To fight high drug prices, Utah will pay for public employees to go fill prescriptions in Mexico

Amid a flurry of national proposals to bring exorbitant U.S. drug prices in line with other countries’ charges, one Utah insurer has a different option for patients:

Pay them to go to Mexico.

PEHP, which covers 160,000 public employees and family members, is offering plane tickets to San Diego, transportation to Tijuana, and a $500 cash payout to patients who need certain expensive drugs for multiple sclerosis, cancer and autoimmune disorders.

“That money is pretty small in comparison to the difference between U.S. prices and Mexico prices,” said Travis Tolley, clinical operations director for PEHP.

The insurer rolled out its “pharmacy tourism” option this fall in response to state legislation requiring state employees’ insurance plans to offer “savings rewards,” or cash incentives, to patients who choose cheaper providers.

PEHP is offering pharmacy tourism benefits for about a dozen drugs for which the price disparity between countries is vast. For example, Avonex, which treats MS, costs about $6,700 for a 28-day supply in the U.S., but about $2,200 through PEHP’s contracted clinic in Tijuana.

For three months’ supply — the maximum allowed under the program — the savings of $13,500 more than covers the $500 reward and transportation, typically less than $300 per person.

“Why wouldn’t we pay $300 to go to San Diego, drive across to Mexico and save the system tens of thousands of dollars?” asked state Rep. Norman Thurston, R-Provo, who sponsored the legislation calling for incentives. “If it can be done safely, we should be all over that.”

FDA takes step toward requiring allergy labels for sesame

The Food and Drug Administration on Monday took a step to consider requiring sesame to be listed as an allergen on food labels.

The request for information came in response to growing concerns about the prevalence of allergies to sesame seeds, which are currently not among the major allergens that are required to be disclosed on food ingredient lists.

“Unfortunately, we’re beginning to see evidence that sesame allergies may be a growing concern in the U.S.,” FDA Commissioner Scott Gottlieb said in a statement.

“Fear of not knowing whether a food contains sesame may lead some people to unnecessarily limit their diets to avoid possible exposure,” he continued.

Currently, allergy labeling is only required for milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans.

But the FDA could move to add sesame to that list.

“Gaining a better understanding of the state of the science on food allergies and how these allergens impact consumers, particularly sesame allergies, is an important and necessary first step toward our consideration of new policies that could require labeling for sesame allergens,” Gottlieb said.

Sen. Chris Murphy (D-Conn.) praised the move.

“I heard from families across Connecticut who struggled to shop for food because they were unsure if a product had sesame,” Murphy said. “A lack of clear labels poses a huge risk to individuals with sesame allergies. I applaud the FDA for taking the first step to begin considering labeling sesame products to help protect the health and safety of our constituents.”

Low Clinical Utility Seen in Treating Low-Risk, Mild Hypertension

Large British study shows no outcome benefit, more adverse events.

Antihypertensive treatment for lower-risk patients with mild hypertension was associated with more adverse events but no better outcomes in a longitudinal cohort study.

Among treatment-naive people with a blood pressure in the 140/90 to 159/99 mm Hg range and no history of cardiovascular disease or risk factors for it, overall mortality during was 4.08% (95% CI 3.80%-4.37%) among those who didn’t start on antihypertensives and 4.49% (95% CI 4.20%-4.80%) among those who did during 5.8 years of follow-up.

That 2% excess risk with treatment wasn’t significant, but there were significant increased risks of hypotension, syncope, electrolyte abnormalities, and acute kidney injury, reported James Sheppard, PhD, of University of Oxford in England, and colleagues, in JAMA Internal Medicine.

There was also no evidence of a relationship when looking at antihypertensive treatment and cardiovascular disease (HR 1.09, 95% CI 0.95-1.25).

The 2017 national guidelines recommend pharmacologic intervention starting at 130/80 mm Hg for high-risk patients and for all individuals regardless of risk with a blood pressure of 140/90 mm Hg or higher.

However, “these recommendations are considered to be controversial particularly with regard to treatment of people with low CVD risk and mild hypertension (ie, sustained blood pressure of 140/90-159/99 mm Hg), for whom there is a lack of clinical trial evidence to support initiation of pharmacologic treatment,” the researchers wrote.

Evaluating Medicare’s New Tools for Open Enrollment

For the 2019 Medicare Open Enrollment period, the Centers for Medicare and Medicaid Services (CMS) released three new web tools, available on, which are designed to help Medicare beneficiaries better understand and compare their Medicare coverage options.

At the same time, CMS released minor updates to the Medicare Plan Finder. We reviewed the three new tools, in part applying the expertise and knowledge we gained from working with beneficiaries for our Modernizing Medicare Plan Finder Report. Two of the tools were responsive to recommendations included in our report.

We found that in general, the new web tools are consumer-friendly and serve as a good starting point for making choices. However, beneficiaries should not rely on them alone for picking a plan. Instead, they should use them as a starting point before using the more detailed and accurate full Medicare Plan Finder or before contacting a local State Health Insurance Assistance Program (SHIP).

