Vast Web Of Federal Regulation Causing Drug Shortages

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    Jan 05, 2012 9:09 PM GMT
    http://news.investors.com/Article/596775/201201041859/big-government-behind-drug-shortages.htm?src=IBDDAE

    The number of prescription drug shortages shot up to a record 267 in 2011, nearly four times the level of just seven years ago, a new report says. It's a shortage made in Washington.

    The number of drug shortages rose by 56 in 2011 from 211 in 2010, according to a study by the University of Utah Drug Information Service. As recently as 2004, just 58 drugs were in short supply.

    "The inability to get crucial medicines has disrupted chemotherapy, surgery and care for patients with infections and pain," the Associated Press reports.

    What happened? As is often the case, government price and output controls are largely to blame for shortages, which have killed at least 15 people since 2010.

    Take Medicare. It limits the prices it pays for drugs. But in Medicare's Plan B, reimbursements to drugmakers often don't cover the cost of a drug — or shrink profits to such low levels it's no longer worth making it.

    Of course, hospitals still need those drugs. A recent survey found more than half of hospitals routinely buy scarce drugs on the black market — often at exorbitant cost, but without improving the quality of care.

    Just as bad, the Food and Drug Administration imposes strict controls on pharmaceutical companies' output.

    As John Goodman of the National Center for Policy Analysis wrote recently: "(A) drug manufacturer must get approval for how much of a drug it plans to produce, as well as the time frame. If a shortage develops (because, say, the FDA shuts down a competitor's plant), a drug manufacturer cannot increase its output of that drug without another round of approvals."

    But, as we know, central planning doesn't work.

    The Drug Enforcement Agency also strictly regulates minute amounts of "controlled substances" used in making prescription drugs. These DEA and FDA rules are "rigid and inflexible," notes Goodman, adding greatly to costs and removing drugs from the market.

    The result of all this overregulation: lots of drug stockpiling by hospitals anticipating shortages, which ironically causes further shortages and higher prices; and a booming black market for prescription drugs.

    It costs nearly $1 billion and takes 12 years to bring a new drug to market, according to Pharma, the drugmakers' industry group. The financial risk is huge.

    Any surprise drugs are now in short supply? It will only get worse — much worse — under ObamaCare.

    As a result of federal government meddling and its endless rules, Americans will see fewer new drugs, less innovation and lead shorter, less-healthy lives.
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    Jan 06, 2012 12:45 AM GMT
    Far from it for me to tell you what to read, but I would trust the NEJM more than an "investor" site as to the underlying causes of the shortages.

    http://www.nejm.org/doi/full/10.1056/NEJMp1109772
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    Jan 06, 2012 12:48 AM GMT
    The main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs.
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    Jan 06, 2012 12:51 AM GMT
    TropicalMark saidThe main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs.


    That is true, but there's the opposite push for Medicare to save money...which is a good thing, right?
  • musclmed

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    Jan 06, 2012 12:56 AM GMT
    TropicalMark saidThe main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs.


    hmm, whats the Adderal shortage from?

    In the past year its been ridiculous. And considering i have a 85% generic prescribing rate it has effected my patients a great deal.

    But TropicalMark why should anyone make a thing if there is no or little profit? Should they be forced to make it?

  • GQjock

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    Jan 06, 2012 1:22 AM GMT
    Gee .... I WORK in the Medical Field and have to witness and DEAL with drug shortages ALL THE TIME

    and it ain't medicines and the cost or the regulations that are needed to get through to bring them to market because there are shortages of some very well known and established medications
    There are shortages when a company no longer finds it profitable to MAKE or DISTRIBUTE a certain drug
    Because the IS NO regulation that forces a company to continue making or to continue distributing medically necessary drugs

    So go peddle you rightwing fairytales where someone might believe in them
    "Kay?
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    Jan 06, 2012 3:46 AM GMT
    q1w2e3 said
    TropicalMark saidThe main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs.


    That is true, but there's the opposite push for Medicare to save money...which is a good thing, right?


    Ah - thank you for admitting that you think that the shortages are not only a good thing but a natural outcome to Medicare.
  • musclmed

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    Jan 06, 2012 4:10 AM GMT
    GQjock saidGee .... I WORK in the Medical Field and have to witness and DEAL with drug shortages ALL THE TIME

    and it ain't medicines and the cost or the regulations that are needed to get through to bring them to market because there are shortages of some very well known and established medications
    There are shortages when a company no longer finds it profitable to MAKE or DISTRIBUTE a certain drug
    Because the IS NO regulation that forces a company to continue making or to continue distributing medically necessary drugs

    So go peddle you rightwing fairytales where someone might believe in them
    "Kay?



    Some of the shortages have to do with profit margins, but you bring to the forefront a real ideological debate.

    Should the Government force a company to make a drug, despite if it is profitable or not?

    It basically boils down to what sort of government you want to live in, One that manages everything? Or one that allows free enterprise.

    Because the truth is I cant treat everything off of that old 4 dollar list. Occasionally I have to treat with new drugs that cost more$

    Is the government going to pick which ones come to market?

    Second I would say I am able to treat many conditions off the Walmart 4 dollar prescription drug list.
    But if you think about it a Starbucks coffee costs more than a month of Anti-hypertensive drug from that list.

    Last if some of you were so inclined force a company make a drug, maybe think about the unchecked portion of society. That being the legal end ( so called 4th branch of government). They make boatloads of money off of bogus class action claims against Generic and Name brand drugs.
    Its very likely there would be less shortages if companies didnt have to figure in the "lawsuit" that would come from a drug that was on the market for 20 years.
    The only people that suffer from this litigation are patients.

    If any are curious look at the Reglan and Paxil class actions advertisements on TV.


    One very widely prescribed drug Adderall is in short supply because of the DEA red tape, and government bean counters limiting supply. And it has nothing to do with any company decision.
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    Jan 06, 2012 5:19 AM GMT
    riddler78 said
    q1w2e3 said
    TropicalMark saidThe main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs.


    That is true, but there's the opposite push for Medicare to save money...which is a good thing, right?


    Ah - thank you for admitting that you think that the shortages are not only a good thing but a natural outcome to Medicare.


    No, don't put words in my mouth. I'm referring to the following:

    NEJM articleBefore 2003, Medicare reimbursed 95% of the average wholesale price — an unregulated price set by manufacturers — whereas oncologists paid 66 to 88% of that price and thus received $1.6 billion annually in overpayments.3 To blunt unsustainable cost increases, the Medicare Modernization Act mandated that the Centers for Medicare and Medicaid Services (CMS) set reimbursement at the average sales price plus a 6% markup to cover practice costs. This policy has reduced not only drug payments but also demand for generics. In some cases, the reimbursement is less than the cost of administration. For instance, the price of a vial of carboplatin has fallen from $125 to $3.50, making the 6% payment trivial. So some oncologists switched to higher-margin brand-name drugs.4 Why use paclitaxel (and receive 6% of $312) when you can use Abraxane (for 6% of $5,824)?


    ASP + 6% is decent for branded drugs like Procrit without breaking the bank for Medicare, but lousy for generic chemo drugs. Easily reformable (e.g. instead of 6% of ASP an alternative administration fee for certain classes of drugs) and in no way represents a "natural" outcome of drug reimbursement.

    But why am I being dragged again into impolite accusations? Thanks but no thanks.
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    Jan 06, 2012 5:25 AM GMT
    q1w2e3 said
    riddler78 said
    q1w2e3 said
    TropicalMark saidThe main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs.


    That is true, but there's the opposite push for Medicare to save money...which is a good thing, right?


    Ah - thank you for admitting that you think that the shortages are not only a good thing but a natural outcome to Medicare.


    No, don't put words in my mouth. I'm referring to the following:

    NEJM articleBefore 2003, Medicare reimbursed 95% of the average wholesale price — an unregulated price set by manufacturers — whereas oncologists paid 66 to 88% of that price and thus received $1.6 billion annually in overpayments.3 To blunt unsustainable cost increases, the Medicare Modernization Act mandated that the Centers for Medicare and Medicaid Services (CMS) set reimbursement at the average sales price plus a 6% markup to cover practice costs. This policy has reduced not only drug payments but also demand for generics. In some cases, the reimbursement is less than the cost of administration. For instance, the price of a vial of carboplatin has fallen from $125 to $3.50, making the 6% payment trivial. So some oncologists switched to higher-margin brand-name drugs.4 Why use paclitaxel (and receive 6% of $312) when you can use Abraxane (for 6% of $5,824)?


    ASP + 6% is decent for branded drugs like Procrit without breaking the bank for Medicare, but lousy for generic chemo drugs. Easily reformable (e.g. instead of 6% of ASP an alternative administration fee for certain classes of drugs) and in no way represents a "natural" outcome of drug reimbursement.

    But why am I being dragged again into impolite accusations? Thanks but no thanks.


    You are being dragged into it because you yourself have stated that the lack of profitability of some drugs have reduced the incentives for companies to produce and distribute. You have also stated that there's an opposite push for Medicare to save money. Do the math.
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    Jan 06, 2012 5:42 AM GMT
    And let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif
  • musclmed

    Posts: 3283

    Jan 06, 2012 3:17 PM GMT
    Christian73 saidAnd let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif


    Ok, well here is Christian73 the self appointed expert on medicine and physician credentialing ( he knows a few or saw some threw the window once)

    I never discussed with you the parameters of what patient population I serve nor is it relevant.

    But this points out your habitual way of getting personal. ( maybe 20th time he does this to me)

    Nephrologists are Internists and I couldn't imagine one not being Board Certified in Internal Medicine....hmm.

    Also Nephrologist's have been known to see Internal Medicine patients, and even occasionally hold an administrative position in health organizations where this topic may come up?

    Why should anyone visit your close minded world were if it doesnt fit Christian73's theory he just attacks it in an immature manner.

    The truth is the Adderal shortage is due to DEA red tape.
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    Jan 06, 2012 4:16 PM GMT
    musclmed said
    Christian73 saidAnd let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif


    Ok, well here is Christian73 the self appointed expert on medicine and physician credentialing ( he knows a few or saw some threw the window once)

    I never discussed with you the parameters of what patient population I serve nor is it relevant.

    But this points out your habitual way of getting personal. ( maybe 20th time he does this to me)

    Nephrologists are Internists and I couldn't imagine one not being Board Certified in Internal Medicine....hmm.

    Also Nephrologist's have been known to see Internal Medicine patients, and even occasionally hold an administrative position in health organizations where this topic may come up?

    Why should anyone visit your close minded world were if it doesnt fit Christian73's theory he just attacks it in an immature manner.

    The truth is the Adderal shortage is due to DEA red tape.


    That wasn't personal. It was a question about your profession.

    I'm sure lots of nephrologists are treating kids for ADHD.
  • musclmed

    Posts: 3283

    Jan 06, 2012 7:20 PM GMT
    Christian73 said
    musclmed said
    Christian73 saidAnd let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif


    Ok, well here is Christian73 the self appointed expert on medicine and physician credentialing ( he knows a few or saw some threw the window once)

    I never discussed with you the parameters of what patient population I serve nor is it relevant.

    But this points out your habitual way of getting personal. ( maybe 20th time he does this to me)

    Nephrologists are Internists and I couldn't imagine one not being Board Certified in Internal Medicine....hmm.

    Also Nephrologist's have been known to see Internal Medicine patients, and even occasionally hold an administrative position in health organizations where this topic may come up?

    Why should anyone visit your close minded world were if it doesnt fit Christian73's theory he just attacks it in an immature manner.

    The truth is the Adderal shortage is due to DEA red tape.


    That wasn't personal. It was a question about your profession.

    I'm sure lots of nephrologists are treating kids for ADHD.



    ADULTS take this medication fyi just as well.

    I don't treat patients under 15.

    But you wouldn't know that would you, since the depth of your knowledge on the topic is google's first page.
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    Jan 06, 2012 9:31 PM GMT
    musclmed said
    Christian73 said
    musclmed said
    Christian73 saidAnd let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif


    Ok, well here is Christian73 the self appointed expert on medicine and physician credentialing ( he knows a few or saw some threw the window once)

    I never discussed with you the parameters of what patient population I serve nor is it relevant.

    But this points out your habitual way of getting personal. ( maybe 20th time he does this to me)

    Nephrologists are Internists and I couldn't imagine one not being Board Certified in Internal Medicine....hmm.

