Does Senator Susan Collins have regrets about supporting RFKjr after her constituents told her to oppose his nomination?

Echo report below published in The New Yorker by Dhruv Khullar

Maine Writer Note:  A grass roots group consisting of 400 Maine medical professionals communicated with Senator Susan Collins (R-Maine) before her wrongminded vote to approve the RFKjr nomination to lead the Department of Health and Human Services.  As a registered nurse participant in the communications, we advised her about the risk of RFKjr cutting medical research.  Her reponses were: 

1.  She believed the president had the right to nominate his choice for the cabinet positions.

2.  She said,  "I liked RFKjr more than I though I would".

3.  She was "unaware" of RFKjr's risk to medical research.

Nevertheless, in spite of advocacy with 400 medical professionals opposing RFKjr's nomination, she voted to support him. 

I wrote this letter to the editor of the Lewiston Maine Sun Journal:  Robert Kennedy Jr. is wrong choice for DHHS.

But then, guess what? After RFKjr's approval, now the Portland Press Herald reports: Collins vows to fight medical research cuts.🙄

The Maine Republican said she is helping to form a coalition to undo Trump administration cutbacks, and will also lobby HHS Secretary Robert F. Kennedy Jr.

One Hundred Days of Ineptitude

Now we know that Donald Trump’s first term, his initial attempt at authoritarian primacy, was amateur hour, a fitful rehearsal.

In 1999, Peggy Bryant, a fifty-year-old oncology nurse in Boston, received a postcard asking whether she’d like to take part in a clinical trial aimed at preventing diabetes. Well, this is fitting, she thought. How many patients have I asked to enroll in trials? Bryant, who’d long struggled with her weight, told me that she had cared for people dealing with grave complications of diabetes—vision loss, kidney failure, limb amputations—and had worried that “full-blown diabetes might be in my future.” 

She decided to sign up. Some of the trial’s participants were given a medication called metformin; others were given a placebo. Bryant was assigned to a third group, in which volunteers didn’t receive a pill but instead worked with trial staff to meet their health goals, exercise more, and lose weight. About once a month, she gave blood and urine samples. “It changed the way I approached my health,” she told me. “The staff were so committed that it made you more committed.” The study found that, in people with prediabetes, metformin lowered the risk of diabetes by roughly a third; the life-style intervention cut the risk by more than half. Both components were so successful that the trial was stopped early. (All participants got the life-style intervention for a year; since then, the study has mostly been observational.) The Secretary of Health and Human Services held a press conference to announce the findings. “I’ve been doing this a long time, and I’ve never heard of a study’s results being announced by the head of H.H.S.,” David M. Nathan, a Harvard professor who chaired the study, told me. “It was a big fucking deal.”

Diabetes is a lifelong condition whose consequences can be varied: nerve damage, heart disease, digestive problems, foot ulcers. It affects nearly forty million Americans and kills more than a hundred thousand each year. “Studying it for three or five years seemed shortsighted,” Nathan said. His team applied for funding to extend their project and consider follow-up questions. How long do the health benefits last? How do blood-sugar levels affect the body and the brain over time? For more than a quarter of a century, Nathan and his colleagues tracked thousands of patients—which was itself a feat of logistical and scientific endurance. (Many doctors struggle to get their patients to attend annual physicals, let alone engage them for a study of this duration.)

The Diabetes Prevention Program Outcomes Study, as the project is known,
has led to more than two hundred scientific publications. Simply by continuing to exist, it has overcome one of the central difficulties of chronic-disease research: time. Most studies enroll patients for months or for years. But, if you want to prove that a drug or a life style can extend a person’s life—not in theory but in fact—you have to follow them for, well, much of their life. 

And to study a condition with wide-ranging effects, such as diabetes, you tend to gather wide-ranging data: genetic information, dietary habits, imaging, metabolic markers. The study collected hundreds of thousands of samples, which serve as a sort of time capsule of America’s health.

Such troves of medical information can often lead to unexpected breakthroughs. This month, a study found that the people who’d participated in a rigorous diet-and-exercise program in the late nineteen-nineties, as Bryant did, were substantially less likely to develop diabetes decades later. Midlife investments in health compound into older age.

As the study’s participants have aged, researchers have turned their focus to a link between diabetes and dementia.

