Who Will Care for the Caretakers?

Many of us are caring for–or know someone who is caring for–a family member, often an aging parent. With 10,000 baby boomers turning 70 every day, caring for this demographic is a growing health care matter, and it’s only time before it becomes a political issue. Let’s take a look at three women and the impact this has had on their lives.

• Aisha Adkins graduated from college with goals, dreams and a bright future. Ten years later, she’s still living at home. No job or car, no savings or the advanced degree she needs to be competitive in her field. Her mother was diagnosed with early onset dementia and cannot be left alone. For the last decade, Aisha has held the demanding role of caretaker for her mother. Aisha takes care of the house, shops and cooks dinner, then retires to her room around 10pm, when her father gets home. She’s had three dates in three years; she’s completely missing those exciting post-college years when young adults really start to find themselves.
• Heather Oglesby is a project officer for the Centers for Disease Control and Prevention in Atlanta.She was 42 when her mother received a dementia diagnosis four years ago. Caring for her mother has stunted her career prospects and weighed on her marriage. She has taken money from her pension plan and refinanced her home to cover her mother’s expenses. “Caregivers are physically, mentally and financially dying,” she told me. “They are a health care crisis in the making.”
• Heather Boldon dropped her demanding paralegal job nine years ago to take care of her mother. Since then, she has moved in and out of lesser-paying jobs, unable to build financial security. “I’m almost 52, and I’m starting from scratch,” said Ms. Boldon, whose mother has Alzheimer’s disease. “I’ve lost ten years of my life. What’s going to happen to me?”

Aisha and her father understand that her mother will need full-time professional care at some point. But they have no idea how they will pay for it. The Adkinses’ situation may be extreme, stemming from an early onset dementia diagnosis. But even for caregivers who keep a foothold in the labor force, the economic cost can be substantial.

The burden of care is profoundly reshaping lives

Unfortunately, stories about these three women aren’t uncommon. This burden of care is reshaping the lives of millions of Americans. About 15% women and 13% of men 25-54 years old spend time caring for an older relative, according to the Labor Department. For those 55 to 64, the share rises to one in five Americans. Some 20% of these caregivers also have children at home.

Demand for care is growing: Blame it on the boomers

“The boomer generation is living longer than when the safety net was put in place,” said Ai-jen Poo, a co-director of Caring Across Generations, a coalition of advocacy groups. Her organization is pushing to add a benefit to cover care — for older adults, children and sick family members — to the nation’s safety net, alongside Social Security and Medicare.

While men are being forced to step up, Ms. Poo noted that “women, in particular, are bearing the brunt of the burden.” By knocking many women in their prime earning years from the work force, the growing strain from care is weighing down the American economy.

For many, leaving the labor force is not an option

More than 60% of the people caring for an older person work, too; 45% of the caregivers work fulltime. Altogether, American families forgo at least $28.9 billion per year in wages when they take time off to take care of their children or sick relatives, according to a study issued in 2016 by the liberal Center for American Progress.

Burden of care only starting to seep into political conversations

The burden of care has not become a political concern with the urgency of health care policy; it is mostly absent from proposals by candidates for the Democratic presidential nomination. But it is seeping into the conversation. Senator Bernie Sanders’s Medicare for All proposal includes a benefit for long-term care. Senator Elizabeth Warren supports universal child care, which she has proposed to finance with a wealth tax. In 2016, Hillary Clinton made this part of her platform, by giving tax credits to those who were taking care of family members.

Ms. Poo argues that it is only a matter of time before care becomes a political priority. “There is no feasible way in this economy that people can manage care without more institutional support,” she said. It most likely will become a political issue and it will end up being a women’s issue.

Many of our clients are seniors who come in to our offices to create their Living Trusts

The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning. California Document Preparers assists our clients in the preparation of their Trusts, which include a Power of Attorney and Advance Healthcare Directive. Most are surprised at how easy it is. Schedule your appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.

The Early Days of the Opioid Crisis: How It Might Have Turned Out Differently

An article in The New York Times tells the tragic story of addiction and its effect on a Virginia coal mining town that has already seen its share of hard times. But it’s more than that. It’s about the lawmakers who had a chance to do the right thing to make OxyContin more difficult to get—and didn’t.

Three brothers bought a small pharmaceutical company, Purdue Pharma

The brothers, all doctors, introduced a version of oxycodone that was reformulated into a slow-release format. That drug was, of course, OxyContin, a powerfully addictive painkiller. The opioid crisis has taken more than 400,000 lives. Hundreds of thousands more addicts are trapped in endless struggles between sobriety and addiction. Many lose that struggle.

Now the Sackler family, realizing they can’t sustain the growing barrage of lawsuits, are declaring bankruptcy. There’s speculation that they’ve salted away billions of dollars in offshore accounts. Purdue Pharma has warned a bankruptcy court that the Sackler family members “may be unwilling–or unable” to contribute billions to a $10–$12 billion settlement toward the costs of the opioid crisis if lawsuits against them are allowed to proceed.

Years before there was an opioid epidemic, Sister Beth Davies saw it coming

In the late 1990s, patient after patient addicted to a new prescription painkiller called OxyContin began walking into Sister Beth Davies’ Appalachian substance-abuse clinic. Around the same time, a local physician, Dr. Art Van Zee, sensed that something was going on as well. Teenagers were coming into his clinic, overdosed on the drug. His lawyer wife, Sue Ella Kobak, had yet another perspective on the growing crisis—a growing wave of crime. All had links to OxyContin.

These three people, each with a unique perspective and first-hand experience with the effects of this addictive drug, were among the first in the country to sound an alarm about the misuse of prescription opioids. This was perhaps the beginning of a cycle of addiction. It spread to illegal opioids like heroin and counterfeit versions of fentanyl. This led to activism against Purdue Pharma that the powerful company crushed.

Those who saw the epidemic unfolding see it as a tragedy of missed opportunities

• Van Zee believed the FDA could have rechanneled the drug’s force by forcing Purdue Pharma to reformulate OxyContin so that it was harder to abuse. It took until 2010 for the drugmaker to do this.
• The Justice Department could have changed the behavior of other opioid makers if it had charged executives of Purdue Pharma in 2007 with felonies, in connection with OxyContin’s illegal marketing.
• Instead, department officials negotiated a deal under which the executives pleaded guilty to misdemeanor charges that did not include jail time.
• In the years that followed, executives of other opioid makers and distributors kept shipping millions of addictive pain pills into towns like this one, apparently without fear of serious penalties.

The consequences of OxyContin inaction continue to impact this mining town

“I think the trajectory would have been completely different,” Dr. Van Zee said recently. “It would not have reached the magnitude that it did.” This former mining town of about 1,900, set in the far southwestern corner of Virginia near the border of Kentucky is still suffering the consequences of addiction.

• Van Zee is 72 and gets up at 4am. to take care of paperwork before spending 10- to 12-hour days at a community health clinic. Some of his patients are still addicted to opioids.
• Sister Beth is now 86, and she continues to run her treatment center. She is seeing more people turning to heroin and fentanyl because they’re cheaper. She’s also seeing the return of methamphetamine. “It never ends, the whole cycle, we are still losing people to these drugs.”

Dr. Van Zee: a reluctant activist who trusted pharmaceutical companies

Both Sister Beth and Ms. Kobak had previously taken on fights in this part of Appalachia to protect the rights of workers and the environment. But Dr. Van Zee was an unlikely activist. When OxyContin came on the market in 1996, he prescribed it for his cancer patients to dull their excruciating pain. He was naïve enough to think that a pharmaceutical company wouldn’t market a drug that had such addictive powers.

A Purdue Pharma sales representative told him that OxyContin was safe because it was a long-acting narcotic; it would not appeal to drug abusers who sought a quick high. But users quickly discovered that crushing an OxyContin pill released large quantities of the narcotic oxycodone.

Sister Beth recalls getting a phone call from the local pharmacist as she was starting to see people addicted to the drug. His words: “Believe me, this is going to be the worst disaster that ever hit Lee County.”

Dr. Van Zee began writing Purdue Pharma executives

Dr. Van Zee was urging the company to pull back on how it was marketing the drug. Frustrated by the lack of response, he and others launched a petition drive in 2001 to convince the FDA to take OxyContin off the market until it could be reformulated and made safer.

• Several executives met with Sister Beth, Dr. Van Zee, Ms. Kobak and others at a local motel.
• They listened as the executives tried to convince them to drop the recall petition, and offered $100,000 to help fund addiction treatment in the area.
• One executive showed a new ad campaign that included a warning label.

By the mid-2000s, the people of Pennington Gap were trying to combat a growing opioid epidemic in other ways.

• Van Zee received training that allowed him to prescribe buprenorphine, a medicine that blunts cravings for opioids.
• Sister Beth, Ms. Kobak, Dr. Van Zee and others helped start a local inpatient addiction treatment facility, the only one for many miles.

In 2007 the Justice Department announced criminal indictments against Purdue Pharma and three of its top executives in connection with deceptive marketing of the drug. That July, Sister Beth stood in drizzling rain outside a federal courthouse in Abingdon, VA, disappointed about the outcome of the case.

A judge had approved a deal struck between the Justice Department and the three Purdue executives. Under it, the men were allowed to plead guilty to a single misdemeanor charge that did not accuse them of personal wrongdoing and for which they would not face jail. “I think it would have made a considerable difference if these people had been arrested and done jail time,” she said. This was a slap on the hand.

Twenty years later, the problems of the opioid epidemic continue to plague this town

Drugs tainted by counterfeit fentanyl are now sold on the streets. Many of the town’s population are meth addicts, prone to flying into psychotic rages. The inpatient treatment facility was forced to close after for lack of funding. Government funding was woefully short of what was necessary for people to get the help they needed. Virginia’s decision last year to expand Medicaid, which has paid for treatment of many low-income people in other expansion states, may have helped, along with an injection of federal grant money to states for addiction treatment and prevention.

Sister Beth, Dr. Van Zee and Ms. Kobak: Watching the legal problems of Purdue Pharma

Earlier this year, Dr. Van Zee and Ms. Kobak flew to Oklahoma so the physician could testify as an expert witness in that state’s lawsuit against the drugmaker. But that never happened. In March, Purdue Pharma agreed to pay $270 million to settle. As a result, all its internal documents remain sealed. Oklahoma state officials said they struck the deal because of concerns that Purdue Pharma, which faces thousands of lawsuits, might soon file for bankruptcy, which, of course, it did.

Dr. Van Zee said he couldn’t question the state’s decision but was deeply disappointed. The lawsuits against Purdue Pharma and other opioid manufacturers and distributors have been consolidated under one federal judge in Ohio. Johnson & Johnson was ordered to pay $572 million to Oklahoma for its role in the epidemic. This is one case in one state. There are more than 2,500 lawsuits that are pending against Purdue Pharma.

Failure of public officials to police actions of corporations

After living through the opioid epidemic for 20 years, Dr. Van Zee, Ms. Kobak and Sister Beth all share the belief that the only way to prevent a similar catastrophe is for the truth to come out about the actions of corporations and the failures of public officials to oversee them. “I hope it puts a light on what huge systematic changes we can make so that this doesn’t happen again.” Twenty years later, hundreds of people are struggling with addiction, and the national failure to contain an epidemic has grown more complex.

Many of our clients are seniors who come in to our offices to create their Living Trusts. The result is numerous conversations on a wide range of topics related to current health and health care issues and end-of-life planning.

California Document Preparers assists our clients in the preparation of their Trusts, which include a Power of Attorney and Advance Healthcare Directive. Most are surprised at how easy it is. Schedule an appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.

An Aid in Dying Update: More Available, Yet Few Will Choose It

On August 1, New Jersey became the eighth state to allow doctors to prescribe lethal medication to terminally ill patients who want to end their lives. On Sept. 15, Maine will become the ninth. By October 2019, 22% of Americans will live in states where residents with six months or fewer to live can determine how and when they will die. (Oregon, Washington, Vermont, Montana, California, Colorado, Hawaii, District of Columbia) Oregon was the first state to pass the Death with Dignity Act in 1997. More than 20 years later, opposition groups remain wary of potential abuse. Hospitals with religious affiliations may refuse to allow their physicians to perform the procedure. Yet opposition is softening as support grows. Aid in dying is more available, yet few will choose it.

A look back on the EOLOA in California

California passed the End of Life Option Act (EOLOA) in 2015. Jerry Brown signed it into law in 2016. Four years and it remains controversial and problematic. While the campaign for aid in dying (or death with dignity) continues to make gains across the country, supporters are increasingly concerned about what happens after these laws are passed—on both sides of the issue.

• Some fear that the law forces the dying to navigate an overly complicated process of requests and waiting periods.
• There are op-out provisions that allow doctors to decline to participate and health care systems to forbid their participation—even in places where aid in dying is legal. In areas where there is a shortage of doctors, it can be difficult to complete the necessary process within the prescribed timeframes.
• Those who oppose the legislation fear that it sets up a slippery slope for abuse.

