Welcome to the first edition of Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
I’m Christine Jordan Sexton, and I have been reporting on health care policy and regulation from Tallahassee for more than 25 years and will be sharing some of my insights in this newsletter.
Do you have a hot tip to share? I’d love to hear from you. You can email me at [email protected] or call me at 850-251-2317.
Legal challenges, new money
With hundreds of billions of dollars in Medicaid managed-care contracts on the line, there could be some contentious battles in the months ahead, both in and out of the Florida Capitol.
Agency for Health Care Administration Secretary Simone Marstiller is so convinced there will be legal challenges as the state begins the process of procuring its Medicaid managed-care program that she is asking the Legislature to include an additional $2 million in her agency’s fiscal year 2022-2023 budget to hire outside counsel. Marstiller said she wanted funding available to her agency “at the ready” to ensure her agency can employ the best outside legal help available.
“This is going to be a very large, high-dollar procurement process. And so, we anticipate the potential for a challenge at the time we put the solicitation out and potentially later at the time that we have awarded contracts, ”Marstiller told members of the House Health Care Appropriations Subcommittee this week.
Marstiller also hinted her agency would be asking lawmakers in the 2022 Session to crack open the law that establishes the state’s mandatory Medicaid managed-care program to reconfigure the Medicaid Regions, along with the number of contracts the state can ink with managed-care plans in each area. Currently, there are 11 regions, and they are set in statute.
After the meeting, Marstiller told Florida Politics the agency did not have specifics about the potential redesign or how the 11 regions would change.
But don’t be surprised if Marstiller dusts off an old plan floated by AHCA in 2017 that consolidated the existing 11 regions into eight.
The 2017 proposal combined current Medicaid Regions 1 and 2 into a new, bigger area called Medicaid Region A. Medicaid Regions 3 and 4 were rolled into new Medicaid Region B. And Medicaid Regions 5 and 6 were rolled together into Region C. The 2017 bill also would have increased the minimum or maximum number of plans AHCA will contract in each area except for Medicaid Region 7 (renamed Medicaid Region D under the proposal), which would have remained the same. While the House supported AHCA’s efforts at the time, the Senate had no appetite for change; 117 health care lobbyists registered to lobby the measure, HB 7117.
Medicaid service boost
Florida has received “conditional approval” for a $1.1 billion plan to enhance spending on Medicaid home and community-based services but appears to be keeping the news on the down-low and isn’t moving quickly to spend the money.
Which begs the question: Why?
Marstiller told members of a House health care spending panel earlier this week the state had received “conditional approval” of its plan and that her agency was working on the budget amendments she said need to be approved for the agency to spend the money.
AHCA did not respond to Florida Politics’ inquiries when the federal government signed off on the plan, at least conditionally. Moreover, there is no information posted on AHCA’s webpage that indicates the conditional approval, which calls for earmarking $266.6 million to providers to help develop and recruit a workforce that can provide home and community-based services to those in need.
About 108,000 people were receiving Medicaid home and community-based waiver service programs as of July. Most of those people were enrolled in the Medicaid iBudget program, which serves people with developmental and intellectual disabilities, or the Community Care for the Elderly program, which provides community-based services to keep people out of nursing homes.
Members of the House Health Care Appropriations Subcommittee did not press Marstiller about the conditional approval, the funds, or when she thought her agency would complete the budget amendments and send them to the Legislative Budget Commission for consideration. Yet, for years, those members have heard about providers struggling to make ends meet and provide the care.
The pandemic, and the new statewide increase in the minimum wage, exacerbated the problem.
Florida Association of Rehabilitation Facilities President and CEO Tyler Sununu said in less than one year, 105 facilities that provide services to people with developmental and intellectual disabilities have closed their doors due to the pressures of inadequate reimbursements.
Sununu said, on average, providers are reimbursed less than what they were in 2003, yet inflation has gone up 48%.
Florida’s Department of Health is asking for a $2 million boost to bring in outside lawyers to help defend the state against a growing number of lawsuits, but at least one lawmaker wants to make sure the funds aren’t directed to COVID-19 related litigation.
DOH Deputy Secretary for Operations Michele Tallent said the increased litigation was “arising from the enactment of new laws and adoptions of new roles governed by the department.”