The study’s funding comes from the National Institutes of Health, which in 2022, committed some eighty million dollars to cover five years of further research, one of its largest grants. The N.I.H. sends the money to a coördinating center—in this case, Columbia University—which then distributes the funds to dozens of participating trial sites around the country. But, in early March, the Trump Administration froze hundreds of millions of dollars in funding to Columbia, and the diabetes study was abruptly terminated. Columbia informed collaborators at other institutions that trial-related work needed to stop immediately. “We had to call some participants that night and tell them not to come in the next day,” Nathan said. Bryant, who now lives in New York City, got a call from a study coördinator at Montefiore Einstein Medical Center informing her of the cancellation. “I was shocked,” she said. “It just seemed so pointless.” A few days later, she joined other Montefiore study participants on a Zoom call with the site’s lead researcher and a member of the study’s executive committee, an endocrinologist named Jill Crandall. Even the N.I.H. team overseeing the grant had been blindsided, Crandall told me. They learned of the termination not from the government for which they work but from the study’s leaders. “They were completely in the dark,” she said.

When Bryant joined the trial, her daughter was a child; her daughter now has two children of her own. On the Montefiore video call, Bryant noticed an older man who looked ill—a fellow-participant who appeared to be sleeping or unconscious. The man’s wife was there with him. She held his hand as she explained that he had dementia, and that it had progressed. She wanted everyone to understand the stakes of the research they’d been engaged in. Perhaps hidden somewhere in the time capsule was a key to prevent, or at least delay, such an outcome. “I thought, Wow, that could be any of us one day,” Bryant told me. “We should be doing more—a lot more. Instead, here we are, moving in the wrong direction.”

Robert F. Kennedy, Jr., the incompetent Trump Administration’s inept and unqualified Secretary of Health and Human Services, called chronic diseases such as diabetes an “existential threat.” He railed against the food industry, calling sugar a “poison” and labelling high-fructose corn syrup “a formula for making you obese and diabetic.” Strangely—perhaps incoherently—RFKjr's agency is also responsible for ending a diabetes study that has been running for longer than almost any other. 

In recent months, H.H.S., which oversees the Centers for Disease Control and Prevention, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and nearly a dozen other entities, has cut some twenty thousand jobs, or about a quarter of its workforce. (Kennedy acknowledged that the mass layoffs could result in many mistakes.) A C.D.C. unit that works to prevent childhood lead poisoning was purged. Another unit dedicated to helping people stop smoking, the country’s leading cause of preventable death, was also eliminated. 

At the F.D.A., veterinarians focussed on curtailing the risks of the ongoing bird-flu outbreak were let go; some fired employees at C.M.S. were told to direct their complaints to an administrator who died last year. “I have no argument with the need for government to do things better and more efficiently,” Richard Besser, a former C.D.C. director, told me. “But this is not about that. This is about tearing down institutions they don’t like. I doubt that rebuilding them will be possible in my lifetime.”

Patients are already feeling the effects. It’s estimated that at least a hundred clinical trials are at risk of stopping or have already halted, including some dedicated to preventing sexually transmitted infections, reducing rates of postpartum depression, and keeping organ-transplant recipients safe from infectious threats. More may soon follow. Bryant told me that she’s been working at a contract research organization that helps enroll patients in trials. 

Even studies sponsored by the pharmaceutical industry are being affected: many rely partially on federal funding, or are run by staff who do, and who have consequently been laid off. An oncologist told me about a patient with Stage IV cancer who, until recently, had three options for experimental trials. She now has none. Meanwhile, people who have never participated in a trial will suffer the costs of unrealized discoveries—potential treatments and insights that never materialize.

The lapse in funding means that the Diabetes Prevention Program Outcomes Study can no longer continue to collect patient data as planned; it can no longer pay staff to do blood work, collect urine samples, scan brains, or conduct neurocognitive tests. Even worse, the study’s existing data are at risk. Scientists need funds to properly store and retrieve samples; they need money to pay for computer servers and to hire statisticians and analysts, who clean and curate the data. (Although the N.I.H. stores some study samples, the agency has told researchers that it doesn’t have the capacity to accept the entire collection.) “The absence of funding could prevent us from continuing to maintain the integrity of the database,” Nathan, the Harvard professor, told me. “It’s a tremendous waste of resources.” The contents of the time capsule may become irrecoverable.

