outlook. UnitedHealth Group, which sells prescription drug insurance, has expressed concern “that Manufacturers have not agreed . . . to protect the underlying pricing of the drugs.”

In a June letter to the Health and Human Services Department, UnitedHealth took the extraordinary step of calling for price controls, saying the government should “require Manufacturers to maintain a ceiling on prices that would preserve the value of the discount for beneficiaries.”

“I don’t think all savings will be lost. But they can certainly recoup some of those savings by increasing prices,” said John M. Coster, senior vice president for government affairs at the National Community Pharmacists Association.

The doughnut hole has been a financial abyss for many senior citizens since Medicare prescription drug coverage was first offered in 2006.

For 2010, beneficiaries enter the coverage gap when their prescription tab hits $2,830, including both their share and the amounts paid by insurance. Once in the gap, they are responsible for 100 percent of the cost and must spend $3,610 of their money before qualifying for catastrophic coverage, which typically pays 95 percent of the cost.

Some people in the doughnut hole forgo their medicine; others take less than the proper dosage.

The health-care law will close the coverage gap by 2020, Obama has said. To do that, it provides a combination of federal rebates and subsidies, and also requires drugmakers to foot the cost of the 50 percent discounts.

According to the consulting firm Avalere Health, the discounts will reduce drugmakers’ revenue by $32 billion over 10 years.

Despite that provision, the pharmaceutical lobby served as a key ally to Obama and congressional Democrats in the health-care battle.

For the industry, the outcome could have been worse. The legislation did not include proposals that posed a potentially greater threat to drugmakers – for example, empowering the federal government to negotiate prices.

And, by shrinking the number of uninsured, the legislation will expand the market for prescription drugs.

For drugmakers, offsetting the doughnut-hole discount would not be as simple as raising the price unilaterally.

There are different measures of prices, and the ones that will be discounted by 50 percent are the product of negotiations between retail pharmacies and intermediaries such as insurance plans. However, those negotiated prices are influenced by the ones that manufacturers set higher up the chain.

“I think you can say any price adjustments are independent of the discount,” Merck spokesman Ronald Rogers said by e-mail.

“What I can say is that all of the competitive market forces that were in place previously remain in place,” said PhRMA Senior Vice President Richard Smith.

But the government is trying to establish much lower prices than market forces alone produced.

As new drugs are introduced, manufacturers will probably factor the doughnut discount into their pricing, said Daniel N. Mendelson, chief executive of Avalere.

Some of the most expensive drugs taken by people in the doughnut hole face minimal competition from generics or brand-name alternatives, making them particularly susceptible to price inflation, said Brit Pim, vice president of government programs development at benefits manager Express Scripts. Those include “specialty medications” for complex diseases, he said.

Express Scripts found that in 2009, the average price for specialty medications rose 13.5 percent.

www.Medtipster.com Source: Associated Press (AP) – 9.16.2010

Generic medications saved the government and Medicare prescription drug plan beneficiaries about $33 billion in 2007, according to a Congressional Budget Office report.

The report, highlighted on Wednesday by the trade group Pharmaceutical Care Management Association, says an additional $14 billion is expected as first-time generics enter the market through 2012. Medicare Part D is Medicare’s prescription drug program.

“This new research highlights the importance of this proven pharmacy benefit management cost-savings tool,” the Pharmaceutical Care Management Association said in a statement. “Tools pioneered by pharmacy benefit managers, including encouraging the use of generic medications, have lowered costs and expanded access to prescription drugs for seniors in Medicare Part D.”

Pharmaceutical Care Management Association is a trade and lobbying group representing pharmacy benefit managers. During the second-quarter of 2010, the group spent $551,889 lobbying the federal government on issues that affect pharmacy benefit managers, including federal reimbursement on pharmacy payments, rebates, and the regulation of imported prescription drugs. Other issues included lobbying for audit reform on pharmacy benefit managers, according to a filing with the House Clerk’s office on July 20.

Pharmacy benefits managers include Medco Health Solutions Inc., based in Franklin Lakes, N.J., which saw a 14 percent jump in second-quarter profit to $356.9 million on a 10 percent boost in revenue to $16.41 billion. Other pharmacy benefit mangers include Express Scripts Inc., based in St. Louis, which saw second-quarter profit surge 50 percent to $289.9 million on a doubling of revenue to $11.29 billion.

www.Medtipster.com Source: News & Observer – 9.12.2010

After years of adding everything from groceries to grills to their inventory, drugstore chains are once again emphasizing their pharmacies.

