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Daily Archives: July 6, 2016

Medical Marijuana Linked To Modest Budget Benefits For Medicare Part D, Study Finds

Prescription drug prices are up, making policy experts increasingly anxious. But relief could come from a surprising source. Just ask Cheech and Chong.

New research published Wednesday found that states that legalized medical marijuana — which is sometimes recommended for symptoms like chronic pain, anxiety or depression — saw declines in the number of Medicare prescriptions for drugs used to treat those conditions and a dip in spending by Medicare Part D, which covers the cost on prescription medications.

The study, which appears in Health Affairs, examined data from Medicare Part D from 2010 to 2013. It is the first study to examine whether legalization changes doctors’ clinical practice and whether it could curb public health costs.

The findings add context to the debate as more lawmakers express interest in medical marijuana. Ohio and Pennsylvania have this year passed laws allowing the drug for therapeutic purposes, making the practice legal in 25 states, plus Washington D.C. The question could also come to a vote in Florida and Missouri this November. A federal agency is considering reclassifying it under national drug policy to make medical marijuana more readily available.

This KHN story also ran on NPR. It can be republished for free (details). logo npr

Medical marijuana saved Medicare about $165 million in 2013, the researchers concluded. They estimated that, if the policy were nationalized, Medicare Part D spending would have declined in the same year by about $470 million. That’s about half a percent of the program’s total expenditures.

That is an admittedly small proportion of the multi-billion dollar program. But the figure is nothing to sneeze at, said W. David Bradford, a professor of public policy at the University of Georgia and one of the study’s authors.

“We wouldn’t say that saving money is the reason to adopt this. But it should be part of the discussion,” he added. “We think it’s pretty good indirect evidence that people are using this as medication.”

The researchers found that in states with medical marijuana laws on the books, the number of drug prescriptions dropped for treating anxiety, depression, nausea, pain, psychosis, seizures, sleep disorders and spasticity. Those are all conditions for which marijuana is sometimes recommended. Prescriptions for other drugs treating other conditions, meanwhile, did not decline.

The study’s authors are separately investigating the impact medical marijuana could have on prescriptions covered by Medicaid, the federal-state health insurance program for low-income people. Though this research is still being finalized, they found a greater drop in prescription drug payments there, Bradford said.

If the trend bears out, it could have meaningful public health ramifications. As doctors and public health experts grapple with the consequences of excessive prescription painkiller use, medical marijuana could provide an alternate path. Experts say abuse of prescription painkillers — known as opioids — is in part driven by high prescribing. In states that legalized medical uses of marijuana, painkiller prescriptions dropped — on average, the study found, by about 1,800 daily doses filled each year per doctor. That tracks with other research on the subject.

Questions exist, though, about the possible health harms or issues that could result from regular use.

It’s unlike other drugs, such as opioids, in which overdoses are fatal, said Deepak D’Souza, a professor of psychiatry at Yale School of Medicine, who has researched the drug.

“That doesn’t happen with marijuana,” he added. “But there are whole other side effects and safety issues we need to be aware of.”

Medical marijuana in jar lying on prescription form near stethoscope. Cannabis recipe for personal use. Legal drugs concept

“A lot of people also worry that marijuana is a drug that can be abused,” agreed Bradford. “Just because it’s not as dangerous as some other dangerous things, it doesn’t mean you want to necessarily promote it. There’s a lot of unanswered questions.”

Meanwhile, it is difficult to predict how many people will opt for this choice instead of meds like anti-depressants or opioids.

Because the federal government labels marijuana as a Schedule I drug, doctors can’t technically prescribe it. In states that have legalized medical marijuana, they can only write patients a note sending them to a dispensary. Insurance plans don’t cover it, so patients using marijuana pay out of pocket. Prices vary based on geography, but a patient’s recommended regimen can be as much as $400 per month. The federal Drug Enforcement Agency is considering changing that classification — a decision is expected sometime this summer. If the DEA made marijuana a Schedule II drug, that would put it in the company of drugs such as morphine and oxycodone, making it easier for doctors to prescribe and more likely that insurance would cover it.

To some, the idea that medical marijuana triggers costs savings is hollow. Instead, they say it is cost shifting. “Even if Medicare may be saving money, medical marijuana doesn’t come for free,” D’Souza said. “I have some trouble with the idea that this is a source of savings.”

