“Whether Congress will act this year to address the affordability of prescription drugs — a high priority among voters — remains uncertain. But states aren’t waiting.
So far this year, 33 states have enacted a record 51 laws to address drug prices, affordability and access. That tops the previous record of 45 laws enacted in 28 states set just last year, according to the National Academy for State Health Policy, a nonprofit advocacy group that develops model legislation and promotes such laws.
Among the new measures are those that authorize importing prescription drugs, screen for excessive price increases by drug companies and establish oversight boards to set the prices states will pay for drugs.
“Legislative activity in this area is escalating,” said Trish Riley, NASHP’s executive director. “This year, some states moved to launch programs that directly impact what they and consumers pay for high-cost drugs.”
And more laws could be coming before year’s end. Of the handful of states still in legislative session — including California, Massachusetts, Michigan, New Jersey, Ohio and Pennsylvania — debate continues on dozens of prescription drug bills. In New Jersey alone, some 20 proposed laws are under consideration.
“Both Democrat and Republican leaders have shown a willingness to pursue strong measures that help consumers but also protect state taxpayer dollars,” said Hemi Tewarson, director of the National Governors Association’s health programs. Riley, Tewarson and others note, however, that states can go only so far in addressing rising drug prices, and that federal legislation would be necessary to have a major impact on the way the marketplace works.
Federal lawmakers are keeping a close eye on the state initiatives, Tewarson said, to gauge where legislative compromise may lie — even as Congress debates more than a dozen bills that target drug costs. Political divisiveness, a packed congressional schedule and a looming election year could stall momentum at the federal level.
The pharmaceutical industry has opposed most — though not all — state bills, said Priscilla VanderVeer, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry’s main trade group.
“We agree that what consumers now pay for drugs out-of-pocket is a serious problem,” said VanderVeer. “Many states have passed bills that look good on paper but that we don’t believe will save consumers money.”
Limiting Gag Rules For Pharmacists
At least 16 states have enacted 20 laws governing the behavior of pharmacy benefit managers. The so-called PBMs serve as middlemen among drugmakers, insurance companies and pharmacies, largely with pharmaceutical industry support.
Those laws add to the 28 passed in 2018. Most of the new laws ban “gag clauses” that some PBMs impose on pharmacists. The clauses, written into pharmacy contracts, stop pharmacists from discussing with customers whether a drug’s cash price would be lower than its out-of-pocket cost under insurance.
With widespread public outrage over gag clauses pushing states to act, federal lawmakers got the message. In October, Congress passed a federal law banning such clauses in PBM-pharmacy contracts nationwide and under the Medicare Part D prescription drug benefit. The Senate passed it 98-2. Even so, many of this year’s PBM laws contain additional gag clause limitations that go beyond the 2018 federal law.
Importing Cheaper Drugs
Four states — Colorado, Florida, Maine and Vermont — this year have enacted measures to establish programs to import cheaper prescription drugs from Canada and, in Florida’s case, potentially other countries. Six other states are considering such legislation.
Medicines in Canada and other countries are less expensive because those nations negotiate directly with drug makers to set prices.
“This is an area where states once feared to tread,” said Jane Horvath, a consultant who has advised Maryland and Oregon, among other states, on prescription drug policy. “Now both Republicans and Democrats view it as a way to infuse more price competition into the marketplace.”
Hurdles remain, however. A 2003 law allows states to import cheaper drugs from Canada but only if the federal Health and Human Services Department approves a state’s plan and certifies its safety. Between 2004 and 2009, the federal government halted nascent drug import efforts in five states.
Even so, momentum for importation has built in recent years in states and Congress as drug prices have continued to rise. And the Trump administration this summer threw its support behind the idea.
Florida Gov. Ron DeSantis, a Republican and close ally of President Donald Trump’s, signed his state’s measure into law on June 11, claiming he did so after Trump personally promised him the White House would back the initiative.
On July 31, HHS announced an “action plan” to “lay the foundation for safe importation of certain prescription drugs.” The plan includes a process to authorize state initiatives. It also requires formal regulatory review, including establishing Food and Drug Administration safety criteria. That process could take up to two years.
Two big problems remain: In the weeks since the announcement, the Canadian government has opposed any plan that would rely solely on Canada as a source of imported drugs. The pharmaceutical industry also opposes the plan.
Creating Drug Affordability Boards
Maryland and Maine enacted laws this year that establish state agencies to review the costs of drugs and take action against those whose price increases exceed a certain threshold.
