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Washington State Drops Budget Provision That Would Have Cut Medicaid Pharmacy Payments
Washington state lawmakers this week eliminated a budgetary proposal that would have reduced Medicaid payment rates to pharmacies to the lowest levels in the country, the AP/Spokane Spokesman-Review reports. The provision would have reduced the payment rate from 86% to 80% of the average wholesale price of branded drugs. It had been approved by the state House and Gov. Chris Gregoire (D) and was intended to address the state"s $9.3 billion shortfall for the current fiscal year.The state"s Department of Social and Health Services moved to make the rate change on April 1, but pharmacy operators and a person living with HIV/AIDS brought a suit in federal court in Tacoma, Wash., and a judge blocked the change. According to the judge"s order, the plaintiffs likely could prove that their best interests had not been sufficiently considered and that the proposal would diminish the quality of Medicaid care in the state. Walgreen had stated that if the rate change occurred, 44 of its 111 stores in the state would no longer be able to fill Medicaid prescriptions. Other pharmacies made similar arguments. The state prepared an argument on behalf of the rate cut, but later decided against it.Along with eliminating the payment reduction, state legislators added a provision that a DSHS analysis is required before rates can be lowered in the next budget, as well as one placing a 2% cap on any future rate cuts. DSHS spokesperson Jim Stevenson said the agency had not started to analyze what would be required to get a rate cut approved, but added, "I think we"re at a stage where we"re going to have to do it soon if we want to get ready for July 1," the start of fiscal year 2010 (AP/Spokane Spokesman-Review, 5/13).
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The Evolution Of Migraine From Episodic Headache To Chronic Disorder

Patients living with migraine have strong reason for new optimism concerning a positive future. Two review articles and an accompanying editorial, "The Future of Migraine: Beyond Just Another Pill," in the current issue of Mayo Clinic Proceedings, are the basis for an ironic premise. "Migraine is a potentially chronic, progressive disease that substantially affects patients, families, workplaces, and society," according to the editorial written by Roger Cady, M.D., of the Headache Care Center in Springfield, Mo. "Ironically, this is the springboard for renewed optimism of a more positive future for patients living with migraine." Traditionally, Dr. Cady explains, migraine has been considered a pain disorder involving separate or even sporadic episodes. Now, the condition is defined as an all-encompassing and progressive disease that negatively affects all aspects of an individual"s life. Migraine can erode quality of life during what should be a person"s most productive years, according to Dr. Cady. Because migraine patients" quality of life has not improved at a pace with medical advances, research is addressing the overall severity and potential progressive nature of migraine, especially migraine episodes as a forerunner of chronic migraine. According to the three articles, these new insights and understandings are requiring professionals to explore well beyond traditional migraine management. "Understanding migraine as a potentially chronic disease mandates a collaborative health care model with patients and health care professionals working in a partnership toward common therapeutic goals," writes Dr. Cady, specifically intervention and prevention. Physicians and patients must be encouraged to be partners, he says, and evaluation must go far beyond the physician just asking, "How are your migraines?" The models must include an invitation to comprehend and address all migraine-related health issues facing patients, Dr. Cady writes. In addition, understanding the evolutionary "stages" of migraine from sporadic to persistent offers an opportunity to develop new therapies that individualize and personalize care. In the future, successful management of migraine will ideally be measured not by stopping an attack but by overall disease management and prevention, according to the researchers. This new understanding of migraine as a chronic disease offers many challenges and rewards, according to Dr. Cady. "Today, the focus of care is rapidly changing from the event of the migraine to the patient with migraine," he notes. These changes present great promise for patients and health care professionals alike, representing assurances of a better future for patients with migraine, concludes Dr. Cady. John Murphy Mayo Clinic


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