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The wrong prescription at the Board of Pharmacy...

Wednesday, February 17, 2010
In a major disappointment, the California Board of Pharmacy today passed watered-down regulations, rolling back an effort by consumers and community of color groups to make prescription drug labels more understandable.

Issues include the minimum size of the text (10 point vs. 12 point) for easy-reading by seniors, and a requirement of instructions written in the patient's appropriate language, for California’s diverse populations that may not read English.

The new rules effectively gut the bill, SB472(Corbett), only requiring a 10 point font. Oral interpretation would be provided only if available, and their was no requirement for translations.

This is not just a consumer convenience, but could have medical and health outcomes, to make sure people take their medications with the right dosages.

Consumer advocacy groups like the California Pan-Ethnic Health Network (CPEHN) and the California Alliance of Retired Americans (CARA) will continue to work on this issue, as will Senator Corbett. More information to follow.


posted by Anthony Wright | Permalink | 6:08 PM


Reading the fine print...

Monday, October 26, 2009
Have you ever had to squint at the tiny print on a prescription label or have to give advice to an elderly family member to interpret their instructions for taking pills? California is in the process of helping to take some of the guesswork--and potential danger--out of deciphering those labels for seniors, people with disabilities, and patients with low English-language proficiency.

California's Board of Pharmacy held a public hearing on Thursday to consider how to implement a new law that requires patient-centered prescription drug labels. This new law requires the instructions to be in a larger font (type-size), and, upon request from the patient, contain instructions in several other threshold languages for people with low English language proficiency. Here is some of the testimony the Board heard:

  • One consumer advocate described an Asian senior client whose doctor had prescribed low-dose aspirins (81 milligrams) for her heart. Upon returning home and looking at the confusing English-language prescription label, she did not recognize any of the words. The only thing she could read was the number "81." So she carefully counted out 81 aspirin tablets and took them all that evening. When she was found later by her family, she was rushed to the emergency room for expensive life-saving treatment.
  • Another senior who spoke to the Board through an interpreter described how confused she was by the ten bottles of different medicines that her doctor had been prescribed for her. She had received an oral consultation from the pharmacist, but all she could remember when she got home was that she was supposed to "take one tablet each day." As a result, because she couldn't read the prescription label, she lined up the bottles and took one pill from the first bottle on the first day, one pill from the second bottle on the second day, and so on. When she returned to her doctor for follow-up treatment several weeks later, the doctor was puzzled that she had experienced no improvement in her condition. She assured the doctor she had been taking her medicine faithfully, but it eventually took him several more visits to determine why the prescriptions were so ineffective and why there had been such a delay in her treatment.
Having a more patient-centered prescription drug label would have helped in those situations and others described at the hearing by consumers, health professionals, and advocates.

In contrast, the retail pharmacy industry testified that this law was too difficult and expensive to implement. However, several individual pharmacists expressed commitment to assist their patients and a willingness to work with the Board to find solutions regarding container size, the pharmacist's liability concerns, and other technology/printing issues.

To the Board's credit, they voted to enter the next formal regulatory step in the process and announced they will schedule another public hearing in January. The Board also hopes to take advantage of special financial and linguistic support offered by a California foundation to translate the most commonly used instructions, such as "take one pill with food" into several non-English languages for general use by pharmacies that operate in the state.

So despite the threats that "all medication will have to be dispensed in mayonaise jars so people can read the labels," we are hopeful that "help really is on the way."


posted by Elizabeth C Abbott | Permalink | 9:05 AM


Big day...

Monday, May 11, 2009
A lot of news on the federal health reform front today. The biggest is the announcement, in the form of a meeting with President Obama and letter from key health industry leaders, including organizations representing insurers, drug companies, hospital, device manufacturers, doctors, and health workers, to commit to $2 trillion in health care savings over the next 10 years.

The New York Times and Los Angeles Times have their write-ups. The range of opinion of the blogs ranges widely, from Time's Karen Tumulty to Joe Paduda of Managed Care Matters to Ezra Klein at The American Prospect to New York Times' Paul Krugman to The Treatment's Jonathan Cohn to Marc Ambinder at The Atlantic and Change.org's Tim Foley.

I'll add my two cents later. The details are not fully fleshed out, but the importance of the announcement today is more political than policy: that the federal health reform discussion is now more serious than it was before.

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posted by Anthony Wright | Permalink | 6:28 PM


Better Living Through Chemistry, and Information

Saturday, April 25, 2009
The drug wars go on here in California: consumer advocates continuing to fight the pharmaceutical industry--the legal one--for safer drugs and better prices.

SB438(Calderon) this year was similar to last year's SB1096(Calderon), a measure widely opposed by consumer groups. SB1096 allowed pharmacists to sell prescribing information to drug companies so drug companies could do even more targeted marketing to consumers. SB438 is slightly better in terms of privacy protections but still has many of the same flaws. Thankfully, it will not proceed this year.

Another bill, SB341(DeSaulnier) would expand the comparative effectiveness efforts at the federal level to California by adding counter-detailing, that is education of physicians and consumers about comparative effectiveness of drugs by impartial sources rather than leaving doctors and patients to rely on drug company marketing. What is that purple pill anyway? This bill failed in Senate Health with Republicans opposed and Democrats Gil Cedillo and Gloria NegreteMcLeod present but not voting. It has been amended to delete the fee on drug companies and is scheduled for hearing again on this Wednesday, 4/29, in Senate Health. We will see if the outcome is any different.

