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New ‘Instructions’ Could Let Dementia Patients Refuse Spoon-Feeding

Kaiser Health News:States - November 03, 2017

People who abhor the thought of being kept alive with feeding tubes or other types of artificial nutrition and hydration have, for years, had a way out.

They could document their wishes to halt such interventions — and have them honored — using advance directives.

That includes patients diagnosed with progressive dementia who are able to record crucial end-of-life decisions before the disease robs them of their mental capacity.

But the practice has rarely — almost never — included provisions to refuse food and fluids offered by hand. Until now.

A Washington state agency that advocates for medical aid-in-dying has created guidelines for dementia patients who don’t want to be spoon-fed at the end of life.

This KHN story also ran on NPR. It can be republished for free (details).

The group End of Life Washington, or EOLWA, which assists people using the state’s 2009 Death with Dignity Act, recently posted new “Instructions for Oral Feeding and Drinking” on its website.

Aimed at people with Alzheimer’s disease and other progressive dementias, the document provides a two-page template for patients to instruct caregivers not to provide oral food or fluids under certain circumstances. There’s another document explaining the do’s and don’ts of using it.

The instructions are ground-breaking for patients who fear losing control not only of their faculties but of their free will to live and die on their terms, said Sally McLaughlin, executive director of EOLWA.

“We get calls from folks with concerns about dementia and concerns about the fact that loved ones with dementia feel like they’re being force-fed,” McLaughlin said. “Many, many folks understand that as they stop eating, they would like no one else to feed them.”

Critics say the new document raises concerns about potential mistreatment of vulnerable patients, arguing that such “instructions” could be used essentially to starve the elderly or incapacitated.

“It really is troubling,” said Stephen Drake, research analyst for the disability rights group Not Dead Yet.

He points to other so-called right-to-die efforts, such as the refusal of artificial nutrition and hydration, saying they started out narrowly defined and then became common practice.

“It really is a big game changer in the number of people whose lives can be ended when they’re in vulnerable situations,” Drake said. “In legal situations, this is a door-opener.”

Proponents of the guidelines say they fill a gap in information for people already interested in navigating the uncertain landscape that surrounds assisted feeding at the end of life.

“What we are saying is that there are objective and somewhat subjective conditions in the future where you can say ‘I’m giving you instructions now to help you interpret my wishes,’” said Bob Free, a Seattle lawyer who helped draft the document. “We have never really seen a standard form or advance directive to govern this.”

The guidelines do not apply to people with dementia who still get hungry and thirsty and want to eat and drink, the authors note.

“If I accept food and drink (comfort feeding) when they’re offered to me, I want them,” the document states.

But if the person appears indifferent to eating, or shows other signs of not wanting food — turning away, not willingly opening their mouth, spitting food out, coughing or choking — the document says attempts to feed should be stopped.

And the guidelines tell caregivers to respect those actions.

“No matter what my condition appears to be, I do not want to be cajoled, harassed or forced to eat or drink,” the document states. It adds that the “reflexive opening” of the mouth should not be interpreted as consent to eating.

“An analogy is the difference between when a knee is tapped with a hammer and the reflexive response is a knee jerk and when a person voluntarily raises his or her knee,” said Free. “We think this is a fairly objective test, which in real life will be clear.”

The new guidelines won’t be binding — legally or ethically, experts say. Nearly two dozen states have laws that address assisted feeding, including many that prohibit withdrawing oral food and fluids from dying people.

“The hard part about advance directives is even though you put your wishes there, it doesn’t mean a medical professional will honor it — or that a facility will honor it,” said Jonathan Patterson, staff attorney for Compassion and Choices, a group that supports medical aid-in-dying.

The new forms follow two recent high-profile cases in which family members said dementia patients were kept alive with spoon-feeding by caregivers, despite written requests to stop.

Margot Bentley, 85, of British Columbia, died last year. She was a retired nurse who had cared for dementia patients before being diagnosed with Alzheimer’s in 1999. In 1991, she wrote a statement stipulating that she wanted no nourishment or liquids if she developed an incurable illness. However, the nursing home where she was a patient continued to spoon-feed her, despite her family’s protests. A court ruling upheld that action, saying that food is basic care that cannot be withdrawn.

