2521_sejda-DYJ.pdf - Chapter 12 References UNFCCC 2014a...

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Unformatted text preview: Chapter 12 References UNFCCC. 2014a. Kyoto Protocol. Available at: . (Accessed: March 5, 2018). UNFCCC. 2014b. Durban: Towards Full Implementation of the UN Climate Change Convention. Available at: . (Accessed: March 5, 2018). UNFCCC. 2014c. Warsaw Outcomes. Available at: . (Accessed: March 5, 2018). UNFCCC. 2014d. Lima Climate Change Conference - December 2014. Available at: . (Accessed: March 5, 2018). UNFCCC. 2015. Synthesis report on the aggregate effect of the intended nationally determined contributions. Available at: . (Accessed: February 26, 2018). UNFCCC. 2017. Paris Agreement Status. Available at: . (Accessed: February 26, 2018). Ungureanu, C.A., S. Das, and I.S. Jawahir. 2007. Life‐Cycle Cost Analysis: Aluminum Versus Steel in Passenger Cars. Aluminum Alloys for Transportation, Packaging, Aerospace, and Other Applications 11-24. S.K. Das and W. Yin (Eds.). The Minerals, Metals & Materials Socieity (TMS):Orlando, Florida: TMS. 234 pp. Available at: . (Accessed: April 9, 2018). UCC (United Church of Christ). 2007. Toxic Wastes and Race at Twenty: 1987 – 2007. A Report Prepared for the United Church of Christ Justice and Witness Ministries. Available at: . (Accessed: April 9, 2018). U.S. Bureau of Reclamation. 2016a. SECURE Water Act Section 9503(c) – Reclamation Climate Change and Water. Prepared for United States Congress. U.S. Department of Interior: Denver, CO. Available at: . (Accessed: March 5, 2018). U.S. Bureau of Reclamation. 2016b. West-Wide Climate Risk Assessments: Hydroclimate Projections. Technical Memorandum No. 86-68210-2016-01. U.S. Department of Interior. Available at: . (Accessed: March 5, 2018). U.S. Census. 2017. Exports, Imports, and Balance of Goods, Petroleum, and Non-Petroleum End-Use Category. Available at: . (Accessed: March 5, 2018). USACE. 2014. Procedures to Evaluate Sea Level Change: Impacts, Responses, and Adaptation. Technical Letter No. 1100-2-1. U.S. Army Corps of Engineers. Available at: 0-2-1.pdf. (Accessed: March 5, 2018). 12-104 TABLE 16–2 List prices for pain medications commonly used in hospital settings, 2017 Pain drug group Number of options with list prices less than $1 per dose Share of commonly used options where list price is available WAC list price per dose Minimum Maximum $0.05 $1,361.16 0 0 2.27 62.33 27 47 0.02 64.80 Neurologic agents 2 67 0.43 6.00 Sedative agents 8 80 0.05 23.37 Musculoskeletal therapy agents 1 13 0.37 405.00 581.67 Opioids 10 Opioid agonists/antagonists NSAIDs and other non-opioid pain relievers 31% Ophthalmic agents 2 50 0.65 General anesthetics 0 0 2.59 Local anesthetics 5 26 0.05 Note: 18.42* 738.47 WAC (wholesale acquisition cost), NSAID (nonsteroidal anti-inflammatory drug). Options include unique combinations of drugs, routes of administration, and dosage forms (e.g., acetaminophen oral capsule, fentanyl citrate injection solution). *List price marked with an asterisk uses average wholesale price in lieu of unavailable WAC. Source: MedPAC summary of Acumen LLC analysis of Medi-Span data (copyright 2017), Clinical Drug Information LLC. • • Musculoskeletal therapy agents are muscle relaxers and are used to treat muscle symptoms, such as spasm, pain, and stiffness. • Ophthalmic agents are used to prevent or treat inflammation and provide analgesia after cataract and other eye surgery. General and local anesthetics are included because clinicians have the option to use these in the hospital setting to reduce or eliminate the use of other pain medications (e.g., using a local anesthetic during recovery following a surgical procedure on a limb). Because the drugs included in our analysis can be prescribed using different dosages depending on unique patient needs, prices for each drug were standardized for a typical midrange dose for a patient of a specified weight.13 This standardization allows comparisons