Tag Archives: Prescription drugs

Florida lawmakers pass bill for Canadian drug importation – Sun Sentinel

From the Overnight News Desk:

Richard’s Note: My late mother worked for a local company that imported drugs for seniors from Canada, the UK, and Israel. The seniors would bring the prescription from the doctor to their office, the employees would fax the prescription and any other documents to the pharmacies in those countries, who would then ship the medications directly to the seniors, without the drugs ever going to the company’s office.

As the two articles cited below state, this would be a departure from Republican orthodoxy on prescription drugs, and could be a model for other states to pursue to bring down the cost of drugs, at least as far as senior citizens are concerned.

I post these articles to honor my mother for her work to help fellow seniors to get less expensive versions of their medications.

Here are the two articles:

Floridians could eventually gain access to cheaper Canadian prescription drugs under legislation the state House has sent to Gov. Ron DeSantis.

Source: Florida lawmakers pass bill for Canadian drug importation – Sun Sentinel

Source: Florida Gov. Ron DeSantis defies GOP orthodoxy with drug importation plan

Run For the Border (Not a Taco Bell Commercial)

Yesterday, one of my contacts in the medical travel space commented on an article that was posted on LinkedIn that explained why the author was sent south of the border to purchase prescription drugs (you thought I was going to just say drugs, right?) for his company.

He found out that the same drugs, made by the same manufacturer, but packaged in Spanish were much cheaper than ones packaged in English and sold north of the border.

I decided to ask for his permission to re-post his article, and with his kind permission, I am doing so here in its entirety, as posted to LinkedIn. Here is the link in case you want to read the original.

Why Pharma Sent Me South of the Border…

Published on February 3, 2019

You may have heard of people heading to other places for medical care, but is it really the right thing to do?

We know that the cost of healthcare is ridiculous. And, of course, no one is to blame…right? (Tongue in cheek)

I can’t blame the doctors – they’re great folks just trying to charge enough to cover the bills after all the red tape is required from insurance, Medicare, federal regs, etc. I can’t blame the hospitals – most of them are running in the red from having to support a widespread indigent population with recurring visits for drug overdoses and covering that overhead with Medicare reimbursement rates of 20%. I can’t blame the insurance companies – they’re the good folks just trying to break even as “non-profits”, right? (Just ask them) I can’t blame us the patients…after all, we’re just trying to get the care we need (note sarcasm as a handful overuse and abuse the system). I can’t blame pharma because they’re just trying to make drugs that save the world (snark, snark). I can’t blame government – they’re just trying to do the most for society (OK…ran out of snarks).

With no one to blame, no one is responsible to fix this.

What does this mean for me as an employer? It’s simple…

HEALTH CARE REFORM STARTS WITH ME…

No outside party can do it – I have to find ways to partner with my employees to find the right solutions to help manage costs. Let’s talk about just one of them.

SOUTH OF THE BORDER DRUG RUNS

It sounds ominous, but it’s one of the best thing we’ve found. Here’s the opportunity – I can get the same medication from the same manufacturer at substantially lower costs because I get it from a pharmacy that just happens to be located five minutes over the Mexican border. It comes in the same packaging, but it’s just written in Spanish. We verify the sourcing, we verify the manufacturing, we verify everything… And everything is above board. By working with the hospital where the pharmacy is located, we coordinate care with the physician in the United States to ensure that the patient has the right prescription, is seen by a physician in Mexico, and receives the quality product when they arrive. Legally, they can transport up to a 90 day supply over the border per day. To make it worth our while, we have them fly down to San Diego, have a courier pick them up and take them over the border for the first 90 day supply, transport them back and have them stay overnight in San Diego. The next day, the transport picks them up, takes them down for the second 90 day supply, bring them back and they fly home. That way they can get a 180 day supply per trip.

So what’s the catch?

I can’t think of one yet. Last year, our company ran a beta test with two individuals with a specialty drug each. We pay for their travel down, pay for the courier to transport them over the border to the hospital where they are met with the physicians at the hospital, we pay for the pharmacy representative, the medication, the overnight accommodations in San Diego, and a stipend to cover food and ancillary costs. What’s in it for the employee? We also cover their co-pay so they do not have to cover any costs for the medication – the medication becomes free to them, saving them hundreds of dollars if not thousands of dollars a year. Additionally, they get to keep any money that they save from the per diem money that we provide to them for their daily costs.

What’s in it for us is the employer?

Last year, after paying for the medication, all of the transportation costs including the employee costs of travel, the concierge fees for our broker who assists us with this arrangement, and all additional fees, the savings on these two individuals for one medication a piece was well over $70,000.

Do I have your attention?

Everything is legal. Everything is above board. Everything is safe. And the customer service is beyond everything that we can imagine.

This is not unique to us. The State of Utah just adopted this as their primary option for specialty medications for their employees. As I understand it, they are using a different service than I do. However, the results are similar.

We will be rolling this out to all of our employees this year. As you can imagine, there is great anticipation about how much we can save as we consider solutions and opportunities with program such as this. When it comes to healthcare, it is a game – and the people who understand the rules will win. The ones who do not understand the rules of the game will continue to pay more and lose.

Until we get a handle on controlling costs with things such as pharmaceuticals, we must continue to look for new ways to control these costs. If you would like additional information on the solution, feel free to message me.

In the meantime, feel free to get a hold of my pharma tourism broker – I promise I don’t get anything from this. I just share good news is I get it. @rockstarcurrywillix

Here’s to your success!

Dr. Wade Larson

@DrWadeLarson

wade@wadelarson.com

http://www.wadelarson.com

Utah insurer will pay for members’ travel to Mexico to fill pricey prescriptions

In an effort to combat rising drug prices, one Utah health insurer will pay its members to travel to Mexico to fill prescriptions for certain expensive drugs, according to The Salt Lake Tribune.

Source: Utah insurer will pay for members’ travel to Mexico to fill pricey prescriptions

Vermont becomes first state to permit drug imports from Canada – POLITICO

In a rebuff to the current neo-liberal regime and its recent plan to tackle drug prices, the State of Vermont became the first in the nation to allow cross-border purchasing of drugs from Canada. Makes sense because the border is not that far away.

Years ago, my late mother worked for a company here in Florida that facilitated drugs to come to patients from Canada, the UK and Israel.

But thanks to successful lobbying by a former Democratic Congressman from Louisiana who after leaving Congress became a lobbyist for the pharmaceutical industry, the government forbade the importation of Canadian drugs.

The measure is one of the most aggressive attempts by a state to tackle rising drug prices that critics say are crippling state finances.

Source: Vermont becomes first state to permit drug imports from Canada – POLITICO

Big Insurer to Put Dispensing Docs on Notice

An article in Healthcare Finance yesterday reported that Aetna has put more than 900 opioid prescribing physicians on notice that they fall with the 1 percent of top opioid prescribers.

Here is the link to the article:

http://www.healthcarefinancenews.com/news/aetna-puts-more-900-physicians-notice-they-fall-within-top-1-percent-opioid-prescribers

What does this mean for workers’ comp?

It means that other insurers need to do the same for the physicians who prescribe opioids for injured workers, but as Joe Paduda recently reported, the drug spend is going down.

But he also said this, earlier this week,  “Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.”

This was for privately insured people, he continued.

“The dollar cost of the drug itself is the least of the cost issues; dependency is strongly associated with much higher utilization of drug testing, overdose treatment, office visits and (my assumption) higher usage of other drugs intended to address side effects of opioids.”

So just because Aetna is watching does not mean that the problem is going to go away any time soon.

An Algorithm a Day, May Keep the Pain Doctor Away

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As previously discussed on this blog, prescription pain medication abuse is a big problem in workers’ compensation, (see Opioid Abuse in Workers’ Compensation: What the Medical Tourism Industry Needs to Know).

There has been a lot of writing on the subject, and a great deal of meetings, webinars, and conferences, with very little solutions being offered, or action taken besides passage of legislation and the creation of state-run databases, as in Kansas and California.

But recently, as reported last week in the Wall Street Journal article, “When Your M.D. Is An Algorithm” by Timothy W. Martin (April 11,2013), a summit was held in Orlando, Florida that brought together patient advocates, policy makers, and law-enforcement officers, as well as representatives of a new cottage industry: companies that are taking a data-driven approach to deal with the drug-abuse problem.

The National Rx Dug Abuse Summit showcased companies that are combining medical research and guidelines with computer analysis to guide doctors about what drugs should be administered, in what doses, or if at all.

These companies, mainly insurers and medical-bill review consultants for companies paying workers’ compensation claims said they are filling an unmet need: that of providing research-driven clinical advice and guidelines to doctors who have not been thoroughly trained on how to treat pain.

There are some doctors, who are skeptical of these programs that have names such as “Opioid Defense Manager” and “VantageComp”. They do not believe that these programs play any role in medical treatment, especially when they are used by companies looking to lower drug costs and medical spending.

One of the 40 analytic companies that attended the conference was Rising Medical Solutions, Inc. Their in-house algorithms, assesses whether an individual is a low, medium or high risk. This is based on a 30-question survey that asks about an injured worker’s optimism about their recovery, their previous injury history and whether they smoke, along with other signs that measure their vulnerability to painkiller addiction.

Rising Medical CEO, Jason F. Beans said that the company had determined that being on painkillers any longer than two weeks, could be an indicator of addiction. Beans also went on to say that, “We enact interventions to prevent the small lower-back claim from becoming a lifelong addiction.”

PMSI’s proprietary Risk Intelligence System, has 18 criteria it says could signal fraud or abuse. According to Ishita Sengupta, director of workers’ compensation at the National Academy of Social Insurance, a nonprofit research group that tracks workers’ compensation benefits and costs, the analytics-driven industry has grown to more than three dozen companies from just a handful a decade ago.

Insurance companies such as AIG, Liberty Mutual and Travelers have added analytical or predictive modeling abilities to their workers’ compensation divisions.

Pharmacy-benefit managers such as Modern Medical Inc.  and consulting firms such as Prium, a Georgia firm that consults to workers’ compensation payers, are also involved with analytics. Michael Gavin, chief strategy office at Prium, said “Your doctor’s approach to pain care may lead you to become addicted—but that is not the case with high cholesterol or high blood pressure.”

All this growth in a nascent industry such as analytics comes about because workers’ compensation spending is soaring. As Martin points out in his article, and as I have pointed out in my white paper, Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation, the average medical cost for lost time claims was $28,000 in 2011, which was nearly double the cost in 2001, when the cost was $15,900.

Both Martin’s article and my white paper cite data from the National Council on Compensation Insurance (NCCI), an industry-created company that tracks workers’ comp spending and the overall health of the industry.

So as the medical tourism grows, and the idea to implement medical tourism into workers’ compensation becomes a reality, medical tourism facilitators and medical tourism providers will be able to know beforehand if a surgical patient who was injured on the job and receiving medical treatment abroad, is already a painkiller abuser or could become one. The provider will have the benefit of the knowledge provided by analytics to determine risk of addiction so that patient addiction can be halted or avoided altogether.

This in turn, will also help the wider medical tourism industry because the very analytics used to determine risk of addiction for injured workers can be used for non-occupational injury patients receiving the same surgery. And that will give the medical tourism industry more credence with the healthcare community at large.