Court ruling affects cost of narcotic
Availability of some methadone changed
The February 2008 recall of transdermal fentanyl patches was an important issue for hospice agencies, but it only was one part of a bigger issue facing hospice agencies and palliative care providers.
"The transdermal fentanyl patches are one choice of a long-acting narcotic pain medication, but decisions affecting two other long-acting narcotic pain medications, oxycodone and methadone, will have a significant impact for hospice providers," says Ric Baxter, MD, hospice medical director and director of palliative care services at St. Luke's Hospice and Health Network in Bethlehem, PA.
Purdue Pharma in Stamford, CT, the manufacturer of Oxycontin, has won a patent infringement suit that will keep the generic form of the medication off the market, says Baxter. "The cost of the extended-release Oxycontin is over and above the per diem reimbursement for medication," he says. While hospice physicians won't start a patient on Oxycontin while in hospice care, many patients are started on the medication while in the hospital, he explains. "The cost of the medication is buried in all of the other hospital expenses, so it doesn't have the same impact as it does when the patient moves to hospice," he says. The patient and the hospice provider are faced with a decision as to whether to continue the Oxycontin or to switch to another pain medication, he adds.
Another long-acting narcotic pain medication that is used for hospice patients is methadone. "The Food and Drug Administration decided that, for safety reasons, 40 mg-strength methadone pills would be available only to drug treatment providers," says Baxter. Although methadone is available in 10 mg strength, patients who need 40 mg may not be able to swallow an additional three pills in addition to all other pills they may be taking, he says. "The additional pills increase the complexity of medication management for the patient and caregiver and increases the likelihood of noncompliance," he says.
Another issue to address is how often medications should be delivered to the home, points out Baxter. By increasing the number of methadone pills fourfold, patients may receive hundreds of pills at a time, he says. "This increases the opportunity for diversion of the narcotic to someone other than the patient because it is more difficult to monitor the number of pills in the bottle," he explains. Delivery of smaller amounts of medication at more frequent intervals is one answer to the dilemma, he suggests.
While medication recalls may grab the headlines, hospice managers and medical directors should stay alert to other medication issues that affect patients, says Baxter. "I think that it is important that hospice providers work with local hospitals and referring physicians to make sure that they understand the financial implications of prescribing certain medications," he says. "By addressing pain management choices prior to admission to hospice, hospice staff can focus on life-closure issues and quality of remaining life as opposed to discussions of medication costs and financial decisions."
The February 2008 recall of transdermal fentanyl patches was an important issue for hospice agencies, but it only was one part of a bigger issue facing hospice agencies and palliative care providers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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