New Jersey and Massachusetts are debating similar legislation this year.
Maryland’s law establishes a five-member board to review the list prices and costs of drugs purchased by the state and Maryland’s county and local governments. The board will probe drugs that increase in price by $3,000 or more per year and new medicines that enter the market costing $30,000 or more per year or over the course of treatment.
If approved by future legislation, upper payment limits on drugs with excessive price increases or annual costs would take effect in January 2022. “My constituents have signaled loud and clear that bringing drug prices down is one of their top priorities,” said state Sen. Katherine Klausmeier, a Democrat representing Baltimore, who sponsored the legislation.
Maine’s law also establishes a five-member board. Beginning in 2021, the board will set annual spending targets for drugs purchased by the state and local governments.
Increasing Price Transparency
This year, four states — Colorado, Oregon, Texas and Washington — became the latest to enact laws requiring drug companies to provide information to states and consumers on the list prices of drugs and planned price increases.
The majority of states now have such transparency laws, and most post the data on public websites. The details vary, but all states with such laws seek to identify drugs with price increases above 10% or more a year, and drugs with price increases above set dollar values.
Oregon’s new law, for example, requires manufacturers to notify the state 60 days in advance of any planned increase of 10% or more in the price of brand-name drugs, and any 25% or greater increase in the price of generic drugs.
“That 60-days’ notice was very important to us,” said Rep. Andrea Salinas, chair of the Oregon House’s health committee, who represents Lake Oswego. “It gives doctors and patients advance notice and a chance to adjust and consider what to do.”
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Lavender is one of many beautiful and fragrant herbs that attracts butterflies and bumble bees, and will repel moths, mosquitos, and flies from the garden. Lavender flowers (buds) can be used as a tea for their relaxing and calming effect (Basch).
There may be as many as 160 active constituents in lavender including linalool (a terpene), linalyl acetate, B-caryophyllene, B-myrcene, alpha-ocimene, B-ocimene, and terpinen-4-ol. Calcium, iron, and vitamin A are also found in lavender.
We’re still learning about lavender’s pharmacology from animals. In a study by Harada et al, adult male mice were tested using a linalool scent delivered in a light/dark box. Some of the mice in the study had the sense of smell (active group) and others did not (control group). The mice in the active group that were exposed to the linalool scent over 30 minutes experienced anxiolysis. The control group did not. The positive effect in the active group was negated by flumazenil, a medication that reverses the effects of benzodiazepine anxiolytics like Valium, Ativan, and others. The authors concluded that the linalool effect was mediated by GABA transmission via benzodiazepine-responsive GABA receptors.
Lavender may also work by modulating T-type calcium channels in the body, providing yet another possible therapeutic effect that deserves more research in humans. Calcium channels play a role in neuron excitability, neuroprotection, sensory processes, sleep, and pain (Alaoui, Ayaz, Kopecky).
Lavender side effects may include sun sensitivity, headache, and allergic reaction, among others.
If you are consuming lavender tea, taking lavender dietary supplements, or using topical lavender essential oil in aromatherapy, please be sure to first discuss the appropriateness of this herb/essential oil with your health care provider or pharmacist to determine if it is safe and right for your health goals. This includes a thorough review by your trusted healthcare professional of any drug/lavender interactions and potential side effects.
For more information please visit https://www.drugs.com/mtm/lavender.html and https://www.gardenmandy.com/types-of-lavender-plants/.
Recipe for Lavender Tea
Add the 1 Tbsp fresh, or 1-2 tsp dried, lavender flower buds to a teacup (mug).
Bring 8 oz – 10 oz water to a boil.
Pour the hot water over the lavender flower buds, steep for 5 minutes. Place a small plate or lid over the top of the cup to keep the steam inside, further infusing the tea.
Remove the plate (lid) from the cup and add honey or agave, sweetening to taste.
Drying Out Fresh Lavender Flowers
If you want to dry out fresh lavender flower buds from your garden, harvest the lavender just before it fully blooms, and cut the flowering stalks right above the leaves. Bind the stalks with the buds into bundles and hang them upside-down in a dark, cool, and dry place for 2 and 4 weeks. Lightly brush the stalks and the lavender buds should fall off, to be stored and used later for tea.
1. Alaoui. Modulation of T-type Ca2+ channels by lavender and rosemary extracts. PLoS One. 2017 Oct 26;12(10): e0186864.
2. Ayaz. Neuroprotective and anti-aging potentials of essential oils from aromatic and medicinal plants. Front Aging Neurosci 2017; 9:168.