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posted by Beth Capell | Permalink | 9:07 AM


Comparative goals..

Thursday, February 12, 2009
The economic recovery package includes $1.1 billion for "comparative effectiveness" research, a comparatively small amount of money in a very big bill, but it's getting a lot of scrutiny and attention, as Victoria Colliver in the San Francisco Chronicle reports.

The attack against comparative effectiveness ranges from anti-health reform hack Elizabeth McCaughey to drug and device manufacturers. The unfair attack is that such research is "rationing." Since when is getting better information on cost and quality a bad thing?

As the links above indicate, a lot has been written on this subject already, but I think as consumer advocates we have a particular focus on this issue.

As consumer advocates, we have a long and proud history of working to make sure that patients get the care they need. For example, we sponsored the HMO Patients' Bill of Rights, which provides for independent medical review of insurers' decisions to deny such care.

At the same time, we are not for allowing drug and device manufacturers to sell anything they want at any price. There is a role for steering patients to the most appropriate, most effective medications and treatments, based on the most relevant research.

Drug and device companies may attempt to use the language of consumer advocates, but their interest is profoundly anti-consumer. We need more transparency and information, not just about the cost and quality of their products, but about their tactics in the coming health reform debate.

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posted by Anthony Wright | Permalink | 10:56 PM


A smoking gun

Monday, December 01, 2008
NY Times today has a great story on how the European Union, fed up with high drug prices, raided a bunch of big-name pharmaceutical companies and published some of the documents from their investigation.

One said:

“I suppose we have all had conversations around ‘how we can block generic manufacturers.'"


"We identify options to obtain or acquire patents for the sole purpose of limiting the freedom of operation of our competitors.”

These aren't new tactics. The Wall Street Journal did a huge expose about this several years ago. But what's interesting to me is that Europe, which many of us believed did not experience the same high drug prices we do here, is also feeling the burden and they're mad about it.


posted by Hanh Kim Quach | Permalink | 12:57 PM


Dr. Colbert, DFA, with the diagnosis...

Saturday, November 15, 2008
The recent Jupiter clincial trial revealing that statins like Crestor may help prevent heart attacks, even for folks who would not ordinarily be prescribed the cholesterol-lowering drug, got front-page news.

While this could be an important breakthrough in science, medicine, and health, there are some concerns, encouraged by the . Leave it to Comedy Central's The Colbert Report to provide a counterpoint:

Colbert brings up some of the legitimate critique of PhRMA: that their research is focused more on finding a steady income stream from existing drugs than on new discoveries. “This is a great breakthrough in the battle to find things to prescribe to people who don’t need them...True, the drug costs $100 a month... But that is a small price to pay to not have the heart attack that there’s no way of knowing that you would have had.”

After a clip of Stanford cardiologist Mark Hlatky urging caution, Colbert quipped, “sounds like someone hasn’t gotten enough free Crestor pens.” Health Access California, CALPIRG, California Labor Federation and other senior and consumer groups supported a bill earlier this year to place limits on the drug company giveaways to medical providers, but the active opposition of PhRMA blocked it. Maybe now that the issue has gotten the famous "Colbert bump" (along with the city of Sacramento), we can be more successful in the future.

The Colbert piece led Scientific American and the Wall Street Journal Health Blog to (in jest?) encourage Colbert’s name be added to the list of candidates for FDA Commissioner as President Obama selects a new administration.

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posted by Anthony Wright | Permalink | 11:22 AM


Erasing the gains on kids coverage, drug discounts, etc.

Tuesday, September 23, 2008
With his line item vetoes, the Governor has made an already bad budget even worse. The additional cuts would deny discounts on drugs for potentially millions of Californians, and make it even harder to get and stay on Medi-Cal coverage. There are also significant additional cuts in human services.

In health care, the passed budget already had severe cuts to health care, including:
* hundreds of millions of dollars of cuts to doctors, hospitals, and other health providers we all rely on;
* increased premiums per month per child in the Healthy Families program; and
* additional reporting requirements on low-income families (every six months) for the purpose of having over a quarter-million California children drop off of health coverage.

The Governor's line-item vetoes also included:
* Eliminating the funding in the budget year for a program to negotiate needed discounts for prescription drugs for millions of Californians (a much-heralded program the Governor has touted nationally that has already been delayed once); and
* Cuts to county administration of Medi-Cal, at the same time that paperwork requirements are increasing, making it harder for counties to process enrollments, and for patients to get assistance to get on and stay on coverage.

On children's health coverage, prescription drug prices, and other health issues, the Governor has erased any gains made his term, and in fact has taken steps backward on what was supposed to be his signature issue.

With gimmicks that steal from future years to paper over this year's hole, with his reduction of taxes and revenues to get us in this mess, and with his rainy day fund that will siphon even more dollars from health care, the Governor's legacy is to further damage the already broken health system.

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posted by Anthony Wright | Permalink | 5:26 PM


Joan Lee, R.I.P.

Monday, July 28, 2008
As someone who has been involved in organizing with senior citizen groups for over a decade, I have learned to recognize that some of my best allies will not be with us forever. But it doesn't make it any better.

Joan B. Lee, a leader in the Gray Panthers locally, statewide, and nationally, passed away Saturday night. She will be missed, not just as an advocate for seniors, people with disabilities, health care, and progressive ideals, but as someone who was known in the corridors of power in Sacramento, and had an impact.
She was an important ambassador between different groups: between different anti-war groups with different tactics here in Sacramento; between seniors and people with disabilities; between senior groups and Latino organizations; and between activists with different strategies around health reform.

We worked with her a lot on many issues, from fighting budget cuts to supporting the universal single-payer health care bill, SB840. We partnered with her and other groups on Medicare Part D, and I remember her actively distributing glossy postcards printed by the national Gray Panthers with a slogan I think she came up with: "PHRMA got the donut, we got the hole."

She was an active member of the OuRx coalition that was successful in a groundbreaking prescription drug discount program, and other key legislation. She was an active members of the Olmstead Advisory Committee, and always looked to bring in the perspective not just seniors but people with disabilities.

It was a pleasure to present in front of the Sacramento Gray Panthers group, which she helped convened monthly at the Hart Senior Center. She also was prominent statewide, as part of the Gray Panthers Affiliation of California Networks
UPDATE: A memorial service is scheduled for Friday, August 15, at 11 am, at the Unitarian Universalist Society of Sacramento, 2425 Sierra Boulevard, Sacramento, CA 95825. Refreshments will be served.

* Condolences can be sent to her family, including her husband Arnie, at their home in Sacramento, at 5313 Fernwood Way, Sacramento, CA 95841.

* Condolences to the Sacramento Gray Panthers can be sent to PO Box 19438, Sacramento, CA 95819

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posted by Anthony Wright | Permalink | 11:53 AM


Setting the Stage for a Budget Summer

Thursday, July 03, 2008
Thursday, July 3rd, 2008

* Democratic-supported budget would largely restore Medi-Cal rate reductions
* California Discount Prescription Drug Program continues
* Semi-Annual Reports and Healthy Families premium increases still in negotiations
* Conference Committee could close down as early as this Sunday, July 6th

Click Here for What's New on the Health Access WeBlog: More on the Health Care Budget Cuts; the Onion on Kids Coverage; Update on MA; Provider Rates; A Clear, Stark Choice; Missed Budget Deadlines; Reporting "Never Events"; How Many More Uninsured Under the Legislature's Budget?; Where Our Premium Dollars Go; Patients, Not Paperwork; Blog Watch

The Budget Conference Committee, led by Senator Denise Ducheny and Assemblyman John Laird, met this Thursday afternoon and reached agreement on a number of items of note to health advocates.

These decisions largely reflect current agreement between the Democratic majorities in the legislature; no budget decisions are final until the Legislature approves a budget by a two-thirds votes, which requires Republican votes, and the Governor signs the budget. However, these decisions shape the parameters of the budget negotiations this summer. The issues addressed today include:

PRESCRIPTION DRUG DISCOUNTS: The California Prescription Drug Discount Program, AB 2911 (Nunez), supported by Health Access California and a broad "Rx Coalition" of consumer, labor and senior groups, was passed and signed into law in 2006. The program would allow up to five million Californians with no or inadequate prescription drug coverage to buy prescription drug at prices 40 to 60 percent below the sticker price. The discounts would be achieved through contracts with pharmacists and negotiations with drug manufacturers.

The program, though, has not yet been implemented due to budget constraints. The program was in danger of being deferred yet another year until a compromise on the measure was reached Thursday. Under the compromise, the program would be started and implemented in the budget year, but the state would defray the costs to administer the program with a small portion of the manufacturer rebates.

MEDI-CAL RATE REDUCTIONS: The Committee also voted to restore most of the 10 percent rate reductions which took effect two days ago. The higher rates will take effect September 1, 2008. Any services provided between July 1 and August 31 will be reimbursed at the lower rate. The partial rate restorations are all contingent upon a budget agreement that includes revenues.

Following is an accounting of how each individual cut was restored and how the committee votes:

* Providers: Restored most of 10% payment reduction ($158.3 million); Vote: 2-1, 2-1, Republican members voting no
* Pharmacies: restored half (5%) of the payment reduction ($76.3 million); Vote: 2-1, 2-1, Republican members voting no
* Pediatric Sub Acute Care: restored all of payment reduction ($1.8 million); Vote: 2-1, 2-1, Republican members voting no
* Long-term Care: restored half (5%) of the rate restoration ($24.6 million); Vote: 2-1, 2-1, Republican members voting no
* Managed Care rates: restored half (5%) of the payment reduction ($99.2 million); Vote: 2-1, 2-1, Republican members voting no
* Breast and Cervical Cancer treatment: restored full amount of payment reduction ($1.2 million); Vote: 2-1, 2-1, Republican members voting no.
* Non-Contract Hospitals: Compromise would treat small, rural and children’s hospitals as contract hospitals. Vote: 3-0, 3-0

CHILDREN SERVICES: Rates paid under the California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) would be mostly restored by September 1, contingent upon revenues. The governor had originally proposed a 10 percent rate reduction for these programs’ services. In both cases, the vote was 2-1, 2-1, with Republican voting against the partial restorations.

ITEMS REMAINING OPEN: Still in negotiations remain the Semi-Annual Status Reports and additional county administrative funding should those reports be approved. Healthy Families premium increases also remain open. Both would not only place paperwork and additional costs onto families with children on Medi-Cal and Healthy Families coverage, respectively, but would also cause a reduction in enrollment and an increase in California children without coverage.

The children's groups that make up the 100% Campaign are urging health advocates to call members of the Conference Committee to urge them to reject these additional barriers to kids' coverage. Their most recent alert is listed here:

CALENDAR: The Budget Conference Committee is expected to return July 6th, Sunday evening to close out the remaining items. Legislative leaders hope to have a vote on the budget by mid-July.

The Senate plans to hold Appropriations hearing the upcoming week and Monday July 14th and then take summer break until August 4th. The Assembly plans to hold its last Appropriations before break on July 16th before leaving and returning on August 4th.

Health Access will keep advocates abreast of these activities. For information, please contact the author of this report Hanh Kim Quach, policy coordinator, at hquach@health-access.org.

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posted by Anthony Wright | Permalink | 9:08 PM


Drug Money

Saturday, June 14, 2008
Assemblyman John Laird, chairman of the Assembly Budget Committee, put up a good fight for the yet-to-be implemented California Discount Prescription Drug Program, which was signed into law in 2006 but delayed because of budget constraints.

The Senate has proposed delaying this again this year for a $5.8 million savings (.006 percent of the state budget). I wanted to clarify something that Assm. Laird said. This program would allow approximately 5.4 million unisnured low- and moderate-income Californias (below 300% of poverty) to buy prescription drugs at a *fair* price (between 40 to 60 percent off). Right now, this population pays the sticker price for drugs -- or they go without.

Sen. Denise Ducheny, chair of the Senate Budget Committee, did not think as much was being lost if the program had not yet been implemented.

The item remains open.

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posted by Hanh Kim Quach | Permalink | 12:19 PM


We live to fight another day for drug discounts...

Friday, May 23, 2008
Wednesday morning, without taking testimony, the Senate Budget Subcommittee chaired by Senator Elaine Alquist, with Senator Alex Padilla concurring, voted to eliminate funding for the drug discount program.

At noon time, I came back to the office and looked at the blog post by my colleague, Hanh Quach, with that wonderful picture of Governor Schwarzenegger signing the bill, framed on either side by supporters including Anthony Wright, Health Access executive director, and Assembly Speaker Fabian Nunez, who stepped down from that position a week ago yesterday.

I found it hard to believe that only a week after Nunez had stepped down as Speaker, the Assembly would just agree with the Senate and eliminate funding for the drug discount program that every article on his tenure as Speaker cited as one of his major accomplishments.

At 1:30pm, I found out I was wrong. The Assembly Budget Subcommittee convened and we discovered that they too planned to eliminate funding, in the technical language of the legislature, “conforming” to the Senate action. Things can move quickly around the Capitol.

I noticed that somehow the drug companies had found out that they were about to win a delay in this program that they had fought so hard to stop—I saw several of their lobbyists in the back of the hearing room.

Fortunately, the Assembly Budget Subcommittee allowed public testimony. Bill Powers, advocate for California Alliance of Retired Americans (CARA), and I spoke. I pointed out that Health Access had sponsored a ballot measure that Pharma spent $80 million to defeat and that the law was a compromise based on the Legislative Analyst Office (LAO). Consumers and labor supported the law, Pharma bitterly opposed. I said we strongly opposed not funding the program.

Bill Powers spoke about the travesty of the Medicare drug program where Medicare cannot negotiate prices with the drug companies. He pointed out that the State of California negotiates with drug companies for both Medi-Cal and for this new program for the uninsured. Medi-Cal gets very good prices from the drug companies—that is why they opposed this new discount program. If we don’t get the new program, Bill said, we will never know for sure how much we can benefit the uninsured.

And rare in what all too often feels pre-scripted, Assemblymember Patty Berg, the Budget Sub chair, moved to hold the item open, postponing action to another day. The Democrats present, Assemblymembers Jim Beall and Ed Hernandez, concurred. I was so relieved I forgot to notice what the Republicans did.

So we still have a chance to win. But it is a slim one. At any time, the Assembly could agree with the Senate and consumers will be out of luck on drug discounts and the drug companies will have won through the backdoor because of the bad budget year. It seems a poor tribute to the work Speaker Emeritus Nunez has done on health care.

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posted by Beth Capell | Permalink | 10:13 AM


Senate Committee says No to Prescription Drugs

Wednesday, May 21, 2008
The Senate budget subcommittee that oversees the state's health budget voted to eliminate funding that would have implemented the California Discount Prescription Drug Program.
By eliminating the $5.8 million in funding for this program, the work that state officials have done the past two years in negotiating lower rates will go to waste.

As many may recall, health advocates went through a bruising battle against Big PhRMA in 2005 ($80 million spent against us) on the ballot, and then won a year later when Gov. Arnold Schwarzenegger signed the bill and even had a fancy signing ceremony in the Capitol Rotunda.

The discount drug program would have allowed the state to negotiate discounted drug prices from pharmaceutical company, helping approximately 5.4 million uninsured families -- the people who now pay FULL PRICE for prescription drugs -- buy drugs at fairer prices. If drug companies did not give satisfactory discounts, then the state could have used the purchasing power of Medi-Cal to leverage lower prices.

Californians below 300% of poverty ($63,600 for a family of four) would have been able to buy drugs at 40-60% off the sticker price. While that's still more than many of us pay for our drugs (insured Californians often pay a fixed co-pay), it's still a lot less than what they pay without the program.

So that means middle-income and low-income Californians, who are already seeing the substantial reductions in their health benefits through public programs for their children, and schools, will now have to pay more for drugs.

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posted by Hanh Kim Quach | Permalink | 11:22 AM


Drug cost-sharing and other wonkery...

Thursday, April 17, 2008
Maggie Mahar and Niko Karvounis at Health Beat host this week's Health Wonk Review. In addition to a better-than-the-original summary of our post on ER overcrowding, the blog hightlights lots of good issues and posts.

There's lots of commentary (some compiled by Brass and Ivory) on the recent New York Times article by Gina Kolata (reprinted in the Sacramento Bee and elsewhere) about the astonishing co-payments and cost-sharing for a new "tier 4" class of prescription drugs.

Here's the Wonk summary and links on this issue:

"...many insurers are now insisting that patients suffering from diseases such as MS, Hepatitis C and some cancers pay a percentage of the cost of super-expensive drugs.

Normally patients are asked to pay a flat fee of $10, $20, or $30, depending on whether an insurer classifies a drug as tier 1, tier 2 or tier 3. But now patients are forced to pay 20 percent to over 30 percent of the cost of “tier 4” drugs that can cost $100,000 a year—or more. Emrich presents the full range of responses coming from MS Bloggers, Health Policy Wonks, and Medical Professionals.

While some think that “Patients have been shielded from costs far too long, subsequently leading to an entitlement mentality,” others sympathize with MS bloggers like Jeri who writes: “I am terrified about what will happen when this Fingolimod trial ends and I no longer get my medication for free. I strongly believe that the medicine is the reason for this long period of remission that I am enjoying, and the health care system is putting a price on that for me. I know it will be out of my reach once it has gone to market and I am forced to pay for it."

Meanwhile, at the Sentinel Effect, Richard Eskow quotes a surprising industry response from Robert Zirkelbach of America’s Health Insurance Plans: "When plan designs are no longer made to change behavior, but simply to transfer high-cost items back to the insured party, that’s risk transfer and not benefit design. As a result, the insurance concept is being subtly modified - and arguably undermined." [Note: this, from an interview by American Prospects’s Ezra Klein.]

Lisa ends by tipping her hat to Merrill Goozner of GoozNews, re-printing Goozner’s post on tier 4 in its entirety.

At Colorado Health Insurance Insider, blogger Louise offers her own very sharp take on tier 4 drugs, and offers her solution for keeping costs down without imposing an unfair burden on a smallgroup of very sick patients. Her concluding paragraph deserves to be reprinted in full: “Charging insured [patients] slightly higher prices for common drugs - the ones that are prescribed to millions of Americans - and not having to charge dramatically higher prices for the rarely prescribed, expensive drugs would be a better way of spreading the rising cost of prescriptions out over the whole population, instead of dumping it at the feet of those who are already battling against some of the nastiest illnesses around.” Amen to that.

Finally, for Health Beat's take on Tier 4, check out Maggie's last post, where she asks “Who Sets the Price at $100,000” and, does anyone happen to know, “Are These Drugs Effective?”

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posted by Anthony Wright | Permalink | 3:01 AM


PHRMA strikes back...

Tuesday, April 01, 2008
Big PhRMA today smothered AB 2821 (Feuer), which would have limited the value of gifts given to physicians to $250 (about one-tenth of what is current practice for many companies), and required them to disclose any gifts (which includes meals, subscriptions, travel, trinkets, etc) of $50 or more. To read more about the bill, and research about pharmaceutical company gifts to physicians, see CalPIRG’s report here, UCSF's research on the issue here, and our previous post about the issue here.

AB 2821 was a far more modest proposal than what the Journal of the American Medical Association had recommended for its community, but not this year and not this bill. It needed nine votes to pass, it got five.

Dr. Michael Steinman, a UC San Francisco medical school professor, spoke of his research, which showed gifts from pharmaceutical companies created an "expectation of reciprocity'' -- that doctors needed to somehow return the favor. His research has also shown how 84% of physicians believed their colleagues were influenced by drug company gifts

CalPIRG staff attorney Mike Russo testified that physicians are visited by drug company representatives an average of 28 times a week – or six times a day. These frequent visits, he said, harmed patient care by increasing the cost of drugs (extra marketing costs and the prescribing of higher-cost drugs when generics would be fine) and creating the appearance of a conflict with the doctor-patient relationship.

Pharmaceutical companies argued -- as is their wont -- that the legislation would be too cumbersome, expensive, yada yada.... The bottom line is, if this type of marketing didn't work, they wouldn't dedicate $19 billion annually to push their drugs to the fore.

The California Medical Association – which was neutral on the bill – said “Sunshine is necessary’’ but believed there were some “differences of opinion’’ about the studies and felt that studies did not suggest that gifts altered their prescribing habits and were offended by the characterizations that maligned doctors and questioned their integrity.

It should be noted that the Journal of the American Medical Association recognizes the potential for the appearance of a conflict of interest and has put forth its own guidelines for self-regulation, which includes a ban on *all* gifts ("eliminating potential gray areas and greatly eases the burden of compliance"), replacing drug samples with a "system of vouchers for low-income patients ...that distance the company and its products from the physician.''

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posted by Hanh Kim Quach | Permalink | 5:56 PM


Drug pushing...

CALPIRG Health Care Advocate Mike Russo (also a Health Access California board member) makes the case for AB2821 (Feuer) in the California Progress Report, and will later today as well at the Assembly Health Committee.

The bill would place a hard cap of $250 of "gifts" to doctors from drug companies, and require better public disclosure of the pharmaceutical companies' marketing practices. These are real cost drivers in our health care system--not only the cost of marketing, but the encouragement to move patients to the most profitable and most expensive drugs, even when more tried-and-true remedies are as effective, if not more so. For everyone who raises the issue of cost containment, this is a simple but important step.

This is part of an ongoing effort by many groups, an "OuRx Coalition," to get a handle on prescription drug costs--such as getting California to use its purchasing power to bargain down the costs of medicines for the uninsured and underinsured, with AB2911(Nunez/Perata) a couple of years ago.

Another consumer-backed bill of a few years ago, SB1765(Sher), had the drug companies create and publish their own guidelines for their marketing practices. A new CALPIRG analysis, "Playing By Their Own Rules," suggests that:
* Drug companies fail to count some meals and other payments as “gifts,” and therefore not subject to the limit;
* Some companies reserve the right to exceed their limits if they so choose;
* Others assert that they are following a limit, but do not disclose what that limit actually is, while a few fail even to post their policies at all.

Clearly, there's a prescription for some stronger oversight.

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posted by Anthony Wright | Permalink | 10:08 AM


Upcoming hearings...

Monday, March 31, 2008
While the Capitol is closed today in recognition of Cesar Chavez, the action starts up again tomorrow, in full forse. Some upcoming hearings of note here in Sacramento:

* Assembly Health Committee will meet tomorrow, Tuesday, April 1st--yes, April Fool's Day. What's not a joke is the drug companies' opposition to AB2821 (Feuer), to limit the "gifts" given by drug companies to doctors. And a spirited discussion on AB1945 (De La Torre), on rescissions. Should be an interesting hearing.

* Next Monday, April 7th, the Senate Budget Subcommittee on Health and Human Services will hold a hearing at 10:30 am on some of the proposed cuts to Medi-Cal, like Quarterly Status Reports.

* An important reform of the individual insurance market, AB1522(Steinberg), sponsored by Health Access California, is up in Senate Health Committee on Wednesday, April 9th. The committee starts at 1:30pm. There are other bills of note as well on the docket.

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posted by Anthony Wright | Permalink | 12:13 PM


Singing the "Blue Pencil" Budget Blues...

Friday, August 24, 2007
Friday, August 24, 2007

* $700 million in cuts is part of agreement with Senate Republican holdouts
* Implementation of children’s coverage outreach and drug discount program delayed
* Primary care clinics and Medi-Cal managed care also face cuts

New on the Health Access WeBlog: More Budget Update; Small Biz for Health Reform; The Veto Threat; Fact Checking the Gov; MA Redux; What is Universal? What is Covered?; Wonked!; Special Session?; Field Poll Analysis; President Bush Attacks SCHIP; New TV Ads; The Social Security Metaphor; New Report on Individual Market Consumer Protections; The Real Difference Between Nunez and the Gov; California Speaks; Kuehl Speaks; Having Our Say; The 2/3 Vote; Healthy San Francisco; Complaints About Insurers.

Earlier today, Governor Arnold Schwarzenegger signed the 2007-08 Budget, totalling over $145 billion. Due to a standoff by Senate Republicans, the budget was passed on Tuesday, August 21st, over 50 days after the beginning of the budget year. Of particular note was the $703 million in cuts the Governor made using his line-item veto authority.

As the governor and Legislature begin discussions on health care reform, more than half of cuts made in the 54-days-late budget that Gov. Arnold Schwarzenegger signed Friday came from the department of Health and Human Services.

While $332 million of the cuts were simply a re-adjustment in Medi-Cal expectations and will not result in a reduction in services, other cuts would have significant impacts on nascent programs.

Among the cuts:

* PRESCRIPTION DRUG DISCOUNTS: $6.3 million from the California Discount Prescription Drug Program Fund: The Governor zeroed out the money to implement this program that would negotiate with drug companies to provide discounts to uninsured and underinsured Californians. In his veto statement, he directed the Department to identify ways to start the work, but the program is likely to be delayed.

Along with legislation on global warming and minimum wage, the Governor has repeatedly mentioned this program – a result of AB2911 (Nunez/Perata) -- as one of the major successes from 2006, including on multiple appearances on "Meet the Press."

* CHILDREN’S COVERAGE: $66 million to make it easier for children to enroll – and stay enrolled – in the state’s Medi-Cal and Healthy Families Program: There's a range of cuts to children's coverage. This includes cutting the $15.4 million to implement SB437 (Escutia) to streamline enrollment, and also cutting $15 million in funds for county outreach and enrollment efforts. These cuts effectively prevents the state from reaching out to more than 100,000 children who could be enrolled in public programs.

The Governor had a major bill signing ceremony on SB437, and has participated in several events on children's coverage, which remains an element of the Governor's health reform.

* CLINICS: $10 million from the Expanded Access to Primary Care. This cut will decrease access to care for uninsured patients through community clinics.

Providing care through community clinics was something that even legislative Republicans have advocated for in their health reform proposals this year.

* MEDI-CAL MANAGED CARE: $106.3 million in cuts to Medi-Cal Managed Care: While the budget retains $54 million in state dollars for an increase to Medi-Cal HMOs.

Yet the Governor would not draw down $53.1 million in federal matching funds, as part of this reduction to Medi-Cal--at the very time that health reform proposals seek to expand the program.

The Governor's budget document is available at:

A California Budget Project analysis is available at:

More information on the budget and health reform is available at the Health Access WeBlog, at

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posted by Anthony Wright | Permalink | 10:07 PM


How to control costs, and more...

Thursday, April 26, 2007
Some laughter at an unexpected part of the conversation at the hearing yesterday... Senator Perata was detailing the various measures in his bill intended to control costs. For example, he stated that "we are in the freaking stone age in terms of medical records," and said that we "are killing people" by not using modern electronic technology to deal with medical records.

Beyond his own bill, he went on a short rant about prescription drug advertising, and the large amount of money spent on the television commercials for "the little blue pill," and the impact it has on health costs in general. He was very skeptical that as a patient he should be asking his doctor about any medication beyond aspirin. "What the heck do I know?" he inquired, wondering why he should be pestering his doctor about drugs, rather than the other way around.

He said if one looks at the sports show, all the advertisements are for "beer, cars, and pills--and not in that order." With a bemused smile, we commented on all TV commercials "and all those smiling men."

Not finished, he even interjected "you don't see the women smiling, only the men."

And then the conversation went back to health reform.

On a more serious note, one way to deal with the issue of prescription drug advertising is at the federal level, in a bill by California Congressman Henry Waxman, as described in this blog post by Steve Blackledge of CALPIRG. Not so seriously, he managed to invoke a comparison to Steve Martin in The Jerk.

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posted by Anthony Wright | Permalink | 1:20 AM


This is our political system on drugs...

Wednesday, April 18, 2007
Here in Sacramento, SB840(Kuehl) passed out of Senate Health Committee this evening, along a party line vote with six "aye" votes. (State Senator Negrete-McLeod was not present during the vote.)

But the issue of "single-payer" health coverage was invoked in Washington, DC, as well.

In a blow to seniors, the federal budget, and common sense, several U.S. Senators blocked a attempt to pass a bill to allow the federal government to use its purchasing power under Medicare to negotiate for prescription drugs. While most Democrats (including California's Boxer and Feinstein) and even six Republicans voted for the measure, totalling 55 votes, it was not enough to get the supermajority 60 votes needed to actually get it passed.

I was curious about the argument quoted in the New York Times write-up:

Senator John Cornyn, Republican of Texas, denounced the bill as “a step down the road to a single-payer government-run health care system.”

Democrats said they were merely trying to untie the hands of the secretary of health and human services so he could negotiate on behalf of 43 million Medicare beneficiaries.

“The Department of Veterans Affairs is able to negotiate for lower-priced drugs,” said the Senate majority leader, Harry Reid, Democrat of Nevada. “H.M.O.’s can negotiate. Wal-Mart can negotiate. Why in the world shouldn’t Medicare be able to do that?”

A 2003 law prohibits Medicare from negotiating or setting drug prices or establishing a uniform list of covered drugs, or formulary.

More than a handful of Republican Senators don't think they are endorsing single-payer health care when simply supporting the common-sense notion of the Medicare program using its purchasing power. The notion of a "bulk discount" is market-oriented, after all.

But it seem Senator Cornyn's argument only makes sense if he thinks the bill will actually be effective--that it will actually provide medicines at lower prices for seniors and Medicare. If it worked, it would spur other reforms... but that wouldn't be a bad thing.

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posted by Anthony Wright | Permalink | 9:32 PM


What can you do for health care?

Monday, April 16, 2007

Monday, April 16, 2007

* "It’s Our Healthcare!" Rally: Tuesday, April 17th
* Senate Health Committee considers SB840 (Kuehl): Wednesday, April 18th
* Call Congress on drug negotiation; SCHIP and covering legal immigrant children
* Health reform and children’s coverage measures up next week

The last two weeks of April promise to be eventful for health care activists in Sacramento, with many activities and committee hearings.


Tomorrow, a broad range of consumer, community, consumer, and labor groups will convene on the east side of the Capitol to kick off a major effort to engage Californians to tell their health care stories. These stores will help to remind decision makers at the Capitol that the reason that the health system needs to be reformed is to protect consumers.

The rally on Tuesday, sponsored by the It’s Our Healthcare! Campaign and the California Labor Federation, will feature Californians who have had a hard time getting health care they need when they need it, or ended up with mountains of medical debt when they sought medical help for their ailments. Photos and the stories of victims of the health care system will be featured in Capitol Park .

Who: More than 200 members of community organizations, unions, and senior groups statewide
What: Rally for Health Care. Launch of statewide story collection efforts.
When: 12noon, Tuesday, April 17th
Where: East lawn (between 12th and N streets) facing the east side of the Capitol.


Sen. Sheila Kuehl will present her universal, single-payer legislation before her own Senate Health Committee on Wednesday, April 18th.

This is the fifth year in a row that Kuehl has authored a version of this bill. Last year, it made it to Gov. Arnold Schwarzenegger’s desk – for the first time in history – but was vetoed. Kuehl hopes to continue to refine the bill and advance it through the legislative process, as an important part of the health reform bill this year.

When: 1:30 p.m.
Where: State Capitol, Room 4203
Listen on the Web: http://www.senate.ca.gov/htbin/testbin/noframe_raudio/


Back in Washington, DC, the U.S. Senate is expected to consider the Medicare Prescription Drug Price Negotiation Act soon. Currently, the government is prohibited from using the bargaining power of 43 million Americans in Medicare to negotiate with pharmaceutical companies for lower drug prices. Earlier this year, the House of Representatives passed a bill to give the government the option to do just that.

National consumer groups have set up a TOLL-FREE HOTLINE FOR TODAY to urge our Senators to vote YES on this important legislative. The number is 1-800-828-0498.


The U.S. Congress is also deliberating the extension and reauthorization of the State Child Health Insurance Program, also known as Healthy Families in California.

One potential change as part of this debate would significantly help California draw down federal dollars for children's coverage. California currently provides coverage for some qualified children who are here legally but have not been here for five years--but the state does not get federal matching funds for this, as we get for other programs.

The Legal Immigrant Children’s Health Improvement Act (ICHIA) (S. 764, H.R. 1308) would allow and reimburse states to enroll these children in those programs. If this law passed, it would go a long way toward helping to cover all children nationally, and help California get its fair share of federal financing. It would also create a more solid foundation for the state’s efforts this year to provide universal health care to all Californians.A letter to Congress from governors is currently being circulated, but Gov. Arnold Schwarzenegger has not yet signed on. If our governor signs on, other Republican governor may also join in support.

In late February of this year, Governor Schwarzenegger sent a letter to Health and Human Services Secretary Michael Leavitt where he reiterated his top healthcare priority -- universal coverage in California. He needs further deliver this message by signing onto the governor's letter being circulated. The deadline is Friday. We need you to contact the Governor's office TODAY and voice your group's support for this letter.

Call Governor Arnold Schwarzenegger

Phone: 916-445-2841Fax: 916-445-4633

The California Partnership has a script for calling.


Back in Sacramento, here's some key bills up next week:

*AB8 (Nunez): It was previously reported that the Assembly Speaker’s health reform legislation would be heard April 17th. That hearing has been postponed to April 24th in the Assembly Health Committee.
* AB1 (Laird/Dymally) which would ensure all children up to 300 percent poverty are covered by either Medi-Cal or Healthy Families will be in Assembly Health Committee April 24th.
* SB48 (Perata): Senate President Pro Tem Don Perata’s health reform measure will be up April 25th in Senate Health Committee.
* SB32 (Steinberg) which would ensure all children up to 300 percent poverty are covered by either Medi-Cal or Healthy Families will be in Senate Health Committee April 25th.

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posted by Anthony Wright | Permalink | 5:41 PM


After today, the deluge

Wednesday, April 11, 2007
After a burst of health-related activity in January and February, the 2007 session has been relatively quiet -- until now.

This week, advocates saw debate on several bills, including two of note:
  • AB1635 (Strickland) would have allowed Medi-Cal recipients to voluntarily enroll in high-deductible plans, and use HSA-like "Health Opportunity Accounts.'' Health Access California opposed the measure as did Western Center on Law and Poverty. The bill died on Tuesday.
  • SB623 (Wiggins) would relieve seniors who are eligible for both Medi-Cal and Medicare to have co-pays for their prescription drugs paid for by Medi-Cal. Last year, when Medicare Part D went into effect, one million of the state's lowest income seniors (earning about $800 a month) were made worse off when they were shifted into the federal program, and required to pay copays on their multiple prescriptions. Under Medi-Cal, they did not have to pay. An effort to ensure these seniors could continue to get their medications without paying last year failed. Wiggins bill passed Senate Health on Wednesday.
The next two weeks, health committees in the Assembly and Senate will be bursting with activity. Health reform proposals by Assembly Speaker Fabian Nunez are expected to be heard on Tuesday, April 17. Sen. Sheila Kuehl's single payer measure, SB840, will be up the next day.

Senate President Don Perata's health reform bill will be up the following Wednesday April 25. And universal children's coverage bills will be up the 24th and 25th also.

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posted by Hanh Kim Quach | Permalink | 11:56 PM


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Anthony Wright is the executive director,
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.