High-dollar Prescribers Proliferate in Medicare’s Drug Program

first_imgSign up for our COVID-19 newsletter to stay up-to-date on the latest coronavirus news throughout New York By Charles Ornstein and Ryann Grochowski JonesThe number of doctors who each prescribe millions of dollars of medications annually in Medicare’s drug program has soared, driven by expensive hepatitis C treatments and rising drug prices overall, federal data obtained by ProPublica shows.The number of providers who topped the $5 million mark for prescriptions increased more than tenfold, from 41 in 2011 to 514 in 2015. The number of prescribers—mostly physicians but also nurse practitioners–exceeding $10 million in drug costs jumped from two to 70 over the same time period, according to the data.Most of the doctors atop the spending list prescribed Harvoni or Sovaldi, relatively new drugs that cure hepatitis C. Other providers on the list prescribed pricey drugs to treat cancer, multiple sclerosis and rheumatoid arthritis.Medicare’s drug program, known as Part D, covers more than 41 million seniors and disabled people. In 2015, it accounted for $137.4 billion in drug spending, before factoring in rebates from drug companies. That was up from $121.5 billion a year earlier.“The trends in this space are troubling and don’t show any signs of abating,” said Tim Gronniger, deputy chief of staff at the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare. “It’s going to be a pressure point for patients and the program for the foreseeable future.”During the recent presidential campaign, both Hillary Clinton and Donald Trump pledged to tackle the rising costs of prescription drugs. Since his election, however, President-elect Trump’s transition agenda for health care hasn’t featured the topic, a shift the Los Angeles Times reported.Medicare has released top-level data on drug spending for 2015, including the number of doctors who prescribed medications worth more than $1 million. But the agency has only published data on individual doctors up to 2014.Dr. Ben Thrower, medical director of the Multiple Sclerosis Institute at the Shepherd Center in Atlanta, was near the top of the list in 2014. He prescribed medications costing $11.5 million that year, mostly for multiple sclerosis drugs. “We get that it’s very expensive,” Thrower said. “I think all the MS providers working in the U.S. would like to see the costs go down.” But prices have climbed steadily in recent years for drugs used to treat the neurological condition, even those that have been on the market for quite a while.Most of the spending on Thrower’s prescriptions – $8.5 million — was for MS drugs Tecfidera and Copaxone, which can slow progression of MS and reduce the chance of relapse. Thrower has received payments from the makers of those and other MS drugs, but said he cut ties with the companies in January of this year.“It was kind of exciting when the first one came out,” Thrower said. “The problem we’ve seen is the cost for these drugs has just gone up and up and up.”Thrower said he no longer prescribes Tecfidera to new patients because it can lower white blood cell counts, putting them at risk for infections.Notes: Counts include initial prescriptions and refills dispensed. Retail price includes patients’ out-of-pocket costs but does not reflect drug maker rebates. *Average prescriptions per patient, per provider has been adjusted to give more weight to doctors who treat more patients. (The unadjusted average is 5.6).Just because a doctor prescribes costly drugs doesn’t mean he or she has done anything wrong, Gronniger said. “It’s much more about drug pricing … than it is about the behavior of any individual physician, many of whom are equally concerned about the price of these products as we are.”Today, ProPublica is updating its Prescriber Checkup online tool, which allows you to look up your doctor and see how his or her prescribing in Medicare Part D compares to others in the same specialty and state. Our tool covers the year 2014. You can compare the percentage of each doctor’s prescriptions that were for brand-name medications, the average cost per prescription and the average number of prescriptions per patient, among other things.Allyson Funk, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry trade group, said Medicare’s figures leave out important context.“It is important to note physicians’ prescribing patterns are dynamic and based on individual patient needs,” she said in a statement. “When looking at Medicare Part D, government data on spending at the point of sale does not include the substantial rebates for brand name medicines negotiated between manufacturers and plans and therefore does not accurately reflect actual prescribing dollars or program spending.”These rebates are confidential by law, but Medicare said this week that the average rebate for brand-name drugs in 2014 was 17.5 percent.The new data on high-spending prescribers is the latest indication of the burden of drug prices on government health programs.In the past couple of years, Medicare’s drug tab has surged, in large part because it picks up the vast majority of the cost of drugs once enrollees exceed a certain threshold each year. In 2015, beneficiaries over the limit, which was $4,700, spent $51.3 billion on drugs. In 2013, the figure was $27.7 billion, government data shows. (Taxpayers, through Medicare, pick up 80 percent of the cost of this so-called catastrophic benefit.) The Associated Press first reported the ballooning cost in July.Another sign could be seen in a drug dashboard released by Medicare this week. It showed that 1 percent of drugs prescribed in the Part D program accounted for more than one-third of the program’s cost in 2015 (before rebates). Some drugs were incredibly expensive. The drug H.P. Acthar Gel, used to treat several conditions, such as multiple sclerosis relapses and a rare kidney disease, cost an average of $162,371 for each of its 3,104 users—a higher per-user cost than any other drug in the program. That’s up significantly from several years ago, when ProPublica flagged the drug’s expense.Harvoni, used by more than 75,000 people, cost an average of $92,847 per person, for a total cost of $7 billion (also before any rebates).Michael Chernew, a professor of health care policy and director of the Healthcare Markets and Regulation Lab at Harvard Medical School, said the number of high-dollar prescribers in Medicare doesn’t surprise him. Given the increased cost of prescription drugs and the latest treatment advances, “the entire distribution is shifting to the right.”Chernew said that, in the long term, Medicare and insurance companies have to examine the total cost of caring for patients with certain diseases, taking into account drugs, hospital visits, medical tests and more. Only then can anyone tell if certain expenses, such as a pricey new drug, are justified.For now, he said, “How do we know what’s good or bad?”Physicians say their top priority must be the patients in front of them, not the costs to the system.Dr. Bruce Bacon, a liver specialist at St. Louis University, had the highest total Part D drug costs in 2014, $22.7 million. He was a frequent prescriber of Sovaldi and Olysio, another expensive hepatitis C medication.Bacon did not return a call for comment for this story. In a 2015 interview, he said he did not realize his prescriptions were so costly to Medicare.“I really don’t think about the cost,” he said. “I think about taking care of the patients. Should I not take care of the patients because the cost is expensive?”Thrower, the multiple sclerosis specialist, said the high cost of drugs frustrates him and his colleagues, but ultimately the successful treatment of patients comes first.“On one hand, we get that,” he said. “On the other hand, when you’re sitting in the exam room and looking someone in the eye, you can’t say, ‘I’m not going to treat you because of the cost.’”ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.last_img read more

Syracuse’s backs carry offense with 3 touchdowns in 24-0 win against Liberty

first_imgThe Orange also turned to two-back sets in the second half in the hopes that by featuring more than one running back in the same formation, they’d create more looks to get them the ball. Babers likened it to having a skilled 3-point shooter and dunker in basketball — one would make sure their shooter was getting looks and the dunker was in the paint. He wants to do the same thing with his backs.Babers doesn’t have a system or a method for which back he plays when, choosing instead to pick the running back he sends out based on a number of factors like which runner is fresh, what the down and distance is, and what play he wants to call. “It’s not scientific,” Babers said. All told, they carried the football 37 times (14 each for Neal and Adams, nine for Howard) and all got touches in goal line situations, early downs and short yardage plays.Howard scored his touchdown with a strong individual effort, falling forward and reaching the ball over the goal line after bouncing a goal line run outside. Adams scored SU’s first touchdown of the 2019 season, following guard Evan Adams and tackle Carlos Vettorello on a well blocked trap play from the Liberty 2-yard line. The same offensive line that struggled out of the gate improved and adjusted to Liberty’s schemes as the game wore on. By Adams’ touchdown, they were holding their own up front. By the time Neal torched the defense for his 42-yard score, they were beginning to operate as a unit.As Neal took the ball from DeVito on the play, the offensive line blocked a trap scheme, similar to Adams’ earlier score. This time, graduate transfer tackle Ryan Alexander moved from the right side of the formation across to his left, sealing the left side of the play. As he did that, fullback Chris Elmore sealed the right edge as Adams pulled from left to right, lead blocking for Neal and creating the hole. A final block on the safety by tight end Aaron Hackett left Neal untouched. Neal saw the cut back lane, planted his foot in the ground and scooted untouched to the end zone. Comments Published on August 31, 2019 at 11:30 pm Contact Andrew: [email protected] | @A_E_Graham Facebook Twitter Google+center_img LYNCHBURG, Va. — Moe Neal took the handoff from Tommy DeVito and saw the exact hole he was looking for. On 4th-and-2 from the Liberty 42-yard line early in the fourth quarter, Dino Babers opted to keep his offense on the field while leading 17-0, trying to get a first down and eventually a score to put the game fully out of reach. Neal went untouched down the middle of the field, straight into the end zone.“Neal’s run was a thing of beauty,” Babers said.That touchdown, which put No. 22 Syracuse (1-0) up by its final margin of 24-0 against Liberty (0-1) in its season-opening win at Williams Stadium, was one of three scored by an SU running back. The Orange’s trio of Neal, Oklahoma transfer Abdul Adams and sophomore Jarveon Howard combined to produce nearly 70 percent of Syracuse’s total yardage and all three touchdowns. On a night when the offensive line and DeVito struggled early and took most of the game to steadily adjust, SU’s running backs became the Orange’s de facto offense.“Just trying to wear those guys down,” Neal said. “Impact our will on them and we did that.”AdvertisementThis is placeholder textBut the Orange’s backs weren’t always tearing through the Liberty defense. In the first quarter, Syracuse’s running backs combined with seven carries for 19 yards. Syracuse’s offense sputtered as the offensive line struggled to open holes and DeVito and his receivers were out of sync — the quarterback ended the frame 3-for-8 with an interception and 21 yards. The Liberty defense keyed on the SU backfield and through scheme and numbers bottled up SU’s rushing attack.Rather than repeatedly getting stymied, Babers adjusted to exploit a spot in the defense he’d discovered on film. Liberty’s defense played a deep defensive backfield that paid heavy attention to the middle of the field, so Babers started calling swing and screen passes to his running backs, freeing them up along the outside either alone in space or with a fleet of blockers. SU first went to this look early in the second quarter, facing 3rd-and-10 from the Liberty 18-yard line when DeVito flipped a pass to Neal, who scampered up the boundary for 14 yards and a first down. Syracuse leaned on this look well into the second half, forcing Liberty to adjust by the time the Flames defensive line had already been worn down. All told, SU’s running backs caught six passes for 86 yards, or two yards shy of half of SU’s passing yards. “We knew that we’d have some options out of the backfield,” Neal said. last_img read more

Video: Bob Myers on Warriors’ 2019 roster, Kevin Durant’s departure, D’Angelo Russell and more

first_imgCLICK HERE if you are having a problem viewing the photos or videos on a mobile deviceBob Myers, the Golden State Warriors general manager, on Monday confirmed that the team is still finalizing its final two-way contract during a post-practice news conference at the team’s facility in Oakland.“There’s Kevin leaving, processing missing him as a person, what he did for us as an organization. … Great part of our fabric. That’s a loss. You feel that and then, unfortunately, you don’t have a lot …last_img read more

Android Tops 2Q Sales In Smartphones, Tablets

first_imgTags:#Android#iOS#now#smartphones#tablets#Windows Phone The Rise and Rise of Mobile Payment Technology Why IoT Apps are Eating Device Interfaces Android vendors are probably having a good day today, as two separate research reports indicate dominance in both the smartphone and tablet sectors for the second quarter of 2013.Kantar Worldpanel ComTech gave its read on the U.S. smartphone marketplace, indicating that Android held 51.5% of smartphone sales from April-June.But there may be a few clouds on the horizon for Android: iOS sales were at 42.5% of sales, up 3.3% from the same time last year. Even Windows had some upward mobility, with a 4% smartphone sales share, up 1.1% from 2012.Meanwhile, Strategy Analytics released its global tablet market report for the same quarter, which showed that Android shipped on 34.6 million tablets this past quarter, which was 67.0% of the total 51.7 million units shipped.Apple shipped 14.6 million tablets in the same period, which was 28.3% of the global tablet sales. Windows operating system tablets shipped 2.3 million units (4.5%).The growth of tablet shipments was the most notable part of the report. In the second quarter of 2012, there were a total of 36.1 million tablets sold, just 1.5 million more than the number of Android-loaded tablets alone that shipped in 2Q 2013. In all, tablets shipments year-over-year grew 43%.Image courtesy of Shutterstock. What it Takes to Build a Highly Secure FinTech …center_img Role of Mobile App Analytics In-App Engagement readwrite Related Posts last_img read more