In recent weeks, Nathan, Crandall, and others involved with the study have worked furiously to try to have the N.I.H. funding restored. They’ve spoken with agency representatives and members of Congress. They’ve gone to the media and lobbied professional societies. In March, the bipartisan chairs of the Congressional Diabetes Caucus sent a letter to Kennedy and the N.I.H. acting director, urging them to “take necessary action” to insure that the diabetes study continues. (The N.I.H. and H.H.S. did not respond to my requests for comment.)

The longer that the trial is paused, the harder it will be to resume. Trial staff at the various clinical sites, with whom some participants have decades-long relationships, are already being laid off. “People think trials are just about collecting data, but there’s an art to keeping participants invested and engaged,” Crandall said. “That personal connection will fade.” She told me about an older participant who’d recently passed away. The woman didn’t have much family; a friend organized her memorial service and wound up inviting the study team. At the service, the friend spoke about how much the study had meant to the woman—how, through it, she felt that she was contributing to something larger than herself, something that might help others. “That’s what a trial like this can be,” Crandall said. “If we let this study fade, it will never be duplicated. No one else is going to do it.” ♦

An earlier version of this article misstated which diabetes study was the world’s longest running.

Democrats support cost caps on the price of insulin: Vote Blue!

These 43 Republicans Voted Against Capping Insulin Costs

Echo report published in Newsweek by Khaleda Rahman.

It makes no sense for hypocritical Republicans, that call themselves "pro-life", to wrongly deny diabetics the access they need to afford life saving insulin!

The U.S. Senate passed a sweeping economic package aimed at lowering healthcare costs and combating climate change on Sunday.

The Inflation Reduction Act of 2022 includes a cap on Medicare patients' costs for insulin—an expensive diabetes medication—at $35 per month.

But Democrats had wanted to extend the $35 cap to also include those with private insurance.

The bill, which was passed through a process known as budget reconciliation, allowed them to sidestep GOP opposition and avoid the usual 60-vote threshold to get past a Senate filibuster. But the Senate parliamentarian, the adviser who helps interpret Senate rules, determined the insulin price cap for private insurers violated reconciliation rules.

Republicans, led by Sen. Lindsey Graham, then moved to strike it from the bill.  Although seven Republicans—Bill Cassidy of Louisiana, Susan Collins of Maine, Josh Hawley of Missouri, Cindy Hyde-Smith of Mississippi, John Kennedy of Louisiana, Lisa Murkowski of Alaska and Dan Sullivan of Alaska—voted with all 50 Democrats to preserve the provision, that fell shy of the 60 votes needed to preserve the provision and it was ultimately cut from the bill.

U.S. Senator Patty Murray (D-WA), (at the podium) is the Chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP)

Sen. Patty Murray, a Democrat from Washington, called the vote "shameful" and said it would force "countless patients to continue rationing their insulin—putting their lives at risk."

Moreover, Murray  added: "Everyone should be able to afford the lifesaving medicine they need."(See Senator Murray's video response posted on Twitter here.)

Sen. Kirsten Gillibrand, a Democrat from New York, wrote in a tweet: "We've already seen far too many people risk their lives and health by rationing insulin they can't afford. It's unconscionable that we're letting this tragedy continue."

Democratic Rep. Bill Pascrell, of New Jersey, said on Twitter that Republicans "told millions of Americans (with Diabetes) who use insulin to go to hell. Remember their names."

The 43 Republicans who voted against the price cap are:

John Barrasso, WY
Marsha Blackburn, TN
Roy Blunt, MO
John Boozman, AR
Mike Braun, IN
Richard Burr, NC
Shelly Moore Capito, WV
John Cornyn, TX
Tom Cotton, AR
Kevin Cramer, ND
Mike Crapo, ID
Ted Cruz, TX
Steve Daines, MT
Joni Ernst, IA
Deb Fischer, NE
Lindsey Graham, SC
Chuck Grassley, IA
Bill Hagerty, TN
John Hoeven, ND
Jim Inhofe, OK
Ron Johnson, WI
James Lankford, OK
Mike Lee, UT
Cynthia Lummis, WY
Roger Marshall, KS
Mitch McConnell, KY
Jerry Moran, KS
Rand Paul, KY
Rob Portman, OH
Jim Risch, ID
Mitt Romney, UT
Mike Rounds, SD
Marco Rubio, FL
Ben Sasse, NE
Rick Scott, FL
Tim Scott, SC
Richard Shelby, AL
John Thune, SD
Thom Tillis, NC
Patrick Toomey, PA
Tommy Tuberville, AL
Roger Wicker, MS
Todd Young, IN

Insulin should be free! Going to Canada to purchased insulin

"...for some patients, it is increasingly difficult to survive as a diabetic in America," Glenn Howatt, published in the Star Tribune, a Minnesota newspaper.  