across drug options. Because we found WAC and AWP price patterns to be similar, we present WAC alone for brevity. Opioids and their alternatives are available at overlapping price ranges Analysis of Medi-Span data (copyright 2017), provided by Clinical Drug Information LLC, shows that the ranges of list prices for opioids and their alternatives overlap (Table 16-2). The menus of opioids and non-opioids that are commonly used in hospital settings both include options that cost less than $1 per dose. Specifically, there are 10 commonly used opioid options combining drug, route of administration, and dosage form (e.g., fentanyl citrate injection solution) that cost less than $1 per dose. The lowest list price is $0.05 per dose, for morphine sulfate intravenous solution. There are 27 commonly used NSAIDs and other non-opioid pain reliever options combining drug, route of administration, and dosage form (e.g., acetaminophen oral capsule) that cost less than $1 per dose. The lowest list price is $0.02 per dose for aspirin oral tablet. The commonly used drug groups neurologic agents, sedative agents, musculoskeletal therapy agents, ophthalmic agents, and local anesthetics all include an option of a drug, route of administration, and dosage form combination that costs less than $1 per dose. All of the pain drug groups commonly used in hospital settings include combinations of drug, route of administration, and dosage form with high—and sometimes very high—list prices. The highest list price among commonly used opioid combinations of drug, route of administration, and dosage form is $1,361.16 a dose for fentanyl citrate nasal solution (Table 16-3, p. 462). The highest list price among commonly used NSAIDs and other non-opioid pain reliever options combining Report to the Congress: Medicare Payment Policy  |  March 2019 461 Chapter 12 References USDA (U.S. Department of Agriculture). 2015. Climate Change, Global Food Security, and the U.S. Food System. 146 pages. Available at: . (Accessed: April 27, 2017). U.S. Department of State. 2014. Final Supplemental Environmental Impact Statement for the Keystone XL Project. United States Department of State Bureau of Oceans and International Environmental and Scientific Affairs. Available at: . (Accessed: March 5, 2018). USFWS (U.S. Fish and Wildlife Service). 2009. Reserve Pit Management: Risks to Migratory Birds. Environmental Contaminants Program, U.S. Fish and Wildlife Service. Region 6. Cheyenne, Wyoming. Available at: . (Accessed: March 5, 2018). USFS. 2016. Effects of Drought on Forests and Rangelands in the United States: A Comprehensive Science Synthesis. General Technical Report WO-93b. January 2016. Available at: . (Accessed: March 5, 2018). USGS (U.S. Geological Survey). 2014. Comparison of the U.S. Lead Recycling Industry in 1998 and 2011. Available at: . (Accessed: June 4, 2018). USGS. 2015. California Water Science Center: The California Drought. Available at: . (Accessed: March 5, 2018). USGS. 2017. Induced Earthquakes: Myths and Misconceptions. Available at: . (Accessed: February 26, 2018). U.S. Government Printing Office. 2005. Energy Policy Act of 2005. Available at: . (Accessed: March 5, 2018). U.S. Government Printing Office. 2007. Energy Independence and Security Act of 2007. Available at: . (Accessed: March 5, 2018). Van Buskirk, J., R.S. Mulvihill, and R.C. Leberman. 2010. Declining Body Sizes in North American Birds Associated with Climate Change. Oikos 119(6):1047–1055. doi:10.1111/j.1600-0706.2009.18349.x. Vandenberg-Rodes, A., H.R. Moftakhari, A. AghaKouchak, B. Shahbaba, B.F. Sanders, and R.A. Matthew. 2016. Projected nuisance flooding in a warming climate using generalized linear models and Guassian processes. Journal of Geophysical Research: Oceans 121:8008-8020. doi: 10.1002/2016JC012084. Vaquer-Sunyer, R. and C.M. Duarte. 