Heightened efforts by the Drug Enforcement Administration to crack down on narcotics abuse are producing a troubling side effect by denying some hospice and elderly patients needed pain medication, according to two Senate Democrats and a coalition of pharmacists and geriatric experts.
Tougher enforcement of the Controlled Substances Act, which tightly restricts the distribution of pain medicines such as morphine and Percocet, is causing pharmacies to balk and is leading to delays in pain relief for those patients and seniors in long-term care facilities, wrote Sens. Herb Kohl (Wis.) and Sheldon Whitehouse (R.I.).
The lawmakers wrote to Attorney General Eric H. Holder Jr. this month urging that the Obama administration issue new directives to the DEA and support a possible legislative fix for the problem, which has bothered nursing home administrators and geriatric experts for years.
The DEA has sought to prevent drug theft and abuse by staff members in nursing homes, requiring written signatures from doctors and an extra layer of approvals when drugs such as morphine and Percocet are ordered for sick patients.
The law, however, "fails to recognize how prescribing practitioners and the nurses who work for long-term care facilities and hospice programs actually order prescription medications," Kohl and Whitehouse wrote. They concluded that delays can lead to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."
Most nursing homes do not have pharmacies and doctors on site, adding to delays for patients who fall ill in the middle of the night and in their transition from hospitals to long-term care facilities.
Justice Department and DEA officials had no immediate comment. The DEA sent out guidance last summer in response to some of the pleas but it did not resolve the central issue of whether a nurse could serve as an agent of a doctor and administer pain medication with a verbal directive rather than a written prescription from a doctor.
The problem took on new urgency this year after the drug agents heightened their enforcement of the rules at pharmacies in Ohio, Michigan, Wisconsin and Virginia. The pharmacies face tens of thousands of dollars in fines if they deviate from strict controls that require doctors to sign paper prescriptions and fax them to a pharmacy before a nurse can administer them in the nursing home setting.
"The system is broken. It isn't working and patients are suffering," said Claudia Schlosberg, director of policy and advocacy for the American Society of Consultant Pharmacists. "While we need to ensure there are proper controls on the medications, the overall law enforcement concern has to be compatible with meeting patients' needs and right now, it's not."
Doctors in nursing homes say the restrictions do not take into account that many more patients, with higher levels of illness and pain, are moving into long-term care sites and out of hospitals.
William Smucker, medical director of the Altenheim Nursing Home in Ohio, said that the "delay is not what I would want for myself or my family, and it's not the way I practice in other settings."
Terence McCormally, a doctor who cares for patients in nursing homes in Northern Virginia, said the tug of war reflects "the tension between the war on drugs and the war on pain."
"Prescribing narcotics in a long-term care facility seems to be more of a nuisance than it needs to be," McCormally said. "For the doctor and the nurse it's a nuisance, but for the patient it is needless suffering."
By Carrie Johnson
Washington Post Staff Writer
Wednesday, October 28, 2009; 2:55 PM
Wednesday, October 28, 2009
Health Care Reform Update
Some HCR highlights for you to consider:
• The public plan remains the top hot button. Because some are opposed to a government run public option, the public option may be termed a “consumer” option that will be run by a non-government entity.
• There will be two cloture (stop debate) votes: 1) to proceed to debate on the floor of the Senate; and 2) to proceed with a vote. Both cloture votes can be filibustered. Some say that the votes are in for the first cloture vote – to proceed to floor debate; it’s the second vote that’s trickier. While some Senators may support moving the process along, they may not be ready to support the proposal.
• We understand that before any Senate bill is released, it will have received a score from the Congressional Budget Office (CBO). But what was just sent to CBO was not an entire bill; rather, it was a set of different options that could be included in a final bill. CBO could release a score on these provisions by the end of next week. However, that timing could be delayed because CBO must also score the House bill. The Senate will wait for a CBO score before voting. The House isn’t under any such restraints.
• We may see the merged Senate bill the week of November 9. Reid wants to get their bill done by Thanksgiving. But there may not be enough time to do so. So now we are looking at the December holidays for a potential end to this battle.
• The public plan remains the top hot button. Because some are opposed to a government run public option, the public option may be termed a “consumer” option that will be run by a non-government entity.
• There will be two cloture (stop debate) votes: 1) to proceed to debate on the floor of the Senate; and 2) to proceed with a vote. Both cloture votes can be filibustered. Some say that the votes are in for the first cloture vote – to proceed to floor debate; it’s the second vote that’s trickier. While some Senators may support moving the process along, they may not be ready to support the proposal.
• We understand that before any Senate bill is released, it will have received a score from the Congressional Budget Office (CBO). But what was just sent to CBO was not an entire bill; rather, it was a set of different options that could be included in a final bill. CBO could release a score on these provisions by the end of next week. However, that timing could be delayed because CBO must also score the House bill. The Senate will wait for a CBO score before voting. The House isn’t under any such restraints.