    Also Nephrologist's have been known to see Internal Medicine patients, and even occasionally hold an administrative position in health organizations where this topic may come up?

    Why should anyone visit your close minded world were if it doesnt fit Christian73's theory he just attacks it in an immature manner.

    The truth is the Adderal shortage is due to DEA red tape.


    That wasn't personal. It was a question about your profession.

    I'm sure lots of nephrologists are treating kids for ADHD.



    ADULTS take this medication fyi just as well.

    I don't treat patients under 15.

    But you wouldn't know that would you, since the depth of your knowledge on the topic is google's first page.


    Lol, it must be specific to California (?lifestyle or otherwise). I have never prescribed Adderall to any nephrology patients...and I've been in practice for the last 7 years, besides some time as a hospitalist.

    Besides DEA red tape, it's plainly just because more people are diagnosed with ADHD (thanks to great marketing by drug companies) and the controlled substances rules haven't been changed yet to accomodate the demand.
  • musclmed

    Posts: 3283

    Jan 07, 2012 12:16 AM GMT
    q1w2e3 said
    musclmed said
    Christian73 said
    musclmed said
    Christian73 saidAnd let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif


    Ok, well here is Christian73 the self appointed expert on medicine and physician credentialing ( he knows a few or saw some threw the window once)

    I never discussed with you the parameters of what patient population I serve nor is it relevant.

    But this points out your habitual way of getting personal. ( maybe 20th time he does this to me)

    Nephrologists are Internists and I couldn't imagine one not being Board Certified in Internal Medicine....hmm.

    Also Nephrologist's have been known to see Internal Medicine patients, and even occasionally hold an administrative position in health organizations where this topic may come up?

    Why should anyone visit your close minded world were if it doesnt fit Christian73's theory he just attacks it in an immature manner.

    The truth is the Adderal shortage is due to DEA red tape.


    That wasn't personal. It was a question about your profession.

    I'm sure lots of nephrologists are treating kids for ADHD.



    ADULTS take this medication fyi just as well.

    I don't treat patients under 15.

    But you wouldn't know that would you, since the depth of your knowledge on the topic is google's first page.


    Lol, it must be specific to California (?lifestyle or otherwise). I have never prescribed Adderall to any nephrology patients...and I've been in practice for the last 7 years, besides some time as a hospitalist.

    Besides DEA red tape, it's plainly just because more people are diagnosed with ADHD (thanks to great marketing by drug companies) and the controlled substances rules haven't been changed yet to accomodate the demand.


    I am an administrator as well ( Plan B) So I can live out my life expectancy.

    the area I do practice in has an unusual population linked to the Entertainment Industry. For the most part its exclusively that demographic.

    Thanks to the Affordable care act, many lost mental health coverage and they have to go to PCP's to get meds formerly written by psychiatrists.

    And yes it took 20 minutes of time at meeting several months ago, its a big problem in Los Angeles and the big cities.

    If you are in 7 years, start now for your IM board re-certification, I just finished and its alot of nonsense.

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    Jan 07, 2012 12:38 AM GMT
    musclmed said
    q1w2e3 said
    musclmed said
    Christian73 said
    musclmed said
    Christian73 saidAnd let's all wonder why a renal doctor is prescribing Adderall... icon_rolleyes.gif


    Ok, well here is Christian73 the self appointed expert on medicine and physician credentialing ( he knows a few or saw some threw the window once)

    I never discussed with you the parameters of what patient population I serve nor is it relevant.

    But this points out your habitual way of getting personal. ( maybe 20th time he does this to me)

    Nephrologists are Internists and I couldn't imagine one not being Board Certified in Internal Medicine....hmm.

    Also Nephrologist's have been known to see Internal Medicine patients, and even occasionally hold an administrative position in health organizations where this topic may come up?

    Why should anyone visit your close minded world were if it doesnt fit Christian73's theory he just attacks it in an immature manner.

    The truth is the Adderal shortage is due to DEA red tape.


    That wasn't personal. It was a question about your profession.

    I'm sure lots of nephrologists are treating kids for ADHD.



    ADULTS take this medication fyi just as well.

    I don't treat patients under 15.

    But you wouldn't know that would you, since the depth of your knowledge on the topic is google's first page.