Cilic obstacle in way of Nadal’s semifinal quest

first_img“The match against Grigor in Brisbane wasn’t that long ago and I played well, he also played well,” Edmund said.“Of course, we can take things from that. There is a lot of things I did do well. Maybe a few things I could do better, and I will try and do that when I play him.”  Top seed Simona Halep eases into last eight MOST READ Don’t miss out on the latest news and information. LATEST STORIES Typhoon Kammuri accelerates, gains strength en route to PH Chief Justice Peralta on upcoming UAAP game: UP has no match against UST PLAY LIST 01:00Chief Justice Peralta on upcoming UAAP game: UP has no match against UST00:50Trending Articles00:50Trending Articles01:29Police teams find crossbows, bows in HK university01:35Panelo suggests discounted SEA Games tickets for students02:49Robredo: True leaders perform well despite having ‘uninspiring’ boss02:42PH underwater hockey team aims to make waves in SEA Games01:44Philippines marks anniversary of massacre with calls for justice01:19Fire erupts in Barangay Tatalon in Quezon City Globe Business launches leading cloud-enabled and hardware-agnostic conferencing platform in PH Slow and steady hope for near-extinct Bangladesh tortoises Kammuri turning to super typhoon less likely but possible — Pagasa Nadal, who lost to Roger Federer in last year’s final, overcame tenacious Argentine Diego Schwartzman in a classic round of 16 encounter and will have to get past former US Open champion Cilic to reach the semi-finals.In Tuesday’s other quarter-final in the top half of the draw, Bulgaria’s world No.3 Grigor Dimitrov is up against British hope and 49th-ranked Kyle Edmund for a place in the last four. FEATURED STORIESSPORTSWATCH: Drones light up sky in final leg of SEA Games torch runSPORTSLillard, Anthony lead Blazers over ThunderSPORTSMalditas save PH from shutoutNadal leads world No.6 Cilic 5-1 in career meetings, including a straight sets win over the Croat in the round of 16 in Melbourne in 2011.   “Now is the moment to make a step forward, to play again more aggressive,” Nadal said.center_img 2 ‘newbie’ drug pushers fall in Lucena sting Spain’s Rafael Nadal hits a forehand return to Damir Dzumhur of Bosnia and Herzegovina during their third round match at the Australian Open tennis championships in Melbourne, Australia, Friday, Jan. 19, 2018. (AP Photo/Vincent Thian)Rafael Nadal sees his quarterfinal showdown with big-match player Marin Cilic on Tuesday as the time to crank up his Australian Open offensive for Grand Slam number 17.The Spanish world No.1 has been in ominous form in the first week after coming into the year’s opening major tournament with knee concerns.ADVERTISEMENT Brace for potentially devastating typhoon approaching PH – NDRRMC “Generally throughout my career, I know that if I’m playing well, if I’m top of my game, that I can challenge most of the guys on the tour,” a confident Cilic said.“And with the win at the US Open I now believe in my own game, I believe in what I’m doing.“I think I’m moving the right direction. It’s obviously a big challenge, but that’s what we also work for at training.“My goal in this year is to win a Grand Slam. It’s a big challenge, but I’m improving every single year.”Extra gearDimitrov beat Edmund only two weeks ago in the quarter-finals at the Brisbane International, but he is prepared for another struggle after his monumental four-set victory over Australian Nick Kyrgios in the round of 16.“He’s gone this far. So for sure I need to be ready. There is no place to underestimate him or anything like that,” Dimitrov said.“I am finding that extra gear in every match and the main thing for me is to really focus on myself.”Edmund, the only British man in the draw after five-time finalist Andy Murray’s injury withdrawal before the tournament, is having his best run at a Grand Slam.He upset US Open finalist and 11th seed Kevin Anderson in the first round and followed up with wins over Denis Istomin, Nikoloz Basilashvili and Andreas Seppi. Read Next “I know I’m going to have a tough opponent with Cilic. I need to play aggressive and play well.”Nadal is respectful of the Croat’s abilities and is expecting another ding-dong struggle with last year’s Wimbledon finalist.“Marin will be a tough one, but at the same time, it’s a beautiful match to play against a great player,” he said.“We know each other. We’ve played a couple of times and I know I need to play well. I hope to be ready to make that happen.”Cilic has moved efficiently through the draw with wins over Vasek Pospisil, Joao Sousa, Ryan Harrison and Spanish 10th seed Pablo Carreno Busta.ADVERTISEMENT John Lloyd Cruz a dashing guest at Vhong Navarro’s wedding NEXT BLOCK ASIA 2.0 introduces GURUS AWARDS to recognize and reward industry influencers View commentslast_img read more

