The latest in the Clozapine REMS Program debacle, which I probably should start calling The Geezer’s Legendary Clozapine REMS Program Circular Saga (TGLCREMSPCS) is that I am almost there–I think. I actually got through the process to get the message:
“Thank You! You are now certified in the Clozapine REMS Program.” No kidding, I actually printed the page and have a Certification ID number.
But when I called my Clozapine REMS Program contact (yes, I have a personal consultant now!), he could not replicate it. In fact, he found another endless circular loop, which led me to sign out and sign back in.
Sure enough, the web site was still making me do everything all over again starting from the intake! The first time it recognized my completion of the Knowledge Assessment for Healthcare Providers and I electronically completed the attestation on the Prescriber Enrollment Form.
When I signed in again, it not only took me back to the intake section…it wanted me to take the Knowledge Assessment for Healthcare Providers over again. Over and over and over…
So it’s definitely a recurring technical problem. I got a hunch this is likely to evolve throughout the day. You might want to check back periodically 🙂
UPDATE: Later, I got this voice mail message from my consultant, indicating very cautious optimism about my chances of success for certification after an adjustment in the website. I called him back and we went through it. Wow.
It still doesn’t work. In fact, there’s another loop. It still makes me take the Knowledge Assessment for Healthcare Providers repeatedly, but there is one difference. I now get an “Alert” box. It just tells me that I still have to complete certification.
Continued Low Rate of Clozapine Use and Wide Variability Found in State Medicaid Programs
Clozapine continues to be dramatically underutilized—despite it being the only drug approved for treatment-resistant schizophrenia—and there appears to be significant variation among states in its use for patients in the Medicaid program.
That’s the finding from an analysis of Medicaid data in 46 states published Monday in Psychiatric Services in Advance. Mark Olfson, M.D., M.P.H. (pictured left), of Columbia University and colleagues updated a previous analysis from 2001 to 2005 to include data from 2006 to 2009. [Iowa is one of the lowest–J. Amos, MD]
Overall, clozapine accounted for 4.8% of antipsychotic use in schizophrenia from 2006 to 2009, with a slight decline during this period (5.7% in 2006 to 4.3% in 2009). Clozapine was least commonly used in the Deep South (Louisiana, Mississippi, and Alabama) and more commonly used in New England, the Rocky Mountain West, and Washington. The highest rate of clozapine prescribing was in South Dakota (15.6%) and the lowest was in Louisiana (2.0%).
The authors of the analysis noted several factors associated with low clozapine use: fiscal stress, inadequate staffing to monitor clozapine, patient reluctance about blood monitoring, and concerns over tolerability.
Recently, the Food and Drug Administration issued modifications to its requirements for blood monitoring for patients receiving clozapine in an effort to lessen the burden on clinicians and patients. “I think the new monitoring system will be quite helpful,” Olfson said in comments to Psychiatric News. “It simplifies the clinical evaluation of neutropenic events, increases access to clozapine for patients with benign neutropenia, and permits those who develop mild neutropenia to continue treatment.” (bold-face type mine)
“Lessen the burden”? You mean they can’t find out that a number of clinicians are having a little trouble certifying under the new “modifications”? Or maybe they don’t see the irony in the Psychiatric News article published July 17, 2015: