Prescription drugs

Some medical marijuana could hit the market in Ohio next month

The first batches of legal medical marijuana may be available in Ohio as early as mid-November but the initial supply is expected to sell out almost immediately, according to state officials (Source: “Legal medical marijuana may be available in Ohio next month,” Springfield News-Sun, Oct. 4, 2018)

Mark Hamlin of the Ohio Department of Commerce said this week that two small-scale cultivators — one in Meigs County and another in Portage County — will have product ready for state inspection in early November.

Hamlin told the Medical Marijuana Advisory Committee that the first batches will serve hundreds, not thousands, of patients. Likely, Ohio will see what played out in the early days in other states: a handful of dispensaries open, sell out in a matter of days, close again until more product is available, Hamlin said.

Board of Pharmacy rules cannabis byproducts can’t be sold in Ohio stores

The Ohio Board of Pharmacy said, in a ruling posted on its website this week, that products that contain cannabidiol (CBD), a chemical found in cannabis plants, are not legal in Ohio (Source: “Ohio Pharmacy Board: No cannabis products can be sold in stores,” Canton Repository, Aug. 31, 2018).

On the shelves of stores throughout Ohio are whole hemp sections with products that contain CBD, such as hemp honey, CBD oils and skin creams. In Ohio, now that medical marijuana is legal, nothing extracted or clipped from a cannabis plant can be bought, sold or owned unless it comes from one of the 56 licensed dispensaries spread throughout the state.

All cannabis products also have to comply with other rules handed down by the legislation that legalized medical marijuana. That means any product derived from cannabis must have a “known source” and show the quantities of active ingredients. The products must also be tested by a state-approved lab.

Report finds Medicaid pharmacy benefit managers charging triple the going rate

A study commissioned by Medicaid officials found that pharmacy benefit managers are charging Ohio's Medicaid program three times the recommended rate (Source: “Drug middlemen charging Ohioans triple the going rate — or more,” Columbus Dispatch, June 27, 2018).

According to the study, CVS Caremark billed the state about $5.60 per script, while Optum Rx charged $6.50 per script, yet the report released last week said the “fees should be in the range of 95 cents to $1.90 per prescription.” 

That means that Ohio Medicaid’s two pharmacy benefit managers, known as PBMs, received as much as $187 million above the typical cost of administering such programs in one year — $130 million to $164 million more for CVS Caremark and $19 million to $23 million for Optum Rx.

Last week, Medicaid officials announced the results of what is believed to be the first attempt by any state to determine “spread pricing,” or the difference between how much pharmacy benefit managers are billing the state and what they are reimbursing pharmacists to fill prescriptions. It found that PBMs made $223.7 million to process nearly 40 million prescriptions from April 1, 2017, through March 31, 2018.

Meanwhile, the Ohio House on Wednesday took aim at PBMs, unanimously approving bipartisan legislation aimed at increasing transparency of drug prices and lowering prescription costs. House Bill 479, sponsored by Reps. Scott Lipps, R-Franklin, and Thomas E. West, D-Canton, would prohibit health insurers and PBMs from charging consumers co-pays amounting to more than they would pay if the drugs were purchased without insurance or more than the pharmacy was being reimbursed to fill a prescription.

It would also ban “gag rules” that prevent pharmacists from telling their customers about cheaper options for acquiring medications, such as paying out of pocket.

Study: More than a third of Americans take medication that can cause depression

Over one-third of Americans take at least one prescription drug that lists depression as a potential side effect, a new study reports, and users of such drugs have higher rates of depression than those who don’t take such drugs (Source: “Common Drugs May Be Contributing to Depression,” New York Times, June 13, 2018).

According to the study published in the Journal of the American Medical Association, many patients are taking more than one drug that has depression as a side effect, and the study found that the risk of depression increased with each additional such drug taken at the same time.