Nora Harris, 64, of Medford, Ore., died on Oct. 11 after an eight-year struggle with early-onset Alzheimer’s disease. More than a year earlier, her husband had gone to court to stop caregivers from spoon-feeding Harris, who had an advance directive that called for no artificial nourishment or hydration. A judge declined, siding with officials who said the state was required to feed vulnerable adults.

Such cases horrify people who fear the same fate. Nancy Christensen, 60, a Seattle nurse, said she updated her living will herself within days of reading about Harris.

“I thought, ‘Wow, I need to be much more specific,’” said Christensen, who appended notes saying she doesn’t want assisted feeding if she can no longer feed herself. “I don’t think anybody thinks about this until they’re too far into it.”

Free, 71, said he plans to fill out the new documents himself.

“It’s been a personal desire of mine to have a dignified death,” he said. “The idea that my sons would have to witness me in a deteriorated state is very frightening and demoralizing.”

Whether VSED, which stands for “voluntarily stopping eating and drinking,” can be authorized in advance by people diagnosed with dementia remains unclear. The question has gained traction in a nation where dementia cases in people 65 and older are projected to reach 7.1 million by 2025. Paul Menzel, a retired bioethicist at Pacific Lutheran University in Tacoma, Wash., said some people want to avoid the most debilitating stages of the disease.

“It’s not misery they’re afraid of,” he said. “They just don’t want years of withering.”

The EOLWA document is a novel tool, but it may not go far enough, said Judith Schwarz, clinical director for End of Life Choices New York, which advocates for medical aid-in-dying. The conditions it lists typically apply to the final stages of dementia, she said. Some patients want the right to refuse food earlier in the disease process in a deliberate effort to hasten death.

Until now, however, there have been few models for articulating those desires.

“It certainly is an improvement over no previous mention of hand-feeding,” Schwarz said. “Maybe this is where it must begin.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation and its coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Big Premium Hike? Blame It On The Kids

Kaiser Health News:HealthReform - November 03, 2017

Dede Kennedy-Simington, an insurance agent in Pasadena, Calif., was “totally dismayed” when she learned recently that the premium on her family’s Blue Shield PPO would rise $391 a month next year — driven largely by huge increases for her two teenage children.

The cost of insuring her 16-year-old daughter will spike 60 percent in 2018, and it will jump 38 percent for her 13-year-old son.

The price surge stems from a change in federal regulations that allows insurers to recalculate the health risks of children within a family’s premium bill.

“This hurts us, but it will be a total non-starter for a lot of families,” Kennedy-Simington said.

Despite the policy change for kids, they will still be considerably cheaper to cover than their parents. In Kennedy-Simington’s case, her two teens account for more than half of the premium increase but less than one-third of the total 2018 premium.

Premiums are rising for a lot of reasons next year. Among the most publicized is a decision by the Trump administration to stop paying insurers for certain subsidies they provide to low-income health plan enrollees under the Affordable Care Act.

This story also ran in the Los Angeles Times. It can be republished for free (details).

Another factor is the complicated new rule, approved last year by the Obama administration, that allows insurance companies to assign more of a family’s overall premium cost to children in individual and small-group policies, starting in 2018.

It also allows insurers to charge higher rates for teens than for younger children beginning at age 15, because teenagers typically rack up bigger medical bills. Up until now, the ACA has not allowed any difference in the amount charged for children from birth to 20.

“A 15-year-old running around on his bike has more chance of something happening to him than a 7-year-old playing video games,” said Ron Goldstein, CEO of Choice Administrators, an Orange, Calif.-based health insurance exchange for small businesses. “You get into high school, there’s football and contact sports.”

Open enrollment for 2018 coverage in the individual market, on and off the health insurance exchanges, started Wednesday.

The new age-related rule applies in most states. However, seven states — Alabama, Massachusetts, Minnesota, Mississippi, New Jersey, Oregon and Utah — plus Washington D.C., do not follow the federal rate-setting formula because they have their own.