Rep. Carlos Guillermo Smith pressed Tallent on how much the state is spending on attorneys in a lawsuit he filed against the DeSantis administration earlier this summer for refusing to release COVID-19 information he asked for in a public record request to the Orange County Health Department.
“I know that there’s probably a lot of litigation you have to consider. The Governor did recently say that recently it might not be a bad idea to reinstate daily COVID-19 data reporting. So, I’m curious, the $2 million In taxpayer money that you are using to fight the release of the COVID-19 public health data, how much is being spent there on that litigation?” he asked during a legislative committee meeting this week.
Tallent said she’d have to get the information from the department’s general counsel office and circle back to him.
Guillermo Smith requested the Orange County Health Department provide him the ages, sex, ethnic and racial demographics of those with confirmed cases of the COVID-19 virus, and vaccination rates for the county. The Associated Press, Gannett Co., The McClatchy Company, The New York Times, Scripps Media, Sun-Sentinel Company, Times Publishing Co. and WP Company have joined Guillermo Smith’s lawsuit.
Meanwhile, the DOH isn’t the only agency requesting $2 million to hire outside legal counsel. The Agency for Health Care Administration also requested $2 million to employ legal counsel in anticipation of litigation as it begins a new Medicaid managed-care procurement. The multi-year contracts are worth more than $100 billion in the aggregate.
The pandemic continues, but as far as policy bills are concerned, it may as well be over. Three months out from the 2022 Legislative Session, lawmakers have filed only a half-dozen or so proposals related to COVID-19, and a few of those are likely nonstarters.
Republican Rep. Elizabeth Fetterhoff is sponsoring the least controversial of the lot. Her bill (HB 117) would make explicit that first responders who become disabled or die from COVID-19 are assumed to have contracted the virus on the job unless it can be proven otherwise. Such a law already exists for other deadly diseases, such as meningitis and hepatitis.
Bills (HB 129/SB 328) filed by Rep. Ardian Zika and Sen. Ana Maria Rodriguez, both Republicans, would require insurers to cover the total cost of at-home COVID-19 test kits whether the patient has a prescription or not. The requirement would sunset Dec. 31, 2023.
Two bills sponsored by Rep. Anthony Sabatini read like red meat for anti-vaxxers, but their fate is uncertain due to the Howey-in-the-Hills Republican’s status as a pariah within his Party.
One of his bills (HB 6009) would strip the State Health Officer’s authority to require anyone to be vaccinated for any disease, including the coronavirus. The other (HB 75) would create a statewide ban on mask mandates and block businesses from requiring their customers or employees to show proof of vaccination.
That proposal would likely face an uphill battle even if it weren’t tied to Sabatini — companion legislation hasn’t been filed, and Sen. Manny Diaz, the Hialeah Republican who chairs the Senate Health Policy Committee, stated he wouldn’t support a ban on private businesses requiring employees to be vaccinated.
Rep. Michael Grieco and Sen. Tina Polsky, both South Florida Democrats, have taken the opposite tack with bills (HB 47/SB 284) that would make it a third-degree felony, punishable by up to five years in prison and a $5,000 fine, to produce counterfeit vaccination certificates.
In case you missed them, here is a recap of other critical health care policy reporting covered in Florida Politics this past week.
Billion-dollar boost — The state’s plan to direct another $1.1 billion in Medicaid money toward home and community-based services that treat people on the Managed Long-Term Care and iBudget Medicaid waivers was granted conditional approval by the feds. This week, as reported by Florida Politics, Marstiller told a House panel the agency was drafting the fine print on the distribution plans for the money. The additional funds were made possible by a 10% increase in the federal Medicaid match for home and community-based services included in the American Rescue Plan.
Plan ‘imminent’ for Medicaid cash — DeSantis administration health officials said the release of their plan on how to spend the $1.1 billion in Medicaid funds is “imminent,” but the state has not yet provided any details on how it plans to distribute most of those funds to the direct service providers who care for the elderly and people with intellectual and developmental disabilities. As reported by Florida Politics, the ambiguity comes when Medicaid direct service providers struggle to keep up with new increased minimum wage requirements and attract a future workforce willing to assist with daily activities that can keep patients living in the community, not in institutional care. A state plan review shows Florida wants to target about 66% of the new funding, or about $622 million, for increased payments to the home and community-based service providers that care for about 108,000 people.
