Pharmacy Benefit Managers Scrutinized For Role In Drug Price Increases

Pharmacy benefit managers – the middlemen who negotiate drug purchases for insurers and large buyers – are coming under growing scrutiny and criticism both in Connecticut and nationwide for their role in the sharp rise of prescription drugs. The third-party companies, called PBMs for short, originally processed claims for pharmacies, but now are hired by Medicare, Medicaid and commercial health plans to manage pharmaceutical benefits. Their reach is broad: they choose what drugs are covered by insurance; negotiate purchasing deals with drug makers; determine co-pays for consumers; decide which pharmacies will be included in prescription plans; and decide how much pharmacies will be reimbursed for the drugs they sell. The growing legions of PBM critics, who include state Comptroller Kevin Lembo, pharmacists and their trade and service organizations, say that the industry is helping drive the unrelenting rise in prescription drug prices and insurance premiums.

PBMs, Lembo’s office and state pharmacists say, use a variety of tactics to capture cash from consumers, payers and pharmacies. One is spread pricing, where they pay the pharmacy less for a prescription than a payer gives them, sometimes even forcing the pharmacist to take a loss.

Smoking Cessation Programs For People With Mental Illness Are Hard To Find

Betty Williams says giving up crack cocaine was easier than her ongoing struggle to quit cigarettes. “A cigarette is a friend,” said Williams, who lives with schizophrenia and chronic obstructive pulmonary disease. People with mental illness account for 44% of the cigarette purchases in the United States, and they are less likely to quit than other smokers. High smoking rates among people with mental illness contribute to poorer physical health and shorter lifespans, generally 13 to 30 years shorter than the population as a whole. About 37% of men and 30% of women with mental illness smoke.

Elder Abuse Investigations More Than Doubled In Seven Years

State investigations of elder abuse, ranging from neglect to emotional abuse to physical abuse, more than doubled in Connecticut between 2011 and 2017, from 3,529 to 7,196. In 2017 alone, the state Department of Social Services (DSS) received 11,123 reports of elder abuse and decided that 7,196 warranted an investigation. That year, self-neglect—when adults are unable to provide for their own basic care—was the most common type of elder abuse reported to DSS, at 30 percent, followed by neglect by others, financial exploitation, emotional abuse, physical abuse, sexual abuse and abandonment. “It’s all trending up,” Dorian Long, DSS director of social work services, said. Some of the recent cases investigated by DSS Protective Services for the Elderly are chilling.

Cancer Death Rates Decline, But Income Is A Factor In Survival

Advances in early detection and cancer treatments have resulted in a 27 percent decline in cancer deaths in the U.S. in the last 25 years, but those benefits are slow to trickle down to those who are lower on the socioeconomic scale, according to a report by the American Cancer Society. In the nation’s poorest counties, the cancer mortality rate is 20 percent higher than in the most affluent counties, and “the difference is much larger for cancers that are the most preventable: cervical, colorectal and lung,” said Rebecca Siegel, strategic director of Surveillance Information Services at the American Cancer Society and an author of the study. Robert Ciemniewski, 57, a longtime smoker from Connecticut, was on the wrong side of the statistical divide when he walked into the emergency room in 2017 with breathing difficulties from what he thought was pneumonia. He did have pneumonia, but he also had advanced lung cancer. Ciemniewski had not had a health checkup since 2013, when he quit his job as a mailman to care for his ailing mother.

Food Pantries Urged To Stock Nutritious Foods To Encourage Healthy Eating

People struggling with hunger suffer from a disproportionate number of chronic illnesses and often rely on food pantries for their groceries. So, pantries are now being urged to undergo a sea change and abandon their traditional emphasis on calories and nonperishable items in favor of more nutritional food. In Connecticut, 440,000 people are food insecure, which means they have limited or uncertain access to sufficient nutritious food, according to 2017 U.S. Department of Agriculture figures, the latest available. They comprise 12.2 percent of the state’s population.People with food insecurity are 25 percent more likely to have heart disease and diabetes, and 50 percent more likely to have kidney disease, cites Feeding America, a national food bank network. “These issues can be prevented or managed better with a proper diet rich in fresh fruits and vegetables, lean meats and whole grains,” said Michelle Lapine McCabe, director of the Center for Food Equity and Economic Development, based in Bridgeport.

Shifting Social Attitudes, Stagnant Budgets Fuel Dramatic Rise In STDs

Despite the best efforts of health departments across the state, the number of reported cases of sexually transmitted diseases (STDs) continues to rise dramatically, mirroring a national trend. According to surveillance data from the Centers for Disease Control and Prevention (CDC), the U.S. experienced steep, sustained increases in STDs between 2013 and 2017. In Connecticut, reported cases of syphilis rose 51 percent during the four-year period, while gonorrhea jumped 25 percent and chlamydia rose 27 percent. According to the CDC’s ranking of all 50 states, Connecticut was 27th for reports of chlamydia, 4oth for gonorrhea, and 45th for syphilis. Health officials acknowledge that the rise in reported STDs cases is partially due to better testing and tracking.

Filling The Primary Care Gap: Nurse Practitioners

Alison McGrory-Watson, a private cook who lives in Deep River, had serious medical problems, including Hepatitis C and post-traumatic stress disorder (PTSD), when she was assigned Nichole Mitchell as her primary care provider at Community Health Center Inc. (CHC) in Middletown. McCrory-Watson was uninsured, and Mitchell went to great lengths to get financial assistance for two new drugs aimed at addressing her medical problems. As a result, McGrory-Watson is now Hep C-free, and she hopes a drug she’s taking for PTSD will quell the lingering effects of being gang-raped as a teenager and witnessing a brutal stabbing as an adult.

There’s something about Mitchell that might surprise you. She’s not a doctor; she’s a nurse. A nurse practitioner (NP), to be precise. But McGrory-Watson insists that the care Mitchell provides is every bit as good as she would get from a physician.

Immigrants Are Wary Of Using Assistance Programs As Feds Weigh Policy Change

When immigrant families bring their children to the Yale Children’s Hispanic Clinic, it’s just not about check-ups and vaccinations. Clinicians help them deal with everything from teething to nutrition to finding a place to live. But these days when front-line clinicians encourage families to use the many services offered through federal public programs, parents have questions—and misgivings. “They are hesitant because they are afraid,” said Patricia Nogelo, a clinical social worker at the Yale Children’s Hispanic Clinic. A proposed change in immigration law is making immigrants in Connecticut and nationally wary of utilizing federal programs that cover health, food and housing assistance.

Affordable Prescription Pricing, Public Insurance Option Among Legislature’s Health Care Goals

Although Gov. Ned Lamont said nothing about health care policy in his inaugural speech to the General Assembly, it’s likely to be a major theme of at least his early months in office. Why? Depending on how it’s calculated, health care makes up 25 to 30 percent of the state budget, according to the Office of the State Comptroller. Lamont will have to balance the need to save money with the desire of many inside and outside the General Assembly to expand and improve health care coverage and lower costs for consumers. “There’s almost two levels,” said Patricia Baker, president and CEO of the Connecticut Health Foundation, which focuses on assuring health equity and access to affordable care for all.

Pharma Cash Flows To Doctors For Consultant Work Despite Scrutiny

With physicians’ compensation from pharmaceutical and medical device companies under increasing scrutiny, payments to doctors in Connecticut for consultant work rose to $8.5 million in 2017, up from $8 million in 2016. Payments for meals, travel and gifts also increased from $3.2 million in 2016 to $3.5 million in 2017, data from the Centers for Medicare & Medicaid Services show. Of the total $27.2 million in payments, $4.37 million – or 16 percent – went to 10 doctors holding licenses in Connecticut. The highest paid doctor was Dr. Paul Sethi, an orthopedic surgeon in Greenwich, who accepted slightly more than $1 million in 2017 in royalty fees, consulting work, and other services from several companies, including Arthrex Inc., and Pacira Pharmaceuticals Inc., maker of Exparel. The drug, Exparel, is marketed as an alternative to opioid painkillers post-surgery.