The Affordable Care Act, aka “Obamacare,” has improved patient’s access to health care since its passing in 2010. The increase in coverage, however, does not address the restriction of prior authorization (PA), where a physician is required by a patient’s insurance company to obtain special approval from the insurance company for a medication or treatment. PA is not only needed for medication, but also for scans, potential ...

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My husband is a type 2 diabetic with mild chronic kidney disease, which has been well controlled on 500 mg metformin BID plus saxagliptin (AstraZeneca's Onglyza). At the end of last year, he got a letter from his Medicare Advantage PPO, UnitedHealthcare (UHC), advising him that the Onglyza (UHC only uses brand names) would no longer be covered and recommending he have his doctor switch him to another DPP-4 inhibitor, either ...

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"Boxed warnings" or "black boxes" are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks. The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes "confuse" and "unnecessarily alarm" patients). So it was no surprise that when the
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In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% ...

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There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today. I have rosacea, a ...

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Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are "unbranded" ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a ...

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Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you "awesome at everything." Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat. Welcome to #GenerationAdderall, the ...

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There was a time when drug reps fed us lunch and gave us an endless supply of pens, pads, and even umbrellas all emblazoned with their newest drugs. They explained why their drug was better than their competitors’ and what it would offer to our patients. I still have my Zantac umbrella in the trunk of my car for rain emergencies. Although it was somewhat annoying, it did keep us somewhat ...

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She had been buying face cream through a friend of a friend for 12 years. This time, it was Pond’s “Rejuveness,” a version of the company’s anti-wrinkle cream that is made and sold in Mexico. But someone in the Mexican state of Jalisco laced the cream with a toxic skin-lightening compound, and it had a devastating effect on the 47-year-old Sacramento resident. She showed up at the emergency room Read more...

From time to time, I am asked by someone about participating in a medical research study.  These situations are usually when an individual, or someone close to them, has unmet medical needs.  Understandably, a patient with a condition who is not improving on standard treatment, would be amenable to participating in a clinical trial to receive experimental treatment. I find that most folks misunderstand and exaggerate the benefits they may receive ...

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Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15. She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome. Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said. “I hate ...

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“6 in 10 Kids Got Opioids After Tonsil Surgery, Study Says.” So screams the headline from The Daily Beast. "In the midst of the opioid crisis, doctors sent many kids home with oxycodone and hydrocodone," it goes on to say. Another example of scaremongering and sensational headlines, or is this something we should still be concerned about? Well, according to the actual article, there was no greater risks of complications ...

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Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from "staying well" to "feeling better." Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it's hard to be active when you're sick. In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the ...

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Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system. To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half. But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled ...

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The bootleg medications were smuggled across the border and sold to mostly Latino immigrants in public spaces throughout Los Angeles — at swap meets, parks, beauty salons and makeshift stands outside mom-and-pop grocery stores. The drugs were cheap, and the customers — mostly from Mexico and Central America — did not need prescriptions to buy them. Some of the products featured brand names and colorful packaging that immigrants knew well from ...

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Take one-half tablet three times per day with meals, increasing by half each week until reaching a maximum of three tablets three times per day. Did you get a new prescription from your doctor? If so, there is a 50 percent chance you will not adhere to label directions. Either the instructions are too complicated, the drugs are too expensive, you do not like the way the medicine makes you feel ...

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When PDL BioPharma’s $40 million blood-pressure medicine faced the threat of a generic rival this year, the company pulled out a little-known strategy that critics say helps keep drugs expensive and competition weak. It launched its own generic version of Tekturna, a pill taken daily by thousands. PDL’s “authorized” copycat hit the market in March, stealing momentum from the new rival and protecting sales even though Tekturna’s patent ran out 
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Pharmacy benefit managers (PBMs) including Express Scripts, CVS Health, and OptumRX are the subject of intense criticism by virtually everyone in medicine and politics. While the purpose of PBM’s group purchasing business model was intended to contribute to lower drug costs and premiums, many of their customers have not experienced these benefits. Instead, many patients are choosing not to take their medications or take ...

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For the last three decades, the numeric pain score has been the go-to assessment for acute pain in the hospital setting. Since this methodology was developed for research purposes to see if drug “A” had an effect on patient “A,” its clinical utility is not just worthless but dangerous. Let’s look at a simple example of a pain order set that is commonly used across the country. If a patient says ...

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In August 2014, a 13-year-old boy with Type 1 diabetes died after being treated by self-described “master herbalist” Tim Morrow who was tried for child abuse resulting in death and practicing medicine without a license. He had told the boy’s mother to stop administering insulin and instead prescribed herbs which he sold. According to one report, Morrow told the parents that insulin was poison, and if they took ...

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