Welcome to this month’s edition of Comp Medical News, an essential update series. Each update features stories from around the country, with special focus on medical treatment guidelines and emergent issues related to medical management in workers’ comp.
First, regulators in various levels of bureaucracy are attempting to strike a balance between patient privacy and public health:
WHO Calls for Greater Transparency in Clinical Trials
The World Health Organization (WHO) released a position paper urging researchers to comprehensively disclose the results of interventional clinical trials on an international basis by reporting completion to its registry within 12 months and publishing results in a peer-reviewed journal within 24 months. The statement, which was published online in PLOS Medicine, states, “In brief, not reporting clinical trial results is likely to lead to dissemination bias. This bias has the following major adverse consequences:
- It affects understanding of the scientific state of the art.
- It leads to inefficiencies in resource allocation for both research and development and financing of health interventions.
- It creates indirect costs for public and private entities, including patients themselves, who pay for suboptimal or harmful treatments.
- It potentially distorts regulatory and public health decision making.”
The WHO also identifies such reporting as a moral and ethical responsibility for clinicians engaged in research.
Read further coverage from MedPage Today here.
Regulators’ Access to Prescription Database is Challenged in California Supreme Court
A case that began with a doctor giving strange diet advice has bloomed into a larger question of regulator access to prescribing practices in California. According to a Kaiser Health News report, investigators with the Medical Board of California ran Dr. Alwin Lewis’ name through the state’s prescription database after a patient complained he pushed her to get on his “five-bite” diet program – no breakfast, then just five bites of any food for lunch and dinner. The diet complaint fell by the wayside as investigators uncovered peculiar prescribing practices, including over-prescribing to two patients. Lewis levied a complaint against the Board in court, saying that it unfairly targeted him. Though access by law enforcement officials to prescription databases has been challenged in various states — successfully in Oregon — the California case is believed to be among the first in the country to challenge medical boards’ unrestricted access. Some patient privacy advocates have stated that access to prescription drug monitoring databases (a key measure to prevent “doctor-shopping” for high-risk meds like narcotics) need to be kept close, and that the Board should have to meet a legal standard for searching what amounts to confidential patient records.
Read more from Kaiser Health News here.
Next, new data reveals drug spending has reached towering heights both overall and in Medicare, as well as in workers’ comp:
$373.9 Billion Spent on Drugs in the U.S. Last Year
According to a recent report issued by the IMS Institute for Healthcare Informatics, American pharmacists filled a record 4.3 billion prescriptions in 2014 that cost nearly $374 billion. Those figures translate to a 13.1% year over year increase, which the authors attribute to a new hepatitis C treatment (Sovaldi) and very few products losing patent protection. Indeed, savings due to the use of generics across the U.S. health care system were only equal to $12 billion in 2014. Savings for that metric usually fall between $15 billion and $30 billion.
Read full details via Pain Medicine News here.
Medicare Itemizes Its $103 Billion Pharmacy Spending for 2013
The federal government released a more comprehensive analysis of Medicare Part D prescription spending, including information on individual prescribers, in an effort to stimulate conversations about actively involving patients in their own care. The data are itemized by individual prescription and show that 14 drugs cost the federal government and Medicare beneficiaries more than $1 billion each, accounting for nearly a quarter of Medicare prescription drug spending in 2013. Most of these were for chronic conditions such as diabetes and depression. The ten most common prescriptions were all for generics, the ten most expensive per claim were all brand name. The Pharmaceutical Research and Manufacturers of America said the report is misleading because it does not take steep rebates for branded drugs into account.
Read more from Kaiser Health News here.
Both of these reports reflect a similar trend in workers’ comp prescription costs, as generics become more expensive and year over year increases in spending become the norm. Express Scripts’ Workers’ Compensation Drug Trends Report revealed a 1.9% increase in 2014 spending for the comp sector. See here.
Lastly, opioid addiction and management continue to occupy regulators and lawmakers looking for solutions to the complicated public health concern:
Congressional Testimony Says Doctors Need Better Training for Both Opioid Addiction and Chronic Pain Treatment
Representatives from the National Institute on Drug Abuse and the Office of National Drug Control Policy testified before the House Energy and Commerce Oversight and Investigations Subcommittee last week about shortcomings in physician training pertaining to opioids. Although a variety of continuing education resources are available to prescribers to learn about substance use disorders and the methods available to treat addicted patients, few providers have had any significant experience and education with the practices. The witnesses urged that although medications such as methadone, in combination with behavioral intervention, were most effective for treating opioid addiction, less than 40% of those receiving treatment for opioid addiction get treated in that manner. Additionally, the subcommittee voiced concerns about the rise in neonatal abstinence syndrome, (NAS) in which a mother takes opioids during pregnancy; one study found that 21% of women who are pregnant are going to receive an opioid. Lawmakers called for stricter controls on pain management.
Read more details about the testimony via MedPage Today here.
CDC Recommends Allowing Basic EMTs to Administer Naloxone, Expansion to Rural Communities
Research published late last month from the Centers for Disease Control and Prevention (CDC) suggests that expanding the number of EMS staff allowed to administer the opioid overdose drug naloxone could result in a significant decrease in opioid-related deaths. The researchers reviewed 2012 data from the National Emergency Medicine Service Information System to find patterns in naloxone administration. Using a logistic regression model, they considered factors such as age, sex, location, 911 calls, EMS certification (basic and advanced) and primary symptoms, as well as other information from the scene of the injury. The CDC discovered that overdose deaths were 45% higher in rural areas but naloxone use was only 22.5% lower. As of now, only twelve states permit basic level EMTs to be trained to utilize naloxone, which can be administered either intravenously or intranasally. The CDC posited that removing that restriction and expanding training would help everyone, especially those in rural areas.
Read more from Pain Medicine News here.
Image Credit: PBS.org “Making Sen$e: Why are Medical Costs So High?”