China Bans EGCS Wash Water Discharge in Coastal Waters

first_imgzoomIllustration; Image Courtesy: Wartsila China has banned the discharge of wash water from open-loop exhaust gas cleaning systems (EGCS) in coastal waters, Reuters cited an official from the country’s Maritime Safety Administration (MSA).The development is a part of an update of China’s domestic emission control area (DECA) regulations, which took effect from January 1, 2019. The ban, applying to wash water used to strip hazardous sulfur emissions from engine exhaust gases, is among the country’s efforts to reduce pollution of its coastal seas.The new rule affects inland ECAs, port waters under coastal DECA and the Bohai Bay, however, it would not be extended to all of China’s territorial waters because of the increased costs for the shipping industry, the MSA official told Reuters.China’s move comes on the back of a similar measure unveiled by Singapore in November 2018. At the time, the Port of Singapore said it would prohibit the discharge of wash water from open-loop exhaust gas scrubbers in its waters when the International Maritime Organization (IMO) 2020 fuel oil sulphur limit enters into force.Singapore launched several initiatives to ban the discharge of wash water from scrubbers into certain regions as the contents of the released water include heavy metals and poly-aromatic hydrocarbons, potentially posing a risk to marine life.As a result, ships fitted with open-loop scrubbers calling at Singapore would be required to use compliant fuel, while ships fitted with hybrid scrubbers would need to switch to the closed-loop mode of operation.World Maritime News Stafflast_img read more

47yearold man makes fifth murder for TCI

47yearold man makes fifth murder for TCI

first_img Recommended for you Traffic relief coming for Blue Hills says Minister Nearly 100 Haitian migrants caught by TCI Police Marine division Facebook Twitter Google+LinkedInPinterestWhatsAppProvidenciales, 18 Sept 2015 – Police are investigating the details surrounding the killing of a Five Cays man on Wednesday. The man’s identity has been withheld by police until next of kin is informed.Magnetic Media is told that the man is a 47-year-old resident of Five Cays who is originally from Haiti, but has been resident of these islands for a number of years. The shooting occurred in an area known as the “Residence,” and the victim was reportedly shot multiple times. Police have made appeals to anyone who was in the area between 8:30 and 9pm to report any activity to the police, no matter how insignificant it may seem. Last night’s killing brought the murder count to five for 2015. Meanwhile, The Royal Turks and Caicos Islands Police Force was faced with a high volume of calls last night due to several crime reports. Police are investigating an assault, which occurred in Dock Yard, a wounding on Snake Hill and one wounding on Mary Jane Lane in Blue Hills. Sources say several people were wounded in the late night incidents. Facebook Twitter Google+LinkedInPinterestWhatsApp Related Items:blue hills, killing, mary jane lane, royal turks and caicos police force Fiery explosion kills Blue Hills manlast_img read more