Florida's New RX Monitoring Program, loopholes?

[alumni]

It's HIPAA, by the way, not HIPPA. Sorry but pet peeve.
When you sign an application for life insurance or health insurance, you are basically waiving any medical privacy protection you may have had under the HIPAA legislation.
The MIB Group is a corporation organized and funded by hundreds of insurance providers specifically to track the medical histories of insureds and prospective insureds.
I think it has actually been in business for more than 100 years in the US.

[PharmD]

And get ready for them to start throwing your way some anti depressants for pain, not clinical depression. Actual pain relief which is a joke. Cymbalta is already pushing this
on their commercials.

@Alternate, could not agree with you more buddy. Eli Lilly(LLY) will say anything to keep a patent floating. In June 2013, you will see a commercial saying, "Cymbalta for heartburn!"

Yes; Cymbalta helps with chronic musculoskeletal pain. Just like cocaine helps with fatigue. Personally, I would rather use opiates than drown in serotonin-norepinephrine all day.

Also; at comparable therapeutic doses for analgesia, Cymbalta wins the heavy symptom prize and even the harder to get off of trophy!

[Loubitan]

It's HIPAA, by the way, not HIPPA. Sorry but pet peeve.
When you sign an application for life insurance or health insurance, you are basically waiving any medical privacy protection you may have had under the HIPAA legislation.
The MIB Group is a corporation organized and funded by hundreds of insurance providers specifically to track the medical histories of insureds and prospective insureds.
I think it has actually been in business for more than 100 years in the US.

@alumni - sorry about the typo. It is so crazy how all of this works. That was a really helpful post. Can't believe it has been around for 100 years. Do you ever wonder how they kept track of the information before computers. Lots of ledgers I am sure.


@PharmD - you are a pharmacy student. So, is that what big pharma does to keep patents going...they change the label usage for the med? Nutz

[PharmD]

@PharmD - you are a pharmacy student. So, is that what big pharma does to keep patents going...they change the label usage for the med? Nutz

Yes @Loubitan. It is the most modern process of evergreening.

"Brand-name drug companies have used a number of strategies to extend the period of market exclusivity on their drugs, and prevent generic competition. This may involve aggressive litigation to preserve or extend patent protection on their medicines, a process referred to by critics as “evergreening”. Patents are typically issued on novel pharmacological compounds quite early in the drug development process, at which time the ‘clock’ to patent expiration begins ticking. Later in the process, drug companies may seek new patents on the production of specific forms of these compounds, such as single enantiomers of drugs which can exist in both “left-handed” and “right-handed” forms,[11] different inactive components in a drug salt,[12] or a specific hydrate form of the drug salt.[13] If granted, these patents ‘reset the clock’ on patent expiration. These sorts of patents may later be targeted for invalidation (“paragraph IV certification”)[14] by generic drug manufacturers."

A classic example would be the patent of Nexium (omeprazole enantiomer S), after the Prilosec (omeprazole enantiomer R & S) patent terminated. Then, to corner the market, AstraZeneca got Prilosec switched to Prilosec OTC.



Watch closely. Many of the patented drugs listed below will be extended, renamed, or evergreened.

[Loubitan]

@PharmD - So when Oxycontin changed its formulation on the ER tablets, did that extend the patent?

[chera]

I thought this was interesting, and I wanted to get a post and conversation going, because I am curious if we have any insurance agents in PR.and also how other states operate in regards to this. This hapenned to me about 16-18 months ago with an insurance company as it relates to my prescriptoins meds Laws and regulations may have changed, and my memory of the story is not too bad.

