Category Archives: Healthcare

Ow.

May 21, 2019 – 4:14 pm

Have you ever heard of trigger thumb? I hadn’t before yesterday.

Trigger finger, yes. Leave it to me to have the oddball injury. Or so I thought.

Officially, I have tendinitis in my left thumb. I don’t even know what I did to injure it, but holy hell, it’s been super painful for about six weeks.

It might be from the fact that the mouse for my laptop is set up for the left hand; I did this many years ago after suffering from carpal tunnel-like symptoms in my right hand, especially after busy days and weeks in the office. Since I started using the mouse on the left side, I haven’t felt a twinge in either hand.

But now, I have pain to spare. It hurts (a LOT) to tie my shoes, open a door with a traditional doorknob, and even lift a glass of water. I thought babying it for a while and not using it any more than absolutely necessary would help, but it didn’t. So off to the orthopedist I went.

I have three options right now:

1. Wear a splint, or a brace, with tape around it part of the day and especially at night, because morning is when it really hurts like a sonofabitch.

2. Get a cortisone injection. This is something I can only do a few times, and it carries with it the expectation that my blood sugar would skyrocket for a while after the injection.

3. Have surgery on the tendon in my thumb.

For now, I’m opting for Step 1, because I can’t do surgery right now (for reasons I will not disclose) and because of the whole blood sugar thing with the injection. If I can avoid those two, at least for the time being, I will.

When I posted about this on Facebook last night, I found many people who have had this same injury in their own thumbs. So I’m not alone, though I wish I were. For even more detail, see this from PubMed Central and the National Institutes of Health.

For a guy who’s on the computer all day, I always thought I was pretty adept at avoiding repetitive use injuries. Unfortunately, I don’t think this is the final chapter in this story.

But just like diabetes, I can’t worry about what got me here… I just have to do what I can to give myself the best chance of success going forward.

By StephenS | Tagged , , | Comments (1)

Eye Care as a Human Right.

April 30, 2019 – 10:11 am

I’ve alluded to this a lot, but since I’m probably the King of Burying the Lead, blogging edition, let me just share that I have a lot of doctor appointments to make and keep this year. A lot, covering so many things.

That includes seeing an ophthalmologist for a comprehensive eye exam. My appointment was last week.

The news was all good, mostly… no glaucoma, no sign of retinopathy or macular degeneration. My prescription changed just a bit, but I needed new eyeglasses anyway, so I’m not complaining.

It sucks that I live in America, where I have to pay a fortune for health care, devices, and drugs. But it’s great that I’m one of the lucky ones in America with coverage good enough to allow me to get to the eye doctor every year.

That’s one of the things about medical insurance, and the fight to make health care less expensive here. If it’s less expensive, it’s naturally more affordable for more people, and that is way less expensive to the government and its citizens than just relying on emergency room care when things get really bad.

That’s true for eye care. It’s true for diabetes management. It’s true for someone with heart disease, and it’s true for those going through depression and a host of other psychological issues.

From a patient point of view, denying coverage, denying care, and denying affordable access to the drugs we need denies us our right to exist on the same plane as someone not living with a chronic condition. And when we do that, we’re not only acting in a shameful way toward our own fellow man, we’re collectively paying more for the privilege to do so.

I still have many more appointments left this year. They’re almost all like this one: designed to check out one part of my body or another so I can detect (hopefully) small problems before I might need to solve larger ones.

Don’t we all deserve the same opportunity?

By StephenS | Tagged , | Comments (1)

Not Fun and Games

March 13, 2019 – 10:11 am

Sometimes, as much as we’d like to, it’s hard to temper the hard truth with diplomacy.

I’ve been trying to calm down ever since I received a letter from my prescription provider, Express Scripts. I’ve been trying to choose my words carefully, trying to understand the other side of the equation, trying to consider how this makes me or the plan I’m a part of better.

Let me tell you, that’s a tall order.

The letter states that I can no longer take part in the automatic refill program through Express Scripts unless I move from the Novolog I’ve been using for a long time, and which works best for me, over to Humalog. In other words, if I have a prescription for insulin, I can get my prescription renewed every 90 days. But only if I use the insulin on their formulary list, which is Humalog.

Now, you might be thinking, this can’t be non-medical switching… you can still get the Novolog, right? First world problems! Stop yer bellyaching!

They’re making it harder and harder for me to still get the drug that works best with my diabetes.

I’ve got nothing against Humalog. It just doesn’t work as well for me. So already, I’m paying three times as much (through my plan) to get the Novolog every 90 days. I’ve been doing this ever since the “preferred drug” on the formulary was switched from Novolog to Humalog.

Additionally, I stayed with Novolog in spite of underhanded dealings where reps from Express Scripts shoved prescriptions in front of my endocrinologist, telling her I asked to switch to Humalog, which is a big fat stinking lie.

Now they’re trying to put roadblocks in my way again.

There’s not a medical reason for this. They’re simply doing it because they want to. Because they really want me to start using Humalog. And they’re trying anything they can to get me to switch.

Non-medical switching, in one form or another, is standard operating procedure for pharmacy benefit managers like Express Scripts. Instead of making it easier to get the drug that helps keep me alive, or at least not making it more difficult, they’re actually paying people money to come up with new ways to keep me from getting it. In subtle and not-so-subtle ways.

This is just another example.

So, my choices, after taking the time to, you know, do my best at managing a 24 hour, 7 day a week condition, are:

1. Spend more time calling and complaining, trying to get Express Scripts to change their minds, as if they were an actual organism with an actual mind

2. Spend more time asking for a refill every 90 days, even though it wouldn’t cost Express Scripts one dime or one minute extra to keep doing things the way they’ve done them. For years.