Still, Bradford maintains that if the industry expanded and medical marijuana became a regular part of patient care nationally, the cost curve would bend because marijuana is cheaper than other drugs.

Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard Medical School, who has written two books on the subject, echoed that possibility. Unlike with many drugs, he argued, “There’s a limit to how high a price cannabis can be sold at as a medicine.” He is not associated with the study.

And, in the midst of the debate about its economics, medical marijuana still sometimes triggers questions within the practice of medicine.

“As physicians, we are used to prescribing a dose. We don’t have good information about what is a good dose for the treatment for, say pain,” D’Souza said. “Do you say, ‘Take two hits and call me in the morning?’ I have no idea.”

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Study: Brand-Name Drugs’ High Copays Soak Medicare Part D Patients

A new study takes a fresh measure of generic drugs’ price advantages, revealing how much more Medicare Part D patients shelled out in copayments for two popular brand-name drugs in 2013.

The result: 10.5 times more.

Copayments averaged $42 for both Crestor, a cholesterol medication, and Nexium, taken for acid reflux, according to researchers whose study was published Wednesday in Health Affairs.

The consumers’ cost for generic therapeutic equivalents was $4, they said.

The findings point to opportunities to save money for Medicare Part D’s elderly and disabled beneficiaries, who fill three or more prescriptions a month on average, according to previous research cited in the study. Half of enrollees received less than $22귔 in income in 2012.

High copays for brand-name drugs might lead patients “to choose between food or medications based on their monthly budget,” the researchers said.

Generics represented 76 percent of the drugs dispensed in Medicare Part D in 2013, but brand names still retained preferential selection in some cases. One contributor is pharmaceutical companies’ practice of negotiating rebates with private insurance companies that provide drug coverage plans to beneficiaries under Medicare Part D, researchers said. After getting a rebate, an insurer might list the rebated brand-name drug as “preferred,” which encourages its selection over other brand medications.

Preferred drugs require lower copays than a rival branded drug, but they are still more expensive than a generic, according to Health Affairs. Physicians can prescribe generic medications if they choose to do so.

Inaccurate information about the amounts of drug rebates also works to Medicare patients’ disadvantage, researchers said.

Insurers at the start of each plan year must report the rebates they expect to get to the government, which takes them into account in setting the premiums that beneficiaries will pay and how much it will pay insurers for providing the benefit. Previous government investigations have found many insurers tend to overestimate their rebates, leading to beneficiaries paying excessive premiums and Medicare overpaying insurers. The government eventually recovers overpayments later when insurers report what they actually received in rebates.  But Medicare beneficiaries are left to absorb the cost of brand prescribing, copays and elevated premiums, researchers said.

To do their study, researchers analyzed cost data for all medications in 2013 under Medicare Part D, a dataset released for the first time last year by the Centers for Medicare & Medicaid Services.

In 2013, the top 10 drugs in Part D, ranked by claims, were all generics, accounting for $4.1 billion in expenses. But ranked by total spending, the top 10 most expensive drugs were all brand names, representing $19.8 billion in spending, CMS said. Nexium was No. 1 — at $2.5 billion — and Crestor was No. 3 at $2.3 billion.

Had generic equivalents been prescribed in 2013 instead, the government, patients and insurance companies could have saved a combined $870 million for omeprazole in place of Nexium and $1.2 billion for atorvastatin instead of Crestor, researchers estimated. Dr. Nicole Gastala, the study’s lead author, said certain aspects of medical culture steer patients toward brand-name drugs.

Patients are frequently biased toward brand names by the power of advertising, and doctors’ interactions with pharmaceutical representatives have the same effect on them, said Gastala, who practices family medicine in Iowa and was a former visiting scholar at the Robert Graham Center for Policy Studies in Washington, D.C.

The cost of a drug is often unknown to both patients and doctors and physicians may have no idea how expensive a copay is.  When doctors prescribe a brand-name, patients rarely second-guess the choice, Gastala said.

Doctors sometimes try to find workarounds to save their patients money.

Dr. Robert Wergin, the chair of the American Academy of Family Physicians, said when generic medications are unavailable in the same strengths as brand-name drugs, he sometimes adjusts the generic version’s dosage to make it equivalent. He may tell patients to cut some generic pills in half to make them equivalent in strength to a brand-name medication, for example.