The U.S. Department of Health and Human Services (HHS) said it revised the way premiums for people under age 21 are calculated to better reflect the cost of medical care for children. The change will also “provide a more gradual transition” to pricier adult rates, the agency said.

Under the previous ACA age calculations, turning 21 ushered in an adult rate with a steep 57.5 percent increase. Adult rates then typically increased incrementally each year to reflect the higher medical costs associated with aging, though they are eventually capped at three times the rate of a 21-year old to promote affordability for seniors.

The formula for calculating annual increases for adults older than 21 will not change.

Under the new rule, health plans can charge a one-time 20.5 percent increase next year for children 0 to 14. For kids ages 15-20, rates will increase every year, starting with a sharp hike in 2018 followed by much smaller ones after that.

For 2018, the increases range from 31.2 percent for 15-year-olds to 52.8 percent for 20-year-olds. Those hikes are already baked in to the premiums insurers have set for their 2018 offerings. And they are related only to age — there may be additional increases to cover the overall rise in medical costs.

Although the rate hikes are bigger for 15- to 20-year-olds, medical expenses for infants are actually higher, according to the nonpartisan Health Care Cost Institute in Washington, D.C. They drop after age 3, then rise again during the preteen and teenage years, according to the institute.

HHS said a single rate category for children ages 0 to 14 makes sense because it “spreads the cost of newborns, avoiding significant premium increases for families with young children.”

As a result of the sharp one-time increase in 2018, a customer turning 21 the following year would face an age-related bump of only 3.1 percent rather than the 57.5 percent jump that would have applied under the old rule, according to the HHS’ revised rate formula.

Some insurance agents predict the bump in charges for kids will only add to a generalized sense of anxiety about higher premiums, particularly given President Donald Trump’s recent move to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, and Congress’ failed attempts to repeal Obamacare.

“Of all years to do this … all these increases are just going to be horrifying,” said Helena Ruffin, an insurance agent in Los Angeles.

In addition to a 12.3 percent average statewide premium increase, Covered California, the state’s Obamacare exchange, tacked a 12.4 percent surcharge onto “silver-tier” plans — the second-least-expensive level of coverage — to offset Trump’s decision to end federal payments for so-called cost-sharing reduction subsidies, which lower out-of-pocket costs for some low-income consumers.

In many states, premium hikes will be much higher next year.

Covered California spokesman James Scullary said next year’s rate increases will be offset by a corresponding rise in premium tax credits, so the vast majority of consumers who qualify for those tax credits will be protected from the surcharge.

Scullary said Covered California did not have a figure to show how much the rate increase for kids contributed to the average statewide premium hike, but he said the overall impact was “very small.”

But for many families — especially those with more than one child and no tax credits to absorb their rising premiums — the impact isn’t small.

People like Kennedy-Simington, who buy their insurance in the individual market outside of Covered California, don’t have subsidized premiums.

Neither do employees of small businesses, who are also subject to the new rates for children. One renewal notice for a small-group Health Net PPO, which covers three adults and two teenagers, shows that the kids — ages 15 and 18 — account for 60 percent of next year’s total $412 premium increase.

Some health plans are sending detailed notices to enrollees affected by the rating change.

Kaiser Permanente’s FAQ, for example, described 2018 as a “transition year” in which all members under 21 will experience “significant increases.” (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

But there may be one small silver lining: Adults may benefit, at least modestly, from spreading the rising cost of medical care across a wider age band.

The American Academy of Actuaries said in a report that raising rates for children to better reflect their costs will reduce adult rates, though by a “significantly smaller magnitude.” The reductions will vary by insurer and depend on the number of children enrolled relative to the number of adults.

Kaiser Permanente said its rate hikes for children would result in “slightly lower increases to older members.”

Kennedy-Simington, a past president of the Los Angeles Association of Health Underwriters, said families with children should compare all possible insurance options, and check to see if they qualify for premium tax credits through Covered California.