2011. Temperature Effects on Oxygen Thresholds for Hypoxia in Marine Benthic Organisms. Global Change Biology 17(5):1788–1797. doi:10.1111/j.13652486.2010.02343.x. Available at: 12-105 TABLE 16–3 Drug, route of administration, and dosage form Publicly available wholesale acquisition cost list prices for opioids and opioid agonists/antagonists commonly used in the inpatient and outpatient hospital settings, 2017 Median list price per dose Opioid pain relievers Alfentanil injection injectable $10.73 Codeine sulfate Oral solution Oral tablet 13.40 1.82 Fentanyl citrate Sublingual lozenge on a handle 15.76 Sublingual tablet 133.31 Injection solution 0.52 Injection solution cartridge 1.30 IV solution N/A IV solution prefilled syringe 2.96* Nasal solution 1,361.16 Hydromorphone HCl Injection solution 5.40 Injection solution reconstituted N/A Levorphanol tartrate oral tablet 42.71 Meperidine HCl injection solution 14.08 Methadone HCl Drug, route of administration, and dosage form Median list price per dose IV solution 0.05 Oral solution 0.86 Oral tablet 0.55 Rectal suppository 0.08 Morphine sulfate pentahydrate epidural suspension 6.87 Oxycodone HCl Oral capsule Oral concentrate Oral solution Oral tablet 5.88 5.63 18.97 0.70 Oxymorphone HCl injection solution N/A Remifentanil HCl IV solution reconstituted 4.38 Sufentanil citrate IV solution Tapentadol HCl oral tablet 101.75 14.36 Tramadol HCl External cream 7.83 Oral suspension reconstituted N/A Oral tablet 0.13 Opioid agonists/antagonists Injection solution 18.72 Oral concentrate 0.09 Buprenorphine HCl Oral solution 1.37 Sublingual film Oral tablet 0.35 Injection solution Oral tablet soluble 0.19 Subcutaneous implant 6.61 13.87 N/A Butorphanol tartrate Morphine sulfate Injection solution 1.78 Injection solution 4.58 Injection solution 1.78 Nasal solution 4.51 Intramuscular device N/A Nalbuphine HCl injection solution Pentazocine lactate injection solution Note: 2.27 62.33 IV (intravenous), HCl (hydrochloride), N/A (not available). All national drug codes (NDCs) for each drug were matched to wholesale acquisition cost (WAC) list prices that were standardized in terms of a single unit (e.g., 1 mg/ml, 1 mcg, 1 percent). If the normal dosage of the drug included a range (e.g., 200–300 mg), these unit prices were then standardized in terms of the midpoint of a drug’s normal dosage. If the normal dosage included a reference to kilograms (e.g., 1 ug/ kg/min), a standard patient weight of 71.4 kg was used to determine the total normal dosage. NDCs with percentage units of measure (UOMs) were converted by checking the package-size UOM in Medi-Span. If a package had grams or milliliters as the UOM, the drug ingredient strength was multiplied by 10 and the NDC’s UOM was changed to match the package-size UOM. If there were multiple UOMs associated with a combination, the price is reported in terms of a single unit because of concerns about unit conversion to the normal dose. *List prices marked with an asterisk use average wholesale price in lieu of unavailable WAC. Source: Acumen LLC analysis of Medi-Span data (copyright 2017), Clinical Drug Information LLC. drug, route of administration, and dosage form is $64.80 a dose for diclofenac potassium oral packet (Table 16-4, p. 464). Higher list prices appear to be determined more (but not exclusively) by the route of administration and dosage form than by the drug ingredient. For example, acetaminophen is available in 12 different route of 462 administration–dosage form combinations with at least one list price less than $2 per dose. The 2017 list price for the one acetaminophen intravenous solution option is not publicly available. However, the price for a midrange dose (i.e., using the same methodology applied in Table 16-2, p. 461; Table 16-3, p. 462; and Table 16-4, pp. 464–465) in Mandated report: Opioids and alternatives in hospital settings—Payments, incentives, and Medicare data ...
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  • Fall '19
  • Morphine, Analgesic, Fentanyl, Clinical Drug Information LLC

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