• We may see the merged Senate bill the week of November 9. Reid wants to get their bill done by Thanksgiving. But there may not be enough time to do so. So now we are looking at the December holidays for a potential end to this battle.
Tuesday, October 13, 2009
America's Healthy Futures Act /Senate Finance
SENATE FINANCE COMMITTEE PASSES HEALTH CARE REFORM BILL
Today the Senate Finance Committee passed America's Health Future Act, a health care reform bill that includes several provisions ensuring the ability of community pharmacies to continue providing critical services to patients.
PBM TRANSPARENCY AMENDMENT IN THIS BILL
The amendment from Senator Maria Cantwell (D-WA) will lead to transparency regarding the deals pharmacy benefit managers (PBMs)—the administrators of prescription drug plans—reach with drug manufacturers. Currently, PBMs retain much of these payments before sharing the rest with employers and patients. PBM profits have ballooned—up 20 percent last year alone—at the expense of everyone else confronting higher insurance premiums. While PBMs claim transparency increases costs, a thorough analysis by the Congressional Budget Office (CBO) deemed it budget neutral. Ultimately, savings will be found as a result of this transparency provision, as Medicare, the Pentagon, and the State of Texas are experiencing, among others.
Today the Senate Finance Committee passed America's Health Future Act, a health care reform bill that includes several provisions ensuring the ability of community pharmacies to continue providing critical services to patients.
PBM TRANSPARENCY AMENDMENT IN THIS BILL
The amendment from Senator Maria Cantwell (D-WA) will lead to transparency regarding the deals pharmacy benefit managers (PBMs)—the administrators of prescription drug plans—reach with drug manufacturers. Currently, PBMs retain much of these payments before sharing the rest with employers and patients. PBM profits have ballooned—up 20 percent last year alone—at the expense of everyone else confronting higher insurance premiums. While PBMs claim transparency increases costs, a thorough analysis by the Congressional Budget Office (CBO) deemed it budget neutral. Ultimately, savings will be found as a result of this transparency provision, as Medicare, the Pentagon, and the State of Texas are experiencing, among others.
Friday, October 9, 2009
Health Care Reform Update - Washington
House: The major issues that must be resolved in merging the three House committee proposals: rates (negotiated rates vs Medicare-based) in the public option; increases to the small business exemption; reductions in affordability credits; matching rates for Medicaid expansions; funding for co-op health plans; advance care/end-of-life counseling; geographic variations in Medicare rates; cost of minimum benefit plan for non-subsidized families; single payer; small employer options through the exchange; extension of the small business tax credit to non-profit employers; comparative-effectiveness research; CHIP costs; how to approach the territories; abortion; and medical malpractice.
Senate: Reports indicate that Senate Finance will vote on its mark this week. Given that today is Thursday, that leaves tomorrow (Friday). We also understand that the merging of the Senate HELP and Finance proposals is well underway and we may see something next week. We anticipate that the merged Senate bill will be on the Senate floor for many weeks.
Senate: Reports indicate that Senate Finance will vote on its mark this week. Given that today is Thursday, that leaves tomorrow (Friday). We also understand that the merging of the Senate HELP and Finance proposals is well underway and we may see something next week. We anticipate that the merged Senate bill will be on the Senate floor for many weeks.
Tuesday, October 6, 2009
Urge Your SENATORS to Support PBM Transparency in Health Reform— Don't Give PBM Lobbyists the Last Word!
Well-funded PBM lobbyists are blanketing Congress with lies and deception. Call your Senators TODAY to ensure final Senate health reform legislation includes critical provisions requiring PBMs to disclosure their enormous fees. This legislation will achieve a new level of transparency that will help plans keep premiums and out-of-pocket expenses down for your patients. Transparency helps reduce drug costs but there is no meaningful Federal or state requirement that PBMs disclose to public or private payers how they conduct business. The facts speak for themselves. PBMs are driving up health care costs by billing plan sponsors much more than they reimburse pharmacies and keeping large shares of manufacturer rebates, among other practices. We need to ensure our patients receive the drugs they need at a fair price. It is only through transparency that health plans will be able to confirm a PBM is securing the lowest drug costs, and to make sure PBMs operate within the interests of the patients and health plans they are meant to serve. We need to ensure your lawmakers know the facts.
Please contact your Senators today. Find your Senators' phone number here or contact the United States Capitol switchboard at (202) 224-3121. A switchboard operator will connect you directly with the Senate office you request.
Please contact your Senators today. Find your Senators' phone number here or contact the United States Capitol switchboard at (202) 224-3121. A switchboard operator will connect you directly with the Senate office you request.
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