“The only way to get prices down is to move from one carrier to another or to downgrade,” she said. “So shopping will be critical.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

House Tax Bill Would Scrap Deduction For Medical Expenses

Kaiser Health News:Marketplace - November 02, 2017

The tax bill unveiled by Republicans in the House on Thursday would not, as had been rumored, eliminate the tax penalty for failure to have health insurance. But it would eliminate a decades-old deduction for people with very high medical costs.

The controversial bill is an effort by Republicans to revamp the nation’s tax code and provide dramatic tax cuts for business and individuals. However, its future is not yet clear because Republicans, who control both the House and Senate, appear divided on key measures.

The medical deduction, originally created in World War II, is available only to taxpayers whose expenses are above 10 percent of their adjusted gross income.

Because of that threshold, and because it is available only to people who itemize their deductions, the medical expense deduction is not used by many people — an estimated 8.8 million claimed it on their 2015 taxes, according to the IRS.

Use Our ContentThis KHN story can be republished for free (details).

But those 8.8 million tax filers claimed an estimated $87 billion in deductions; meaning that those who do qualify for the deduction have very high out-of-pocket health costs.

“For many people, this is a big deduction,” said David Certner, legislative counsel for AARP, which opposes the change. AARP has calculated that about three-quarters of those who claim the medical expense deduction are 50 or older, and more than 70 percent have incomes $75,000 or below. Many of those expenses are for long-term care, which is typically not covered by health insurance. Long-term care can cost thousands or tens of thousands of dollars a year.

Sen. Ron Wyden (D-Ore.), ranking member of the tax-writing Senate Finance Committee, called the bill’s elimination of the medical expense deduction “anti-senior.”

But defenders of the bill say the elimination of the deduction should not be seen in isolation.

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The House tax bill also proposes eliminating billions of dollars in corporate tax credits that have played a key role in the booming “orphan drug” industry.

In an FAQ posted on the House Ways and Means Committee website, the bill’s sponsors denied that the change would “be a financial burden.”

“Our bill lowers the tax rates and increases the standard deduction so people can immediately keep more of their paychecks — instead of having to rely on a myriad of provisions that many will never use and others may use only once in their lifetime,” the sponsors said.

Getting rid of many current deductions “is being done to finance rate cuts and increase the standard deduction and child tax credit,” said Nicole Kaeding, an economist with the business-backed Tax Foundation. So, for many tax filers, she said, “there will likely be offsetting tax cuts.”

On the other hand, those offsetting cuts almost by definition will not make up the difference for people with very large medical expenses, who are the only ones who qualify for the medical deduction.

“That’s why tax reform is hard,” Kaeding said.

Strikingly absent from the bill — for now — is any reference to the elimination of the tax penalty for failure to have health insurance. The so-called individual mandate is one of the most unpopular provisions of the Affordable Care Act, which Republicans failed to change or repeal earlier this year.

Sen. Tom Cotton (R-Ark.) is continuing to push language to add to the bill that would eliminate the penalty. President Donald Trump has added his endorsement via Twitter: “Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts,” he wrote Wednesday.

But while the president is correct that there would be savings from eliminating the mandate, the Congressional Budget Office has also estimated that millions more Americans would become uninsured as a result.

House Republicans Aim To Yank Tax Credits For Orphan Drugs

Kaiser Health News:Marketplace - November 02, 2017

As part of a sweeping tax reform bill, House Republicans on Thursday proposed eliminating billions of dollars in corporate tax credits that have played a key role in the booming “orphan drug” industry.

For more than three decades, pharmaceutical and biomedical companies have claimed a 50 percent tax credit for the cost of clinical trials on orphan drugs, or those that treat rare diseases affecting fewer than 200,000 people.

The credits were approved as part of the 1983 Orphan Drug Act, which has been under scrutiny in the past year as the country grapples with skyrocketing drug prices. Drugs that win special orphan status get a package of financial incentives, including the credits and seven years of market exclusivity. The drugs routinely have five-digit price tags and have become a sought-after market for drugmakers.

The National Organization for Rare Disorders (NORD) predicted, drawing from a 2015 report, there would be 33 percent fewer orphan drugs coming to market if the credit vanishes — “an unprecedented decrease in the development of these life-improving therapies,” NORD’s statement read. The group said advocates had sent over 500 letters to Congress in support of the credit.

Use Our ContentThis KHN story can be republished for free (details).

The powerful Biotechnology Innovation Organization, along with 20 drug companies such as Novo Nordisk, Horizon and Sanofi, wrote to Congress late last month urging them to keep the credit in the tax overhaul bill. BIO vowed Thursday to work with lawmakers to save the credit. If they fail, the repeal would be effective in January.

Yet, James Love of the think tank Knowledge Ecology International welcomed the potential repeal as a way to begin a conversation about “deeper reform” in the financial incentives for rare diseases.

Love noted that cancer drugs and “huge blockbuster drugs [have] qualified for orphan tax credit[s] … and certainly provided no relief from high prices.”

Earlier this year, the high prices caused one of the bill’s creators and champions, former U.S. congressman Henry Waxman (D-Calif.), to co-author a report that suggested restricting or replacing the tax credit in some manner. The authors of the report do not take a position on the Republican tax reform bill.

 A KHN investigation in January this year, which was published and aired by NPR, found that many drugs that now have orphan status aren’t entirely new. Of about 450 drugs that have won orphan approval since 1983, more than 70 were drugs first approved by the Food and Drug Administration for mass-market use. Those include cholesterol blockbuster Crestor, Abilify for psychiatric disorders and rheumatoid arthritis drug Humira, one of the world’s best-selling drugs.

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The Republican tax plan would eliminate a decades-old deduction for people with very high medical costs, but it does not include a provision to eliminate the penalty for people who don’t get health insurance.

In March, the Government Accountability Office confirmed it would investigate potential abuses to the law after Sens. Orrin Hatch (R-Utah), Chuck Grassley (R-Iowa) and Tom Cotton (R-Ark.) sent a letter to the agency, asking if the law needed to be changed.

This summer, the FDA announced an orphan drug modernization plan and promised to eliminate a backlog in drugs applying for the rare disease status. In a September update, FDA Commissioner Scott Gottlieb wrote he wants to ensure financial incentives are granted “in a way that’s consistent with the manner Congress intended” when it passed the law decades ago.

Orphan drugs hit $36.1 billion in sales last year, according to a report released last month by QuintilesIMS and NORD. And, according to EvaluatePharma’s 2017 Orphan Drug Report, orphan drugs will account for nearly 22 percent of global prescription sales, excluding generics, by 2022.

With that growth, the cost of the orphan drug tax credits to the U.S. government also grows.

“A billion here and a billion there and eventually it’s real money,” said Nicholas Bagley, a law professor at the University of Michigan who has studied the credits.

In 2018, the U.S. is expected to grant nearly $2.8 billion in orphan drug tax credits to companies, according to estimates from the Treasury Department. And, the reduced tax revenue for the U.S. government increases every year, to total $75 billion from 2018 to 2027.

“Repealing this credit will effectively increase the cost of doing research on orphan drugs,” said Kathy Michael, an analyst with PricewaterhouseCoopers’ US Pharmaceutical & Life Sciences Tax Sector.

“It’s significant,” she said, adding that a number of companies have used the credit and that many have drugs in the pipeline that could qualify for the credit down the road.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Facebook Live: It’s ACA Sign Up Season. Here’s What you Need To Know This Year.

Kaiser Health News:HealthReform - November 02, 2017

The open enrollment season for health insurance under the Affordable Care Act began this week. And a lot has changed for consumers who buy their own individual coverage through the health law’s state and federal marketplaces. For example, the sign-up period is shorter than it has been in the past. There also will be less on-the-ground assistance available to help them navigate the ins and outs of these online marketplaces. And that’s just the beginning. This live chat features KHN senior correspondent Julie Appleby answering questions about these changes and offering tips for consumers about how to shop around and compare options for the 2018 coverage year.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

Podcast: ‘What The Health?’ How Confused Are We?

Kaiser Health News:HealthReform - November 02, 2017

Open enrollment started with more of a whimper than a bang Nov. 1, as the Trump administration continued to talk down the health law it is required to operate. Meanwhile, on Capitol Hill, lawmakers continue to struggle to reach agreement on legislation to renew funding for the Children’s Health Insurance Program, which expired Oct. 1. And President Donald Trump’s commission on the opioid epidemic released its final report and recommendations.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Joanne Kenen of Politico and Paige Winfield Cunningham of The Washington Post discuss these topics as well as possible health changes included in the emerging tax overhaul bill in Congress.

Among the takeaways from this week’s podcast:

  • Wednesday was a strangely quiet opening day for Obamacare enrollment. The administration had no special announcements or events — but former President Barack Obama released a video, and other interested groups, such as hospitals, insurers and brokers, may step in to try to encourage people to sign up.
  • Republicans continue to blame Democrats for problems with the Affordable Care Act, while Democrats say the GOP is strangling the law. This messaging war may prove critical for the 2018 midterm campaign.
  • Republicans are deeply divided about whether to include a provision in the tax reform bill that would get rid of the ACA’s individual mandate penalty. The provision would save the federal government money, but it would also result in millions fewer Americans with health insurance, according to the Congressional Budget Office. Among those urging its inclusion, however, is Trump.
  • Democrats may be between a rock and a hard place on the bill to fund the Children’s Health Insurance Program. They love that program, but Republicans want to raid the ACA’s public health prevention fund to pay for CHIP.
  • The administration released a proposed rule last Friday that could have significant changes in which health benefits are guaranteed for consumers buying coverage on the ACA marketplaces.
  • President Trump has yet to offer more money to fight the problem of opioid abuse, but many of the individual recommendations from his commission are being welcomed by the public health community.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Kaiser Health News’ “’No One Is Coming’: Hospice Patients Abandoned At Death’s Door,” by JoNel Aleccia and Melissa Bailey.

Stephanie Armour: Slate’s “Going Out With a Bang,” by Melissa Jayne Kinsey.

Joanne Kenen: Health Affairs’ “Choosing Wisely Campaign: Valuable For Providers Who Knew About It, But Awareness Remained Constant, 2014-2017,” by Carrie H. Colla and Alexander J. Mainor.

Paige Winfield Cunningham: Vox.Com’s “The fax of life,” by Sarah Kliff.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

HHS activa ayuda para habitantes sin seguro de las Islas Vírgenes de EE.UU. que necesitan medicamentos

HHS Gov News - November 02, 2017

Como parte de la respuesta de todos los estratos del gobierno del Presidente Trump ante el huracán María, el Secretario Adjunto de Preparación y Respuesta (ASPR, en inglés) del Departamento de Salud y Servicios Humanos de los Estados Unidos activó su Programa de asistencia para medicamentos en casos de emergencia (EPAP, en inglés) para que los residentes de las Islas Vírgenes de EE.UU. tengan acceso a los medicamentos imprescindibles que necesitan. El programa cubre los costos de los medicamentos recetados para personas sin seguro médico afectadas por catástrofes. Trece farmacias de las Islas Vírgenes de EE.UU. participan en el EPAP.

“Este programa brinda asistencia esencial a personas sin seguro que dependen de ciertos medicamentos recetados para proteger su salud luego de catástrofes”, expresó el Dr. Robert Kadlec, Secretario Adjunto de Preparación y Respuesta de HHS. “Invitamos a los residentes de las Islas Vírgenes de EE.UU. que puedan usar esta asistencia que la aprovechen para asegurarse de obtener el suministro adecuado de los medicamentos que necesitan”.

Sin costo para los pacientes no asegurados, quienes necesitan ciertos medicamentos durante una situación de emergencia pueden obtener un suministro para 30 días en cualquiera de las farmacias que trabajan con el EPAP. La mayoría de los farmacéuticos que figuran en la base de datos de Express Scripts están disponibles. Para más información, consulte

Los pacientes pueden renovar sus recetas cada 30 días mientras esté activo el EPAP.

También pueden recurrir al programa para reemplazar medicamentos recetados de mantenimiento, algunos suministros médicos específicos, vacunas o equipos médicos que perdieron como resultado directo de una emergencia declarada o como resultado secundario de las pérdidas o daños causados al transitar un sitio en emergencia para acceder al refugio designado.