    Lol, it must be specific to California (?lifestyle or otherwise). I have never prescribed Adderall to any nephrology patients...and I've been in practice for the last 7 years, besides some time as a hospitalist.

    Besides DEA red tape, it's plainly just because more people are diagnosed with ADHD (thanks to great marketing by drug companies) and the controlled substances rules haven't been changed yet to accomodate the demand.


    I am an administrator as well ( Plan B) So I can live out my life expectancy.

    the area I do practice in has an unusual population linked to the Entertainment Industry. For the most part its exclusively that demographic.

    Thanks to the Affordable care act, many lost mental health coverage and they have to go to PCP's to get meds formerly written by psychiatrists.

    And yes it took 20 minutes of time at meeting several months ago, its a big problem in Los Angeles and the big cities.

    If you are in 7 years, start now for your IM board re-certification, I just finished and its alot of nonsense.



    So basically, he's giving speed to spoiled entertainment industry folks.

    Got it!
  • musclmed

    Posts: 3283

    Jan 07, 2012 12:57 AM GMT

    Christian73So basically, he's giving speed to spoiled entertainment industry folks.

    Got it!


    There is an Oxycodone shortage from time to time, are those pain patients prescribed "heroine" ?

    thank god you dont take care of people Christian73.

    Patients who have ADHD are not prescribed "speed"

    Are cameramen , and writers spoiled? Do tell, because everyone wants to hear who Christian73 will pass judgment on next?

    again a clear distraction from the thread topic. And in total line with your way of dehumanizing people, especially on topics you know nothing about.

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    Jan 07, 2012 2:19 AM GMT
    musclmed said
    Christian73So basically, he's giving speed to spoiled entertainment industry folks.

    Got it!


    There is an Oxycodone shortage from time to time, are those pain patients prescribed "heroine" ?

    thank god you dont take care of people Christian73.

    Patients who have ADHD are not prescribed "speed"

    Are cameramen , and writers spoiled? Do tell, because everyone wants to hear who Christian73 will pass judgment on next?

    again a clear distraction from the thread topic. And in total line with your way of dehumanizing people, especially on topics you know nothing about.



    I sincerely hope you got your degree from a correspondence school because if you're representative of today's medical schooling, we're doomed.

    ADHD is a nearly fictional disease and Adderall is an amphetamine.

    And, as others have noted, the reason for shortages is greed. If the drug isn't making money, it's a not a priority to manufacture. Were it up to me, the government would establish nonprofits to produce all generic drugs and fuck Big Pharma.
  • musclmed

    Posts: 3283

    Jan 07, 2012 2:37 AM GMT
    Christian73
    I sincerely hope you got your degree from a correspondence school because if you're representative of today's medical schooling, we're doomed.

    ADHD is a nearly fictional disease and Adderall is an amphetamine.

    And, as others have noted, the reason for shortages is greed. If the drug isn't making money, it's a not a priority to manufacture. Were it up to me, the government would establish nonprofits to produce all generic drugs and fuck Big Pharma.


    I am definitive not a Psychiatrist, but thank you for enlightening the RJ community with your expertise on the topic.

    What other conditions don't exist Christian73.

    And you know about medical schools, I forgot, your 100 other posts on the topic. Your aunt is a nurse and you know a few doctors? did i remember that right?

    Codeine is a opiate, so is Heroine?

    We use anti-depressants for pain management is that wrong as well?

    Your only experience with Amphetamines may be interactions with Exctasy/ Crank or Crystal meth

    They are NOT the same, and patients do not get HIGH with ADD when taking prescribed stimulants.
    We also use use stimulants for Respiratory disorders and Narcolepsy, is that wrong too?

    Lets see how far you can go with the discussion with your friend google.

    Of course your entitled to your opinion. But don't you think before declaring a disease doesn't exist you should have some knowledge on the topic.
    My question is, based on what do you declare ADD non existent.
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    Jan 07, 2012 4:53 AM GMT
    musclmed said
    Christian73
    I sincerely hope you got your degree from a correspondence school because if you're representative of today's medical schooling, we're doomed.

    ADHD is a nearly fictional disease and Adderall is an amphetamine.

