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*TROPICAL STORM ISAIAS MOVING NORTHWARD ALONG THE EAST COAST* This product covers Southeast New York, Northeast New Jersey, and Southern Connecticut ***TROPICAL STORM ISAIAS MOVING NORTHWARD ALONG THE EAST COAST*** NEW INFORMATION --------------- * CHANGES TO WATCHES AND WARNINGS: - A Tropical Storm Watch has been issued for Orange and Putnam - The Tropical Storm Watch has been upgraded to a Tropical Storm Warning for Bronx, Eastern Bergen, Eastern Essex, Eastern Passaic, Eastern Union, Hudson, Kings (Brooklyn), New York (Manhattan), Northeastern Suffolk, Northern Nassau, Northern Queens, Northwestern Suffolk, Richmond (Staten Island), Southeastern Suffolk, Southern Fairfield, Southern Middlesex, Southern Nassau, Southern New Haven, Southern New London, Southern Queens, Southern Westchester, Southwestern Suffolk, Western Bergen, Western Essex, and Western Union * CURRENT WATCHES AND WARNINGS: - A Tropical Storm Warning is in effect for Bronx, Eastern Bergen, Eastern Essex, Eastern Passaic, Eastern Union, Hudson, Kings (Brooklyn), New York (Manhattan), Northeastern Suffolk, Northern Nassau, Northern Queens, Northwestern Suffolk, Richmond (Staten Island), Southeastern Suffolk, Southern Fairfield, Southern Middlesex, Southern Nassau, Southern New Haven, Southern New London, Southern Queens, Southern Westchester, Southwestern Suffolk, Western Bergen, Western Essex, and Western Union - A Tropical Storm Watch is in effect for Northern Fairfield, Northern Middlesex, Northern New Haven, Northern New London, Northern Westchester, Orange, Putnam, Rockland, and Western Passaic * STORM INFORMATION: - About 830 miles south-southwest of New York City NY or about 900 miles south-southwest of Montauk Point NY - 29.7N 79.9W - Storm Intensity 70 mph - Movement North or 355 degrees at 9 mph SITUATION OVERVIEW ------------------ Tropical Storm Isaias, located off the north Florida coast, will continue to move to the north this morning, turning north-northeast this afternoon along the southeast coast. Isaias will continue moving northeast tonight over Eastern North Carolina. Isaias will slowly weaken as it accelerates northeast on Tuesday, likely moving over our area Tuesday afternoon and evening. There is still some timing and intensity uncertainty with this storm. However, confidence continues to increase with respect to the magnitude of local hazards and impacts. The main threats with this system involve heavy rainfall, strong winds, minor to moderate coastal flooding, along with high surf and dangerous rip currents. Locally heavy rain is expected with a widespread 2 to 4 inches, with localized amounts up to 6 inches possible. The heaviest rain is most likely to occur across New York City, Northeast New Jersey and the Lower Hudson Valley early Tuesday morning through Tuesday evening, and eastern sections Tuesday afternoon into Tuesday night. The strongest winds are likely to occur across Long Island, coastal Connecticut, and the New York City Metro. Dangerous marine conditions are likely across all of the coastal waters Tuesday and Tuesday night. High surf and dangerous rip currents are expected along the ocean beaches Monday through Wednesday. The effects from Tropical Storm Isaias are expected to diminish quickly from southwest to northeast across the area Tuesday night into Wednesday morning. POTENTIAL IMPACTS ----------------- * FLOODING RAIN: Protect against life-threatening rainfall flooding having possible extensive impacts across northeastern New Jersey, New York City, and the Lower Hudson Valley. Potential impacts include: - Major rainfall flooding may prompt many evacuations and rescues. - Rivers and streams may rapidly overflow their banks in multiple places. Small streams, creeks, canals, and ditches may become dangerous rivers. Flood control systems and barriers may become stressed. - In hilly terrain, destructive runoff may run quickly down valleys, and increase susceptibility to rockslides and mudslides. - Flood waters can enter many structures within multiple communities, some structures becoming uninhabitable or washed away. Many places where flood waters may cover escape routes. Streets and parking lots become rivers of moving water with underpasses submerged. Driving conditions become dangerous. Many road and bridge closures with some weakened or washed out. * WIND: Protect against dangerous wind having possible significant impacts across Southeast New York, Northeast New Jersey, and Southern Connecticut. Potential impacts include: - Some damage to roofing and siding materials, along with damage to porches, awnings, carports, and sheds. A few buildings experiencing window, door, and garage door failures. Mobile homes damaged, especially if unanchored. Unsecured lightweight objects become dangerous projectiles. - Several large trees snapped or uprooted, but with greater numbers in places where trees are shallow rooted. Several fences and roadway signs blown over. - Some roads impassable from large debris, and more within urban or heavily wooded places. A few bridges, causeways, and access routes impassable. - Scattered power and communications outages, but more prevalent in areas with above ground lines. * SURGE: Protect against locally hazardous surge having possible limited impacts across shoreline communities. Potential impacts in this area include: - There is potential for widespread minor to locally moderate coastal flooding across the Lower New York Harbor and South Shore Back Bays, with localized minor flooding impacts elsewhere. - Localized inundation with storm surge flooding mainly along immediate shorelines and in low lying spots. - Sections of near shore roads and parking lots become overspread with surge water. Driving conditions dangerous in places where surge water covers the road. - Moderate beach erosion. Heavy surf also breaching dunes, mainly in usually vulnerable locations. Strong and frequent rip currents. - Minor to locally moderate damage to marinas, docks, boardwalks, and piers. A few small craft broken away from moorings. * TORNADOES: Protect against a tornado event having possible limited impacts across Southeast New York, Northeast New Jersey, and Southern Connecticut. Potential impacts include: - The occurrence of isolated tornadoes can hinder the execution of emergency plans during tropical events. - A few places may experience tornado damage, along with power and communications disruptions. - Locations could realize roofs peeled off buildings, chimneys toppled, mobile homes pushed off foundations or overturned, large tree tops and branches snapped off, shallow rooted trees knocked over, moving vehicles blown off roads, and small boats pulled from moorings.