The New Jersey bill had neared passage several times, but derailed in 2014 when Governor Chris Christie threatened a veto. Legislators passed the Aid in Dying for the Terminally Ill Act in 2019 and the governor signed it in April. Governor Janet Mills: “I do believe it is a right that should be protected by law–the right to make ultimate decisions.”

So what’s changed? All states are required to track usage and publish stats

Data show that whether a state has six months or 20 years of experience (Oregon, the pioneer in aid in dying), the proportion of deaths involving aid in dying (also known as physician-assisted suicide) remains tiny.

California’s 2017 data show that 632 people made the necessary two verbal requests to physicians, after which 241 doctors wrote prescriptions for 577 patients. This out of 269,000 deaths that year. The law shows no evidence of widespread abuse or misuse of the law. Attitudes within the medical community are changing. A number of national organizations and a dozen state medical societies have gone from opposing the law to taking neutral stances.

Despite Catholic organizations and other opponents, polls show broad support

In March, an aid-in-dying bill passed the Maryland House of Delegates but failed after a tie vote in the Senate. Opponents are attempting a ballot initiative to repeal Maine’s new law and pursuing a slow-moving court case to invalidate California’s. Yet public opinion polls consistently show broad support for aid in dying.

The small number of users suggests most Americans would not choose this option

There’s enough data from a number of states now to identify trending. The low numbers of users show that most users would not choose this option. However, it may also reflect difficulty in actually using these laws.

A recent survey of 270 California hospitals, published in JAMA Internal Medicine, found that 18 months after implementation of the state’s EOLOA, more than 60% — many of them religiously affiliated — forbade affiliated physicians to participate. Compassion & Choices is intensifying efforts to persuade local health care systems, doctors and hospices to agree to consider patients’ requests.

Laws drawing scrutiny; many believe they’re too difficult with too many safeguards

The model has been the first-in-the-nation Oregon law, which took effect in 1997. The law requires that a terminally ill patient:

• Sees two doctors.
• Makes two oral requests for a lethal prescription, plus one in writing.
• Waits 15 days.

For a terminally ill patient who perhaps lives in a rural area where doctors are scarce or even in an urban area where they’re booked up for weeks in advance, this can become challenging. A Kaiser Permanente study shows that at least a third of those who inquire about the aid in dying measure become too ill to complete the process or die before they qualify. Hawaii’s law took effect in January. It requires a 20-day wait, and they’ve an additional mental-health consultation requirement.

Dementia, testamentary capacity and Aid in Dying

• Rural areas face physician shortages, and Compassion & Choices has urged that nurse-practitioners and physician assistants be allowed to provide aid in dying in states where they can legally write prescriptions.
• One legislator has introduced several bills that would permit those in the early stages of dementia and other neurodegenerative diseases to use aid in dying, securing prescriptions theycould then use later as their illnesses progressed. “You could make the request when you were cognitively able to do it,” he said.
• Yet every existing state law bars that. Those requesting aid in dying must be able to show mental capacity; dementia patients will have lost that ability by the time they’re within six months of dying.

The support for aid in dying continues to gain momentum. The fact that very few people are actually using this measure may be tamping down the fears of those historically opposed to the measure.

Many of our clients are seniors who come in to our offices to create their Living Trusts

The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning. California Document Preparers assists our clients in the preparation of their Trusts, which include a Power of Attorney and Advance Healthcare Directive. Most are surprised at how easy it is. Schedule an appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.

A Brain Scan May Predict Alzheimer’s. Should You Get One?

Juli Engel was delighted when a neurologist recommended a PET scan to determine whether amyloid — the protein clumps associated with an increased risk of Alzheimer’s disease — was accumulating in her mother’s brain.

Her mother, Sue Engel, is 83 and lives in a retirement community in Florida. She’s been experiencing memory problems and the other signs of cognitive decline that her family could no longer ignore. There were, of course, the small things that drive us all crazy–losing our keys and wandering into rooms, then forgetting why we’re there. But for Juli, there were more serious indicators: Mom had been financially exploited, suffered an insurance scam and caused an auto accident. Time for an intervention.

PET scans can detect amyloid plaques that can indicate Alzheimer’s

PET scans can detect the amyloid plaques that occur commonly in older people’s brains that contribute to Alzheimer’s disease. Receiving an early diagnosis can be devastating to patients and their families, but it can help patients get their affairs in order and make the most of the time they have left. They can begin taking medications that may slow down the spread of the disease. Alzheimer’s can be a slow-moving illness, and early diagnosis gives patients time to join support groups, spend time with their families and learn how to live as fully as possible in their remaining years.

