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    How NADAC, WAC, and ASP Shape Drug Costs

    How NADAC, WAC, and ASP Shape Drug Costs

    April 20, 2026
    The Hidden Costs Employers Don’t See in Traditional Health Plans

    The Hidden Costs Employers Don’t See in Traditional Health Plans

    March 22, 2026
    The Impact of COVID-19 on Patient Trust

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    Understanding of Clinical Evidence in Peptide and Hormone Use

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Home Perspectives

My Dying Wish

I wish to go on my terms.

Laurie Engels by Laurie Engels
January 10, 2024
in Perspectives
0
My Dying Wish

Richard Catabay

I encourage all of us to have a hard discussion with your family and close friends on the subject of dying. It is the one subject that unites all of us. No one gets out of escaping death. In the United States today there are eleven states which have some form of medically assisted death that gives the patient control over how and why they die. Just this past weekend a woman from Connecticut sued the state of Vermont and won her case to travel to Vermont to access medical assistance in death to end her life. This issue affects us all!

The organization Compassion and Choices supports furthering this legislative work in additional states. Here in Montana, they are hoping to get it out of the legislative committee this year. The title of their company – compassion and choice – really drills down to the core basic idea of having a choice in how we depart for the unknown. Aside from any religious beliefs one takes to heart, it is my opinion at the end of life the choice should be ours to make.

In a recent poll, over 86% of Americans want to die at home. They want to spend their final days where they are most comfortable, spending time making memories. How is it then that more Americans die in the hospital than anywhere else? These patients are often subjected to painful procedures and left on machines that literally leave them with no quality of life. Americans today are living longer with more chronic conditions such as diabetes, cancer, and heart disease. Yes, life expectancy may be greater, but the quality of life is not. This is why it is critical to have these discussions before confronted with an emergency situation.

This topic is quite personal to me. I looked after both my parents until they passed, giving them the gift of dying in their home where they lived for fifty years. My Mom passed at age 87 after a long illness. My Dad passed at age 92 very suddenly. I am the youngest of five and my siblings are all alive and well.

Even though I have had a difficult life as a disabled chronic pain patient, I felt I was in, “relatively good health.” But in September 2023, I was suddenly short of breath, and to my complete shock and surprise, I was diagnosed with Acute Myeloid Leukemia . Not only did I end up with a rare blood cancer that less than 1% of all cancer patients are diagnosed with each year, I ended up with the worst genetic mutation this disease can conjure. The one year survival rate with treatment is 10%. I was faced with the choice of being immediately put into the hospital, started on chemo which has a significant mortality rate itself, and faced with the option of a pending bone marrow transplant.

All told I could have been in the hospital months on end, sick as a dog, and away from all I love and care about. Or I could have a much shorter life span, live at home with my dogs and feel comfortable in hospice. In this way, I see my cancer as a blessing from God, as almost a gift in a weird, twisted sense.

Life as a chronic pain patient in 2024 involves the roller coaster ride that twists and turns every 30 days. That is when the dreaded thoughts come: “is this the month I lose access to my medication”, “will the pharmacy have my medication in stock”, “will the pharmacist be willing to fill my prescription”. Rinse and repeat the ride every 30 days.

It takes a huge toll both emotionally and physically. I still do not know what the future holds for me. My cancer has spread to my spine and pelvis. I am finally with a great hospice company that is treating me with care and compassion. I do not know what the end will be like or when it will come. I wish I had the choice of going out on my terms but sadly I will not live long enough to see it be legal in Minnesota. Please have these tough discussions with your loved ones. Do not leave them having to make choices for you, let them know where and how you wish to exit this earth.

Blessings!

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Laurie Engels

Laurie Engels

I have lived my life in MN growing up the youngest of five. I graduated high school in 1976 and got my BS in Animal Science at the U of MN. I started graduate school but never finished. I have spent the last 25 years of my life devoted to breeding and showing English Setter dogs. I live by myself in Minneapolis.

Comments 0

  1. Mary nowak says:
    2 years ago

    Laurie I have known you for many years through Aoourc love of English Setters. I think you’ve made a wonderful impact on our breed with your love and dedication. I support you in wanting to have a say in making the transition to the other side. We should not have to suffer when our quality of life is non existent Government should never be allowed to make these type of decisions for us. I pray for you and admire your strength and courage to put it this extremely personal thoughts out there for everyone to read. I pray god will take care of you and you have a peaceful passing dreaming of your next best in show dog.!

    Reply
    • Laurie Engel says:
      2 years ago

      Thanks Mary

      Reply

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Videos

summary

An in-depth exploration of drug pricing, including key databases like NADAC, WAC, and ASP, and how they influence the pharmaceutical supply chain, policy, and patient advocacy. The episode also introduces MedPricer's innovative pricing intelligence platform, offering valuable insights for healthcare professionals, policymakers, and patients.

Chapters

00:00 Understanding Drug Pricing Dynamics
03:52 Exploring the Drug Pricing Database
10:07 Patient Advocacy and Drug Pricing
13:56 Market Intelligence in Drug Pricing
How NADAC, WAC, and ASP Shape Drug CostsDaily Remedy
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Policy Shift in Peptide Regulation

Clinical Reads

FDA Evaluation of Certain Bulk Drug Substances in Compounding: Clinical Interpretation

FDA Evaluation of Certain Bulk Drug Substances in Compounding: Clinical Interpretation

by Daily Remedy
April 19, 2026
0

Clinicians increasingly encounter patients using or requesting peptide-based therapies sourced through compounding pharmacies. The U.S. Food and Drug Administration has identified a subset of bulk drug substances, including certain peptides, that may present significant safety risks when used in compounded formulations. The clinical question is whether these regulatory signals reflect meaningful patient-level risk and how they should influence prescribing behavior. This matters because compounded peptides often sit outside traditional approval pathways, creating uncertainty around quality, dosing consistency, and safety. Understanding...

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