    And, as others have noted, the reason for shortages is greed. If the drug isn't making money, it's a not a priority to manufacture. Were it up to me, the government would establish nonprofits to produce all generic drugs and fuck Big Pharma.


    I am definitive not a Psychiatrist, but thank you for enlightening the RJ community with your expertise on the topic.

    What other conditions don't exist Christian73.

    And you know about medical schools, I forgot, your 100 other posts on the topic. Your aunt is a nurse and you know a few doctors? did i remember that right?

    Codeine is a opiate, so is Heroine?

    We use anti-depressants for pain management is that wrong as well?

    Your only experience with Amphetamines may be interactions with Exctasy/ Crank or Crystal meth

    They are NOT the same, and patients do not get HIGH with ADD when taking prescribed stimulants.
    We also use use stimulants for Respiratory disorders and Narcolepsy, is that wrong too?

    Lets see how far you can go with the discussion with your friend google.

    Of course your entitled to your opinion. But don't you think before declaring a disease doesn't exist you should have some knowledge on the topic.
    My question is, based on what do you declare ADD non existent.


    Psychiatric diagnoses are particularly problematic and ADHD is particularly troubling because it has exploded by 400% in the past decade or so to the point that millions of American children are drugged on a daily basis. Yet, ADHD is almost unknown outside of Western societies, and the "epidemic of ADHD among baseball players' coincided directly with the banning of stimulant use by major league players.

    The diagnosis has been controversial within the psychiatric community since its inception and politically it has been questioned by both sides of the aisle. There have also been widespread reports of teenagers and adults using ADHD drugs to get high and illegal trafficking in said drugs. Aside from illicit use, Americans are the most drugged population in the world. A good book on the subject is "Our Daily Meds."

    My knowledge comes from reading extensively on the subject, knowing kids and adults diagnosed with ADHD, having a particular interest in addiction and psychiatry due to a family history with both issues. I presume you're following the extensive controversy around the DSM-V and the complaints that new and revised diagnoses are part of an ongoing pathologization of normal human variation.

    As a doctor, if you do not know this, one wonders if you should be treating anyone.
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    Jan 07, 2012 5:18 AM GMT
    musclmed said
    Thanks to the Affordable care act, many lost mental health coverage and they have to go to PCP's to get meds formerly written by psychiatrists.


    Please elucidate.

    http://www.healthcare.gov/blog/2010/08/mentalhealthupdate.html
    http://www.huffingtonpost.com/2011/01/12/health-care-reform-mental-health_n_807744.html

    I'm recertifying this year. Not looking forward to the paperwork.
  • musclmed

    Posts: 3283

    Jan 07, 2012 9:25 AM GMT
    q1w2e3 said
    musclmed said
    Thanks to the Affordable care act, many lost mental health coverage and they have to go to PCP's to get meds formerly written by psychiatrists.


    Please elucidate.

    http://www.healthcare.gov/blog/2010/08/mentalhealthupdate.html
    http://www.huffingtonpost.com/2011/01/12/health-care-reform-mental-health_n_807744.html

    I'm recertifying this year. Not looking forward to the paperwork.


    Mental health coverage parity has caused many companies to DROP coverage all together.

    So if a company provided some mental health, it was required to equal in total dollar amount to the Medical side.

    An unintended consequence the companies are just DROPPING the mental health coverage. The law doesn't require them to cover mental health at all.
    Something not mentioned in the articles you listed.


    http://www.1-800-therapist.com/news-article/2008-law-may-result-more-insurance-providers-dropping-mental-health-coverage-employees

    [quote][cite][/cite]Some health plans are dropping mental-health and addiction-treatment plans entirely to circumvent the Mental Health Parity and Addiction Equity Act, which was signed into law in 2008 and takes effect for many plans beginning in 2011. Among those shirking mental-health benefits entirely include the Screen Actors Guild (SAG), which covers almost 12,000 enrollees, the Plumbers Welfare Fund (3,500 members) and Woodman's Food Market (2,200 employees).[/quote]

    Because of this the plan refuses to pay for ANY mental health ICD9 codes, so they are asking providers to start taking on mental health and not paying for it.