El EPAP ofrece un mecanismo eficiente para que las farmacias inscritas procesen reclamaciones de medicamentos recetados, suministros médicos específicos, vacunas y algunos tipos de equipos médicos duraderos para personas elegibles en áreas de desastre identificadas a nivel nacional.

Los residentes de las Islas Vírgenes de EE. UU sin seguro afectados por el huracán María pueden llamar a Express Scripts al 855-793-7470 para saber si su medicamento o equipos médicos duraderos en particular están cubiertos por el EPAP y para encontrar una farmacia participante.

El Presidente Donald Trump declaró a las Islas Vírgenes de EE. UU área de catástrofe de grandes dimensiones el 21 de septiembre de 2017, a raíz del paso del huracán María.

El ASPR encabeza el equipo del HHS que prepara al país para responder a y recuperarse de los efectos adversos para la salud que suponen estas situaciones de emergencia, a través del apoyo a las comunidades para que puedan soportar la adversidad, fortaleciendo sus sistemas de salud y respuesta y optimizando la seguridad sanitaria nacional. El HHS es la principal agencia del gobierno nacional para la protección de la salud de los estadounidenses y la provisión de servicios humanos esenciales, especialmente para los más vulnerables.

Hay información acerca de las acciones de salud, seguridad y el HHS en En puede acceder a anuncios de servicios públicos con consejos de salud para después de un temporal. Invitamos a los residentes del territorio continental de los Estados Unidos a que compartan estos consejos con sus familiares y amigos en Puerto Rico y las Islas Vírgenes de EE. UU.

Hay actualizaciones e información de salud disponibles también en:

ASPR - @PHEgov

HHS - @HHSgov

CDC - @CDCgov

HHS activates aid for uninsured U.S. Virgin Islands residents needing medicine

HHS Gov News - November 02, 2017

As part of the Trump Administration’s government-wide response to Hurricane Maria, the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) activated its Emergency Prescription Assistance Program (EPAP) for the U.S. Virgin Islands to give residents access to the critical prescription medications they need. The program pays for prescription medications for people without health insurance who are affected by disasters. Thirteen pharmacies in the U.S. Virgin Islands participate in EPAP.

“This program provides vital assistance to people without insurance who rely upon certain prescription medicines to protect their health after disasters,” said HHS’ Assistant Secretary for Preparedness and Response Robert Kadlec, M.D. “I encourage U.S. Virgin Islands residents who can use this assistance to take advantage of it to ensure they have an adequate supply of the medicines they need.”

At no cost to uninsured patients, those needing certain drugs during an emergency can obtain a 30-day supply at any of the EPAP participating pharmacies. Most pharmaceuticals listed in the Express Scripts database are available. For more information see

Patients can renew their prescriptions every 30 days while the EPAP is active.

They also can use the program to replace maintenance prescription drugs, specific medical supplies, vaccines or medical equipment lost as a direct result of the declared emergency or as a secondary result of loss or damage caused while in transit from the emergency site to the designated shelter facility.

EPAP provides an efficient mechanism for enrolled pharmacies to process claims for prescription medication, specific medical supplies, vaccines and some forms of durable medical equipment for eligible individuals in a federally identified disaster area.

Uninsured U.S. Virgin Islands residents affected by Hurricane Maria can call Express Scripts, 855-793-7470, to learn if their medication or specific durable medical equipment is covered by EPAP and to find a participating pharmacy.

President Donald Trump issued a major disaster declaration for the U.S. Virgin Islands on Sept. 21, 2017, due to Hurricane Maria.

ASPR leads HHS in preparing the nation to respond to and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security. HHS is the principal federal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

Information on health, safety and HHS actions are available at Public Service Announcements with post-storm health tips are available at Residents in the continental United States are encouraged to provide these tips to family members and friends in Puerto Rico and the U.S. Virgin Islands.

Updates and health information also are available at:

ASPR - @PHEgov

HHS - @HHSgov

CDC - @CDCgov