Pharmacists are being asked – and paid by insurance companies – to monitor their customers’ health. That could include counseling them on chronic diseases, making sure they’re taking their medications, and screening for maladies from diabetes to high cholesterol.

While many pharmacists have long done more than dispense pills, this is the first time many have been able to offer such a wide range of medical services – partially because of changes in the way pharmacists are educated, and partially because of legislative changes that have cleared the way for an expanded role.

For pharmaceutical chains, the change is an opportunity to develop new sources of revenue in a highly competitive industry.

For customers, it’s another option for health care, and one that may be less expensive and take less time than a trip to the emergency room or an urgent care clinic.

“I think it’s a mixture of everything that’s going on,” said David Catalano , a Raleigh pharmacist who works for Walgreens . “[Customers] are trying to get some advice as quick as they can from someone they can trust.”

The emphasis on pharmacists makes economic sense for health insurers. Pharmacists have expertise and often have a customer’s entire medical picture, so they can catch prescription overlaps or possible drug interactions. Nor do they command the same fees that a physician does from a health insurer.

The push toward enlisting pharmacists to do more than dispense drugs comes as the nation is trying to lower health care costs. A 2007 study from the New England Healthcare Institute estimated that 13 percent of total health care expenditures – more than $290 billion a year – are made simply because people don’t take their medications as prescribed. Those people have a higher likelihood of winding up in the emergency room or with other complications because they did not follow their doctor’s instructions.

But not everyone is happy with pharmacists treading on turf that was once solely the territory of doctor’s offices and urgent care clinics.

“Store-based health clinics can offer patients an option for episodic care but cannot replace the patient-physician relationship,” said Rebecca Patchin , a doctor from California and board member of the American Medical Association . “Patients deserve timely access to affordable, high-quality care provided by health care professionals that are appropriately and adequately trained. Convenience should never compromise safety.”

‘Closer than my doctor’

Over the past four years, James Evans has come to rely on Prasanna Bafna, a pharmacist near his Durham home, for much of his medical advice.

On Thursday, Evans was at his Rite Aid for an hourlong counseling session with Bafna.

They reviewed Evans’ medications, including drugs for diabetes, high blood pressure and poor circulation.

Though the pharmacist didn’t tell him to make any major changes, Evans said the opportunity to speak with a medical professional for such a length of time is invaluable.

“It’s wonderful,” said Evans, 76, of Durham. “When it’s time for my medicine, it’s right on time. I don’t have to stand there and wait on it. The other pharmacist I used to go to, you’d have to sit and wait for hours. … [Bafna] is closer than my doctor. My doctor is eight or nine miles from here.”

Proponents of the expanded role of pharmacists say that getting customers like Evans to utilize the new services being offered is key to making the system work and lowering health care costs.

Reimbursement rates

In general, pharmacists are not reimbursed as much money as doctors are for immunizations and the like, said Dan Mendelson , CEO of Avalere Health , a health care advisory company in Washington, D.C., and a Duke University adjunct professor.

“Most pharmacies are not allowed to bill for a pharmacy visit,” he said. “They’re allowed to bill for a vaccine, but there’s no routine office visit into the pharmacy that gets paid for by the insurance.”

The insurance companies may choose to reimburse the pharmacists more money or for additional services if there is a shortage of doctors or other circumstances in a particular region, Mendelson added, but “it depends on what the insurance company is trying to accomplish with respect to its network.”

The model is getting a boost from federal legislators. Some changes triggered by the new health care law will take effect later this month, with other changes rolled out in the years to come.

As of this year, laws in all 50 states also allow pharmacists to administer immunizations, something that also clears the way for expanded services.

Some companies are using the additional services simply as another way to get customers through the door, even if some of the services are not yet reimbursed by insurance, Mendelson said.

“It’s really about bringing purchasers into the box,” he said. “That’s what they call it. The box is the four walls in the pharmacy. If you can bring purchasers into the box then you’re doing fine. If a consumer comes in and they buy all kinds of other stuff, you’re doing well.”

Enhanced training

In addition to legislative changes last year, there have also been changes in the pharmacy industry that have helped pharmacists reach this point, said Edith Rosato , senior vice president of pharmacy affairs for the National Association of Chain Drug Stores .