3. Harada. Linalool odor-induced anxiolytic effects in mice. Frontiers in Behav Neurosci 2018;12: Article 241.
4. Kopecky. T-type calcium channel blockers as neuroprotective agents. Pflugers Arch 2014; 466 (4): 757-765.
5. Basch. Lavender (Lavandula angustifolia Miller). J Her Pharmacother 2004;4: 63-78.
The use of topical analgesic patches, thermal wraps, or TENS units is one way to manage ACUTE pain instead of taking oral opioid narcotics and non-steroidal anti-inflammatory drugs (NSAIDs), including acetaminophen.
Please first discuss the use of topical analgesic patches, wraps, or TENS units with your primary care physician (PCP) before trying them out for CHRONIC pain, as she/he knows your medical and surgical history, medication allergies, and is in the best position to guide your pain management if you are already taking other oral analgesic medications.
Popular active ingredients in analgesic patches include methyl salicylate, menthol, camphor, capsaicin, and lidocaine. Advantages of patches over oral analgesics include delivery of medication directly to the involved area, avoidance of most GI-related side effects, and ease of administration. Disadvantages can include skin burns (as some patches contain irritating ingredients). Patches with metal backing should not be used at the same time as heating pads or thermal wraps to avoid skin burns. Any OTC analgesic patch can cause unwanted skin irritation, reddening, burning, or medication allergy in those who are sensitive to any ingredients. Wraps can cause excess heat and TENS units can cause excess nerve stimulation.
Topical analgesic products work as counter-irritants, local anesthetics, thermal (heat) generators (wraps), or electrical nerve stimulators (TENS units).
Medications included in counter-irritant patches are classified into three categories, that:
• increase local blood flow (methyl salicylate)
• cool the skin area (like menthol, camphor)
• intentionally irritate/redden the skin area and distract from a deeper pain underneath it without increasing blood flow to the skin area (capsaicin)
Methyl salicylate is an analgesic, an anti-inflammatory agent, can dilate local blood vessels and raise skin temperature.
Menthol (oil of wintergreen), derived from Mentha piperita (peppermint), cools the skin and increases skin blood flow by dilating blood vessels.
Capsaicin, derived from hot chili peppers, works by depleting substance P in the nerve endings and is thought to temporarily decrease the number of nerve fibers in the involved skin area. It takes up to six weeks for pain sensation to return once capsaicin topical therapy is discontinued so skin monitoring is advised.
Lidocaine, a local anesthetic, is thought to interrupt the pain signal by its action on damaged peripheral nerves and may be useful in treating neuropathic pain. For most people, the amount of lidocaine absorbed through the skin is not problematic. However, for some in whom unpredictably higher lidocaine absorption and blood levels occur, the cardiac properties/side effects may be a concern. OTC lidocaine patches are to be used as directed on the package label for up to 7 consecutive days MAX.
Thermal analgesic wraps (e.g., ThermaCare) can increase both local skin and muscle blood flow. Wraps contain activated charcoal heat cells, iron powder (for conductivity), and sodium chloride.
Icy Hot Smart Relief TENS Unit Starter Kit, example of an FDA Class II approved medical device, uses nerve stimulation to help relieve back & hip or knee & shoulder pain. TENS stands for ‘transcutaneous electrical nerve stimulation.’
Quell is a new FDA Class II approved medical device that is somewhat costly. It’s called a wearable technology that also uses nerve stimulation to allay pain.
In general, TENS units work by sending pulses to the nerves in a particular area and up the spinal cord. This is thought to reduce pain signals from reaching the brain by triggering the release of our own endorphins.
Patch/Wrap Safety Tips
• Wash your hands with soap and water after applying
• Do not reuse
• Do not use for longer than 7 days without consulting your PCP for advice
• Apply 30 minutes after a shower; remove one hour before a shower
• Dispose of safely to avoid unwanted exposure to children and pets
TENS Unit Safety Tips
• Do not combine with heat wraps or topical medication-containing patches
• Do not combine with oral Rx or OTC pain medications unless instructed to do so by your PCP
• Start with the lowest level of electrical stimulation/intensity and increase if needed to manage your pain
More well-designed, long term studies involving OTC analgesic patches/wraps/TENS units are needed. Please talk with your pharmacist for more information on how to properly use topical OTC analgesic patches/wraps/TENS units.
This information is not meant to be a substitute to medical advice from your PCP.
