Study: Medicare drug plan saves hospital costs (AP)

CHICAGO � A new study suggests that Medicare's 5-year-old prescription drug plan is keeping seniors out of hospitals and nursing homes, saving the federal program an estimated $12 billion a year in those costs.

The savings only offset a portion of the $55 billion a year the government spends on Medicare Part D, as the drug plan is known. But the study's authors say it means seniors are staying healthier and enjoying a better quality of life.

"This is what people always hope for: If people get drug coverage, they won't need hospitalization," said Marsha Gold of the nonpartisan Mathematica Policy Research, who wasn't involved in the new study. "If it holds up, that's great news."

The Harvard analysis, appearing in Wednesday's Journal of the American Medical Association, found Medicare saved an average of about $1,200 a year for each senior citizen who had inadequate drug coverage before Medicare Part D. Most of the savings came from hospital and nursing home costs.

That translates to an annual savings of $12 billion, experts said.

With subsidized drug coverage, seniors can afford drugs that prevent trips to the emergency room by lowering cholesterol and blood pressure and controlling diabetes, said lead author Dr. Michael McWilliams of Harvard Medical School.

Other savings come from doctors no longer admitting patients to hospitals just so Medicare would pay for drug treatments � like injectable clot-busting drugs for deep vein thrombosis � that can be given more cheaply in a doctor's office, McWilliams said.

"Spending on one type of service can reduce spending on another type of service," McWilliams said. "By expanding Medicare to include drug benefits, clearly we're spending more, but we're getting a lot of value out of that spending."

The findings suggest that lawmakers, while grappling with reducing the federal deficit, should consider all of Medicare's moving parts and how they affect each other, experts said.

"It's critical to think about the entire program. They can't just be thinking about how to pay hospitals differently," said Julie Donohue, a health policy researcher at the University of Pittsburgh, who wasn't involved in the new study. "They have to think about the whole delivery system and the whole Medicare system."

It's tough for researchers to pinpoint the effect of a policy change because they usually can't randomly assign people to participate in a program or not. Medicare Part D is voluntary. Enrollees pay premiums that cover about 25 percent of the cost. There were 23 million Part D beneficiaries last year.

For the new study, researchers analyzed nondrug Medicare spending for about 6,000 seniors from 2004 through 2007.

The Medicare drug benefit started in January 2006. Before then, about 2,500 of the seniors in the study reported having generous drug coverage, which many bought as supplemental insurance. About 3,500 reported having limited or no drug coverage.

By comparing spending trends before and after 2006, the researchers were able to calculate any nondrug savings.

Previous studies show Medicare Part D increased use of antibiotics and drugs for diabetes, high blood pressure, depression and other chronic conditions.

The nation's 1-year-old health care law is gradually closing the Medicare drug coverage gap, the "doughnut hole," which also should keep seniors out of hospitals, McWilliams said.

But another view on the doughnut hole came from Joseph Antos, a health policy expert at the conservative-leaning American Enterprise Institute. Antos said the doughnut hole "turned out to be a very good idea" because it encourages seniors to use cheaper generics instead of more expensive brand-name drugs.

"It's disastrous policy to whittle away at the doughnut hole," Antos said. "If we see generic usage drop, that means the program is going to cost more."

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Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson.

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Online:

JAMA: http://jama.ama-assn.org

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Eye anatomy at camp? Kids get taste of med careers (AP)

WARRENTON, Va. � Again and again, 12-year-old Brianna Bowens cautiously pokes the human eyeball. On purpose.

The donated eye is tougher than you'd think. It takes a few slices with a sharp scalpel to pierce the white part � the sclera, she learns � and eventually remove the cornea in front.

Dissecting a human eye isn't the normal fare of summer camp. It's part of an unusual program at a small northern Virginia hospital that aims to hook kids as early as middle school on the possibilities of a medical career.

It's not for the squeamish. But no one's ever fainted over the eyes.

"I've got a strong stomach," says Brianna, of Stafford, Va., who wants to be a pediatric surgeon "or maybe a nurse."

She betrays her excitement when she's done, the twig-like optic nerve, magnifying lens and clear cornea carefully laid out. Whipping out her cellphone, she exclaims, "Wait, I've got to take a picture."

