Amazing, isn’t it! Viruses are so dynamic and notorious. They have been in humans trying to adapt, mutate to replicate, become more infectious and eventually become lethal….the way it’s showing up these days!
But on the positive note, they are not invincible either! Now that we know CoVID-19 better, we will definitely get after it and invent treatments and vaccines. For now, we can follow the guidelines of social distancing, basic hygiene and most importantly, hand washing measures to keep it away from us.
Lately, there has been a lot of excitement about Lopinavir-Ritonavir, Hydroxychloroquine and other treatments. Surprisingly, people are starting to hoard these medicines, especially HCQ (Hydroxychloroquine) since it’s so cheaply available in pharmacies with a prescription. I do not understand why are doctors freely writing HCQ prescriptions for their known friends, families and VIP patients just so that they can have them.
As per guidelines set by health systems with directions from CDC, there are several stages of COVID-19 cases like mild, moderate, severe and critical. These stages are based on severity of symptoms and intubation status. So HCQ is not even needed in most mild cases. In cases of moderate and higher severities, you would rather go to the hospital to fix the respiratory depression, clear the airway, suppress the secretions and prevent emergencies instead of carelessly taking HCQ at home. This is dangerous because patients can actually die if respiratory complications are not controlled which can only be done in a hospital setting. Then what’s the point in hoarding medicines at home when they should be reserved for patients who actually need them!
And if symptoms are relieved but the virus is not eliminated, they might be under the illusion that they are cured and will not practice social distancing and other measures as seriously as they should be. This would make them even more contagious.
Here is a very thought provoking and interesting article from Medscape by Dr F Perry Wilson:
Click the link above for the detailed article but I urge you to read the part I liked the most:
“Now let’s look at the study. Thirty-six patients in France with COVID-19 were examined. Twenty of them got hydroxychloroquine and 16 were controls. But this was not randomized; treated patients were different from those not receiving treatment. The researchers looked at viral carriage over time in the two groups and found what you see here:
This appears to be a dramatic reduction in coronavirus carriage in those treated with hydroxychloroquine. Awesome, right? Sure, it’s not randomized, but when we need to make decisions fast, “perfect” may be the enemy of “good.” Does this study increase my 50/50 prediction that hydroxychloroquine could help?
Well, with data coming at us so fast, we have to be careful. There is a huge fly in the ointment in this study that seems to have been broadly overlooked, or at least underplayed. There was differential loss to follow-up in the two arms of the study; viral positivity was not available for six patients in the treatment group, none in the control group. Why unavailable? I made this table to show you:
Three patients were transferred to the ICU, one died, and the other two stopped their treatment. By the way, none of the patients in the control group died or went to the ICU. Had these six patients not been dropped, the story we might have is that hydroxychloroquine increases the rate of death and ICU transfer in COVID-19.”
Bottom-line: Please stop hoarding medicines. When dealing with COVID-19, an unknown enemy with a drug which has created an excitement with unknown clinical outcomes (based on the above article), it would be foolish to self-medicate with HCQ. The right approach would be to go to hospital if your symptoms are moderate to higher severity.
Even more, please focus on prevention than cure. Stay away from everyone, practice social distancing, wash hands, take showers after work, keep your homes clean, get educated on symptoms on CDC website and stop doing things just because others are doing them. Only follow advice from your healthcare providers.
First of all, please do not panic. Don’t think that Corona virus will kill everyone like the pandemic Plague did! Remember, epidemics like COVID-19 or SARS or EBOLA can be dangerous or even life threatening if we don’t take precautions and try to contain it. But if we follow the guidelines and basic rules, then we can definitely steady this ship. People start reacting to news or WhatsApp messages as if the world will come to an end soon! There are lines as long as a mile in department stores, people going crazy for masks or hand sanitizers. Thank god, they are not boarding their homes with hurricane shutters….lol! FYI, there are more than 1000 fatalities per week from preventable diseases like FLU/pneumonia! So numerically, this is not even comparable.
Having said that, we must make sure that we are following all the recommendations suggested from CDC and health organizations. One of the most important suggestion is to AVOID unnecessary travels. Avoid going to vacations, cruises, theme parks, etc to make sure we are not risking ourselves to getting exposed to the virus. This virus can come from individuals who may not seem sick (incubation period) but can easily spread it by coughing, sneezing or simply from their breaths. This virus can survive on surfaces for up to 3 days. So someone who sat on a bench can infect others who may sit on the same bench, touch it and then somehow get it into their lungs (touching nose, mouth). That’s why, it’s so important to keep ourselves away from mobs till this epidemic is contained.
Stay home, practice good hygiene, keep your homes clean, not have too many parties or visitors and enjoy your time at home with your families. Yes, it might feel like house arrest but it’s better to be safe than sorry. Hand sanitizers are good to prevent bacteria but not viruses. So avoid excessive use of hand sanitizers since they are not good for skin if used excessively. Washing hands is the best thing you can do to get rid of any dirt including viruses. Any time you touch any surface like door knobs, public benches, shopping carts, car doors, make sure hands are washed. Avoid contacts. May be change to Indian way of greeting “Namaste” 🙏 instead of hugs, kisses or even hand shakes. It might sound weird but believe me, lesser the body contacts, fewer the exposures to virus or any germs, in general.
Be aware of the symptoms of infection in case you get exposed to it. Here are some of them:
Difficulty breathing (severe cases)
Also know you local health centers that test for Corona virus. Here is a link for people in US to keep handy just in case:
If tested positive, follow the recommendations by the healthcare team and seek treatment. As of now, there is no known specific treatment. Some antivirals are being tried and have shown some promise. There is a lot of research underway for treatments and vaccines.
Normal healthy adults have recovered well from this infection. Just like any other infection, older people or people with comorbidities may take longer to recover or in extreme cases, some have not recovered and lost their lives.
Good luck to all of us! Be informed, cautious but calm ! We will all get through this battle against corona virus and be successful if proper precautions and guidelines are followed.
Being financially healthy keeps you healthy! It may sound mean but analyzing the health care of our country really proves the point. Working as a pharmacists, we know how many people chose not to buy their medications just because they couldn’t afford their copays. In most cases, the copays are around $5 to $100. But there a lot of people who cannot afford these copays. This is a sad situation! Here is an article from medscape that demonstrates this:
“Americans with diabetes are experiencing more financial hardship from medical bills than those without diabetes, even when they have health insurance, new research shows.
Results from an analysis of data on medical bills among adults aged 18-64 years from the National Health Interview Survey in 2013-2017 were published online February 6 in Circulation: Cardiovascular Quality and Outcomes by Cesar Caraballo, MD, of the Center for Outcomes Research and Evaluation, Yale New Haven Health, Connecticut, and colleagues.
Nearly two in five of the 8967 adults with diabetes surveyed reported financial hardship from medical bills, including medical debt or the inability to afford needed medical care. This hardship, in turn, was associated with high financial distress, food insecurity, cost-related nonadherence, and foregone or delayed medical care.
“Our study findings illuminate the health- and nonhealth-related consequences as a potential side effect of burdensome medical bills from diabetes mellitus management…These findings underscore
the need for price transparency and clear communication with patients and their families on costs of care,” say Caraballo and colleagues.
“Great consideration should be taken on presenting less expensive but still effective treatment options, as well as a need to comprehend patient’s insurance coverage and financial obligations in our management decision-making processes,” they add.
And the older Medicare population isn’t immune either.
Another study — this one on costs affecting the insulin-requiring Medicare population aged 65 and older — found that provisions in the Affordable Care Act intended to reduce the impact of the Medicare Part D “doughnut hole” were counteracted by rising insulin prices.
Those findings were published online February 10 in Diabetes Care by Chien-Wen Tseng, MD, of the Department of Family Medicine and Community Health, University of Hawaii, Honolulu, and colleagues.
“Lower insulin prices and other solutions are necessary to improve access to treatment for Medicare beneficiaries with diabetes,” Tseng and colleagues assert.
Medical-Related Financial Hardship Brings Other Issues
The 8967 adults aged 18-64 with diabetes included in the National Health Interview Survey study by Caraballo and colleagues would extrapolate to represent about 13.1 million individuals across the United States.
They were a mean age of 51.6 years and 49.1% were women.
Annually during the survey, 41.1%, corresponding to 5.4 million nationally, were part of families reporting financial hardship from medical bills, including 15.6% (corresponding to 2 million) reporting that they were unable to pay their medical bills at all.
Inability to pay bills at all was most prevalent among those who were low-income and uninsured (39.1%) and least common among middle- or high-income and insured (8.5%) individuals.
However, of the 3613 adults reporting financial hardship because of medical bills, 83.2% were, in fact, insured.
In turn, among individuals with diabetes, those in families with versus without financial hardship because of medical bills had higher financial distress (52.1% vs 25.4%), food insecurity (30.0% vs 12.8%), cost-related nonadherence (34.7% vs 9.1%), and foregone/delayed medical care (55.5% vs 21.6%) (all P<.001).
These associations remained significant after adjustment for sociodemographic, economic, and clinical confounders.
All of these adverse factors were significantly greater among those with versus without diabetes in the survey.
In summary, after adjustment for known confounders, individuals with versus without diabetes were at greater risk for overall financial hardship (odds ratio [OR], 1.27), high financial distress (OR, 1.14), food insecurity (OR, 1.27), cost-related nonadherence (OR, 1.43), and foregone/delayed medical care (OR, 1.30).
Stuck in the Doughnut Hole: Rising Insulin Prices
Meanwhile, the study by Tseng and colleagues examined Medicare Part D coverage, which applies to the 3.1 million beneficiaries who require insulin (type 1 and type 2 diabetes).
In the Part D coverage gap (also referred to as the “doughnut hole”) — which dates back to the Medicare Modernization Act of 2003 — beneficiaries pay a percentage of the drug’s price until they reach the point of catastrophic coverage.
To minimize that burden, the Affordable Care Act incrementally reduced beneficiaries’ cost-sharing during the gap, from 100% of the drug price in 2010 to 25% in 2019. At the same time, manufacturers were required to provide greater discounts during the gap, reaching 70% by 2019.
Tseng and colleagues analyzed nine insulins, including the top five by 2017 Part D spending ($8.2 billion or 62% of Part D insulin expenditures), averaging monthly and out-of-pocket cost requirements across plans nationwide, with cost projections based on 50 units/day and no other medications.
From 2014 to 2019, the average annual insulin price rose 55%, from $3819 to $5917.
Monthly out-of-pocket cost for insulin in the covered (predoughnut) phase rose 18%, from $49 to $58. Accounting for all Part D phases, the projected yearly out-of-pocket cost for insulin increased 11% from $1199 to $1329.
In contrast, if insulin prices hadn’t risen and instead remained at 2014 levels, annual out-of-pocket cost would have dropped 19% to $967 because of lower coinsurance in the gap.
This wasn’t uniform, though. Lantus pens had the lowest price increase (19%), and for that the annual out-of-pocket costs dropped by $167. However, if the price hadn’t risen patients would actually have saved $292.
With Levemir, which had the greatest price increase (165%), annual out-of-pocket costs increased by $992 instead of falling by $297 had the price remained unchanged.
In 2019, eight of nine insulin prices exceeded $4800 annually, with patients’ projected out-of-pocket costs surpassing $1000 under a standard Part D plan.
Of concern, Tseng and colleagues say, “Insulin list prices continue to rise, driven by multiple complex factors including manufacturers competing by offering greater proprietary rebates to pharmacy benefit managers for formulary placement.”