Please see the article in Drug Topics March, 2019 by Frieda Wiley PharmD, Contributing Writer, including commentary by Cathy Rosenbaum PharmD.
https://www.drugtopics.com/sites/default/files/legacy/mm/digital/media/drtp0319_ezine.pdf (page 37)
Senior men having difficulty sleeping at night due to extended periods of interrupted breathing may be at increased risk of heart-related death. This problem is thought to be due to poor oxygenation (study indicator) stemming from sleep apnea and other related factors, according to an Australian study in European Heart Journal (2018). Researchers Linz and Baumert reported that men with ≥ 12 minutes of oxygen saturation below 90% during their sleep cycles increased risk of heart-related death by nearly 60% in the study. The importance of restful, well-oxygenated sleep in relation to health and healing cannot be underestimated for many reasons. If you suspect you are one of the individuals with sleep apnea or other sleep-related health issues, please talk with your primary care physician and ask for a sleep study to uncover the root cause of your problem and get help.
Please ‘Like’ us on www.Facebook.com/rxintegrativesolutions to receive an ongoing list of seminars and workshops conducted by Dr. Cathy Rosenbaum.
Health & Wellness Seminar Topics for Your Church/Support/Corporate/Civic Group:
- Health & Wellness Trends For The Future – Oh, The Places We’ll Go!
* Pharmacogenomics, the Future of Personalized (Precision) Medicine & Gene Therapy (Disease Cures vs Treatment)
* The A to ZZZZ’s of Sleep Health
* Memory Health: Even Elephants Forget Sometimes!
* Bottled Water Sources/Plastics/Filtration Systems- What You Don’t Know May Hurt You!
* Taking the ‘Poly’ Out of Polypharmacy (Overprescribing of Medications)
* Eight Balance Points for Healing: Building Integrative Health & Wellness Tool Kits That Fit Your Health Goals & Lifestyle Choices
* Herbs of the Bible
* Homegrown Medicinal Herbs & Teas
* Debunking Myths About Dietary Supplements
* Medical Marijuana: The Healthcare Professional’s Perspective
* Caregiving: From Compassion Fatigue to Compassion Satisfaction
* The Truth About OTC Diagnostic Tests (e.g., Hair Analysis, Iridology, Electrodermal Testing, Antioxidant Skin Fold Testing, Saliva Testing,
Thermal Biofeedback, Electromyography Biofeedback, More)
* Antioxidants & Chemotherapy – Dance Partners or Double-Edged Swords?
* Antioxidants & Health
* A Primer of Nontraditional Medicine Practices in the Greater Cincinnati Area
* Let’s Have Some Applause for Menopause
* Men’s Health: Everything You Want to Know but Are Afraid to Ask
* Vitamin-Crazed Insurance Policies: Are Multiple Vitamins Really Needed Throughout Life?
* The Holistic Approach to Wound Care Management
* The Holistic Approach to Managing Stress
* Essential Oil Aromatherapy for Healing: Does This Modality Pass the Sniff Test?
Neti pots can be used to clean out mucus, allergens, and debris that build up on the nose and sinus cavity. They are safe if used correctly. A recent case report involving a woman who allegedly passed away from an amoeba acquired from unsterile water used in her neti pot over many months reminds us to do diligence when preparing saline water and cleaning pots to stay safe.
* Keep your neti pot clean regardless of whether it is made of plastic, ceramic, glass, or some other material.
* Use a safe water source for the saline solution you prepare for your pot (e.g., preferably sterile or distilled water).
* Use proper technique with your neti pot to get a good rinse. If you are unsure of how to use it, contact your favorite pharmacist for a quick demo.
The Center for Disease Control tells us to wash our neti pots after each use. Some of these pots are dishwasher safe, but not all. Please read the directions on the box.
Neti pots can be hand washed with dish soap and hot water and air dried. Don’t use hand towels that contain lint to dry them, as the lint can go up your nose and cause other issues.
If you think your neti pot is contaminated, you can use a chlorine bleach solution to cleanse it, but be careful to thoroughly rinse out any soap or bleach from the pot before you reuse it. This will prevent unwanted residue getting into your nostrils.
Don’t use tap water run through a Brita filter or any home filter unless you boil it for 3 to 5 minutes and then cool it down to room temperature first. Boiled water is storable for up to 24 hours.
For more information, please visit www.apha.us/CDCSafeNetiPots.
To schedule a one hour health & wellness consultation with Dr. Cathy Rosenbaum, please visit www.rxintegrativesolutions.com or email firstname.lastname@example.org. Be mind body spirit healthy.