  • musclmed

    Posts: 3283

    Jan 07, 2012 9:44 AM GMT

    Christian73Psychiatric diagnoses are particularly problematic and ADHD is particularly troubling because it has exploded by 400% in the past decade or so to the point that millions of American children are drugged on a daily basis. Yet, ADHD is almost unknown outside of Western societies, and the "epidemic of ADHD among baseball players' coincided directly with the banning of stimulant use by major league players.

    The diagnosis has been controversial within the psychiatric community since its inception and politically it has been questioned by both sides of the aisle. There have also been widespread reports of teenagers and adults using ADHD drugs to get high and illegal trafficking in said drugs. Aside from illicit use, Americans are the most drugged population in the world. A good book on the subject is "Our Daily Meds."

    My knowledge comes from reading extensively on the subject, knowing kids and adults diagnosed with ADHD, having a particular interest in addiction and psychiatry due to a family history with both issues. I presume you're following the extensive controversy around the DSM-V and the complaints that new and revised diagnoses are part of an ongoing pathologization of normal human variation.


    As a doctor, if you do not know this, one wonders if you should be treating anyone.

    Yes but is it FICTIONAL diagnosis as you say. Nice dissertation. But what does anything you just typed or pasted here have anything to do with whether ADD is a legitimate diagnosis.


    "ADHD is a nearly fictional disease and Adderall is an amphetamine.

    Really doctor Christian73. Try saying that to someone diagnosed with the problem.

    First you started questioning why I would prescribe Adderall as a Nephrologist . honestly a few times in my career. Only as a continuation medication. But it is certainly nearly impossible to find due to a DEA red tape situation. And it certainly comes up when several hundred patients in your health network have the problem.

    Second you question much of all Psychiatry

    Whether or not you are WELL READ, that's all you are. You do not take care of real patients Dr Christian. That's why you lack the context and experience to take the opinions you find on the internet and put them in the proper context.

    You always seem to go back to this personal attack

    Christian73"As a doctor, if you do not know this, one wonders if you should be treating anyone.
    "

    By what miracle of god do you know what it takes to treat any patient or train any physician.

    By the way DSM-V is set to obliterate Narcissist personality disorder. I should submit some of your theories of medicine for them to reinstate the disorder in the DSM-V. It sure has convinced me it exists.

    Las if I were to encapsulate Hubris with a picture, your Avatar would be denote it.


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    Jan 07, 2012 3:58 PM GMT
    My own opinion (which is endorsed by all of my partners): If I'm not an expert in prescribing specialized medicines, I will not renew a medicine when patients ask me. Adderall is one of those medicines. Similarly, if a patient were on Cytoxan for chemo reasons, they'd better go back to their oncologist for it, even though I do prescribe Cytoxan for completely different reasons.

    "Thanks to the Affordable care act, many lost mental health coverage and they have to go to PCP's to get meds formerly written by psychiatrists."

    "Many" is a vague term.

    http://healthland.time.com/2011/12/09/despite-fears-mental-health-parity-law-has-not-caused-drop-in-coverage/
    But the new GAO report found that 96% of businesses with more than 50 employees that responded to the survey offered mental health and substance use disorders coverage both before and after the law went into effect. Only 2% said they dropped this coverage to cut costs after 2008.

    The most common change after the law was passed was broader coverage, with fewer limits on things like the number of therapy visits permitted, and lower out-of-pocket costs for employees.

    Unfortunately, only 24% of employers responded to the GAO survey, so it is possible that it is not representative or biased toward those that made positive changes. Only 168 employers provided usable responses. However, other national reports on mental health coverage before and after the 2008 law reported similar results.


    http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/KeepMentalHealth.aspxA February 2010 Hewitt survey of 70 Fortune 500 employers that offer mental health benefits confirms Mahieu’s assertion. None of the surveyed companies had eliminated mental health/substance abuse coverage since the law was enacted in 2008. Many took steps to comply with the initial legislation. For example:

    • All surveyed companies eliminated annual and lifetime maximums, a key component of the new regulations.

    • One in five (20 percent) modified mental health or substance abuse precertification requirements or adjusted the diagnoses and services covered under the plan, such as eliminating or adding coverage for specific services or adding out-of-network coverage.

    • Almost all (98 percent) maintained their administrative arrangement with their mental health or substance abuse vendors.