Insulin outlaws: High cost of medication drives Minnesotans across the border to Canada

(MaineWriter-In my opinion, Insulin for diabetics should be free.)

Diabetes activists cross the border to snare affordable medicine and supplies.

Fort Frances, Ontario – Six Minnesota diabetes activists, who have dubbed themselves the “Caravan to Canada,” approached the U.S. border crossing last Sunday with a mixture of apprehension and defiance.

Their three vehicles were carrying insulin, carefully packed in coolers, that they had bought the day before at a Canadian pharmacy just three blocks away.

Together, they had spent $1,265 for insulin supplies that in the United States would cost an estimated $12,400 — a savings of $11,000.

But as they crossed the Rainy River into International Falls and made their way to the small border outpost wedged among industrial buildings, they wondered if they would be searched — or even if the insulin would be seized.

“I was nervous when all of a sudden we approached the border,” said Lija Greenseid, the trip’s organizer and mother of a teenage daughter with Type 1 diabetes.

Importing prescription drugs into the United States is illegal, and government health officials have warned consumers that drugs bought outside of American’s regulatory umbrella could be counterfeit and unsafe.

But as they crossed the Rainy River into International Falls and made their way to the small border outpost wedged among industrial buildings, they wondered if they would be searched — or even if the insulin would be seized.

“I was nervous when all of a sudden we approached the border,” said Lija Greenseid, the trip’s organizer and mother of a teenage daughter with Type 1 (insulin dependent) diabetes.

Importing prescription drugs into the United States is illegal, and government health officials have warned consumers that drugs bought outside of American’s regulatory umbrella could be counterfeit and unsafe.

But they made the trip because, for some patients, it is increasingly difficult to survive as a diabetic in America. 

High costs are draining their savings; insulin prices doubled between 2012 and 2016.

Insurance restrictions are making it harder for them to get the insulin that works best for them, as well as the supplies they need to test their blood and inject the medication.

“We talk about freedom here all the time, but the medical system here causes people to be shackled,” said Greenseid.

“I always thought it was just me that had these issues,” said Vicky Luedtke, a Type 1 diabetic who has never been involved with activism before. “I met these amazing people and I saw it is more than just me. It is a huge epidemic.”

Traveling with the group was Nicole Smith-Holt, whose son Alec Smith died about two years ago. He was rationing insulin because he couldn’t afford what he needed.

She made a symbolic purchase of a single vial of insulin — one vial would have extended her son’s life.

“There are so many what-ifs,” she said. “I would have crawled here if I had known that I could come to Canada.”

The public outcry over high insulin prices has sparked some movement. Congress has held hearings, one insurer has capped insulin co-pays and one drug maker will offer a generic insulin at half price. But even at that discount it will still cost five times as much as insulin sold in Canada.

In Minnesota, both the House and Senate have passed bills that would give people access to insulin during an emergency, although the differences between the bills need to be worked out in a conference committee.

Insulin’s high cost in the United States reflects many factors, including patent protections that keep competitors out of the market. The pharmacy trade group PhRMA contends that net prices have dropped but that consumers often don’t see that because they don’t receive the rebates that the industry pays to health insurers and their pharmacy benefit managers.

But unlike most other industrialized countries, drugmakers can set their own prices in the United States. The Canadian government, for example, negotiates with the three big insulin makers that dominate the market worldwide, which results in insulin prices that can be one-tenth of those in the United States. Insulin also can be purchased in Canada without a prescription.

The public outcry over high insulin prices has sparked some movement. Congress has held hearings, one insurer has capped insulin co-pays and one drugmaker will offer a generic insulin at half price. But even at that discount it will still cost five times as much as insulin sold in Canada.

In Minnesota, both the House and Senate have passed bills that would give people access to insulin during an emergency, although the differences between the bills need to be worked out in a conference committee.

Insulin’s high cost in the United States reflects many factors, including patent protections that keep competitors out of the market. The pharmacy trade group PhRMA contends that net prices have dropped but that consumers often don’t see that because they don’t receive the rebates that the industry pays to health insurers and their pharmacy benefit managers.

But unlike most other industrialized countries, drug makers can set their own prices in the United States. The Canadian government, for example, negotiates with the three big insulin makers that dominate the market worldwide, which results in insulin prices that can be one-tenth of those in the United States. Insulin also can be purchased in Canada without a prescription.

$410 v. $5,250

Travis Paulson, another member of last weekend’s caravan, can remember when insulin cost $8 a vial.

“It just kept climbing,” he said.

The medication is now so expensive that he doesn’t use health insurance to buy it. Instead, he gets it mostly from Canada — driving there from his Eveleth home when the weather is good or using a mail-order pharmacy in Vancouver. He hasn’t bought insulin in the United States for many years.

“It is just craziness to what the prices have gotten to in America,” he said.

Paulson paid about $410 in Canada for 15 vials of insulin that would have cost $5,250 in the States. 

The supply should last him three to four months.

On his insulin trips to Canada, Paulson often stays overnight. “They can get suspicious if you come and leave on the same day,” he said. “I don’t want my car to be torn up and searched.”

But he has never had a problem getting it across the border.
Although it is illegal, the U.S. Food and Drug Administration (FDA) website says “it typically does not object” to imports if they are for personal use and the supply is for less than three months.

Drug importation from Canada is not new for Minnesotans. Beginning in 1995, the Minnesota Senior Federation organized bus trips to buy drugs north of the border. They gained more popularity after Mark Dayton, then a U.S. senator, pledged his government salary to pay for the trips.

The state of Minnesota also got involved. In 2004, then-Gov. Tim Pawlenty set up the nation’s first state-sponsored program to help residents buy drugs from Canada. The FDA opposed the program but never acted to shut it down.

After Medicare introduced drug coverage in 2006, demand for both services dwindled. The bus trips stopped in 2007 and the state shut down its program in 2010 after facilitating 25,000 prescriptions at a savings of $1.7 million.

Dropped her insurance

Twenty years ago, the demand for Canadian drugs was not as high among Americans under age 65. Back then, most people with private insurance faced a small copay. But since then, health insurers have adopted deductibles as a way to control costs and shift more expense to the consumer. Many people now pay sums like $7,500 before their insurance kicks in.

That means diabetics often spend the first few months of each year paying the full cost of insulin. 

Additionally, insurers have limited the number of insulin formulations and supplies to one or two brands, another move to cut spending.

As a result, some people, like Luedtke, are going without insurance. “When I had insurance, I couldn’t get my medications,” she said. “I would rather take all my money and invest it in myself.”

Luedtke, who runs a fitness studio, works with doctors and other providers who specialize in cash-paying customers. Without having to employ office staff for insurance company paperwork, these providers can offer lower prices.

Still, she is concerned what would happen should she develop a major illness.

“I do worry about that a lot, especially with diabetes,” she said. But, she added, “I worry more about not having insulin than health insurance.”

Altogether, it took about 15 minutes for five people in the caravan to buy the insulin at a small Fort Frances pharmacy called Shoppers Drug Mart.

Customs turned out to be even faster the next day. As they had decided the previous night, they told the border officer that they were bringing insulin back in.

The disclosure drew no interest or questions from the agent. Instead, he asked about alcohol, tobacco and firearms.

After the caravan made its way through, they stopped to talk.

“That was a nonevent, huh?” said Greenseid.

“Let’s do it again,” said Luedtke. “None of us are asking for something free. We just want to be able to take care of ourselves.”

Mississippi has dismal health and economic data

Mississippi has highest poverty and lowest income

Mississippi again unhealthiest state in the country

It's time again for the United Health Foundation's annual state health rankings report, and like last year, Mississippi comes in 50th.

Despite being a leader in telehealth and, historically, childhood vaccinations, Mississippi's high rate of childhood poverty, obesity and cigarette smoking contributes to it being the unhealthiest state in the country, according to the 2017 America's Health Rankings report.

Of the five categories examined in the report, Mississippi ranked overall 50th for one: clinical care. This has to do with Mississippi's doctor shortage, lack of mental health providers and preventable hospitalizations.