3. Make the switch to Humalog and get the automatic refill every 90 days

I will likely go with #2, though doing so makes me very unhappy. But hey… happiness or unhappiness are not part of the equation when it comes to pharmacy benefit managers. For Express Scripts, there’s only one part of the equation that counts. And I think everyone knows what part that is.

By StephenS | Tagged , , | Comments (3)

Drug pricing straight talk.

February 20, 2018 – 10:11 am

I read an interesting online piece from CNN Money the other day. If you haven’t had a chance, read it HERE. I’ll wait.

Although I was surprised at first that the director of the U.S. Food and Drug Administration would weigh in on drug pricing, I have to say that his comments here are pretty much what I would expect, and it’s what I’ve been thinking for a while too.

Indeed, there have been drug companies playing fast and loose with the rules governing when their drugs could be available to be made as generics. There have been, in some cases, instances of companies restricting access to brand name drugs for makers of generics who want to use them to help develop their own products, and use them for comparison in clinical trials to help measure efficacy of their generic versus the brand name benchmark.

In true drug company and pharmacy benefit manager fashion, there is a lot of gray area in the rules governing what can be made generic when, and how. In a way, you can understand it from their point of view… they don’t want to see a lot of their profit go away because a generic (or in the case of insulin, a biosimilar) could be purchased for much less than the original product.

Yet we’ve seen generics make a huge difference in the affordability of high blood pressure and high cholesterol drugs. It would be nice to purchase our diabetes drugs for far less than we purchase them today. Can’t we make this happen?

I think that’s what the FDA Director is saying here. He uses political terms like “free market”, but at least he acknowledges that the needs of patients should trump a 20-plus year near monopoly for a particular medication.

We are seeing changes, slow changes in insulin now. Novo Nordisk’s Fiasp is a very fast-acting insulin, and over the next few years, it may change a lot of how people manage their diabetes. If it does, expect to see prices drop for Novolog. We’ve seen the first biosimilar insulin in the United States in Eli Lilly’s Basaglar, and that has already had an effect on the price of Sanofi’s Lantus, which it is biosimilaring(?). Plus, my endo suddenly has lots of free Lantus samples to pass along.

I completely believe this statement from Dr. Gottlieb, in describing the various changes under consideration by the FDA:

“All of these steps are going to have an impact, and I don’t think there’s one silver bullet,” Gottlieb said. “If anyone [thinks] there is one thing you can do with policy intervention that is going to dramatically change drug prices, that’s not true.”

It’s going to take a lot of effort on the part of regulators, advocates like you and me, and yes, industry to shepherd a change in the approach of brand name and generic drugs. We’re not going to get down to a few dollars out of pocket for our insulin prescription. But hopefully, as time goes by, we’ll see additional choice, both in medications and the cost of those medications.

I think that would qualify as making something happen.

By StephenS | Tagged , , | Comments (2)

Three large companies want to disrupt healthcare. Don’t hold your breath.

February 6, 2018 – 10:11 am

I’ve been waiting to write about this until I could consider all sides of the story. Now that I’ve had a few days to mull it over, here are my thoughts about the Jeff Bezos/Warren Buffett/Jamie Dimon healthcare whoziwhatsis.

Let me preface my remarks by saying that this is NOT financial advice. I don’t know squat about what you should do with your money.

Now, some basic facts: The companies that are run by the three business titans noted above are partnering to explore ways to reduce the cost of healthcare, first for their own employees, then, potentially other companies’ employees. After the announcement, the Dow Industrial Average lost over 300 points. Since then, over 1500 more points have been shaved off the Dow.

The initial selloff last Tuesday affected insurance company stock as much as anything, and that’s understandable to a degree. But to this observer, the panic seems to be a little premature. Right now, to borrow a little political vernacular, this announcement is a big nothing burger.

I mean, sure… Amazon has made a mountain of money changing the way people shop. Berkshire Hathaway has made investors rich for over 40 years. And JPMorgan Chase is America’s biggest bank. However, healthcare in these United States is full of layer upon layer upon layer of complexity, and getting through all that complexity will take time. Maybe a lot of time.

At the federal level, there is government regulation and government regulators. Healthcare is regulated in the individual states too, and sometimes, even at the local level.

How about doctors, nurses, and other medical professionals? Some of them charge so much for their services only because the cost of their education was so high they have to charge extra just to break even after paying on their student loans.

And since we’re in the 21st century, we have to consider technology. Not the kind that helps us deliver insulin or tells us our glucose levels. I mean the kind of technology that intersects patients all over the country, and for now at least, allows providers to get paid based on medical codes entered through software designed to help them figure out what each treatment is worth.

Hey, guess what? I haven’t mentioned a thing yet about insurance companies or drug prices. Like I said, layer upon layer upon layer of complexity.

If Bezos, Buffett, and Dimon are going to revolutionize healthcare in the USA, they have their work cut out for them. It’s going to take a while.

Insurance premiums are three times more expensive than they were 18 years ago. Out of pocket deductibles for these plans are three times more expensive than they were 12 years ago. There’s a sea of red tape to wade through to help companies and patients get affordable, accessible, compassionate healthcare.

But… we won’t really know whether the cycle of escalating costs can be broken unless someone actually tries. Whoever tries will need deep pockets to succeed. And a fair amount of patience. This triumvirate of business tycoons has the money. Let’s hope they have the intestinal fortitude to see it all the way through.

By StephenS | Tagged , , , , , | Comments (3)