Tom Gaile of the Old Dominion Eye Foundation teaches the crash course at Fauquier Hospital's medical camp, using eyes donated for education, to explain the importance of organ and tissue donation.

"This is something that's going to stay with them the rest of their lives," he says.

Programs to entice budding scientists, from building robots to measuring pollution, increasingly are becoming part of the summer ritual. On the health side, it can be harder to find hospitals that free up space and staff to give youngsters a taste of what beginning medical students learn � how to suture skin, take blood pressure, put on a cast, insert an IV, type blood � much less handle precious donated eyes.

But more medical camps are cropping up, although no one keeps a count. And if 12 sounds young, well, Virginia in particular is targeting middle-school students so they line up enough science courses for the best shot at increasingly competitive college training programs.

"You can't wait `til you're a senior and decide `I want to go into health care,'" says Barbara Brown, vice president of the Virginia Hospital & Healthcare Association, which helps fund the camps.

She counts 760 mostly middle-school students going through one- to five-day medical camps at 26 hospitals this summer.

The idea is to show kids a wide variety of critical health careers, from nurse-anesthetists to pharmacists to physical therapists.

"Nobody ever says, `I want to be an organ recovery technician,'" says Julie Fainter of Fauquier Health, who coordinates the medical camp in this town west of Washington, D.C.

Judging from the questions that pepper Gaile, maybe some will. Does removing the eye affect funeral viewing? No, the lids are closed. People can donate only the cornea or the entire eye, important as the sclera is transplanted in some eye surgeries and the rest is used for research. Does an eye's color change after it's out of the body? Yes, all irises turn brown after a while.

Marquesia Atwater, 14, came from suburban Atlanta after her mother did a Google search for medical camps.

"I decided my whole life I wanted to be a doctor," she says, a decision the camp cemented. As she examined the eye's lens, she says, "I never knew there was so much stuff in an eye."

During July and August, 92 kids will spend two days each in Fauquier's camps designed for either beginners or returning students. Funded mostly through a $15,000 hospital association grant and staff contributions, kids pay $50 to attend.

Eyes aren't the only hands-on experience.

How do you learn to stitch up a cut when you can't practice on people? They use pigs' feet, but nurse Wendy Greenwood makes sure the kids keep things sterile just like as if it was a person.

Gloves on. Swab the wound with iodine. No scratching your nose, Greenwood tells one student � and watch where you lay the curved needle so no one gets stuck.

Will Merriken, 12, of Warrenton, Va., finishes seven stitches, each a little faster as he gets more comfortable with the painstaking knots. "It's much easier once you have practiced and got the motions down."

On to the hospital's lab. If a kid's going to get lightheaded, this is where it happens, Fainter says, maybe because of the faint chemical odor or the warmth necessary for culturing bacteria. She arms them with peppermints to ward off wooziness.

Inside, Will volunteers first to prick his finger and test his blood type. He drips blood onto a slide and medical technologist Suzie Capron explains how different antibodies make one type clump but not another. He's a B-positive.

Down in the emergency room on a quiet Wednesday morning, Dr. Greg Wagner gathers a dozen of the students for what's called a mock code, a resuscitation drill that doctors and nurses perform to fine-tune their own skills.

Paramedics race in a mannequin: A 45-year-old woman in cardiac arrest.

The kids, each assigned an ER job, spring into action under Wagner's direction. One pumps air into the "patient's" lungs. One inserts a tube to open the windpipe. Three trade off CPR. Another sets up the defibrillator, calling "Clear!" before each of three shocks. Others give injections of heart-stimulating drugs.

Ten minutes later, they abruptly fall quiet as Wagner asks how long they should keep trying before declaring death. No one volunteers.

"How often do patients pass away?" 14-year-old Lark Nash of Warrenton finally asks.

Probably once a week, Wagner responds, describing the hardest part of his job. Nurses reveal a body bag lining the bed, and the students zip it over the mannequin.

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Drug prices to plummet in wave of expiring patents (AP)

The cost of prescription medicines used by millions of people every day is about to plummet.

The next 14 months will bring generic versions of seven of the world's 20 best-selling drugs, including the top two: cholesterol fighter Lipitor and blood thinner Plavix.

The magnitude of this wave of expiring drugs patents is unprecedented. Between now and 2016, blockbusters with about $255 billion in global annual sales are set to go off patent, notes EvaluatePharma Ltd., a London research firm. Generic competition will decimate sales of the brand-name drugs and slash the cost to patients and companies that provide health benefits.

Top drugs getting generic competition by September 2012 are taken by millions every day: Lipitor alone is taken by about 4.3 million Americans and Plavix by 1.4 million. Generic versions of big-selling drugs for blood pressure, asthma, diabetes, depression, high triglycerides, HIV and bipolar disorder also are coming by then.

The flood of generics will continue for the next decade or so, as about 120 brand-name prescription drugs lose market exclusivity, according to prescription benefit manager Medco Health Solutions Inc.

"My estimation is at least 15 percent of the population is currently using one of the drugs whose patents will expire in 2011 or 2012," says Joel Owerbach, chief pharmacy officer for Excellus Blue Cross Blue Shield, which serves most of upstate New York.

Those patients, along with businesses and taxpayers who help pay for prescription drugs through corporate and government prescription plans, collectively will save a small fortune. That's because generic drugs typically cost 20 percent to 80 percent less than the brand names.

Doctors hope the lower prices will significantly reduce the number of people jeopardizing their health because they can't afford medicines they need.

Dr. Nieca Goldberg, director of The Women's Heart Program at NYU Langone Medical Center in Manhattan, worries about patients who are skipping checkups and halving pills to pare costs.

"You can pretty much tell by the numbers when I check the patient's blood pressure or cholesterol levels," that they've not taken their medications as often as prescribed, she says.

Even people with private insurance or Medicare aren't filling all their prescriptions, studies show, particularly for cancer drugs with copays of hundreds of dollars or more.

The new generics will slice copayments of those with insurance. For the uninsured, who have been paying full price, the savings will be much bigger.

Daly Powers, 25, an uninsured student who works two part-time jobs at low wages, says he often can't afford the $220 a month for his depression and attention deficit disorder pills. He couldn't buy either drug in June and says he's struggling with his Spanish class and his emotions. He looks forward to his antidepressant, Lexapro, going generic early next year.

"It'd make all the difference in the world," says Powers, of Bryan, Texas.

Generic medicines are chemically equivalent to the original brand-name drugs and work just as well for nearly all patients.

When a drug loses patent protection, often only one generic version is on sale for the first six months, so the price falls a little bit initially. Then, several other generic makers typically jump in, driving prices down dramatically.

Last year, the average generic prescription cost $72, versus $198 for the average brand-name drug, according to consulting firm Wolters Kluwer Pharma Solutions. Those figures average all prescriptions, from short-term to 90-day ones.

Average copayments last year were $6 for generics, compared with $24 for brand-name drugs given preferred status by an insurer and $35 for nonpreferred brands, according to IMS Health.

Among the drugs that recently went off patent, Protonix, for severe heartburn, now costs just $16 a month for the generic, versus about $170 for the brand name. And of the top sellers that soon will have competition, Lipitor retails for about $150 a month, Plavix costs almost $200 a month and blood pressure drug Diovan costs about $125 a month. For those with drug coverage, their out-of-pocket costs for each of those drugs could drop below $10 a month.

Jo Kelly, a retired social worker in Conklin, Mich., and her husband Ray, a retired railroad mechanic, each take Lipitor and two other brand-name medicines, plus some generic drugs. Both are 67, and they land in the Medicare prescription "doughnut hole," which means they must pay their drugs' full cost, by late summer or early fall each year. That pushes their monthly cost for Lipitor to about $95 each, and their combined monthly prescription cost to nearly $1,100.

Generic Lipitor should hit pharmacies Nov. 30 and cost them around $10 each a month.

"It would be a tremendous help for us financially," she says. "It would allow us to start going out to eat again."

For people with no prescription coverage, the coming savings on some drugs could be much bigger. Many discount retailers and grocery chains sell the most popular generics for $5 a month or less to draw in shoppers.

The impact of the coming wave of generics will be widespread � and swift.

Insurers use systems that make sure patients are switched to a generic the first day it's available. Many health plans require newly diagnosed patients to start out on generic medicines. And unless the doctor writes "brand only" on a prescription, if there's a generic available, that's almost always what the pharmacist dispenses.

"A blockbuster drug that goes off patent will lose 90 percent of its revenue within 24 months. I've seen it happen in 12 months," says Ben Weintraub, a research director at Wolters Kluwer Pharma Solutions.

The looming revenue drop is changing the economics of the industry.

In the 1990s, big pharmaceutical companies were wildly successful at creating pills that millions of people take every day for common conditions, from heart disease and diabetes to osteoporosis and chronic pain. Double-digit quarterly profit increases became the norm.

But the patents on those blockbusters, which were filed years before the drugs went on sale, last for 20 years at most, and many expire soon.

In recent years, many drug companies have struggled to develop new blockbuster drugs, despite multibillion-dollar research budgets and more partnerships with scientists at universities and biotech companies. The dearth of successes, partly because the "easy" treatments have already been found, has turned the short-term prognosis for "big pharma" anemic.

"The profit dollars that companies used to reinvest in innovation are no longer going to be coming," warns Terry Hisey, life sciences leader at consultant Deloitte LLP's pharmaceutical consulting business. He says that raises "long-term concerns about the industry's ability to bring new medicines to market."

But pharmaceutical companies can save billions when they stop promoting drugs that have new generic rivals, and U.S. drug and biotech companies are still spending more than $65 billion a year on R&D.

The 20 new drug approvals in the U.S. this year, and other important ones expected in the next few years, eventually will help fill the revenue hole.

For now, brand-name drugmakers are scrambling to adjust for the billions in revenue that will soon be lost. Many raise prices 20 percent or more over the last couple years before generics hit to maximize revenue. Some contract with generic drugmakers for "authorized generics," which give the brand-name company a portion of the generic sales.

Brand-name companies also are trimming research budgets, partnering with other companies to share drug development costs and shifting more manufacturing and patient testing to low-cost countries.

Pharmaceutical companies have cut about 10 percent of U.S. jobs in four years, from a peak of about 297,000 to about 268,000, according to Labor Department data. Nearly two-thirds of the cuts came in the last 1 1/2 years, partly because of big mergers that were driven by the need to shore up pipelines and boost profit in the short term by slashing overlap.

Drug companies also are trying to stabilize future sales by putting more sales reps in emerging markets such as China and India, and diversifying into businesses that get little or no generic competition. Those include vaccines, diagnostic tests, veterinary medicines and consumer health products.

As the proportion of prescriptions filled with generic drugs jumped to 78 percent in 2010, from 57 percent in 2004, annual increases in prescription drug spending slowed, to just 4 percent in 2010. According to the Generic Pharmaceutical Association, generics saved the U.S. health care system more than $824 billion from 2000 through 2009, and now save about $1 billion every three days.

The savings are only going to get greater as our overweight population ages. People who take their medicines regularly often avoid costly complications and hospitalizations, says AARP's policy chief, John Rother, bringing the system even bigger savings than the cheaper drugs.

In addition, many patients taking a particular brand-name drug will defect when a slightly older rival in the same class goes generic.

Global sales of Lipitor peaked at $12.9 billion in 2006, the year Zocor, an older drug in the statin class that reduces bad cholesterol, went generic. Lipitor sales then declined slowly but steadily to about $10.7 billion last year. That still makes Lipitor the biggest drug to go generic.

For patients, it's a godsend.

Douglas Torok, 59, of Erie, Pa., now spends nearly $290 every three months for insulin for his Type 2 diabetes, plus four daily pills, including Lipitor, Plavix and two generics, for his blood pressure and cholesterol problems. The $40,000-a-year foundry supervisor fears not being able to cover the out-of-pocket costs when he retires and doesn't have a generous prescription plan.

In the meantime, once Lipitor and Plavix get generic competition his copayment will plunge from the current $1 per day for each.

"I will pay $16 for 90 days" for both, says Torok, who hopes to travel more. "It's a big deal for me on my income."

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Brand-name drugs going off patent through 2015: http://www.medcohealth.com/art/corporate/anticipatedfirsttime_generics.pdf

Brand-name and generic drug price comparisons:

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CDC: Chickenpox deaths plummeted since vaccine (AP)

ATLANTA � Chickenpox vaccine has dramatically cut deaths from the disease, especially in children, says a new government study proclaiming an important public health victory.

Researchers from the Centers for Disease Control and Prevention found that chickenpox deaths fell from an average of 105 per year to 14 after the vaccine had been available for a dozen years.

Deaths declined in all age groups, but the drop was most significant among children.

"To see the near elimination of chickenpox deaths in this country is very exciting," said Jane Seward, a CDC official who co-authored the paper. She has been involved in the agency's chickenpox vaccine program for 15 years.

The report was released online Monday by the journal Pediatrics.

Chickenpox is caused by a virus and is highly contagious. Symptoms include an itchy skin rash and fever. Most kids suffer no more than that, but some suffer complications like skin infections, swelling of the brain and pneumonia. Severe cases are more common among adolescents and adults who get it for the first time. Also, the virus � called varicella � can reactivate in people later in life and cause a painful illness called shingles.

While rarely fatal, chickenpox was very common before the vaccine � nearly one in 10 pre-adolescent children would get it in a year, said Dr. Eugene Shapiro, a Yale University expert in infectious disease.

In 1995, the government first recommended that all children get a dose of chickenpox vaccine. One dose turned out to be about 86 percent effective. A second dose is now recommended.

The new CDC study looked at national records for deaths attributed to chickenpox. In the five years before the vaccine, an average of 105 Americans died of the virus annually. By 2007 � 12 years after the vaccine � the annual death toll had dropped to 14, and almost all were adults.

The vaccine deserves credit for the decline in children's deaths, Seward said. It's also likely cut adult deaths because there are fewer infected children around to spread it to adults, she added.

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Online:

CDC: http://tinyurl.com/chickenpoxinfo

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'30 days of hell' for US victim of German E. coli (AP)

ATLANTA � In early May, John Meyer stayed at a lakeside hotel in Hamburg, Germany. He attended a business conference. He went sailing. And he became one of the few U.S. victims in one of the worst food poisoning outbreaks in recent world history.

Meyer went to the hospital a week later with what turned out to be a rare and deadly strain of E. coli bacteria that caused thousands of illnesses, mostly in Germany. He would spend the next month in a Massachusetts hospital, much of the time a delirium, while doctors worked around the clock to save his life.

Meyer is one of six U.S. cases linked to the German outbreak and he's the first to talk about his terrible experience, speaking to The Associated Press by phone from his home in Franklin, Mass.

"It was 30 days of hell," said his wife, Loreen.

Meyer was in Hamburg as that city was emerging as the epicenter of a food poisoning disaster that would be among the deadliest in memory. More than 4,000 people in Germany and other countries became ill since the outbreak was detected in May, including several hundred who developed a serious complication that can lead to kidney failure. At least 53 died.

The outbreak ultimately was traced to a batch of fenugreek seeds from Egypt. The seeds, which taste a bit like burnt sugar, are sometimes used as a spice in cooking. Fenugreek sprouts are used in salads.

Meyer believes he must have eaten fenugreek while attending a business meeting at the Hamburg hotel. He thinks the tainted seeds, or sprouts, could have been in the fresh fruits and vegetables at a breakfast bar. There would be some irony if that was the case: It's hard to find good produce during hurried business trips, and Meyer had welcomed the opportunity to eat healthy.

"In this case, it backfired," he said.

Meyer's lawyer provided the AP with lab results and government investigation reports into his illness. Massachusetts state health officials also confirmed he was infected with the rare German E. coli strain. Meyer declined to allow his doctor to speak to the AP and he would not agree to be photographed.

Some common forms of food poisoning can cause symptoms within a day of eating tainted food, but Meyer said he felt no ill effects during a six-day European business trip that included two days in Hamburg and a brief stop in France afterward. He returned home on May 13 feeling fine.

However, this unique and dangerous E. coli bug takes a week to announce its presence. Meyer first became aware something was wrong on May 18. He was at his desk at Senior Aerospace that morning when his abdomen began hurting.

At 52, he is a cyclist who eats two Greek yogurts each day. He says he's never had food poisoning, but on that day he went home in pain.

By midafternoon, he was hit with bloody diarrhea and a dawning sense of alarm. "Whatever it was, it wasn't a minor thing," Meyer said. His wife Loreen, a high school biology teacher, was home by then and worried. She took him to nearby Milford Regional Medical Center.

Doctors there saw him quickly but weren't able to diagnose him. They recommended follow-up with a gastroenterologist the next day and sent him home for the night. But when he got home the diarrhea accelerated. "Every hour, and then it started getting even closer," he recalled.

Loreen took him back to the hospital that night and he was admitted.

Though it all happened less than two months ago, Meyer's memory is fuzzy on what happened the next several weeks. He had intense stomach pain and his kidneys stopped working. Doctors put him on fluids to rehydrate him. They treated him with different antibiotics, and cleansed his blood using dialysis and other measures.

The infection affected his mind. He recalled staring at a clock in his hospital room and not being able to tell time. "I was thinking, `Why do they have this strange clock in here, and why is it set up differently?'"

Meyer said he grew paranoid, believing that his doctors had written him off for dead. Doctors had not given up on him, but were perplexed. A test for the most dangerous form of E. coli familiar to Americans came back negative. They sent specimens for additional analysis to lab with the Centers for Disease Control and Prevention lab in Atlanta.

In early June, CDC confirmed it was the German strain.

Around that time, he had begun to recover. His kidneys were improving. His awareness returned. He was moved out of intensive care more than three weeks later, and on June 17 he was sent home.

But he was far from normal. He and his wife said his muscles had atrophied, his red blood cell count was still down, and the lining of his colon had become a layer of dead tissue, unable to absorb nutrients. A man who had been an athletic 6-foot 2 and 185 pounds was down to 162 pounds and able to walk only short distances using a cane. He was hungry, though. Voracious, even, eating two breakfasts, two lunches and two dinners each day.

"He had such a huge appetite because he was still not able to absorb as many nutrients," his wife said.

Now he's up to 170 pounds and working part days from home. He's been in physical therapy and regaining his strength, though he's months away from the kind of vigorous exercise he used to do.

Meyer and his wife contacted a local attorney, saying they were worried about possible problems with getting health insurance to pay his hospital bills. That turned out not to be an issue. But the attorney referred the couple to Bill Marler, a Seattle lawyer considered the nation's pre-eminent plaintiff's attorney in food poisoning cases.

Marler is looking into the possibility of a lawsuit, with potential targets including the company that owns the Hamburg hotel where Meyer stayed.

He called Meyer's suffering "horrific," and echoed Meyer's wife in worrying that he may suffer long-term problems.

For his part, Meyer feels lucky to have survived, crediting his doctors for saving his life and his good health and fitness before the illness for helping him get through it.

"Many unfortunate people didn't survive," he said. "It really is a frightening thing."

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Govt proposes clearer labeling of meat additives (AP)

WASHINGTON � The Agriculture Department wants consumers to know when there's less chicken in their chicken.

A proposed rule aimed at food companies would require that poultry and other raw meats be labeled appropriately when they're plumped up by added solutions such as chicken broth, teriyaki sauce, salt or water. The practice of adding those ingredients is common, but many consumers don't know about it.

According to USDA, about one-third of poultry, 10 percent of beef and 90 percent of pork may have added ingredients � about 40 percent of all raw, whole cuts of meat. The rule does not apply to ground beef, which may have other added substances.

"Consumers should be able to make an informed choice in the store, which is why we need to provide clear, informative labels that will help consumers make the best decisions about feeding their families," said Elisabeth Hagen, head of food safety at the department. "It has become evident that some raw meat and poultry labels, even those that follow our current guidelines, may not be clear."

Labels now say that the meat contains added solutions or is "enhanced," but they may not be visible to consumers or understandable. If the rules are finalized, the label would now have to be part of the product title. An example of the new labels would be "chicken breast � 40% added solution of water and teriyaki sauce," according to USDA.

Richard Lobb of the National Chicken Council says the poultry industry is split on the issue, as some companies add ingredients to their poultry and some don't. He said the level of added ingredients in poultry is generally 15 to 18 percent of the piece of meat.

Red meat processors immediately objected to the rule. The American Meat Institute called it "wasteful" and "unnecessary" and said it would cause prices to go up for consumers.

Consumer groups have been pressuring the department to crack down on the practice for several years, saying the added ingredients are unhealthy.

"Who wants to pay $4.99 a pound for the added water and salt?" said Michael Jacobson, executive director of the advocacy group Center for Science in the Public Interest. "Besides cheating customers financially, `enhancing' meat and poultry delivers a stealth hit of sodium."

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