She credits federal plans which began paying pharmacists to counsel Medicare and Medicaid patients in the hopes of improving results. She also said that an academic change was also key Students earning a pharmacy degree must now get a year of training on counseling and interacting with patients.

That set the foundation for the industry to focus more on patient care services, Rosato said.

So far, studies have indicated the services are working.

Raleigh-based Kerr Drug has taken the lead in this state in offering preventive care and has gone so far as to design some stores to focus exclusively on health and wellness. In Asheville, the company partnered with the city and the Mission-St. Joseph’s Health System to see whether pharmacists with expanded roles could help diabetes patients better manage their diseases and save in overall health care costs.

Kerr found that the annual health care costs for the diabetes patients participating in Asheville declined by 9.8 percent per year. One employer had an average reduction of 41 percent in sick days taken by participating patients, which equated to an estimated $18,000 in increased productivity for the company.

The need for these types of clinics will only increase as the population grows older and more people are diagnosed with chronic illnesses such as diabetes, said Rebecca Chater , executive vice president of Kerr Health , a subsidiary of Kerr Drug.

“Look at the number of people who are now moving into Medicare age,” she said. “If you look at medication use in that population, people who are within the Medicare system have 13 different prescriptions on average, with 50 different medications filled each year on average. The opportunity is huge.”

But getting to a point where insurance companies are willing to reimburse for more preventive services and pharmacists are willing to offer them is tricky business, said Jay Campbell , executive director of the N.C. Board of Pharmacy.

“There is a bit of a chicken and the egg aspect,” he said. “Health care being the huge expenditure it is, folks aren’t going to want to spend money until there’s a demonstrated benefit for those services. But private insurers have to start seeing enough of a value to provide the reimbursement.”

‘Cookbook medicine’

Still, some physicians say there are risks to having health care administered by pharmacists instead of doctors.

Linwood Watson , a family medicine doctor with an urgent care clinic called Rex Express Care in Knightdale, said he thinks patients like the new options because they are very transparent. There is a set fee for each service, and no secrets about what things will cost.

“Everyone wants cookbook medicine, but what happens when your body doesn’t read the book?” he said.

Pharmacies respond by saying that they work closely with area doctors to offer referrals to customers who do not have a primary care physician or need further medical expertise.

But with so many options and such a fragmented system, Watson said, he feels patients will have to take more responsibility for their own care in order to ensure continuity.

“If you want to go buy a car, and you want a good deal, you’re going to have to do some research, keep some records and be prepared,” he said. “Are you prepared to do that for your health care?”

Copyright © 2010 McClatchy-Tribune Information Services

www.Medtipster.com Source: Health Blog – Wall Street Journal Blogs, By Katherine Hobson – 9.02.10

The government today released some new stats on prescription-drug use through 2008. The headline finding: Over the previous decade, the proportion of Americans (of all ages) reporting they took a prescription drug in the past month rose to 48% from 44%.

Some other key findings:

The percentage of people reporting the use of multiple prescription drugs in the last month also rose, to 31% for two or more prescriptions and 11% (a near-doubling of the previous 6%)) for five or more drugs.

As you’d expect, prescription-drug use varied by age, with about 20% of kids under 12 and 90% of older Americans (defined as age 60 and over — sorry, Mom!) reporting the use of at least one drug in the past month.

Among the 60-plus crowd, more than 76% used at least two drugs in the past month and 37% used at least five. Of that finding — which stems, of course, from the fact that older folks often have multiple diseases — the report says that “excessive prescribing or polypharmacy is also an acknowledged safety risk for older Americans, and a continuing challenge that may contribute to adverse drug events, medication compliance issues and increased health-care costs.”

The type of drugs used most often were asthma meds for kids, central nervous system stimulants (such as those used to treat ADHD) for teens, antidepressants for the middle-aged and cholesterol-lowering drugs for older people.

The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade association for drug makers, said in a statement that “as we learn more about disease, prescription medicines are justifiably playing an increasingly important role.” The group noted that many patients still lack access to needed medications, and that in many cases early interventions and improved compliance would improve health outcomes. “The best solution for all patients is to strike the right medical balance between proper and effective use of prescription medicines and other therapies and interventions,” it said.

A few months back, the pharmacy-benefits manager Medco issued its own figures for prescription-drug use and spending, covering 2009. It reported that use among adults held fairly steady, edging up slightly among those over 65 and dropping a bit for those aged 50-64 — but use among those 19 and under rose by 5%.