A PET scan’s downside

Amyloid plaques occur commonly in older people’s brains, but not everyone with amyloid will develop dementia. Nor does a negative PET scan mean someone won’t develop dementia. Medicare doesn’t cover the scans’ substantial costs of $5,000-$7,000.

The healthcare community debates PET scans: Few benefits at significant costs

• Brain damage from Alzheimer’sbegins years before people develop symptoms, and worried patients and their families may start turning to PET scans to learn if they have this biomarker.
• While scientists at Washington University in St. Louis have developed a blood test for amyloid that can predict the development of plaques in the brain, it is years away from everyday use in doctors’ offices.
• Some experts fear PET scans offer few benefits, at substantial costs. Currently the criteria developed by the Alzheimer’s Association and nuclear medicine experts call for PET scans only in cases of unexplained or unusual symptoms and unclear diagnoses.

Even with detection, we have no corresponding treatment for Alzheimer’s

Alzheimer’s rates climb steeply at older ages, when people grow more likely to die of other causes before they can develop symptoms. But older people also may be among the 30% or so of those with amyloid deposits who, for unexplained reasons, retain normal cognition. “If we start treating everyone with preclinical Alzheimer’s, what treatments would those be? Multiple trials have failed to find drugs that prevent, reverse or substantially slow Alzheimer’s disease, perhaps because these treatments were introduced too late in the disease’s course.

Concerns about broader acceptance

Some worry about “indication creep,” when a drug or test approved for patients with a particular condition becomes used for others. They also worry about crushing costs for Medicare. “Even if a scan cost zero dollars, I wouldn’t recommend it,” said Dr. Ken Covinsky, a geriatrician at the University of California, San Francisco. “Do you really want to know that you have amyloid in your brain, years ahead of cognitive problems that may never develop?”

PET scans can act as motivators

Proponents of making PET scans more widely available argue that knowing their amyloid status may motivate patients to make lifestyle changes. Stopping smoking, exercising and eating a healthier diet are all found to reduce dementia, even among those at higher genetic risk. Perhaps, too, patients will be more likely to begin advance care planning.

What the scan will mean for Juli Engel

For the Engels, the test delivers tangible results. Once the neurologist documents her mother’s incapacity, Juli can take steps to prevent her mother from driving; she’ll be able to move her into assisted living when needed. As a geriatric care manager, Juli thoroughly understands the trajectory of this disease. Because she also knows that both her maternal grandparents had Alzheimer’s, she is considering her own future, too. Does she have amyloid in her brain? Her family is full of scientists, and we tend to want to know these things,” she said.

Many of our clients are seniors who come in to our offices to create their Living Trusts

The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning. California Document Preparers assists our clients in the preparation of their Trusts, which include a Power of Attorneyand Advance Healthcare Directive. Most are surprised at how easy it is. Schedule an appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.

Drug Prices: Finally. Something Everyone Agrees On

Anyone who relies on prescription drugs or cares for someone who does knows that drug prices are soaring. The average annual cost of a brand-name drug has more than tripled in the past decade. Older adults take an average of 4.5 medications each month, which can add up to a total retail cost of more than $30,000 a year for brand-name drugs.

Strong patent laws plus limited pricing regulation over for-profit pharmaceutical companies mean these companies are pretty much free to charge whatever they want for the medicines they offer.

So why is it different now?

• Prices are so out of control that even in our historically divided Congress, Democrats and Republicans actually have found something to agree on.
• Several bipartisan bills have been introduced to attack the problem.
• The AARP believes that a combination of tactics can bring drug prices under control, including giving the federal government the ability to negotiate when buying drugs.
• It also includes legalizing the safe importation of drugs sold at lower prices in other countries and capping patients’ out-of-pocket costs.
• A final approach is to change patent rules in place now and allow manufacturers of brand-name pharmaceuticals to freeze out competition from generic alternatives that could lower prices.