“Since measures to close the Part D gap were fully implemented in 2019, future price increases will not be counteracted unless new policies are enacted to reduce patients’ cost-sharing,” they conclude.
US prices for insulin have come under intense scrutiny in recent years. Around a quarter of patients with diabetes are said to ration use of this medication ― which, for those with type 1 diabetes, is essential for life ― because of high costs.
Patients and parents of children with diabetes have long protested, and some states have started to cap prices ― most recently, Illinois, which has said that no person covered by state-regulated commercial health insurance plans should pay more than $100 per month for insulin.”
Contact us to help you find that financial assistance on your medications. Our pharmacist will help you find that financial assistance from manufacturers and foundations so you can stay adherent on your treatments. Click here to contact us:
(Is it too late to reverse the damage! Reduce rather than recycle. Recycle rather than trash.)
If we don’t act now, literally now, then even God cannot save us! Do we realize the damage we do to our environment every day of our normal life? I am going to focus this discussion on bottled water.
How casually do we drink water from a plastic bottle and toss it away anywhere? Look at the picture above! Isn’t there anything wrong or alarming with this situation? Landfills are getting fuller. One of the studies indicate that US has 58 years to not worry before they have to build additional facilities for landfills. Besides, plastic being not a biodegradable item or a very slow decomposing substance (takes about 1000 years to decompose), it’s actually contaminating our oceans and marine life. This has resulted in deaths of lot of marine life which in turn has affected the ecosystem.
Although, the modern ways of destroying or burning trash have revolutionized the whole aspect of pollution or environmental harm, there is a significant concern over consistency of these processes across the globe. In countries like US, the methane and other poisonous gases released are symphoned over to generate energy. This is great! But what about other countries! It’s a huge concern when it comes to resources and initiatives from a lot of other countries.
Recycling sounded like a solution for the last couple decades. Millions of Americans have been doing their due diligence in filling their recycling bins but recent studies have suggested that recycling of plastic or glass doesn’t make too much sense and that they would rather be disposed in trash! Sounds demoralizing right? Especially, common citizens like us, who have been thinking about this whole environmental damage and what will our generations go through! Some movies have shown how scary our future could be!
Recycling glass and plastic can actually be more cumbersome considering the economics. Plus the enormous quantity of water needed to clean up plastic and glass before they can be sold is worth considering! If glass bottles break, they can actually spoil the other good recyclable stuff, so then nothing renders recyclable.
China is a big factor in changing economics of recycling. China used to be the biggest importer of global recyclable goods. But now with the new trade situation, it’s not the same. Recycling goods cannot be sold at as cheap price as it was to China. Plus, studies have shown that China hasn’t dealt with plastic well and eventually plastic has ended up in our oceans.
“China’s ban may actually reduce the amount of plastic that ends up in the oceans,” he told NPR’s Planet Money podcast. “China was not very careful about what got into their oceans for a long period of time, and if some of the plastic piles were just too corrupted they could do whatever they wanted with it.”
Water- a natural resource! Why sell?
How did companies start selling water? It’s a free resource to mankind. God would be wondering too about this! Lol! There are people in so many parts of the world that don’t get clean drinking water and people are selling it in bottles. Here is something to make note of that says that bottles of fwater is no better than our tap water. Actually tap water goes through some regulations and checks that bottled water doesn’t!
“15 Outrageous Facts About The Bottled Water Industry. “
“Water used to be free.
In fact, it still is — at least in nations blessed with plentiful clean tap water like the U.S. — but that doesn’t stop the world from spending over $100 billion on bottled water a year.” Continue reading…..
Final word: Please use your reusable bottle for carrying drinking water. Do not buy bottled water for two reasons: a) It’s supposed to be free. b) Prevents irreversible damage to the environment. C) Do not use disposables at home.