The state ranked 49th for behaviors and 44th for community and environment — both in which Louisiana came in last — 47th for policy and 48th for health outcomes.

Mississippi has the highest infant mortality rate of any state with 8.8 deaths per every 1,000 live births.

Of the 35 countries in the Organisation for Economic Co-operation and Development, only Turkey and Mexico have higher infant mortality rates than Mississippi.

The health ranking report said Mississippi's rate of babies born underweight — still the highest rate in the nation at 11.4 percent of births — decreased in the last year.

However, according to the 2017 March of Dimes Premature Birth Report Card, Mississippi's rate of premature births is rising, 13.6 percent this year, up more than half a percent from 2016.

Many of Mississippi's health issues are tied to the state's high rate of poverty.

"Poverty influences a family's ability to meet children's basic needs and may limit access to health care, healthy foods, educational opportunities and physical activity choices. Children living in poverty are three times more likely to have unmet health needs than other children," the report reads.

Nearly one-third of Mississippi children, or more than 220,000 kids, live in poverty. This disproportionately affects African-American children in the state, almost half of whom live in poverty compared to 17 percent of white children.

In the report, Mississippi also came in last for cardiovascular deaths, including heart disease, stroke, hypertension, heart attack and heart failure — 352.5 of every 100,000 people.

"Cardiovascular disease is treatable and may be prevented by maintaining a healthy weight, eating healthy, participating in physical activity, limiting alcohol and avoiding tobacco. Cardiovascular disease is responsible for 17 percent of medical spending and 30 percent of Medicare spending," the report states.

In general, Mississippi had the highest rate of premature deaths, accounting for 10,950 years of life lost per 100,000 people. Mississippi also ties with Mexico for life expectancy at 75 years, the lowest in the country.

More than 12 percent of Mississippians lack health insurance, giving Mississippi the sixth worst uninsured rate in the nation.

Mississippi had the third-highest rate of diabetes and preventable hospitalizations and the fourth lowest number of primary care physicians, 105.9 per 100,000 people versus 149.7 nationally.

Mississippi also ranks 49th for its number of dentists, 42.2 versus the national average of 60.8 per 100,000 people.

"Nearly one-third of U.S. adults have untreated tooth decay, and despite steady growth in working dentists, many areas and populations do not have an adequate supply of dentists to meet current needs," the report states.

The state ranks 45th for its number of mental health providers, 132.6 per 100,000 people compared to a national average of 218.

Mississippi has often received praise for its high childhood immunization rate — 99.7 percent of kindergartners were fully vaccinated in 2014 — which can be partially attributed to the state's strict exemption laws. But in the 2017 health ranking report, Mississippi comes in last for adolescent vaccinations.

A statement from the Mississippi State Department of Health said the rate of Tdap vaccinations have improved since the state enacted a 7th grade entry requirement for the 2012-2013 school year.

"We actually received the CDC Healthy People 2020 Immunization Coverage Award for the most improved coverage among adolescents in September," said the statement from State Epidemiologist Dr. Paul Byers. "While there have also been improvements in the rates for meningococcal vaccination and some improvements in use of the HPV vaccine, HPV has been underutilized in Mississippi for both males and females. For childhood vaccination rates it is important to note that the Mississippi vaccination rate for kindergarten entry is greater than 99% and has been among the highest in the U.S. for a number of years."

Mississippi ranks near the middle for its rate of early childhood vaccinations with just over 70 percent of children between 19 and 35 months receiving all recommended doses.

Mississippi came in second to last for both obesity and inactivity behind West Virginia and Arkansas, respectively. Almost 23 percent of Mississippians smoke cigarettes, "which can damage nearly every organ and potentially cause respiratory disease, heart disease, stroke, cancer, preterm birth, low birthweight and premature death."

The report shows Mississippi with a relatively low rate of drug deaths — ranked eighth in the country — but that could be more indicative of the state's reporting of those deaths. Law enforcement officers have told the Clarion Ledger that overdose deaths in the state are underreported, making the prevalence hard to measure.

Presumably because of its historically high childhood vaccination rate, Mississippi ranked first for having the lowest rate of pertussis (whooping cough) cases in the nation.

Mississippi ranked 15th for a relatively low rate of violent crimes, 281 offenses per 100,000 people.

The state had the highest rate of Salmonella cases in the country.