Veterans’ Affairs Prescription Drug Coverage: A Voice of Reason

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Just this week, U.S. Senator Daniel Akaka (HI), Chairman of the Senate Veterans' Affairs Committee, addressed his Senate colleagues to respond to misconceptions and alleviate concerns surrounding VA prescription drug coverage; a sane voice among too many rhetoric ones. Last week I wrote about the absurdity of suggesting H.R. 4, the Medicare Prescription Drug Negotiation Act of 2007, was "...well-intentioned, but misguided quick fix [which] could literally endanger the health and lives of veterans...." The full-text of what Senator Akaka said can be found here (;=894

). What follows includes my comments on some of what he said.

Many Voices

"[M]uch has been said recently about the way in which VA purchases drugs and the manner in which medications are provided to beneficiaries." "Concerns have been raised about veterans' access to drugs, the quality of the benefit, and VA's formulary and pricing. Much of what has been said about veterans medication coverage is, frankly, wrong."

Notwithstanding all the gripes so many Veterans have about the VA system, never once have I heard any of us say anything negative about its drug cost savings or the level its benefit.

"While there is no question that VA's formulary is an important component of VA pharmacy management, decisions about which drugs are on the formulary are not made by bureaucrats nor are they made by those solely concerned about the bottom line." "VA employs a scientific review process to select drugs to be available to beneficiaries and to ensure quality care. Physicians and clinical pharmacists from the VA's regional offices manage the formulary." "If a drug is needed which is not on the formulary, VA has a quick process to ensure that the drug will be prescribed. This off-formulary process is so robust, in fact, that last year, VA dispensed prescriptions for an additional 1,416 drugs. So, to put a finer point on this, when a non-formulary medication is clinically needed -- it is provided."

Over the last six years, on three occasions my VA doctors (!) have prescribed a non-formulary item. After a short review process, all three were approved. Ironically, one item was even added to the formulary after it and its benefits became known locally.

"While some concern has been expressed that the VA formulary covers only 30 percent of the 4,300 drugs available on Medicare's market-priced formulary, this is not the case. Rather, it is my understanding that VA actually offers 11 percent more drugs than are available under Part D of Medicare." "VA offers 4,778 drugs by way of a "core' national formulary which requires that they must be made available at all VA medical care facilities." "To those who argue that VA's formulary is "among the most restrictive in the marketplace," I would only say that the Institute of Medicine [("IOM")] took a good long look at VA and found that in many respects it is actually less restrictive than other public or private formularies. The Chairman of the IOM Committee said that if VA did not have a formulary process like it has, they would have indeed urged that one be created just like it."

The IOM (

) serves as adviser to the nation to improve health. Established in 1970 under the charter of the National Academy of Sciences (which was created by the federal government to be an adviser on scientific and technological matters), the IOM provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The IOM process uses unpaid volunteer experts who author most reports. Each report: must go through an institutional process assuring a rigorous and formal peer review; has a requirement that findings and recommendations be evidence-based, and; if not evidence-based must be based on a noted expert's opinion. And, they liked what the VA was doing.

"Some have suggested that veterans receive substandard care because of the VA drug benefit. The literature says otherwise. Veterans get better pharmaceutical care than private or public hospitals, according to a study last year published in the Archives of Internal Medicine."

The Archives of Internal Medicine (

) promotes the art and science of medicine and the betterment of human health by publishing manuscripts of interest and relevance to internists practicing as generalists or as medical specialists. It began publication in 1908, and is an international peer-reviewed journal.

"VA's mail order pharmacy has been criticized, as well. VA employs nearly 10,000 pharmacists and technicians and is regarded by many pharmacy organizations as excellent. VA also operates 230 outpatient pharmacies. VA also trains more Doctors of Pharmacy than any other single organization in the U.S. And most significantly, while the error rate for prescriptions in the US is between 3 and 8 percent, the error rate in VA is less than one one-hundredth of one percent."

Let me say that again. The error rate for prescriptions in the US is between 3.0% and 8.0%. The error rate in VA is less than 0.01%. That is "between 0.03 & 0.08" versus "less than 0.0001."

"We know that VA gets the best prices, but I think the essential question is: Do veterans get the necessary drugs to promote the best health care? The answer -- based on peer-reviewed studies -- is a resounding yes." "When veterans' groups testify before Congress about their needs and desires, the only thing they say about their drug coverage is that they want to keep it the way it is." "And if some believe that veterans aren't happy with their drug access and pricing, it is news to me, and to the Administration."

Me too! I have helped many a retired veteran whose "good health plan" is "killing 'em" when it comes to their monthly drug costs. When they learn their private physician can write a script that they can have filled at the VA for $8.00 per 30-day supply, it does much put a smile on their face.

"We can learn a number of lessons from the VA as we consider Medicare price negotiations." "As Chairman of the Veterans Affairs Committee, I will closely monitor the evolution of this issue to ensure VA retains access to affordable drugs. The gains that can be made in Medicare - and the improvement of quality -- are just too great to do nothing."

Yes they are...

--- Regards, Walt Schmidt