The Economic Triage of Emergency Medicine

From EP Monthly:

High deductible healthcare plans are altering EMTALA’s “prudent layperson standard” as patients triage themselves away from the ED based on what they think they can afford.

95% of Minnesotans now have health insurance

From the Star Tribune:

The percentage of uninsured Minnesotans has dropped to the lowest level in state history, and the second-lowest level in the nation, following the end of enrollments under the Affordable Care Act.

About 180,500 Minnesotans gained health insurance from last September to this May, with the vast majority getting coverage through one of the state’s public health programs, a report from the University of Minnesota found.

That left just 4.9 percent of all Minnesotans lacking health coverage on May 1, about a month after the federal health law’s first major sign-up deadline. That’s down from 8.9 percent last Sept. 30.

HHS fights back to keep expanded 340B drug discounts

From ModernHealthcare:

The drug industry scored a victory last month against the Obama administration’s plans to give hospitals millions of dollars in discounts through the 340B program on orphan drugs. But HHS is sticking to its position that the Patient Protection and Affordable Care Act promises breaks on the expensive drugs when they’re used for non-orphan indications.

HHS said in a court filing Thursday that the agency plans to appeal a District Court ruling that struck down its regulations on the federal 340B drug discount program—or issue guidance that would replace the rule and compel drugmakers to provide the discounts. The Pharmaceutical Research and Manufacturers of America, a trade group for the drug industry, argued in a lawsuit last year that HHS misinterpreted the law and overstepped its rulemaking authority.

Orphan drugs are some of the costliest drugs on the market and are designated to treat conditions or diseases that affect fewer than 200,000 Americans. But it’s common for drugmakers to seek broader indications for these drugs. Johnson & Johnson’s Remicade, for example, is an orphan drug that’s now used for common indications such as rheumatoid arthritis. The drug brings in billions of dollars in sales each year. It is J&J’s top-selling drug, making up 10% of the company’s revenue in 2013.

“We strongly encourage HRSA to maintain its current orphan drug policy so rural and cancer hospitals are not faced with significant drug price increases,” said a spokesman for Safety Net Hospitals for Pharmaceutical Access, an association representing providers participating in the 340B program, referring to HHS’ Health Resources and Services Administration.

The Gadget That Aims to End the Epidemic of Prescription Overdoses

From Wired:

Dr. Eric Edwards tells the story of a woman who was found on the floor of her home, blue in the lips and barely breathing, after an opiate overdose. She wasn’t using heroin. She wasn’t taking illicit morphine. For years, Edwards explains, her physician had been prescribing opiates to manage her pain, and though she had taken her normal dose, she ODed because she was also taking an antibiotic for pneumonia and it had interfered with the metabolization of her normal medications.

She was facing what doctors call a life-threatening respiratory depression event, and when she was found, a family member drove her the two hours to the nearest hospital. When she got there, the ER gave her a shot of naloxone–a kind of antidote to opiate overdoses–and it saved her life. But Edwards says she was incredibly lucky that she survived long enough to get the shot. Edwards says she should have had the antidote in her home, and her family should have already known where it was and how to use it. “They need a fire extinguisher,” he says, “just in case.”

Edwards is the chief medical officer at Kaleo, a small pharmaceutical company that has built such a fire extinguisher. Typically, administering naloxone requires extensive training. But this summer, Kaleo will introduce Evzio, a kind of auto-injector that painlessly and easily delivers a life-saving dose of the medication. Fast-tracked and approved by FDA, it works simply enough that individuals can use it on their own. Naloxone has been used since the 1970s by EMTs, community harm reduction advocates, and inside hospitals, but Evzio will be the first naloxone delivery method that is specifically intended for use in the home by prescription drug patients.