Imagine a patient who needs to check his/her sugar 10-12 times a day. To do this, patient has to carry the testing supplies with them at school or at work. Patients have to prick themselves multiple times, log their readings and then make adjustments on their insulin doses based on the readings. For type I diabetes patients or complicated type 2 patients, controlling blood glucose becomes very challenging in most cases. Subtle variations in diet, physical activity or emotional stress can change blood sugars instantly. So, in these cases, if the blood sugar is not checked and insulin dose not adjusted, patients can suffer from the unknown sugar level. These spikes or lows in sugar can be harmful. Highs can lead to ketoacidosis, lows can lead to hypoglycemia-both are life threatening conditions. This is why, Continuos Glucose Monitoring can be life saving.
CGM devices are fully automatic devices which give patients and their caregivers, alerts about highs and lows, thereby patients can take appropriate action about what dosage of insulin should be administered or not administered. There are patients on insulin pumps which can be programmed and synced with CGM devices. This enables appropriate automatic delivery of insulin based on patient’s blood glucose. Caregivers can even monitor patient’s blood glucose remotely. For example, a parent can constantly monitor his/her child’s blood glucose on the cell phone app or receivers from work when the child is at school. Studies have proven that CGM has significantly helped improve blood glucose monitoring and achieved much better control on diabetes. Now patients do not have to carry testing kits at work or school and don’t have to deal with the pain from several pricks a day!
Study results published in the Annals of Internal Medicine show that continuous glucose monitoring (CGM) systems can help patients with Type 2 diabetes better control their BGLs.
The study, which was sponsored by Dexcom, is the second arm of the DIaMonD study (Multiple Daily Injections and Continuous Glucose Monitoring) that reported findings on users T1D earlier this year.
After 24 weeks, Type 2 patients on multiple daily insulin injection therapy (MDI) who used the study’s CGM system lowered their average HbA1C levels from 8.5 percent to 7.7 percent. Patients with higher HbA1C baselines saw even more pronounced reductions — those with an A1C of 9.0 percent or higher saw an average 1.4 percent decrease. Meanwhile, the control group, which used fingerprick tests and a standard BGM, saw their average A1C levels decrease from 8.5 percent to 8 percent. While the gain from using a CGM may seem modest, it’s actually statistically significant.
“This arm of the DIaMonD study is one of the first to examine how well CGM works for people with Type 2 diabetes on MDI,” said Kevin Sayer, president and CEO of Dexcom, in a statement. “We are pleased to see a significant A1C reduction in this study, showing that the millions of people globally with Type 2 diabetes on MDI insulin therapy can benefit from CGM use.”
According to the study results, the A1C reductions occurred with minimal change in insulin dosages or dosing regime. Furthermore, CGM users also reported decreased time in hyperglycemia and increased time in their target blood sugar range compared to the control group.
Traditionally CGMs have been used with those with Type 1, but that trend may be shifting. In the study, CGM users reported high levels of satisfaction with the system. By the end of the study, 93 percent of the users were still regularly using the device, and they rated the benefits of the technology high and the hassles low.
Historically the approach is to give those with Type 2 an insulin and treatment regime until it begins to fail before adding more medication. Monitoring, in theory, would allow patients with Type 2 to have immediate feedback on their bodies and potentially avoid adding more medication.
Study participants ranged from 35 to 79 years old, with a mean age of 60. The study used the Dexcom G4® PLATINUM CGM System, which employs the same software as the current Dexcom G5® Mobile CGM Systemapproved by the FDA for standalone use in insulin dosing.
Most insurances are covering CGM devices like Dexcom with a prior authorization from doctors. Some still don’t cover it because its not on their formularies. Some have it in their formulary but their criteria are very strict. These insurances require the patients to be type 1 only even though they have uncontrolled type 2 diabetes and are on intensive insulin regimen. Freestyle Libre system is also a good option for people who cannot afford Dexcom or Medtronic. Some DME pharmacies can also help these patients with their ability to bill medical plans.