About 200 prescription drugs can cause depression, and the list includes common medications like proton pump inhibitors (P.P.I.s) used to treat acid reflux, beta-blockers used to treat high blood pressure, birth control pills and emergency contraceptives, anticonvulsants like gabapentin, corticosteroids like prednisone and even prescription-strength ibuprofen. Some of these drugs are also sold over-the-counter in pharmacies.

Dima Mazen Qato, an assistant professor and pharmacist at the University of Illinois at Chicago who was the lead author of the paper, acknowledged that there are still “a lot of unanswered questions,” and that the study only points to a correlation, not a cause-and-effect relationship. 

“We didn’t prove that using these medications could cause someone who was otherwise healthy to develop depression or suicidal symptoms. But we see a worrisome dose-response pattern: The more of these medications that have these adverse effects that you’re taking concurrently, the higher the risk of depression,” Qato said.

Ohio won’t meet Sept. 8 deadline for medical marijuana, regulators say

State regulators working to meet a Sept. 8 deadline to set up Ohio's medical marijuana program now say there won't be any products available to patients by that time (Source: “Ohio won't have any medical marijuana on shelves by Sept. 8 deadline,” Cleveland Plain Dealer, June 5, 2018).

Mark Hamlin, senior policy advisor to the Ohio Department of Commerce, said last week that the date by which marijuana plants needed to be in the ground in order to meet the deadline has passed. Plants can take 12 to 16 weeks to grow and none of the 25 provisional grow licensees have been OK'd to start growing.   

Ohio passed its medical marijuana law in May 2016 but left the details up to three state agencies, including the Department of Commerce. The agencies spent several months drafting rules and accepted applications for growers, processors, testing labs and dispensaries late last year. 

The law set Sept. 8 -- two years from its effective date -- as a deadline for the program to be "fully operational." By that time, legislators envisioned, patients with one of 21 qualifying medical conditions would be able to buy and use marijuana after registering through a doctor who is certified to recommend cannabis in Ohio.

To learn more about medical marijuana in Ohio, visit HPIO’s online resource page.

Cleveland Fed researches opioid impact on region’s economy

Research by the Cleveland Federal Reserve Bank concludes that opioid abuse causes economic conditions to decline and abuse rates do not go up as a result of downturns in the economy (Source: “Cleveland Fed researches opioid economic impact,” Canton Repository, June 1, 2018).

Researchers found that prime-age men and women in areas with higher opioid prescription rates were less likely to participate in the labor force and have jobs from 2006 to 2016. The difference was nearly 5 percentage points for men and 1.4 percentage points for women between areas with the highest and lowest prescription rates. “That’s effectively like doubling your unemployment rate,” said Mark E. Schweitzer, the Cleveland Fed’s senior vice president of research and community development.

Cleveland Fed surveys of regional businesses, economic development agencies and social service providers showed that opioid use made it harder for companies to find workers who could pass drug tests and strained social services, such as foster care and addiction treatment.

But when researchers looked at data from the Great Recession, they found opioid use during that time remained stable despite a tough economy.

The Cleveland Fed is one of 12 regional Federal Reserve Banks, and its district covers Ohio, western Pennsylvania, eastern Kentucky and the northern panhandle of West Virginia, a region that has been hit hard by the opioid crisis.

Schweitzer said the research doesn’t say that ending opioid prescriptions would send everyone back into the labor force. Nor did the research consider the rise of illegal, synthetic opioids such as fentanyl. The paper also cautioned against the idea that an improved economy would solve drug abuse issues.

HPIO forum to explore what's working to fight addiction in Ohio, neighboring states

The Health Policy Institute of Ohio is hosting a forum June 26 titled “What’s next in the addiction crisis? Policy, practice and collaboration across the region.”

Speakers at the event will detail recent policy changes in Ohio and neighboring states (Pennsylvania, West Virginia, Kentucky, Indiana and Michigan) and present opportunities for improvement. Attendees will also have the opportunity to participate in small group discussions to identify opportunities for regional collaboration and public-private partnership, and develop an evidence-informed policy agenda.

