Photo: Abby via Flickr
Health journalists received a few lessons in economics during a discussion last week on some alarming drug trends – largely the result of a broken market – that are threatening patient care and undermining the U.S. health care system.
At a New York City chapter event, Phil Zweig, a longtime financial journalist who also runs a group called Physicians Against Drug Shortages, spoke about the scarcity of generic drugs in hospitals and clinics – a problem that has persisted for years. Hospital group purchasing organizations (GPOs), which are not regulated and essentially negotiate supply purchases for hospitals, have the ability to charge market share to the highest bidder. Zweig said they can do this because the safe harbor provision in the 1987 Medicare anti-kickback law excluded GPOs from criminal prosecution for taking kickbacks from suppliers.
“The more you can pay to a GPO, the more market share you get,” Zweig said.
Because of the exclusive contracts that GPOs award, the number of competitors in the market shrinks, which has led to a shortage of generic prescription drugs – everything from sterile injectables to chemotherapy agents. Continue reading
This spring, Gilead Sciences Inc. introduced Solvaldi, a drug that could cure the liver virus that causes hepatitis C. The drawback, however, was the cost of $84,000 or about $1,000 per pill, as Julie Appleby reported at Kaiser Health News.
“And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug – and who pays for it,” she wrote.
Bernard Munos wrote in Forbes that the cost of one recently introduced cancer medication was $66,000 and another was $90,000.
At such high prices, consumers may be unable to afford these medications and insurers may not cover them. If insurers do cover these high-priced drugs, they may require patients to pay the typical copayment of 30 percent or more.
In a new report from the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC), researchers argue that insurers need a new approach to paying for specialty medications. Continue reading
Reporters curious about the financial relationship between physicians and pharmaceutical companies can use publicly available data as a starting point – although that comes with some caveats, journalists and industry leaders say.
During the workshop “Covering prescription drug data,” Charles Ornstein, ProPublica senior reporter, pointed out resources that ProPublica has created that reporters can use to write stories about doctors in their communities. Continue reading
When The Cincinnati Enquirer set out to look at the societal costs of the deadly opioid crisis, reporter Lisa Bernard-Kuhn was assigned to look at the role of chronic pain.
During more than eight months of reporting, she looked into how doctors measure pain, how effect opioids are at treating pain, patients’ expectations and more.
In an article for AHCJ, she explains how she was able to get doctors and patients to talk on the record and shares some of her most useful sources and lessons learned.
A new report from the Dartmouth Atlas Project documents the wide variations of use of drug therapies by Medicare patients across the U.S., shedding additional light on how geography plays an important role in quality and cost of care.
Dartmouth researchers also find that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains
differences in the quality and quantity of prescription drug use.
For example, heart attack victims in Ogden, Utah, are twice as likely as those in Abeline, Texas, to be prescribed cholesterol lowering medication to reduce risk of another heart attack, an inconsistency which reflects how medicine is practiced in the United States, according to Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice. Continue reading
Seven patients in Tennessee are sick after injections from a compounding pharmacy, health officials say. AHCJ has some presentations from a recent panel, The Boston Globe’s award-winning coverage of a similar outbreak and a questionnaire about how they reported on it and more resources for reporters who are looking into compounding pharmacies.
Presentations from a panel at Health Journalism 2013:
From compounders to drug shortages: Covering pharmacies and pharmacists
• Michael R. Cohen, R.Ph., M.S., president, Institute for Safe Medication Practices
• William Churchill, M.S., R.P.H., chief of pharmacy services, Brigham and Women’s Hospital
• John Walczyk, pharmacy manager, Johnson Compounding and Wellness Center
Keldy Ortiz wrote about the panel for Covering Health: Growing challenges to safety, adequacy of drug supply
The Boston Globe‘s coverage of a fungal meningitis outbreak tied to contaminated drugs won first place in the public health category of the 2012 Excellence in Health Care Journalism Awards. See the coverage as well as a questionnaire about how they reported on the topic.
In her tip sheet on the anti-aging movement, Arlene Weintraub touches on compounding pharmacies. She notes that the U.S. Food & Drug Administration has tried unsuccessfully to put a halt to improper marketing claims by compounding pharmacists and its continuing efforts in this area are well worth following. In the aftermath of the earlier meningitis outbreak traced to a compounding pharmacy, at least two legislators said they will draft legislation to give the FDA more oversight of compounding pharmacies.
On April 26, senators introduced a draft bill to make clear oversight responsibilities for pharmaceutical compounding.
Budget Victim: Inspections For Compounding Pharmacies, WBUR, May 20
The FDA has a section of its website devoted to compounding pharmacies.
This also might be a good time to remind public officials that there is now guidance on what information should be made public when someone dies or falls ill during a public health emergency. The document – developed by leaders in public health and health-care journalism – provides a framework for releasing such information as the age and location of private individuals who have been affected by an epidemic or other public-health event.
Pharmacy industry groups
… As we gather more resources, we will add them to this post …
ProPublica’s Tracy Weber, Charles Ornstein and Jennifer LaFleur, in an analysis of Medicare prescription records, found that “some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive,” with no attempt by the federal government to monitor or deter the practices.
“… officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government.”
Despite concluding that a drug research lab’s violations “were so ‘egregious,’ and pervasive that studies conducted there between April 2005 and August 2009 might be worthless,” the FDA didn’t pull the drugs tested there from the market, according to a ProPublica piece by Rob Garver and Charles Seife.
The FDA is refusing to release information about those drugs, saying that “We believe that this did not rise to the level where the public should be notified.”
A statement from the agency said, “The issue is not a lack of transparency but rather the difficulty of explaining why the problems we identified at Cetero, which on their face would appear to be highly significant in terms of patient risk, fortunately were not.” Continue reading
Essential, commonplace drugs are in short supply, including morphine, epinephrine and chemotherapy agents. Those shortages have led to a greater reliance on compounding pharmacies, such as the one blamed for contaminated steroid injections that sickened more than 700 people, of whom 50 died.
In the AHCJ conference session, “From compounders to drug shortages: Covering pharmacies and pharmacists,” pharmacists described the growing challenges to the safety and adequacy of the U.S. drug supply.
Michael R. Cohen, R. Ph., M.S., president of the Institute for Safe Medication Practices, gave several reasons for drug shortages, including Medicare payment restrictions that reduce profits and FDA actions that take manufacturing plants off line. Meanwhile, people have been sickened by contaminated drugs from compounding pharmacies for years before the fungal meningitis outbreak of that resulted from the contaminated steroids. Continue reading
Can a doctor’s prescription be bought for a tuna sandwich?
Whether it’s a tuna sandwich, steak dinner or a four-figure payment, there’s always the possibility of influence. And that’s how conflicts of interest begin in the medical field.
That was the message this morning from reporters Peter Whoriskey of The Washington Post and John Fauber of the Milwaukee Journal Sentinel during their panel on reporting on medical and financial conflicts of interest during AHCJ’s Health Journalism 2013 in Boston.
“Their job is to sell as much product as they can and maximize profits,” Fauber said of the pharmaceutical companies. “One of the ways they do that is by creating financial relationships with various stakeholders, which can be doctors, medical societies or medical schools. While this may be good for the bottom line of the drug companies, it may not work out for the patients.”
Fauber advised journalists to be on the watch for several things: promotional speaking gigs by physicians; participation in continuing medical education (CME) events; financial relationships between medical journal editors and drug companies; and royalties that come back to hospitals and physicians.
“It struck me very quickly that all the cynicism the media brings to politicians or companies, anybody, is held in abeyance for doctors and anybody that wants to heal you,” Fauber said. Continue reading