“I went to medical school, and I can’t remember a class where we talked about business models and rebates and [the pharmaceutical industry],” Wergin said. “My focus is on the individual patient.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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Consumers’ Sunscreen Picks Don’t Always Track With Doctors’ Advice, Study Says

When it comes to consumers choosing sunscreen, they are often drawn to a product’s scent, texture and, of course, performance, according to a study published Wednesday in JAMA Dermatology. It also found that, in many instances, these sunblocks don’t measure up to the standards recommended by the American Academy of Dermatology.

The AAD recommends sun protection products contain broad spectrum coverage, an SPF of 30 or higher, and water or sweat resistance. But four out of every 10 products fell short of the recommendations.

Steve Xu, one of the study’s primary authors and a dermatology resident at Northwestern University’s Feinberg School of Medicine, said he hopes these findings spur health professionals to better tailor their recommendations by understanding what drives patients’ preferences.

“If this is a product that everyone loves, that everyone likes,” Xu said, “there should be an impetus” for dermatologists to know why people like it.

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This KHN story can be republished for free (details).

This insight is important because using sunscreen is a modifiable behavior that is proven to reduce the risk of skin cancer. But, based on the latest available data from the Centers for Disease Control and Prevention, only about 31 percent of adults in 2010 — the most recent year for which this data is available — regularly use a product with an SPF of 15 or higher.

Specifically, the researchers sought to pinpoint the characteristics and the most-cited pros and cons of highly rated sunscreens as described by shoppers on Amazon.com. Of the total 6,500 sunscreen products that were available, they evaluated reviews of the top 1 percent — the 65 products with the highest number of consumer comments. These included products for the face, for the body and for children and covered a broad range of prices — ranging from 68 cents to $23.47 per ounce.

In analyzing consumer’s observations, the researches focused on the five most helpful and most critical, and looked for keywords including “cosmetic elegance,” “affordability,” “product ingredients” and “skin compatibility.” Products drew comments such as, “it absolutely reeks” and “not effective” to “I’m absolutely obsessed with this SPF” and “I was able to stay out at my children’s soccer games for the entire afternoon with no sunburn.”

Meanwhile, the sun-blocking agent is now incorporated into beauty products like moisturizers, foundations and lip balms. The amount of options, coupled with the consumer’s lack of knowledge about broad-spectrum and water resistance, can lead consumers astray when choosing a sunscreen, noted Roopal V. Kundu, a study coauthor and associate professor of dermatology and medical education at Northwestern University’s Feinberg School of Medicine.

Kristen Chase, copublisher and CEO of Coolmompicks.com, a parenting blog, says it is not always easy for shoppers to know which sunscreen is best. It is something that has been a topic on her blog.

She follows all the rules and does research when it comes to choosing sunscreen for her kids. She also follows guidelines about making sure her kids are protected before they leave the house and that they reapply frequently.

But Chase, who is not affiliated with the study, understands how the options, coupled with the hectic pace of family life, may lead to uninformed decisions.

“Sometimes we grab it because we see a picture of a kid on a bottle,” she said.

The wider selection also has led to the creation of more specialized products like hypoallergenic and organic sunscreens. While these specifications could appeal to consumer preferences, Xu said the extra labels may not amount to much in improving product’s effectiveness.

“This is what we have for objective performance for sunscreen,” Xu said in reference to AAD standards.  “Everything after that is a matter of opinion.”

As summer brings extra rays from the sun, Xu said consumers can choose the best sunscreen by adhering to the AAD guidelines and following several tips for optimal protection:

  • Apply sunscreen at least 15 minutes before sun exposure.
  • Use 1 oz. — enough to fill a shot glass — of sunscreen to generously cover the exposed areas of the body.
  • Reapply sunscreen at least once every two hours.

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Viewpoints: Hospitals Should Reveal Medical Errors; FDA Takes Time On Muscular Dystrophy Drug That Patients Don’t Have

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Bill Gates Defends Drug Pricing System, Saying The Companies Are ‘Turning Out Miracles’

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State Highlights: Baltimore Nabs $1.26M Homeless Health Care Grant; Budget Shortfalls Plague Calif. Coroner’s Office

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Stem Cells Could Usher In A New Era For Treating Cavities; 20 Years Post-Dolly And No Human Clones

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Struck By Steve Jobs’ ‘Excruciating’ Wait, Apple CEO Aims At Organ Shortage With New Software

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Judge Blocks Kansas’ Efforts To Strip Planned Parenthood Funding

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Missouri Governor Vetoes Bill That Would Charge Medicaid Patients For Missed Appointments

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