In April of 2018, HPIO released a report, “Ohio Addiction Policy Inventory and Scorecard: Prevention, Treatment and Recovery,” which provides policymakers and other stakeholders with the information needed to take stock of Ohio’s policy response to the addiction crisis over the past five years. This report identifies nine opportunities for improvement, which will be explored at this forum. 

Native American tribes call for separate opioid lawsuit against drug makers

Native American tribes devastated by the opioid epidemic asked a judge to set up a separate track for their lawsuits targeting makers and distributors of the painkillers for creating a public-health crisis (Source: “Native Americans Demanding Chance to Try Opioid Suits Separately,” Bloomberg News, May 10, 2018).

Santee Sioux Nation of Nebraska, the Winnebago Tribe and others feel “marginalized’’ by having their cases lumped in with states’ opioid claims, David Domina, a lawyer for the tribes, told U.S. District Judge Daniel Polster Thursday. Polster is overseeing more than 600 lawsuits blaming opioid makers, such as Purdue Pharma LP and Johnson & Johnson, and distributors like McKesson Corp. of understating the risks of prescription opioids, overstating their benefits, and failing to halt suspiciously large shipments to pharmacies. States, local governments and Indian tribes are seeking to recoup the costs of dealing with waves of opioid addictions.

Polster, who has been pressing for a quick resolution of the suits, said he’d consider the request.

“If there is a resolution, it won’t be without’’ the tribes’ consent, the judge said.

Because of the havoc opioid addiction is wreaking among native people, tribal leaders felt “the need to speak out’’ against being lumped in with other groups, Domina said at a hearing in Cleveland. The Omaha, Nebraska-based lawyer represents all the tribes in his state. More than 30 other tribes, including the Cherokee Nation and the Navajo Nation, have filed suits over the fallout from opioid addictions.

Kasich proposes new opioid rules

Gov. John Kasich on Wednesday announced new rules he said will help prevent chronic pain patients from becoming addicted to prescription painkillers (Source: “Gov. John Kasich proposes new opioid rules for chronic pain patients,” Cleveland Plain Dealer, May 2, 2018).

The new rules for chronic pain do not set limits on what can be dispensed. The rules call for doctors to re-evaluate patients' opioid use at periodic "safety checkpoints" when patients are increased larger doses of painkillers.

Physicians will look for signs of opioid misuse when patents are upped to 50, 80 and 120 morphine equivalent doses per day. About 97,000 Ohio patients were prescribed more than 50 MED in 2017, according to the Ohio Board of Pharmacy.

In April, HPIO released “Ohio Addiction Policy Inventory and Scorecard: Prevention, Treatment and Recovery,” which provides policymakers and other stakeholders with the information needed to take stock of Ohio’s policy response to the state’s addiction crisis by reviewing state-level policy changes enacted in Ohio from 2013-2017.

Opioid prescriptions dropped in 2017, study finds

The number of prescriptions for opioid painkillers filled in the U.S. fell dramatically last year, showing their biggest drop in 25 years and continuing a decline amid increasing legal restrictions and public awareness of the dangers of addiction, new data show (Source: “New data: Americans filling far fewer opioid prescriptions,” Associated Press via Akron Beacon Journal, April 19, 2018).

Health data firm IQVIA’s Institute for Human Data Science released a report Thursday showing an 8.9 percent average drop nationwide in the number of prescriptions for opioids filled by retail and mail-order pharmacies. All 50 states and the District of Columbia had declines of more than 5 percent. Declines topped 10 percent in 18 states, including all of New England and other states hit hard by the opioid overdose epidemic, such as Ohio, West Virginia and Pennsylvania.

There was an even greater drop in total dosage of opioid prescriptions filled in 2017, down 12 percent from 2016. Reasons for that include more prescriptions being for a shorter duration, a 7.8 percent decline in new patients starting on opioid prescriptions and far fewer high-dose prescriptions.