Bottomline: If you have uncontrolled type 1 or type 2 diabetes, talk to you doctor about a CGM device. Your pharmacist can help you get it at at your pharmacy and train you on how to use it. Technology has also helped mankind and this is no different. As you read earlier, there are numerous studies that have shown CGM to be an effective tool to control diabetes.
A recent article from Medscape says that colchicine, being a very good anti-inflammatory drug helps reduce atherosclerosis and thus heart attacks. It’s believed that atherosclerosis is an oxidative process where arteries are blocked to the formation of plaques or blocks due to inflammatory mediators (obesity is linked to inflammatory conditions). Aspirin has been helping patients to reduce atherosclerosis by reducing platelet aggregation.
“Colchicine is a potent anti-inflammatory drug, and there is an accumulation of data suggesting that inflammation is relevant to the progression of atherosclerosis. The COLCOT study included 4745 patients who were recruited within 30 days of their MI. They all received two antiplatelet agents and a statin, and they underwent angioplastyif necessary. Then they were assigned colchicine at a low dose of 0.5 mg/day or placebo. The average follow-up was 23 months, and we found a 23% reduction in the primary efficacy outcome, which was the combination of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring revascularization.”
The anti platelet effect of aspirin can be inhibited by NSAIDs so it’s important that NSAIDs be taken at least an hour administering aspirin. And consult your doctor if you take any NSAIDs. NSAIDs are not recommended for a longer term or regular basis. I wonder what’s the correlation between anti-platelet drugs and anti-sclerotic drugs like Colchicine.
Plaques in the blood vessels rupture over time and that’s how platelets flock in to clot the blood at the damaged area. So, I guess, colchicine, being a non- NSAID anti-inflammatory drug offers a pretty good option for CV patients, especially for the ones who also suffer from Gout. If no plaques, no platelets. I am pretty sure more studies on colchicine as a CV drug will enlighten all of us about pros and cons, risk-benefit and other facts.
There was a time when people died of common bacterial infections. As decades and centuries past by, treatments became so easy. It feels like modern science has answers to all known infections. Then suddenly now, we have dragged ourselves to a horrific situation of “Drug Resistance”!
In today’s world, people want instant results. Whether it’s to get news updates on digital media, connecting to people all over the world in seconds, getting an instant coffee or buying instant food. What more! This behavior stretches to getting instant prescription too from a doctor, online consultation or even buying them directly from pharmacies without involving doctors. Antibiotics are abused day in and day out. We talk about opioid abuse because of its potential of habit forming and to kill people but antibiotic abuse is seldom addressed. There will be a day when people can’t find treatment to common infections like middle ear infections, strep throat or a UTI. We humans have been inflicting so many problems on ourselves by continuing to be frivolous.
People insist their doctors to write antibiotics as soon as they get sick. For example, a person with influenza demanding a friend physician to prescribe Zithromax or an Augmentin. Antibiotics are powerless against influenza and other illnesses caused by viruses. So when someone takes antibiotics for the wrong illness or uses too many too often, this kills off helpful bacteria that populate the body, threatening the delicate balance upon which health depends.
If an antibiotic is given to a patient without actually diagnosing the infection, it might be a wrong antibiotic. Here is more on this issue of societal pressures, inappropriate use and diagnosis, agricultural use, hospital use- all contributing to more and more spread of drug resistant species:
The use of antimicrobials, even when used appropriately, creates a selective pressure for resistant organisms. However, there are additional societal pressures that act to accelerate the increase of antimicrobial resistance.
Selection of resistant microorganisms is exacerbated by inappropriate use of antimicrobials. Sometimes healthcare providers will prescribe antimicrobials inappropriately, wishing to placate an insistent patient who has a viral infection or an as-yet undiagnosed condition.
More often, healthcare providers must use incomplete or imperfect information to diagnose an infection and thus prescribe an antimicrobial just-in-case or prescribe a broad-spectrum antimicrobial when a specific antibiotic might be better. These situations contribute to selective pressure and accelerate antimicrobial resistance.
Critically ill patients are more susceptible to infections and, thus, often require the aid of antimicrobials. However, the heavier use of antimicrobials in these patients can worsen the problem by selecting for antimicrobial-resistant microorganisms. The extensive use of antimicrobials and close contact among sick patients creates a fertile environment for the spread of antimicrobial-resistant germs.
Scientists also believe that the practice of adding antibiotics to agricultural feed promotes drug resistance. More than half of the antibiotics produced in the United States are used for agricultural purposes. However, there is still much debate about whether drug-resistant microbes in animals pose a significant public health burden.” Source: https://www.niaid.nih.gov/research/antimicrobial-resistance-causes:
The situation is dire indeed: According to the newest data, more than 2.8 million people in the United States experience an infection from antibiotic resistant bacteria each year. Moreover, these “superbugs” cause 35,000 deaths per year in the country.
CDC has updated the estimated number of infections with antibiotic resistance per year from 2 million to nearly 3 million.”
The fact that so many bacteria are not responding to first- or even second-line treatments means that people with these infections face much higher risks and poorer health outcomes.
According to one recent study, “Of all antibiotics sold in the [U.S.], approximately 80% are sold for use in animal agriculture.”
Farmers have resorted to such high rates of antibiotic use in animals to boost growth rates and prevent infections, which are more common among livestock due to ways that producers handle these animals for breeding or as a source of meat.
With the introduction of Medicare Part D in 2006, we had four letters to remember A,B,C,D. To most seniors and people eligible for Medicare, it’s still a confusion. All they know is: “I have Medicare”. In markets like south florida, most people are not aware of the 4 alphabets. They are under the impression that they are covered completely just because they have Medicare! I am focusing this discussion of Medicare Part D or prescription drug coverage within Medicare. Its upto us, the pharmacists, nurses, doctors to educate these patients.
Pharmacists report to us that, beginning of the year is hell for them…lol! First of all, most people have changed their insurances. Then, their copays are a big surprise. Someone who paid nothing last year gets to hear that his new copay is $950 or $2500! WOW! So, then, my pharmacist folks wrok hard to find these patients financial assistance through foundations so they can get their medications. And believe me, the processes aren’t just click of a button.
A lot of Marketting is done by third parties or insurers offering Medicare plans including C and D. A lot of education and TV ads are targeting this population so they understand and make good choices during open enrollment. But the question is: why do these people have to suffer during the “coverage gap” or “donut hole”?
To a lot of people who are actually Medicare D beneficiaries and even HCPs, it seems like “donut hole” has something to do with donuts… lol! But it’s not. Donut hole is a coverage gap when these patients use up a certain amount (around 3700) after which they pay about 25% of the cost of the medication. This is where problems come in.
The first hurdle is that these patients cannot be offered copay assistance from manufacturers as per Anti- kickback law, manufacturers cannot incentivize any patient to buy medications that are paid by Medicare or Medicaid or Tricare. So with this law in place, a lot of patients can not afford the copays. As a result, they chose either not to fill their prescription or cut their doses in half to make one month supply last 2 months. Unless, they know hardworking, dedicated pharmacists who can help them with financial assistance from foundations, they end up being NON-ADHERENT! But foundations do not necessarily have funds all the time. Its like “first come first” basis and after the funds run out, the other patients are left unfunded or untreated.
Non-adherence: costing big
Stats reveal that non-adherence is a big liability on health care costs. While the original purpose of instituting the gap was to limit the cost of the Part D program, it has resulted in unintentional consequences.
Read this article which details how does donut-hole affect adherence, health outcomes and thus health care costs.
Imagine, scenarios like a patient with grade 4 prostate cancer not been able to afford his medications. In such cases, patients refuse to get their refills and call doctors for going back to infusion chemo which is so much more aggressive and give undesirable side effects. In some cases, where chemo is not a possibility, patients just let go the medicine and hope to get funds from foundation whenever its available.
For some disease states like Psoriasis or Atopic dermatitis, there are rarely any funds available through foundations. So, patients are either forced to change treatments or come up with thousands of dollars as copay per month. Middle class usually suffers in these situations.
Luckily, PAP or “patient assistance programs” are available with most specialty brand medications. But again, patients are not aware of these. It falls on HCP team to coordinate the patient with the manufacturers. So, a question comes to my mind! Why are manufacturers allowed PAP but no copay assistance. This is what makes Medicare a bit confusing.
Sticky situations come in when the medication is a generic and the patient is in donut hole or has high deductible in the beginning of the year. Moreover, if foundations have no funds, then what? PAP doesn’t apply since its a generic. Copay is unaffordable and no funds available. Pharmacists become helpless in these situations. Non-adherence is imposed on these patients.
A thorough understanding of Medicare plans is needed to help patients chose the right plan for them.
All pharmacists and HCPs need to be proactive to find financial assistance to avoid Non-Adherence and thus, mortality.
Medicare needs some thought about deductibles, copays and Donut-hole.
More generics need to hit the market so costs become affordable.
What a wonderful time we live in! All answers are right at your fingertips. There is hardly anything that’s a secret nowadays. Any layman who is savvy with his smart phone can get information about anything. I wonder how did we manage getting information about a decade ago. For purposes other than health, library and newspapers used to be our resort but for health related queries, we were helpless. Going to doctors everyday was not a viable option.
But today, everything can be found online or apps! If you want to know about symptoms of any disease, you can just search in seconds. What more that a friendly app can actually train you to prevent a disease! If you want to know anything about your medication, the information is at your fingertips! Drug-interactions, side effects and proper administration techniques are all available online or apps or YouTube. Some apps even monitor your physical activity and encourages you to stay fitter and healthier.
Gadgets like Fitbit can continuously challenge you to walk or run more miles. Devices like Dexcom can continuously report your blood sugar. Apps like Glucocious can train you about everything related to diabetes, it’s prevention and management. Apple’s health app monitors your steps everyday. Medscape is an online bible for medications. Then there are apps that can measure creatinine clearance, body composition, BMI, etc.
There are online resources to connect with MDs or pharmacists or other providers. So for minor ailments or quick questions, you don’t have to wait for your next appointment or drive to your pharmacist. For any medication related query, feel free to submit your query online at:
Mobile devices and apps have provided many benefits for HCPs, allowing them to make more rapid decisions with a lower error rate, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. Most importantly, these benefits have been shown to have a positive effect on patient care outcomes, as evidenced by a reduction in adverse events and hospital length of stay. These and other benefits mobile devices and apps provide to HCPs are discussed in the following section.
One major motivation driving the widespread adoption of mobile devices by HCPs has been the need for better communication and information resources at the point of care. Ideally, HCPs require access to many types of resources in a clinical setting, including:
Communication capabilities—voice calling, video conferencing, text, and e-mail .
Hospital information systems (HISs)—electronic health records (EHRs), electronic medical records (EMRs), clinical decision support systems (CDSSs), picture archiving and communication systems (PACSs), and laboratory information systems (LISs).
Informational resources—textbooks, guidelines, medical literature, drug references.
Clinical software applications—disease diagnosis aids, medical calculators.
Apps are only for reference purposes. They don’t not replace your doctor’s or provider’s diagnosis, clinical judgement, experience and treatment.
The information is very helpful to patients as well as HCPs. Alerts of errors, help stay current, provide most accurate information about dosing and dosing criteria, helps people understand their medications and disease states in user friendly language, facilitate communication and prevents delay of information.
Most importantly, it’s so handy, free and available whenever needed.