I while ago I applied for a Life Insurance Policy...it was the kind where you have to have a doctor physical and blood test with the insurance companies doctor. Part of the application asked me to list ALL the prescription drugs I was prescribed and had taken over the past 24 month period. Of course, I had forgotten about a type of sleeping pill that a friend, who is a cardiologist wrote for me, as I was leaving for Europe for work, and he recommend something other than Ambien for airplane sleeping, and I wanted to try it. I think it was Lunesta or something else lousy that did not work. I totally forgot about it, and it was not in my medical or insurance chart, and I did not list it on the insrance application. When the insurance agent did the policy quote and final proposal, he told me that I had left off this prescription from my list of meds. I told him that he was wrong....and out he came with a list of my meds from his file on me. He was totally correct...and I left this Lunesta crap off the insurance application. The pills sucked, and I threw them away and never really took the pills. . I asked my agent how he obtained that list of my meds, and he told me the application, I signed, allows them to investigate me. I told him I was aware of that, but wanted to know how he received such a consise list of my meds...ones that are not in my medical chart or insurance company records. I asked about my privacy and HIPPA, etc. The answer to the question, "how did they get such an accurate list of my meds," is apparently, insurance companies have access to the Prescription Drug Monitoring Program....HOWEVER INSURANCE COMPANIES HAVE ACCESS TO AN ENHANCED AND MORE COMPREHENSIVE VERSION. I believe that most states Prescription Drug Monitoring Programs only list scheduled medications. Well, Life Insurance companies have access to ALL your medications including cholestoral, high blood pressure...everything. I know that most states PDMP only state controlled meds. Some states might show all. But insurance companies get access to all of the meds. you take. It is like a credit bureau for prescription drugs...they can get it through your date of birth, Social Security Number, addresses, insurance company info, and if you don't have all of these, they can pull it through a combination of these things to make sure they have the right person. I remember my heated post on 12/31 with @alumni talking about what was going on in Florida, and I specifically said that our freedoms and anonymity is being taken away in small, baby steps with little things that the majority of people won't realize. This is another one of those things. How many people know that your prescription meds. list can be accessed when you apply for a Life Insurance Policy. I had to have this policy for my business, and most people would never buy a Major Life Insurance Policy, where the insurance company makes you do a physical. I was shocked by this. Are there any insurance people here In PR? Does anyone else know about this? Then if you question this....the Obama White House will tell you that they are keeping insurance rates down, and it is for the greater good.

Loubitan, what you're talking about has already been a HUGE problem for people living in the state of KY. It seems as though everyone has access to peoples private medical/prescription records. There, I know there's one website that you can go to and retrieve virtually ALL this information on anybody in the state. Insurance agencies and billers, police officers, social service workers, as well as employees at doctors offices. Even though only certain people are supposed to ever be able to access this information (and they are required to have a very specific reason for doing so), that is not what happens in reality.
As a matter of fact, I've even heard rumored that this database has been used by police as a "profiling" tool.

[PharmD]

@PharmD - So when Oxycontin changed its formulation on the ER tablets, did that extend the patent?

Exactly!

Purdue Pharma "Reformulates" Oxycontin and in doing so, extends their patent. They were 15 years into a 20 year patent, and needed to reformulate for public relations reasons as well.

[alumni]

So when Oxycontin changed its formulation on the ER tablets, did that extend the patent?

Sure they did.

[Maggiemaie]

FYI:

The Medical Information Bureau (MIB) was originally established in 1902, it serves the information needs of almost 500 health and life insurance companies in North America that seek health, credit and other information about those consumer-patients who request to be insured. The MIB states its mission as "detecting and deterring fraud that may occur in the course of obtaining life, health, disability income, critical illness, and long-term care insurance." Those savings, the MIB claims, help to lower premiums to insurance-buying consumers.


What Information does the MIB Collect?
•Credit information
•Medical conditions
•Medical tests and results
•Habits such as smoking, overeating, gambling, drugs
•Hazardous avocations and hobbies
•Motor vehicle reports (poor driving history and accidents)

The information collected by the MIB stays on file for seven years. If any of its members have requested your file in the previous 12 months, that will be listed with your records.

You have access to your MIB report once each year at no cost to you. You must call the MIB at (866) 692-6901 (TTY (866) 346-3642 for hearing impaired

[waverunner]

@lighthouse, I hate to bring this up, but did you not sign a contract with your first (or second) pain dr? I can't find the link now, but patients usually sign contracts with their pain doctors, it's considered prudent medical practice in this field but I suspect it's mainly to protect themselves when the DEA comes a knockin; that they have countermeasures in place to detect prescription drug abusers. Anyway, one part of the contract I linked to in a blog had a stipulation that you must fill all your prescriptions at only one pharmacy and the dr would send a copy of the contract to that pharmacy. Every dr may be different, though. So did you sign a contract, perhaps didn't read what you signed, cause lots of patients "robosign", and I want to shake them and say "read what you're signing!!" you know? Just wondering because that is good cause for your pain doc to discharge you. Hate telling you that as pancreatis is so blatantly painful, there's very little dispute about treating the pain with narcotics, at least in hospital settings.

RE: FL's database. Like all databases (and there were a couple of glitches in this one) they're not going to be up and running as of Jan 1, 2012 just because that was the "effective" date; there's some catch-up and nonuniform reporting going on as the law did ask pharmacies to go back 6 months into 2011, forget how long, and enter all this data and THAT I cannot see happening quickly, from a manpower point of view. Might explain the Publix pharmacy blooper. But summary in all of this, like everyone says, safest to be as honest as possible.

Another note about the switch to methadone you mentioned: Have heard that docs are trying to switch patients to methadone whenever there is an opening to do so, and you gave your first doc an opening in posing a switch as a possibility. Have read that in both pain docs, and those private drs who treat addicts with suboxone, trying to switch them over to methadone which everyone knows is by far the worst alternative of the two, but there are uncaring docs in this specialty who are trying to do this. Don't have experience here so don't know why.

Good luck to you, WR

*This post was auto-merged. The following text was added 36 minutes after the last post:*

FYI:

The Medical Information Bureau (MIB) was originally established in 1902, it serves the information needs of almost 500 health and life insurance companies in North America that seek health, credit and other information about those consumer-patients who request to be insured. The MIB states its mission as "detecting and deterring fraud that may occur in the course of obtaining life, health, disability income, critical illness, and long-term care insurance." Those savings, the MIB claims, help to lower premiums to insurance-buying consumers.


What Information does the MIB Collect?
•Credit information
•Medical conditions
•Medical tests and results
•Habits such as smoking, overeating, gambling, drugs
•Hazardous avocations and hobbies
•Motor vehicle reports (poor driving history and accidents)

The information collected by the MIB stays on file for seven years. If any of its members have requested your file in the previous 12 months, that will be listed with your records.

You have access to your MIB report once each year at no cost to you. You must call the MIB at (866) 692-6901 (TTY (866) 346-3642 for hearing impaired

Maggie, you are so right, it is a very good idea to pull this report. I requested my medical history last year and blow me down, I received a short letter saying "nothing on file" which puzzled the H*** out of me as I've had many a test, operations, etc. They gave three reasons as to why this could be and I fit in the last category: I had been covered by a group policy not monitored by MIB and sure enough, for the longest time, was under State insurance so I lucked out. Was toying with life insurance for the fam but knew I wouldn't qualify if I answered truthfully (Globe's 50K offer) so didn't bother sending in the "Just Answer Three Questions" application. Breaks my heart as they sure could use it.

BTW, regarding credit info, IRS sent me a letter llast year that I owed them over $5K from a college loan "I over-reported" on my last income tax report, and I hadn't even filed it yet. Someone had submitted a 1099 in my name, my SS# and had taken out a federal college loan for which they wanted a deduction and REFUND! Took quite awhile to get that straightened out and scared me to death checking all my accounts to see what else the thugs had done, but so far that's it.

So now that the horse has already left the barn, I do have identity theft and highly recommend it in this day and age. It really knocks you out when you get hit with that and it's happening so unbelievably often...never would have dared to do this so blatantly even as little as 10 years ago.

[lumphead]

There's probably a 'grace' period before they will start cracking down on Doctors who do not use the PDMP. The first question, however, would be, is it mandatory for Doctors to use it? Some states do not require their physicians to log data into the databases.

[pia]

Fl was one of the few remaining states that didn't have a monitoring program that is why there was such a great number of pain clincs and all the out of state patients. What angers me is that all these poor pain patients and many are seniors living in FL are going to have a hard time getting their meds

@costa1107
You are so right, the senior citizens living in FL as well as any others who are in need due to chronic pain are the ones that are hurt the most by this.

I live in Miami (Dade county) and have gotten the "look" from a doctor or two when going to an out patient clinic for pain in my hip. Things in FL really started cracking down when Jeb Bush was govenor. His daughter was caught obtaining narcotics illegally.

I do remember that Scott was initially against the rx database, but then did a complete about face. typical politician. The last I heard was that the database wasn't actually ready yet. I wonder if that Eforce is it?

[pia]

Hey whatever happened to those ideals from the 60's and 70's?
Anti- Estabishment! Big Brother is Watching! It seems like the government is constantly thinking up new ways to invade our privacy.

Why doesn't Big Brother find ways to help things that are important to all of us and our planet like:
developing alternative forms of energy
solar power
wind mills
feeding our hungry
stop big business (HMOs) from taking all our $ and giving us less and less medical care

this list goes on and on... anybody?

[alumni]

There's probably a 'grace' period before they will start cracking down on Doctors who do not use the PDMP. The first question, however, would be, is it mandatory for Doctors to use it? Some states do not require their physicians to log data into the databases.

These state monitoring programs typically require pharmacies to regularly report scheduled prescription medications that they fill not doctors.
I'm not aware of any operational state Prescription Monitoring Programs that somehow require mandatory participation by the physicians practicing in their jurisdictions.

[Rocksteady17]

...Sherry Green, CEO of the National Alliance for Model State Drug Laws, told Reuters that some doctors are concerned that the database programs could breach patient confidentiality, and interfere with needed pain treatment. They also worry that the databases could be used against doctors who need to prescribe high amounts of painkillers.

Some doctors object to being required to consult the database every time they prescribe potentially addictive medication, and say it should be left to their discretion, according to Green. They also say using the database is time-consuming. States are trying to increase the speed of the database so that doctors can access information while patients are still in the office. Some states allow doctors to authorize another staff member to use the database on their behalf.
The article notes some doctors see laws requiring mandatory use of the databases as putting law enforcement above health care. The Kentucky Medical Association was able to fight a provision that would have moved the state’s database to the Attorney General’s office.
Many prescription monitoring databases allow doctors and pharmacists to access information from neighboring states, which helps cut down on people driving across state lines to find more prescriptions.
from the website:
Some Doctors Object to Prescription Drug Monitoring Databases | The Partnership

also an update from The Alliance of State Perscription Monitoring Program
http://www.pmpalliance.org/content/p...ws-and-updates

[ronbon]

I have a compound problem in obtaining my pain medications. I take 30, 60 mg Avinza's (slow release morphine) and 90, 30 mg morphine sulphate immediate release (breakthrough pain) each month as prescribed by my pain management doctor. My insurance is Medco and they have started accumulating the days I receive my meds early. Now, when I get my refills each month, I may have to wait several days later to fill it due to the times I received then a little early in the past. My previous provider (insurance) did not do this practice. This would not be a problem but I travel a lot. Say I get my prescriptions on a Friday and I have to wait several days. In the meantime, I leave on Sunday to go out of town. With all the pill mill problems, it is impossible for me to get my script filled out of town. And I have run out due to this situation and you guessed it, I get very ill from withdrawal. I can't even begin to describe how sick I get when this happens. This does not happen a lot but enough to create this situation too often as far as I'm concerned. I knew I was going to run out so I went to my family doctor and asked him to give me some oxycodone for my arthritis. He gives me enough to last me a couple of months but better yet, it is enough opiate to keep me from going into full withdrawal and help with my pain issues until I can get back in town to fill my scripts. My question is; am I positioning myself to get arrested for Dr. shopping? My intent is not to doctor shop but to keep from going into withdrawal due to the situation that has been created. I've done this several times in the past and nothing has come of it. My regular pain mismanagement doc treats me for back and neck while my regular doc is treating me for arthritis. The arthritis is a side effect of Chrone's which I also have. It is a never ending battle. I just worry about getting in trouble due to a legitimate pain issue(s).

[CP08]

So I live in Texas, but I know this is a nationwide new rule as of at least a year ago. I am 25 years old with a spinal fusion and I had a hand surgery while I was on my medication so I decided to pay for that pain medicine without using insurance. It now does not matter. This is why they ask for your I.D any narcotic prescriptions are sent to one city in the state that you live in and when you see pain management doctors if you read the fine print you sign that they have every right to make sure you are not receiving any narcotics from other doctors at all. aLSO, EVEN IF YOU CHOSE NOT TO PAY WITH YOUR INSURANCE A COUPLE TIMES IT MAY WORK BUT EVENTUALLY IT WILL CATCH UP WITH YOU ANd they WILL SEND A LIST OF ALL NARCOTICS to ALL DOCTORs that you are seeing, the doctors that you are getting them from whether you took them or not. Like for my hand I was in surgery so they sent my friend to go get them refilled so i JUST TOOK THEM AND DROPPED THEM OFF AT MY DOCTORS OFFICE TO GET RID OF THEM in the correct way and this also caused my doctor to extremely trust me. Trust me I have extreme paine as well and have went through the methadone situation as well which did not work for me either no matter what the dose. You just need to call and either try and speak with your doctor and explain the situation and usually if you have a good doctor they will work with you otherwise the best advise is to find another, but if you have already seen another there is a chance that both of those doctors are going to get a letter from the pharmacies in a month or two and then you will be dropped from both as I have been through this exact situation so you need to make sure that this is a situation you go ahead and tell the doctor you chose and take any remaining pills you take with you to your appointment to show him and how him what is working for you/ or what is not so they can be properly disposed of and hell believe you that you will no longer be going to see other doctors and y'all can attempt one more time to find a program right for you but what you are doing is going to have you end up in extreme pain because both doctors are going to drop you and it could be a myth before you find another pain management doctor. Because though you are not to a doctor it is going to look like you are just going to get as many pills as you can by seeing two so then once you're dropped its very unlikely your going to be able to find a doctor that doesn't extremely manage you making the cost go up. I would extremely suggest talking to your doctor ASAP.

[Kexessa]

aLSO, EVEN IF YOU CHOSE NOT TO PAY WITH YOUR INSURANCE A COUPLE TIMES IT MAY WORK BUT EVENTUALLY IT WILL CATCH UP WITH YOU

The databases for tracking narcotics is not tied to insurance. Whether it is a doctor checking the database prior to prescribing, or a pharmacy checking before filling a prescription - how the prescription is paid for is not a factor.

Here is a link with a lot of information on how different States run their databases, current legislation, lists some States current laws and has other links related to the subject.

Prevention of Prescription Drug Overdose and Abuse