Grim stats for long-term care facilities — A new AARP report shows nursing home resident deaths shot up 22%, and staffing shortages continued to plague the industry over the four weeks ending Sept. 19. “With more than 11,000 lives lost in Florida’s long-term care system since the start of the pandemic, we can only hope that the recent decreases in new cases and hospitalizations could mean that the darkest days of this global public health crisis are behind us” AARP Florida State Director Jeff Johnson said. The report did show that the nursing home worker vaccination rate jumped four points to 53%, though that’s still double digits behind the national average (67%) and the industry-standard (75%).
Papers, please — The Florida Health Insurance Advisory Board mulled eight potential changes to present to lawmakers as the 2022 Legislative Session nears. As reported by Florida Politics, the list presented by Board member Louisa McQueeney included a requirement that insurers provide patients with a complete copy of their medical records upon request. Also in the mix is a requirement that small employer health plans cover applied behavior analysis therapies for children with autism. The insurance industry-dominated panel won’t vote on the recommendations until its next meeting. The Office of Insurance Regulation did not set a future meeting date before adjourning the meeting.
NICU panel roster released — AHCA on Friday named the 17 medical and nursing experts who will serve on a committee meant to “negotiate” new rules to regulate the operation of intensive care units for some of the state’s sickest newborns. As reported by Florida Politics, retired Judge Gregory P. Holder will serve as the panel mediator, which will also include representatives from Jackson Health System, Broward Medical Center, Nemour’s, West Kendall Baptist Hospital, AdventHealth for Children and AdventHealth for Women, Ascension Florida & Gulf Coast, Broward Health Medical Center, as well as the University of Florida and the University of South Florida. AHCA Chief Bureau of Health Facility Laura MacLafferty and Amy Miles, a senior attorney at the agency, were also appointed to the panel.
Balance billing challenge crashes in court — A challenge to the 2020 law banning non-contracted air ambulance providers from “balance billing” insured patients was tossed by a North Florida federal judge on Wednesday, Florida Politics reports. The law in question prohibits air ambulance companies that do not have a contract with an insurance provider from charging patients the balance of bills not paid by insurance, which can often run into the five-figure territory. Florida Association of Health Plans President and CEO Audrey Brown, one of the lobbyists who pushed for the law, hailed the ruling. “Florida is the only state in the nation to find a legislative path forward, that has been upheld time and again by the court system, to ban air ambulances from balance billing Floridians, an anti-consumer practice that burdened our state’s families,” she said.
Groundwork laid for PCAs — AHCA is moving forward with a regulation that lays the groundwork for the use of personal care attendants in Florida nursing homes and will hold a meeting on the proposal in Tallahassee on Oct. 29, Florida Politics reports. The agency has not published a copy of the proposed regulation, but AHCA Deputy Secretary for Quality Assurance Kim Smoak said the agency thinks the rules can be finalized by the end of the year. Until then, the temporary program put into effect by former AHCA Secretary Mary Mayhew remains in effect. Under the current AHCA program, a PCA may work in a nursing home for up to four months, assisting with direct care services after taking an eight-hour training course. The personal care attendant would be required to be directly supervised by nursing staff.
More health care news
In addition to the coverage on Florida Politics, these stories are worthy of your time.
“Lawmakers push Florida Health for more COVID-19 data” via Forrest Sanders of WPTV — Members of a Senate panel pushed for more COVID-19 data from Florida health officials. It comes after the department switched from daily to weekly virus reports during the summer. Lawmakers on the Senate Health Policy Committee questioned the change while getting an update. Melissa Jordan, the division director at Community Health Promotion, said the department continues to provide daily case data to the Centers for Disease Control and hasn’t “found it necessary” to return to more frequent reports. “Sometimes, those seven-day average trends are a better measure of how communities are doing overall.” Some lawmakers were left unsatisfied. Sen. Janet Cruz asked Jordan whether the health department embraced herd immunity and felt she didn’t get an answer.
“Lawmakers eye education efforts to address health care worker shortage” via Regan McCarthy of WFSU — After the delta variant caused a surge of coronavirus patients in Florida, health officials say the number of cases is continuing to trend down. But Mayhew, now president and CEO of the Florida Hospital Association, says staffing concerns remain. “We had a workforce shortage prior to the pandemic. The pandemic has been like a gasoline can over that fire, so the workforce shortage is now greatly exacerbated as a result of the pandemic,” Mayhew told the state Senate Committee on Health Policy Wednesday. Mayhew says the “stress and strain” of the pandemic led to a 25% turnover rate among hospital nurses. That number rises to 30% among critical care nurses. Nursing homes are experiencing similar problems.