AARP has launched Stop Rx Greed

• This is a national campaign to persuade federal and state lawmakers to take action on the issue. The campaign includes lobbying efforts, consumer-information programs and the release of new research about drug prices.
• We’re the only nation in the world that doesn’t negotiate the price of drugs
• The U.S. has the highest prescriptions drug costs in the world. One reason is that we’re the only industrialized nation whose government doesn’t bargain with drugmakers over pricing.
• Australia, Japan and most European nations have some form of a national health program with drug review boards that negotiate with manufacturers. They analyze whether a new drug is more effective than its previous incarnations, or simply a slightly modified version. They’re often able to negotiate significant discounts because they can walk away if companies won’t cooperate.
• A quick example: The asthma medication Advair costs $310/month in the US; it’s $38 in Germany. The list is endless and it breaks your heart. Especially when you read about people who are dying because they can’t afford their medications.

Proposed solutions to lowering drug prices 

• Let Medicare negotiate directly with drugmakers.
• Give Medicare Part D plans more flexibility in creating their lists of covered drugs.
• Leverage a drug’s price in other countries to identify the price here.

Let’s keep this in mind: Even as Advair’s $38 pricetag in Germany is a fraction of what it costs here at home, the drugmakers are still making money.

Prices are lower elsewhere, specifically Canada. Why not import those?

Tempting, but there’s a very good reason why we can’t just import all of our drugs from Canada, where prescription drugs cost 33% less than in the U.S. It’s illegal, though you likely know someone who gets his/her meds from Canada and has been doing it for years.

Proposed legislation would let patients buy lower-priced medicines from Canadian pharmacies for personal use. Critics say this would lead to harmful counterfeits. But there are ways to institute safeguards. The FDA has already safely imported drugs to address critical shortages. And more than 40% of drugs, both brand-name and generic, are made overseas.

The problem: 20 years of patents before generics can hit the marketplace

At the bottom of all of this is the long, expensive development cycle to get a drug on the market. To encourage innovation and allow pharmaceutical companies to recoup their expenses, the federal government grants 20-year patents on new drugs that give companies the exclusive right to market the medication.

Because it takes years to get the drug to market, manufacturers end up with a monopoly

They do everything they can, including making insignificant tweaks to the meds to extend those patents and prevent generics from entering the market. In 2012, the GAO estimated that generics had saved the U.S. health care system $1 trillion during the previous decade. By extending these patents, big pharma is preventing consumers from accessing affordable healthcare.

So whom should we believe?

Big Pharma justifies high drug prices to cover the costs of research and development at $2.6B/ drug. But wait. Virtually all of today’s new drugs, such as blockbuster immunotherapies for cancer, have roots in government-funded research at the National Institutes of Health or leading academic centers across the country. Every one of the 210 new drugs approved by the FDA between 2010 and 2016 began life in NIH-funded labs, representing grant funding totaling more than $100B, a 2018 report by researchers at Bentley University reveals. That’s right. This is publicly funded research—it’s not coming out of the pockets of the drug companies.

Drug companies rarely, if ever, pursue these fishing expeditions of basic research, the stuff that might one day lead to a breakthrough drug but doesn’t have an immediate payoff. That work is increasingly funded by taxpayers.

Policy makers are considering a variety of options, such as demanding a higher return on investment for taxpayer-funded research that is ultimately commercialized, or allowing the government to control the patents of drugmakers that charge unreasonably high prices.

What to do: Increase generic competition

• Increase the availability of generics. Pending bills would beef up FDA budgets for reviewing generic applications to accelerate approvals of generic drugs.
• Limits on out-of-pocket costs. Cap out-of-pocket drug costs for Medicare Part D enrollees.
• Value-based pricing. Right now, a drug’s pricetag often bears no relationship to its clinical benefits. How do you distinguish a genuine advance from a mild improvement?

More enlightened consumer education 

As part of its drug-pricing blueprint, HHS is calling for increased price transparencyso consumers can make more informed decisions.

• Medicare and Medicaid have updated their pricing dashboards.
• Congress passed an anti-gag clause allowing pharmacists to tell consumers about drugs that are more affordable than ones they’ve been prescribed.
• Drugmakers are being encouraged to include list prices in their direct-to-consumer advertising.

The bottom line:“Real people suffering from real diseases should not have to beg, borrow or steal to control their diseases,” says Rena Conti, associate research director of biopharma and public policy for the Institute for Health System Innovation and Policy at Boston University.

Many of our clients are seniors who come in to our offices to create their Living Trust

The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning. The rising cost of medications is a frequent topic. California Document Preparers assists our clients in the preparation of their Trusts, which include a Power of Attorney and Advance Healthcare Directive. Most are surprised at how easy it is. Schedule an appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.