Halloween causes severe fear and confusion in dementia sufferers

Halloween is a fun time for many, dressing up, collecting as many sweets as possible and joining in on the community spirit. However, for dementia sufferers, Halloween can cause severe fear and confusion.

According to the experts at Radfield Home Care services, Alzheimer’s and dementia can cause a blurred sense of reality, and therefore unexpected knocks at the door, scary masks and fearful costumes can trigger distress as they lack the ability to differentiate between fantasy and reality.

Not everyone will realise that an elderly person may feel afraid and be intimidated by visitors and strangers at their door in the evening when it’s dark. For a person with dementia, scary masks and costumes are a blur of reality that can trigger confusion and distress. Or, that disruption to their routine and environment can be difficult for them to deal with.

As Halloween has spread in popularity across the UK some areas carry an unwritten ‘no pumpkin’ rule. Children and families who are trick or treating will only visit houses that have a lit pumpkin at their door or in the window. Unfortunately, not everywhere adheres to this rule so Radfield have created a friendly ‘No Trick or Treat’ poster for their clients.

Radfield stresses that they don’t want to stop anyone else having fun by celebrating Halloween but do ask that people show compassion and understanding for the elderly and vulnerable.

The objective is to raise awareness within local communities to respectfully avoid visiting the homes of any elderly people or those with dementia who want to ‘opt-out’ of Halloween.

Alternative State-Level Financing for Hepatitis C Treatment—The “Netflix Model”

Drug prices in the United States remain the highest in the world.1 New payment approaches are needed, a point illustrated by the new treatments for hepatitis C virus (HCV) infection that are highly effective but also very expensive, at least from the view of many payers, physicians, and patients. Five years after the introduction of these drugs, and due in many cases to budgetary constraints of state Medicaid programs and prisons, only 15% of the estimated population of more than 3 million individuals with HCV infection in the United States have been treated.

The Department of Health of the State of Louisiana, a state with a high prevalence of HCV infection and low treatment rates, recently published a Request for Information regarding an alternative payment approach, seeking to engage a drug corporation in a subscription-based arrangement to pay for HCV treatment for the state’s residents.3 Gilead Pharmaceuticals indicated the corporation’s willingness to explore the idea.4 The National Governors Association has released a white paper endorsing subscription-based models for treating HCV infection as well.5

In a few media outlets, the idea has been referred to as “the Netflix model,” a term used to describe subscription-based models in general.6 Netflix is a video-streaming service that provides unlimited content for a flat fee; the analogy is a pharmaceutical corporation providing an unlimited supply of its HCV treatments to treat all infected residents of a state in exchange for a flat recurring fee.

The current shortfall in HCV treatment is in part due to the reliance on the per-prescription revenue model. Often what generates the most revenues and profits for drug corporations is charging a higher price per prescription, even if that approach leads to a lower number of filled prescriptions. With HCV treatments, state Medicaid programs and prison systems have responded by limiting access to these drugs, even though it would be better if persons with infections such as HCV were treated rapidly and broadly and even though current pricing puts these therapies in the range of typical cost-effectiveness thresholds. Put simply, under the per-prescription model, the states’ only alternatives are unappealing: raising taxes or reallocating funds from other parts of their discretionary budget, including other priorities in health care.9

The proposed subscription model developed for HCV elimination within a state includes several key components. First, the subscriber should not be the state, but a purchasing coalition constituting all payers for health care. The coalition would have 3 purposes: to provide scale for the buyer, streamline a statewide effort at HCV elimination across payers, and ensure that the payers collectively recapture the long-term cost savings from avoided future medical costs. Currently, no payer has sufficient certainty those future savings will accrue to them. The purchasing coalition would ideally include state governments, private insurers, and agencies that cover federal employees, veterans, and military members who reside in the state.

Second, in exchange for the subscription fees over a fixed number of years, the drug corporation would not only provide access to its HCV therapies, it would also commit to patient and provider outreach efforts to enhance treatment rates in tandem with complementary commitments by the purchasing coalition. To ensure implementation, the contract between the coalition and the drug corporation would include bonus or milestone payments due on achieving predefined public health targets, such as treating 80% of the prevalent population.

Third, the subscription price would be determined through a bid process open to all manufacturers.

The Intercept Is Crowdfunding A Fellowship In Honor Of A Dying Progressive Activist

The Intercept launched the Ady Barkan Reporting Fellowship on Monday, honoring a progressive activist with Lou Gehrig’s disease at the center of protests against the GOP tax cut legislation and Brett Kavanaugh’s confirmation to the Supreme Court.


The Intercept, an online news site launched by eBay co-founder Pierre Omidyar in February 2014, hopes to crowdfund upwards of $70,000 to hire an experienced journalist for the year-long reporting fellowship. The recipient could begin as early as January and would be tasked with covering social movements and protests of the kind Barkan has led and championed.


Although the fellowship is currently a one-time opportunity, The Intercept would ultimately like to fund a year-long fellowship in Barkan’s honor every year, according to Ryan Grim, the outlet’s Washington bureau chief. (Grim, who ran HuffPost’s Washington bureau until June 2017, previously edited this reporter’s work.)

Grim was covering Barkan’s protests of the Kavanaugh confirmation and approached him with the idea for the fellowship. Barkan, a regular opinion columnist for the Columbia University newspaper who interned for the editorial board of The Miami Herald, warmed to the proposal.


“I want to promote journalism with a conscience ― journalism that takes the progressive movement seriously, and journalism that takes human dignity seriously,” Barkan told HuffPost. “I think the Intercept does all that, and I would love to help encourage more young journalists to pursue that kind of livelihood.”


Barkan, a 34-year-old attorney, has a history of innovating grassroots movements that force elected officials and technocrats to face the people affected by their decisions. As a leader at the Center for Popular Democracy, which advocates for low-income communities, Barkan pioneered the Fed Up campaign in 2014, which successfully nudged the Federal Reserve in a more progressive direction.


In October 2016, Barkan was diagnosed with ALS, a terminal disease that slowly paralyzes people. Barkan, who has a two-year-old son with his wife Rachael King, renewed his commitment to rank-and-file activism, vowing to do everything in his remaining days to stop President Donald Trump’s agenda, beginning with the proposed tax cuts.

Children and Youth with Special Healthcare Needs in Emergencies

Nearly 1 out of every 5 children in the United States has a special healthcare need. Children and youth with special healthcare needs (CYSHCN), also known as children with special healthcare needs (CSHCN), require more care for their physicaldevelopmentalbehavioral, or emotional differences than their typically developing peers. A special healthcare need can include physical, intellectual, and developmental disabilities, as well as long-standing medical conditions, such as asthmadiabetes, or a muscular dystrophy.

All children have unique needs in emergencies, but care for children with special healthcare needs is often more complex because of their various health conditions and extra care requirements. They may have a hard time moving from one place to another, urgent or constant medical needs, difficulty communicating or have trouble with transitioning to different situations. A disaster can present all these difficulties at once. Knowing what to do can help maintain calm and keep your family safe. Read more about the real stories of children with special healthcare needs preparing for and responding to emergencies.

Planning is key. It is important for families to have an emergency care plan in place in case a public health emergency like a natural disaster, act of terrorism, or disease outbreak occurs. If there is a child with special healthcare needs in your family, you and your family can prepare by developing a written emergency care plan and practicing your plan. For example, a plan can include medicines or assistance devices that your child needs. If possible, let your child help make the plan. Healthcare providers can work with families of children with special healthcare needs to make sure the child’s needs are covered in the family emergency plan and to identify support networks in your community.

Appropriate response. Stay as connected as possible with children and with others, as these connections can help in providing care and support in an emergency while distracting children to lessen their worries and anxiety. Talk to children about what is happening in a way that they can understand. Keep it simple and consider the child’s age and type of disability. For example, it may be hard to know how much information a child with autism is learning through television and conversations. Adults may have to look for clues that provide information on the feelings and fears of these children.

In Detroit, surviving without running water has become a way of life

On her worst days, Mattie McCorkle admits, she feels “less than a person.”

Once or twice a week, the Detroit mother of three collects her loose change and buckets from her bathtub. She drives to a carwash and fills her buckets.

This is how she’s collected water to bathe herself and her three children since the City of Detroit shut the taps to her home for nonpayment in June.

“You never get used to it. It’s embarrassing. Here I am, 40 years old, filling buckets to get by,” said McCorkle, a supermarket cashier.

“It wears me out.”

Detroit’s aggressive water shutoff campaign has received international attention since it began in 2014, but until now, it was unknown how many people continue to live without service long after disconnections.

For years, city officials said the vast majority of shut off customers have water running again within 48 hours when they are put on payment plans.

Now, new city records obtained by Bridge Magazine show occupants of least 1,500 homes –  and perhaps as many as 2,715 – still remain without water after disconnections this year.

That’s at least 1 in 7 of the city’s 11,422 shutoffs so far this year. More than 900 of those occupied homes have been without water at least three months.

Why Changing General Education Preparation Improves Outcomes for Students with Special Needs

Though I had never intended to become a special education teacher, I felt that the best way to learn how to address the needs of Manuel and other diverse learners in my classroom was to learn how to implement the strategies specifically designed to provide multiple points of access, engagement, and differentiated assessment.

Within the first semester next year, I was able to implement many of the strategies I learned in class.

By the end of that year, my students were making progress, and I finally felt the feeling I went into teaching to feel: I was making a difference.

I believe that teacher certification should be restructured to provide all teachers with enough of a basic level of knowledge to teach diverse learners, including more comprehensive strategies that focus on inclusive practices.

Seventy to eighty percent of general education teachers surveyed report that they feel unprepared to teach diverse learners. And yet, according to IDEA, ninety five percent of students with disabilities spend at least part of their day in the general education setting. Special education teachers are given entire semesters to learn the process that provides targeted support for students based on their academic or behavioral needs, yet general education teachers are the ones expected to implement it in their classrooms. If I had been trained using the techniques and coursework provided to special education teachers, I would not have had to seek out an additional degree to fulfill the basic expectations of my job.