The Centers for Medicare Services, CMS New Policy February 2019

In my recent book, I wrote about the federal government's overreaching into the physicians' private treatment of the pain patient.  I pointed out that the Veterans Administration was making life difficult and increasing the pain levels of VA patients.

How?  VA Administrators have been crawling all over their doctors and mid-level practitioners to enforce their policy of limiting pain meds and quantities of meds for patients.  VA also has discontinued a doctor's authority to combine two different classes of meds in a particular patient: opioids and benzodiazepines.

CMS, the Center of Medicare Services, issued a new policy that pain meds in the opioid category would be limited to a 7-day supply.  To me that is federal politics butting into health care.  This is important stuff to patients.  Let the doctor play doctor, let the politicians play politics.

Additionally, CMS is recruiting pharmacists to be the enforcers of the new regulations.  Young pharmacists will get their kicks being the pain prescription police; old pharmacists will see it as one more pain in the butt.  CMS will have their hound dogs--pharmacists--enforce their policies by means of transmitting warning messages to the pharmacy computer.  This is all being done 'in the interest of patient safety' because the government cannot control the influx of narcotics into the USA.  It has little to do with patient safety; it is politics, pure and simple, and I oppose it all.

You may go to a pharmacy hoping to obtain the script that your doctor just prescribed for you.  If you are taking a med from CMS's banned class--anti-anxiety drugs--the pharmacist will study your secret PDMP report: your Prescription Drug Monitoring Report.  Also any electronic messages from Medicare, other insurers, or Rx processing companies must be addressed by the understaffed pharmacist.  Electronic alerts include messages like patient safety, refill too soon, duplication of therapy, excessive quantity or dose, soft halts and hard halts.

A pharmacist can override some warnings; others require that the prescriber be consulted.  Additional information from the doctor may be required by the claims processor.  Think time and hassle and stress and worry.  Don't expect a positive outcome.  This new CMS standard will be disseminated and most insurers will follow suit.

Expect things to get worse if you are a pain patient and/or an anxiety patient.  The USA intends to punish you.  Without your meds you will get worse, you will have a more difficult time working, living a meaningful life, and possibly surviving the day.  This is secret stuff.  You only find out when your refills are denied.  Good luck.

$3 million to be wasted by federal government

I read that the CDC, the Centers for Disease Control, is granting $3 million dollars to a couple of Professors/Researchers at the University of Washington: a doctor and a pharmacist.  Because it's my old school, I read on and learned that the study will be to quantify how and why senior citizens 65-plus fall down and get hurt sometimes.  The two ladies want to blame the falls on two classes of medications: the opioids and the benzodiazepines.  Of course, that's the politically correct thing to do.  It sounds pretty stupid so far--and biased.

 https://sop.washington.edu/uw-researchers-gray-and-phelan-to-study-the-impact-of-deprescribing-to-reduce-falls-in-older-adults/

Initially I was surprised, but not really surprised at all, that once again the federal government was using its political weapons and our money to pressure doctors NOT to prescribe pain medications and anti-anxiety drugs to seniors who are sick.  Another study against patients and their meds...

Of course to medical doctors and pharmacists, it is self-evident that the two drug classes may cause sedation and/or mental cloudiness, and should be prescribed with care in the elderly population.  How elementary do we have to be here?  I can remember taking a course in geriatric pharmacy over thirty years ago in which this topic was well covered.  We pharmacy students visited a large skilled nursing facility and learned all about the rules.  Patient chart review, scrutiny of patients' meds, interactions with physicians and med students.  We had federal regulations back then that required a monthly medication review of each resident's meds by a pharmacist at skilled nursing facilities.  This is still going on.

So why waste $3 million dollars on this nonsense?  Problems with falling are already documented and addressed to minimize harm to seniors.  Maybe the study is simply a part of the academic machine that needs study money to pay the bills.  Nope, it's something else disguised as a study.

Our government is working diligently to harass and scare doctors, pharmacists, patients, and the families of patients that opioid meds and anti-anxiety meds are so toxic and perilous that the medical use of them should be severely constrained and restricted.  The country's inability to stop the illegal importation of narcotics is not a legitimate reason for taking your uncle's anti-anxiety med away from him.  We have a surplus of young healthy zealots with fancy degrees who want to get a job, but not really a job at which demanding work is required.  Applying for and obtaining grant money for a subject that is in favor, politically, gets you that job, that extra degree, that medical journal visibility, and keeps you out of the hard work: the airless patient exam room or the helter-skelter pharmacy.

Substituting first-generation antihistamines for benzodiazepines for anxiety treatment is improper and unhelpful, even though we have been told 100 times that it is medically proper and filled such scripts.  Substituting anti-psychotics in the young adult population for anti-anxiety drugs is commonplace and improper.  Substituting anti-inflammatory drugs in a patient whose pain condition merits an opioid is malpractice, unless the combination of the two is utilized.  Prescribing tricyclics to a patient who needs a sleeping medication is dishonest.  Changing an Rx for a sleeping med or an anti-anxiety drug to an anti-depressant isn't appropriate either, in my view.

A consulting pharmacist who makes a living arguing to discontinue current needed meds, and in doing so, harms the patient's wellbeing, should be shot.  (just a figure of speech, not literal.)

I got off track here but I could go on and on.

I'd like to see treatment return to the relationship between doctor and patient and all the other intruders--the consultants, insurance companies, politicians, youthful experts--take a hike.
Wait...I don't think that the relationship was ever between doctor and patient...we've always had the insurance people making money from the relationship.