Children ~ when pharmacy management cut benefits: echo from West Virginia

"Big pharma" is an euphemism for "Big profits", at the expense of quality patient care.

Diabetes insulin

In other words, when pharmacy management programs cut particular drugs our of their formulary lists (meaning the medicine is not covered), the result is that patients must either pay the price gouging costs or suffer the health  consequences. In the situations where children with diabetes cannot obtain their pharmacy needs through their insurance plans, either via Medicaid or private coverage, the problem can lead to preventable chronic health diseases or even early death.  Although this "echo", editorial published in the West Virginia Gazette Mail newspaper and blogged by me, the opinion describes the situation in the Mountain State and the price gouging, in fact, is also going on in other states.

Children pay when insurers cut diabetes coverage

Children with diabetes face a lifetime of challenges. 

However, if insurers continue to exclude more and more diabetes-related medications and supplies from coverage, those children and their families could be saddled with a lifetime of exorbitant out-of-pocket costs as well.

West Virginia’s rate of diabetes has steadily increased. More than 15 percent of West Virginians have been diagnosed with the disease, the highest rate among all states.

The growing incidence of diabetes may be one reason pharmacy benefit managers (PBMs) — the private companies health plans hire to oversee their prescription drug benefits — consistently exclude diabetes-related medications and supplies from coverage, more than any other treatment category. That’s according to a study by the Doctor-Patient Rights Project, which analyzed the increasing use of formulary exclusion lists, the catalogs PBMs issue to lay out the medicines they will no longer cover.

In the last four years, the number of diabetes-related medications or supplies excluded from coverage by the nation’s two largest PBMs (CVS and Express Scripts) has increased by almost 80 percent, the only treatment category where the PBMs consistently increased the number of excluded medicines every year. Diabetes-related treatments now account for one out of every five medicines excluded from coverage by these PBMs.

PBMs use formulary exclusion lists to compel patients to choose less-expensive treatment, falsely assuming that every diabetes patient will respond the same way to every treatment. They are a form of forced, nonmedical switching designed to save the insurer from having to pay for treatments chosen by the patient and physician.

The Doctor-Patient Rights Project found that many patients asked to switch to a new medication choose to pay out-of-pocket for the treatment their doctor originally prescribed, rather than switch to the insurer’s preferred drug. In effect, formulary exclusions simply transfer more of the cost of prescribed treatments to patients and their families.

Studies show that patients forced to shoulder more of the expense of their medications are more likely to try to make the prescriptions for their original medication last longer by splitting pills or skipping doses of insulin.

People with diabetes who do not experience immediate symptoms from not following proper treatment protocols may wrongly conclude that the medicine remains just as effective or that they need less of it. This is especially true of low-income and minority patients, who are already more likely to develop diabetes and to experience diabetes-related organ failure.

All parents want the best for their child, including the medicine the doctor believes will best care for their child’s diabetes. 

Insurers that refuse to cover certain prescribed diabetes treatments, thinking that parents will simply switch to the insurer’s cheaper alternative, may be gravely mistaken. Forced nonmedical switching may simply increase out-of-pocket expenses for parents, and, as a result, increase the lifetime treatment costs for their children with diabetes.

Forced nonmedical switching may even backfire as a cost-saving strategy for insurers. When patients fail to adhere to proper medication protocols, they make treatment less and less effective.

Reduced adherence, in fact, accounts for up to 10 percent of hospitalizations, 25 percent of nursing home admissions and as many as 125,000 premature deaths annually, according to a study in the Journal of Managed Care & Specialty Pharmacy. 

As a result, it contributes an extra $100 billion to $289 billion in medical expenses each year, at least some of which fall to insurers to pay.

Insurers that target diabetes-related medications and supplies for exclusion are being short-sighted.

When they fully cover prescribed treatments, insurers permit parents to start their children on the most effective medications and to use them appropriately. As a result, they experience improved clinical outcomes and fewer lifetime medical costs. The money saved by letting doctors drive treatment decisions more than compensates for the higher pharmaceutical costs.

This opinion was authored by Jeff Hitchcock, the founder and president of Children with Diabetes, one of the most established and well-trafficked online diabetes communities, and a member of the Doctor-Patient Rights Project. 

Stewart Perry is the past national chairman of the board of the American Diabetes Association, and the parent of a child with diabetes.