‘An insane amount of money’: Florida’s demand for travel nurses raises concerns of price gouging” via Liz Freeman of the Florida Times-Union — As staffing agencies for travel nurses double and triple their fees to hospitals, the Florida Hospital Association is tracking complaints of price gouging in other states. California’s hospital association last month asked the state Department of Justice to conduct a probe on behalf of its 400 hospitals. “We need your immediate support to ensure that high-quality, affordable care remains available for all who will need it in the coming weeks and months.” Hospitals in Florida have responded to staffing shortages differently, but nearly every hospital uses travel nurses to combat the shortage and handle surging patient volumes due to the pandemic. The cost hospitals are paying for travel nurses is a huge concern.
“Primary care practice officially defined in Florida for APRNs practicing autonomously” via Amanda L. Waesch and Rachel Stermer of Brennan Manna & Diamond — The Florida Association of Nurse Practitioners explains when an APRN’s practice is considered primary care and when it is not. For example, administering Botox may be regarded as primary care if the provider is using it for migraines in a primary care setting while administering it in a MedSpa or using it for wrinkle treatment outside of a primary care setting would not be considered primary care and would require the APRN to practice under a collaboration agreement. It is important to note that even if APRNs are working in a primary care setting and offering primary care to their patients, they may not practice autonomously until they have applied for an autonomous license and have been approved.
“The next big thing in health insurance? Scheduling your online visits first” via Julie Appleby of Kaiser Health News — Many insurers offering virtual-first plans hire outside firms to provide medical staff. The physicians may hold licenses in several states and not be located nearby. Insurers say participating online doctors can access patients’ medical information and test results through the insurers’ electronic medical records system or the third-party online staffing firm. Experts warn that what might prove tricky is transferring information from physicians, clinics, or hospitals outside of an insurer’s network. Sharing patient information via EMRs is challenging even for doctors operating under traditional insurance plans with in-person visits — especially moving data between different health systems or specialty practices. In general, virtual-first health plans may carry lower premiums or provide such financial incentives as no copays for online visits.
“Why experts say people should get both flu and COVID-19 shots as soon as possible” via Verónica Zaragovia of WLRN — Dr. Leandris Liburd, associate director for minority health and health equity at the federal Centers for Disease Control and Prevention in Atlanta, explained the urgency: This is actually the ideal time to get a flu shot before the end of October because you get ahead of the flu season, and so what we want to do this year is to be able to protect ourselves, protect our families by getting a flu shot and then going through the winter with the confidence that we can likely avoid hospitalizations because of severe complications associated with the flu. We have more than 50 years of experience with flu vaccines. We know they’re safe. We know that they are effective.
“Florida Health Insurance Advisory Board to vote on eight legislative recommendations” via Nicole Pasia of State of Reform — McQueeney, communications director of Florida Voices for Health, presented the following recommendations: 1) Allow small group plans to offer employee/dependent coverage. 2) Deductible credit transfers between plans. 3) Provide consumers with one free copy of medical records. 4) Prohibit insurance carriers from changing prescriptions drug formularies during a policy year. 5) Prohibit balance billing for emergency medical transportation. 6) Require carriers to include Applied Behavior Analysis (ABA) as a covered benefit. 7) Include services addressing Fetal Alcohol Spectrum Disorder (FASD) as an optional covered benefit. 8) Prohibit copay accumulator programs.
Statutory rule changes
Diagnosis sifts through the latest statutory and technical rule changes, so you don’t have to.
— The Florida Department of Health proposes Rule 64D-3.049 to set the guidelines for general and specific protocols for controlling COVID-19 in school settings. More here.
— AHCA proposes amending Rule 59 C-1.008 regarding certificate of need application procedures to remove references to the terms “hospitals” and “general hospitals” and revise the CON application forms. More here.
— The Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling is proposing to amend Rule 64B4-3.003 to extend the length of time an applicant has to get licensed. More here.
— The Board of Nursing Home Administrators proposes amending Rule 64B10-16.001 to revise application form DH-MQA-NHA0003. More here.
While there are several sources for tracking the latest lobbying registrations, these are vital signings in the health care silo.
— Melody Arnold, who joined RSA Consulting as Director of Government and Community Affairs last month, has officially registered to lobby for the firm’s suite of health care clients. Before joining RSA, Arnold spent several years working as the Florida Health Care Association’s Associate Director of Government Affairs, a position that saw her advocate for the state’s 500-plus long-term care facilities. Her principals at RSA Consulting include AdventHealth, Community Health Centers of Pinellas, the Florida Association of Community Health Centers, Moffitt Cancer Center, Northside Mental Health Center, Premier Community HealthCare Group, Suncoast Community Health Center and Tampa Family Health Centers. Additionally, Arnold will continue her work with FHCA from her position at RSA Consulting.
— Ron Book and Kelly Mallette of Ronald L. Book PA have signed a lobbying contract with Banyan Health Systems, a community health center with several locations across Broward and Miami-Dade counties. The company provides mental health, substance abuse treatment, and primary care services and is seeking money in the 2022-23 budget to help them cope with a spike in demand for their services, particularly among underserved and indigent populations. On the policy level, Banyan wants to be a part of shaping any potential rewrite of the Baker Act, the state law that allows for the involuntary commitment of individuals in danger of harming themselves or others.
— Dean Cannon and Kim McDougal of GrayRobinson added the Florida Association of Rehabilitation Facilities to their client sheet on Oct. 8. The organization (also represented by Book and Mallette) hopes to convince lawmakers to set aside an additional $93 million to address staffing challenges at group homes for adults with intellectual and developmental disabilities. Currently, Certified Nursing Assistants who work in group homes are paid about $11 an hour, making the job uncompetitive compared to entry-level positions in other industries, such as retail. The additional funding would boost CNA pay to approximately $14 an hour. The ask comes after staffing and other challenges have forced more than 100 group homes to close this year, and FARF said 75% of members that remain open report they have had to cut services such as park visits or in-home arts and crafts classes to ensure residents receive care.
Pencil it in
3 p.m. — The Department of Children and Families opens responses to ITN 2021-001 for electronic benefit transfer cards.
Register for the virtual meeting at global.gotomeeting.com/join.
4 p.m. — The House Health Care Appropriations Subcommittee meets and will discuss the Florida Health Care Connections (FX) Fiscal Agent Replacement Update. The Department of Elder Affairs will provide its Enterprise Client Information and Registration Tracking System Project Update.
Place: 17 House Office Building
4 p.m. — The House Public Integrity & Elections Committee meets and will hear a report from the Department of Children and Families on settlement of claims against the Florida Coalition Against Domestic Violence. The committee also will listen to a report by the Chief Inspector Executive Office of the Governor, Melinda Miguel.
Place: 404 House Office Building.
4 p.m. — The Senate Children, Families, and Elder Affairs Committee meets and will discuss a presentation by the Department of Children and Families providing an overview of out-of-home care placements and recruitment, retention, and licensure of caregivers. Panel participants include Andry Sweet, president and CEO, Children’s Home Society of Florida; Mike DiBrizzi, CEO, Camelot Community Care; Calyn Stringer, Licensed Foster Parent and Foster Family Support Recruiter & Trainer, Northwest Florida Health Network Foster Family; Irene Ruckus, president and CEO, Children’s Home Network; Paul Vernon, Foster Parent and Treasurer of Florida State Foster/Adoptive Parent Association.
Place: 37 Senate Office Building.
1 p.m. — The House Health & Human Services Committee meets to have a discussion on staffing shortages with Steven Bennett, MA, Workforce Development Manager, Florida Association of Community Health Centers; Mary Mayhew, President & CEO, Florida Hospital Association and Tracy Greene, NHA, vice president of Operations, Southern Health Care Management, LLC.
Place: 17 House Office Building.
2:30 p.m. — The Agency for Health Care Administration holds a public hearing on proposed changes to Rule 59G-1.060, regarding Medicaid provider enrollment policies.
Place: Agency for Health Care Administration, 2727 Mahan Drive
Or register at: gotowebinar.com/register.
10 a.m. — The Senate Governmental Oversight and Accountability Committee meets and will discuss a Department of Management Services presentation relating to the Division of State Group Insurance and the state group insurance program.
Place: 37 Senate Office Building.
10 a.m. — The Senate Health Policy Committee meets and will be updated on the implementation of legislation from 2019 and 2020, including SB 59, Automated Pharmacy Systems (2020); HB 389, Practice of Pharmacy (2020); and SB 366, Infectious Disease Elimination Programs (2019).
Place: 412 Knott Office Building.
11 a.m. — The House Professions & Public Health Subcommittee meets and will hear a presentation from Jennifer Wenhold, MSW, CPM, Interim Director, Division of Medical Quality Assurance, Florida Department of Health. The committee will also hear from a panel of providers: Darby D. Miller, M.D., MPH; Ahad Mahootchi, M.D.; David Rouse, O.D., F.A.A.O; Mark T. Marciano, O.D.
Place: 212 Knott Office Building.
11 a.m. — The House Children, Families & Seniors Subcommittee meets and will hear a presentation on at-risk boys by the National Guard: Florida Youth Challenge Academy and an update from the Department of Children and Families on the implementation of SB 80 and SB 96.
Place: 102 House Office Building.
2 p.m. — The Agency for Health Care Administration holds a public hearing on proposed changes to Rule 59G-4.140 regarding Florida Medicaid coverage of hospice services.
Register at gotowebinar.com/register.
3 p.m. — The House Finance & Facilities Subcommittee meets and will hear an update on the Prescription Drug Importation Program from Secretary Simone Marstiller, Agency for Health Care Administration.
Place: 17 House Office Building.
3:30 p.m. — The Department of Children and Families opens responses to its RFP 2021 025, seeking a vendor to streamline eligibility processes for the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families and Medicaid.
Register for the virtual meeting at gotomeeting.com.
3:30 p.m. — The Department of Children and Families opens responses to its RFP 2021 020, regarding the delivery of electronic data held by financial institutions on clients that receive public benefits or are applying for public benefits.
Register for the virtual meeting at gotomeeting.com
Hulu’s newest miniseries, Dopesick, debuted this week to widespread acclaim, stirring the rightful disgust of audiences for its portrayal of the nation’s opioid crisis. The 8-part series weaves storylines, targeting perpetrators and humanizing victims as it documents the gut-wrenching sequelae that followed the release of OxyContin.
Based on Beth Macy’s book Dopesick: Dealers, Doctors and the Drug Companies that Addicted America, Hulu’s release will undoubtedly inspire a broader conversation about the forces that drive and deter prescription drug addiction and abuse in Florida.
But where, exactly, does Florida stand?
In 2009, 1 in 8 deaths were attributable to prescription drug overdoses, and in 2010, 90 of the top 100 physicians purchasing oxycodone in the United States were based in Florida. Statistics such as these led the Florida Legislature to implement the state’s first Prescription Drug Monitoring Program (PDMP) in 2009 to encourage the safer prescribing and use of controlled substances. The original law required practitioners to report the dispensing of controlled substances to a central database within 15 days but did not require practitioners to check the database for a patient’s prior use before prescribing. Amendments to the law in 2011 required reports to the database to be made within seven days. In 2017 and 2018, regulations were again amended, requiring that dispensing be reported no later than close of the next business day and requiring practitioners to check the database to review a patient’s history before prescribing or dispensing such drugs.
How have these reforms impacted prescription drug abuse in Florida? A review of longitudinal data suggests some successes and areas for renewed attention.
Between 2010 and 2020, the number of registered users in Florida’s PDMP increased more than 2,100%, from an initial 5,787 in 2010 to 131,880 in 2020. Similarly, between 2012 and 2020, the number of Floridians who were able to fill Schedule II prescriptions from five or more prescribers at five or more pharmacies decreased nearly 90% — demonstrating the desired decline in “doctor shopping.” Perhaps as a result, over the past decade, the volume of Florida deaths caused by opioid drugs, not including fentanyl or heroin, has dropped 41%.
These findings are hopeful, but with a sobering twist: the portion of Florida deaths caused by fentanyl has exploded over the past 10 years, increasing 2,319% to account for greater than 3,000 deaths last year.
Kudos to Hulu for drawing attention to the layered tragedies of prescription drug addiction — and to Florida leaders for the stands taken.
To watch the Dopesick trailer, click on the image below: