https://www.youtube.com/user/veritasvisuals
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If you are not vocal about your under/untreated pain YOU ARE INVISIBLE
Posted on August 24, 2022 by Pharmaciststeve
PBM Specialty Pharmacy Requirement Hurting Patients, Specialists Say
Posted on August 24, 2022 by Pharmaciststeve
PBM Specialty Pharmacy Requirement Hurting Patients, Specialists Say
https://www.medpagetoday.com/pharmacy/pharmacy/100359
Hassles with prior authorization, delivery make it harder to dispense needed medications
Pharmacy benefit managers (PBMs) are requiring more and more patients to use specialty pharmacies to obtain their drugs — especially for cancer and other chronic illnesses — and medical specialty groups are saying that it’s increasing paperwork and hassle for themselves and their patients without adding any value.
Wayne Woodbury, RPh, pharmacy director at Southern Oncology Specialists in Huntersville, North Carolina, had one patient who regularly received an IV immunoglobulin (IVIG) infusion. “Every year, at the beginning of the plan year when she would renew, [the PBM] would say, ‘This medication you get, an IVIG, you can’t fill that through the provider’s pharmacy; you’ll have to use ours.'”
Patient Pushback Required
The first year that happened, “I pushed back as far as I could; I called the insurance carrier that the PBM owned and told them, ‘This is a therapy that is weight-based and it’s therapeutic-level-based,” Woodbury said in a phone interview. “Every month, the patient comes in, she gets blood work and gets weighed, and based on the lab work and her weight, the dose is determined, so our provider would prefer that we’d be able to dispense that and dose-adjust accordingly, rather than getting the shipment from the preferred pharmacy and [risking] underdosing or overdosing.'” Woodbury said he was told that although he couldn’t make that request, the patient herself could do it, and she was able to get an override for it after several hours on the phone, he said.
That worked for 2 years, but then the patient’s employer switched insurers and a new PBM was involved, Woodbury said. Not only that, but the PBM was using a third-party intermediary to manage the prescription component — “to deal with all of the prior authorizations, deal with the prescription claims coming in and where they were sent,” he continued. “I think they use them for a clearinghouse of sorts, getting the information and ascertaining what level of treatment is this and how can we best get this medication distributed?”
Woodbury’s office tried again to get an exception for this patient “and they were an outright ‘No,'” he said. “Unfortunately we weren’t able to provide the medication for the first time in 3 years … so we had it shipped to [an approved pharmacy] and they ship it to our office every month. If it’s not here in time, we may have to change her appointment.”
The intermediary gave the patient a list of reasons why they wouldn’t allow the in-house pharmacy dispensing, “a long list of what they called negligent acts by us, saying when they initially sent the request for the prescription, we didn’t send it back in a timely manner, didn’t get prior authorizations in a timely manner, and refused to give them clinical information,” Woodbury said, adding that none of that was true. “These are all things we do as part of our process — what it takes them 7 to 10 days to do, we can do in a matter of 2 hours to a day.”
Woodbury said he does see a role for PBMs “when it comes to maintenance therapies for certain disease states, because those are disease states where the therapy is established … You know what therapy you’re going to be on, and the monitoring is not as frequent as acute indications in the oncology/hematology space. There’s a place for them there; they are able to offer medication in bulk, sometimes at a discount.”
“To Us, It’s a Person”
Laurie Dieringer, MBA, office administrator at the Lafayette Cancer Center in Lafayette, Indiana, is having similar experiences at her office’s multispecialty infusion center. One patient in particular had been on a chemotherapy drug for a while, “and he’s been filling it in-office for the last couple of years,” Dieringer said. “I went to process the refill in July and got a rejection — all of a sudden we’re out of network and he has to get it at the specialty pharmacy. There was no [prior] notification to the office or the patient.”
This is further complicated by the fact that “a lot of these patients have copay assistance or foundation assistance,” which Dieringer helps manage. In addition, when there’s a dose reduction, “I know it instantly — I don’t have to wait and send a fax” to the outside pharmacy, which otherwise autofills the refill for the same dosage, she said.
Dieringer informed the patient of the change. He was upset and pointed out that he was still working, and asked, “‘Is it going to get mailed to my house? What if somebody steals it?’ That’s a valid concern,” she said. To the PBM, “it’s just a fill. To us it’s a person, it’s a patient and you must try and do the best for the patient.”
Eventually Dieringer’s office was able to convince the specialty pharmacy to ship the medication to another nearby pharmacy so the patient could pick it up there, she said, adding that sometimes prescriptions are delayed because the specialty pharmacy needs to contact the patient about something and the patient doesn’t recognize the phone number and doesn’t answer. “It can take weeks — and I’ve even had it take months — for the patient to get their medication.” The hassles of having to use the specialty pharmacy — a process called “white-bagging” — are so great that two local hospitals have refused to do it and are now sending all their infusion patients to the center Dieringer works at, she said.
Other Specialties Also Affected
And it’s not just oncologists that are having this problem, according to Madelaine Feldman, MD, president of the Coalition of State Rheumatology Organizations. Rheumatologists have been having the same issue with their infusion drugs, she said in a phone interview. “We’ve been fighting against white-bagging, which has been an issue, over the last 3 years or so.”
Although PBMs say that white-bagging can save money for employer groups, oftentimes that doesn’t seem to be the case, Feldman said, noting that one member of the coalition’s Payer Issue Response Team is the office manager for her husband’s rheumatology practice, and she has found that the price that her office would “buy and bill” for a particular drug is often cheaper than the price that she is quoted by PBM pharmacy technicians or what the human resources person in a self-insured employer’s office says they are getting billed for.
Asked to comment on the issue, the Pharmaceutical Care Management Association — an industry group for PBMs — said in a statement that “Specialty pharmacy dispensing on physician-administered drugs is often much less costly and allows for claims processing to occur in real time through the drug benefit rather than through the medical benefit, where physician ‘buy and bill’ can lead to payment delays and high costs. Specialty and other high-cost medications are often misused and underutilized without PBM and specialty pharmacy management programs, support systems, and monitoring tools in place.”
The association included a comment from a 2019 Massachusetts Health Policy Commission report, which found that “clinician-administered drugs are typically high-cost, and spending for clinician-administered drugs represented almost one-quarter of all commercial drug spending and 4% of total commercial health care spending in Massachusetts in 2015. Spending for these drugs is also growing rapidly; commercial spending for these drugs grew 5.1% in 2015 and 9.5% in 2016.” MedPage Today also sought comment from one of the nation’s largest PBMs, but they were unable to respond by press time.
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15M Medicaid enrollees risk coverage loss when COVID-19 health emergency ends, HHS reports
Posted on August 24, 2022 by Pharmaciststeve
15M Medicaid enrollees risk coverage loss when COVID-19 health emergency ends, HHS reports
https://www.healthcaredive.com/news/Medicaid-lose-coverage-hhs-aspe-public-health-emergency/630266/
- About 17% of enrollees in Medicaid and the Children’s Health Insurance Program, or 15 million people, could lose their coverage when states resume regular eligibility checks once the COVID-19 public health emergency ends, HHS projected in a report from the Office of the Assistant Secretary for Planning and Evaluation.
- Loss of eligibility will require 9.5% of beneficiaries to transition to another source of health insurance, while nearly 8% will leave the program despite remaining eligible due to difficulty navigating the renewal process and other administrative issues, HHS reported.
- The agency said it is taking steps to reduce the risk of people becoming uninsured at the end of the public health emergency, including working with state and federal marketplaces to facilitate enrollment in other coverage options and stepping up outreach and education efforts. About 5.3 million children and 4.7 million young adults ages 18 to 34 are predicted to lose coverage. Of those, nearly a third are Latino and 15% are Black.
Dive Insight:
Health policy experts have been sounding the alarm about potential coverage losses for millions of Americans, including children, when pandemic protections expire. The nation’s uninsured rate fell to a historic low of 8% in the first quarter of this year, due in large part to the suspension of Medicaid coverage terminations that has swelled the number of participants in the program.
To help mitigate the disruption, the CMS issued guidance to assist states in November 2021 for transitioning those who will lose Medicaid and CHIP eligibility to other health insurance, such as subsidized plans, through Affordable Care Act marketplaces.
The extension of premium subsidies in the new Inflation Reduction Act is expected to improve access to alternative coverage for some losing Medicaid eligibility at the end of the public health emergency. The legislation extends enhanced marketplace subsidies until 2025.
Of those predicted to lose Medicaid and CHIP eligibility, 2.7 million people are expected to qualify for marketplace premium tax credits, the ASPE report said. Among this group, more than 60% are expected to qualify for zero-premium marketplace plans under the provisions of the American Rescue Plan. Another 5 million people are expected to obtain employer-sponsored insurance.
An estimated 383,000 people projected to lose Medicaid eligibility would fall in a coverage gap in the 12 non-expansion states because they have incomes too high for Medicaid but too low for marketplace tax credits.
Coverage losses due to administrative hurdles are also a high risk due to the volume of redeterminations that states must conduct and the length of time since Medicaid agencies last communicated with many beneficiaries, ASPE warned. The CMS is coordinating efforts with state Medicaid and CHIP agencies to minimize coverage lapses, the report added.
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IV acetaminophen has been a tremendous disappointment when compared to opioids in terms of both efficacy and reducing opioid-related side effects
Posted on August 24, 2022 by Pharmaciststeve
Two equally bad ways of treating acute pain in elderly ED patients?
https://www.pharmacyjoe.com/two-equally-bad-ways-of-treating-acute-pain-in-the-elderly/
In this episode, I’ll discuss an article comparing IV acetaminophen with IV hydromorphone for acute pain in elderly ED patients.
IV acetaminophen has been a tremendous disappointment when compared to opioids in terms of both efficacy and reducing opioid-related side effects. I have not yet seen a study demonstrating a clinically meaningful improvement of IV acetaminophen over an IV opioid for acute pain. However, there continues to be a desire to find a niche for IV acetaminophen, especially in patient populations at risk for opioid related side effects such as the elderly. To this end a Randomized Study of Intravenous Hydromorphone Versus Intravenous Acetaminophen for Older Adult Patients with Acute Severe Pain was recently published in Annals of Emergency Medicine.
The authors sought to compare the efficacy and adverse event profile of 1,000 mg of intravenous acetaminophen to that of 0.5 mg of intravenous hydromorphone among patients aged 65 years or more with acute pain of severity that was sufficient enough to warrant intravenous opioids.
The primary outcome being investigated was an improvement in a 0 to 10 pain score from baseline compared to 60 minutes after study medication was administered. The secondary outcomes included the need for additional analgesic medication and any adverse events that could be related to the study medication. The authors pre-specified a minimum clinically important difference of an improvement of 1.3 or more on the 0 to 10 pain scale.
The patients enrolled definitely represented a cohort with severe acute pain as the median baseline pain score was 10/10.
After 60 minutes, the patients who received 1000 mg IV acetaminophen improved by 3.6 and the patients who received 0.5 mg IV hydromorphone improved by 4.6 out of 10.
Overall pain relief after 1 dose however was not very good for either group. Almost half of the IV acetaminophen patients required additional doses of an analgesic, as did just over one-third of the patients who received IV hydromorphone.
Adverse events were similar between groups and minimal consisting of dizziness, drowsiness, headache, and nausea.
Unfortunately, it seems that efforts to provide analgesia with lower doses of opioids like 0.5 mg IV hydromorphone or alternatives to opioids like IV acetaminophen cannot reliably provide adequate pain relief in a cohort of elderly ED patients with severe acute pain.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
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why I often post about politicians: Healthcare Has Always Been Political
Posted on August 23, 2022 by Pharmaciststeve
Healthcare Has Always Been Political
https://www.daily-remedy.com/healthcare-has-always-been-political/
The Hippocratic Oath is not what you think it is. It was never intended to define the responsibilities of a physician. Rather, it was written by students of Hippocrates to distinguish their training from other physicians who were trained elsewhere.
Think of it like antiquity’s version of branding. It gave physicians practicing the Hippocratic method a competitive advantage in the clinical marketplace of patients.
Flash forward two millennia and not much has changed. In late nineteenth century, many for-profit medical schools were sprouting throughout the country, producing medical students of poor quality in droves. To standardize the curriculum, ostensibly to improve the quality of medical education, the Carnegie Foundation for the Advancement of Teaching appointed academician Abraham Flexner. In 1910, he presented Medical Education in the United States and Canada, a report that defines North American medical curriculum to this day.
Dr. Rudolf Virchow, the father of pathology, succinctly epitomizes the ethos of the report: “Medical practice is nothing but a minor offshoot of pathological physiology as developed in laboratories of animal experimentation.”
The report may have standardized medical education, but its more lasting consequence was to couple medicine with science, prioritizing the biomedical model over the experiential model of medicine.
Dr. William Osler, a firm believer in the Hippocratic method of direct patient engagement, was outraged. He believed this report would remove medicine from the bedside and put it in a research facility. He was right. But the powers-that-be simply ignored his premonitions and set up a more technical, more scientific approach to medicine. Flash forward today and we see the lingering effects of this shift: medicine emphasizes pharmaceuticals as treatment and expensive procedures as therapy.
History does not repeat itself, but it sure rhymes. While never overtly proven, many believe Flexner’s report was motivated by oil barren John D. Rockefeller, who sought to convert his large storage of petroleum into novel pharmaceuticals that could be used to treat diseases that had no cure a century ago.
But in order to treat, we have to first define treatment, which implies we need data and outcomes to study. As a result, we saw the growth of biomedical medicine, which determines a particular treatment by applying the scientific method into medicine.
We do not intend to belittle recent medical advancements made by the pharmaceutical industry. Indeed, the mRNA COVID vaccines are nothing short of a miracle. But we do see a conspicuous pattern where medicine is influenced by covert political pressures under the guise of either standardizing or improving medical care.
We see it repeating itself once again when we look at today’s post-pandemic healthcare.
Never in recent memory has the country’s views on healthcare been so polarized. One study even found a physician’s political affiliation affects the quality of care provided.
It seems like all of healthcare is at the eye of the political storm. The repeal of Roe v. Wade has galvanized abortion into a voting issue. Opioid litigation continues to make headline news, right alongside escalating numbers of opioid overdoses and calls for harm reduction policies.
It seems all things healthcare are now all things political. Health disparities in patient outcomes are now acknowledged to correlate with systemic inequities in societies. Climate change is now a systemic health crisis, as per the American Medical Association.
These insights are undoubtedly important advancements in medicine. Few would argue otherwise. But we must be wary of the underlying motivations that drive them. They appear decidedly political.
Healthcare has always projected an idealistic front, but the underlying factors that influence its advancements have usually been political in nature – whether it was the students of Hippocrates seeking a competitive advantage or an industry-funded academic report.
We must not lose sight of this as we continue to mold a post-pandemic model of healthcare. It remains far too political to solely focus on patient care. It seems like healthcare is a branch of politics instead of an independent entity.
As it currently stands, to predict trends in healthcare, watch how the political winds blow. They carry the sails of healthcare. This is the problem.
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Pharmacogenomics and what it can mean for high acuity pts and their medications
Posted on August 23, 2022 by Pharmaciststeve
Over the last year or more, I have been talking and promoting the use of PGx (pharmacogenomics) DNA testing. We ran a PGx test that our PCP recommended only to discover that it did not cover opiates – in discussing this test with our PCP – he was under the false impression that it did. Not only that but I talked to a Pharmacist at this company, he shared with me some other “short comings” of their testing & reports. So I found another company that did cover opiates and a total of 200 FDA approved meds… so we did that test https://www.clarityxdna.com/clarityx-comprehensive-test/
It came back and it suggested that Barb may have some metabolism issues with both of her LA & IR opiates and one of her other medications. I have shared the report – all 70 pages – with our PCP and my observations & opinions of what it revealed.
But on Barb’s report there was something that was very strange that showed up… Barb was diagnosed with Breast Cancer in 1994 – the end of this month she will be a 28 yr survivor – with breast CA, a woman is not considered “cured” until 10 yrs …
Barb was our Master Fitter/Trainer in our Mastectomy prosthetic center… We knew that the younger a woman was when diagnosed with breast CA… the more likely it would metastasize to brain/bone/lung/liver and that was typically fatal. Because of what she saw working with women with breast CA she did self breast exam several times a week… Her lump became palpable between Sunday and Wednesday and she went for a follow up mammogram on Friday.. which confirmed there was a lump… one of the staff walker Barb from the mammogram center to the surgeon’s office she had used before… he even skipped lunch – because he was scheduled to go out of town for a seminar.. A biopsy was scheduled for Monday and her lump was malignant and growing at TEN TIMES the normal rate. A modified radical was scheduled for Wednesday. Back then, a lumpectomy was not believed to be a good option. Her lump was already 1.9 Cm and no lymph nodes were involved… made it a STAGE ONE under the classification used at that time… a 2.0 Cm it would have been classified as a stage-2. She finished several doses of chemo on New Years’ eve of 1994.
Barb was prescribed the normal medication post chemo that was suppose to suppress any further metastasize of the cancer.. with breast CA , 60% of the metastasizes happen within the first 3 yrs. For Barb this medication cause a significant – almost fatal – side effect – temporary BLINDNESS and the first time she experienced this – SHE WAS DRIVING ALONE…
Of course, this medication was discontinued IMMEDIATELY… of course back in 1994, the internet was nothing like it is today- as far as depth of research material. I read all the FDA available literature… nothing showed up… I contacted our PCP … NOTHING… I contacted her Oncologist … NOTHING… I contact the pharma’s research dept that made this brand name drug … NOTHING…
Back then the pharma Glaxo, was providing a internet bulletin board for pharmacists… it was based at the St Louis College of Pharmacy.. somehow.. I was asked to be one of ELEVEN national moderators for this bulletin board.. and because of this, I was fairly active on this bulletin board. One of the pharmacist at the St Louis College of Pharmacy was a “informational specialist”… so I was at the end of my resources trying to find out about this seemingly unknown reaction to this med that Barb had experienced. She was able to locate a obscure article in a England Medical Journal from the 70’s that MENTIONED this side effect with this med.
Now back to where this post started, in Barb’s PGx report – which has three columns …. one column listing meds that she should normally metabolize, second column listing meds that she MAY HAVE metabolism problems with and a third column where meds SHOULD NOT BE USED – based on the pt’s abnormal liver enzyme issues and the ONLY MED on the 70 pages there was ONE MED LISTED IN THE SHOULD NOT USE COLUMN… and it was this med that Barb had this obscure side effects that almost no literature listed it back in 1995.
Of course our DNA was not fully mapped until the early 2000’s and that is what all this pharmacogenomics testing is based on… but it clearly demonstrates how important this testing can be to some/many/all high acuity pts – sickest of the sick and taking a “boat load” of meds. Everyone needs to remember that what medical science knows about the human system is dwarfed by what it doesn’t know.
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Most good pain advocates work “off the radar/behind the scene” and not always seeking to be the center of attention
Posted on August 23, 2022 by Pharmaciststeve
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Here we go again: Before We Push the New Omicron Vaccine, Let’s See The Data
Posted on August 23, 2022 by Pharmaciststeve
When the first COVID-19 vaccines, came to market… two were made with a – what I considered – a process that was too new and too untested… that was the Pfizer & Moderna based on the mRNA process and the third one was being produced by J&J/Jansen using a process that we had used to make our flu vaccines for decades. Our Congress passed a law that indemnified the pharmas from any law suits/liabilities of producing those vaccines. Over my 52 yr career, I can’t count all the “new meds” that came to market after 10+ yr of clinical trials only to see them pulled from the market from serious adverse events of people taking the meds, either with other meds the pt was taking and/or other comorbidity health issues the pt had. I don’t ever remember Congress indemnified any pharma- against lawsuits – when they brought out a new med to market. To me, that was a red flag… and millions of doses being administered under a FDA “emergency use authorization”. This article dated Aug, 2022, does now – does not recommend the J&J even as a booster – but we got both the initial J&J vaccination and as a booster and WE ARE STILL ALIVE…
There seems to be too much “fuzzy data” being published about the adverse events with these vaccines and they seem to LUMP all the vaccines together, when the J&J vaccine is an entirely different animal than the other two.
We always get our annual flu vaccine – during the optimum time frame – of the last of Sept thru the first couple of weeks in Oct. Unless something that is published about the “new” COVID-19 vaccines and the only ones made available is made using the mRNA process.. I think that we are going to skip any more COVID-19 vaccines… there appears to be some very effective treatments for anyone testing positive for COVID-19. Everyone can make their own choice to take what seems like what is going to be multiple “jabs” per year in perpetuity. To me that suggests that these mRNA vaccinations may only be providing a passive immunity that will typically last 60-90 days.
Before We Push the New Omicron Vaccine, Let’s See The Data
https://sensiblemed.substack.com/p/before-we-push-the-new-omicron-vaccine
The White House is pushing Americans hard to take a novel Covid vaccine before the studies are complete.
By Marty Makary, MD
On Tuesday, White House Covid Coordinator Dr. Ashish Jha implored Americans to get the new Covid vaccine: “It’s going to be really important, that people this fall and winter, get the new shot,” he said in a conversation with the U.S. Chamber of Commerce Foundation.
But where’s the data to support such a sweeping recommendation? The new mRNA vaccines expected to be authorized next month have no clinical trial results that are public. In fact, we know nothing about them. Urging the American people to blindly obey to take a novel mRNA vaccine is not only bad medicine, it’s bad policy. And it’s certainly not following the science.
We just saw this data ambush approach two months ago with the Covid vaccines for babies and toddlers. Here’s how the timeline played out. The White House and public health officials promised them and pushed them hard for children between the ages of 6-months and 5 years. Then vaccine manufacturers released data and declared them safe and effective (the media blindly parroted the message). Here’s the catch. The underlying data actually showed the study sample was too small to make safety conclusions, and most of the claimed effectiveness was statistically invalid. The Pfizer vaccine in babies and toddlers had no statistically significant efficacy. Moderna’s vaccine had an efficacy of just 4% in preventing asymptomatic children aged 6 months to 2 years. (Some European countries have restricted the use of Moderna’s vaccine for anyone under the age of 30 due to the risk of myocarditis). One frustrated CDC official told me the vaccines are so ineffective in young children it wouldn’t matter if you, “inject them with it or squirt it in their face.” Maybe that’s why after a month of pushing Covid vaccination for children under five, only 3% of them got the jab.
Supporters of pushing the new omicron vaccine might point to annual influenza vaccines that are blindly offered each year, but:
1) they use a traditional vaccine platform that has withstood the test of time. In contrast, the novel Covid vaccines have been associated with a serious adverse event rate of 1 in 5,000 doses according to a German study published three months ago by the Paul-Ehrilich Institut. While the National Institutes of health has dedicated over a billion dollars to study long-Covid (which has yielded nothing), its spent virtually no money to investigate Covid vaccine complications, like heart injury in young people.
2) There is currently no scientific consensus that a repeated Covid booster strategy is the right approach. Some scientists are concerned about what is called immune imprinting from multiple booster doses that can weaken the immune system. A recent article published in the journal Science noted a reduced immune response against the Omicron strain among people previously infected who then received three Covid vaccine doses compared to a control group that previously had Covid and did not have multiple shots.
3) The new Omicron vaccine, which is based on earlier Omicron strains, has been tested against newer Omicron strains currently in circulation—a distinct research advantage over studying flu shots. But the results have not been made public. Doesn’t the public have a right to know the results?
It may be that an omicron specific vaccine recommendation for the fall is warranted, but pushing it hard before the data is available makes a mockery of the scientific method and our regulatory process. In fact, why have an FDA, if White house doctors feel that a new medication would likely benefit public health.
Despite the secrecy surrounding data on the new vaccine, Dr. Jha endorsed the new vaccine in his remarks. “Based on everything we’ve seen so far, all the data suggests it should be highly effective against the new variants,” Jha said.
Is that aspirational political talk or a scientific conclusion based on sound data? The distinction is critically important because the public has lost trust in health officials after watching them repeatedly make things up as they go and declare them as truths rather than hypotheses. We need public health leaders to show some humility, stick to the science, and be more transparent with data then they ever have been before. If Jha is following the science, we need to see the data.
Marty Makary MD, MPH is a professor at the Johns Hopkins School of Medicine, the Johns Hopkins Carey Business School, and author of the New York Times bestselling book The Price We Pay.
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When stores, like pharmacies, can’t stay open as promised, it’s time to shop elsewhere
Posted on August 22, 2022 by Pharmaciststeve
When stores, like pharmacies, can’t stay open as promised, it’s time to shop elsewhere
https://www.blueridgemuse.com/node/64327
Often, Floyd’s CVS Pharmacy is closed, without notice, for days at a time . They’re not alone.
A lot of Floyd County residents found themselves without access to needed prescription medications because the pharmacy at CVS on Main Street in the town is closed for a third straight day, citing a failure to have a licensed pharmacist on the premises.
To make matters worse, those who need to save money with lower prices at the Dollar General store a few blocks north are closed as well. Unanticipated closures during normal business hours have become the norm at both stores.
An increasing number of county residents have shifted to The Pharm House, which stays open during its posted hours and provides needed prescriptions, often at better prices while honoring insurance discount cards.
Others tell us that they are now driving to Christiansburg at least once a week to obtain prescriptions at Walmart at better prices. The store is open, as is a CVS location and the pharmacy at Kroger.
“CVS is a pathetic, pitiful operation that leaves people in danger when they can’t provide needed prescriptions on time,” says one resident, who asked not to be identified. Calls to CVS’s headquarters for comment were not returned. Emails, too, were not answered.
The problem is not limited to pharmacists. Pharmacy technicians are quitting at CVS, Walgreens, Rite-Aid, and other locations around the nation, citing increased stress and an inability to keep up with an increasing backlog of prescriptions.
“It got to the point that it was just such an unsafe working environment, where you are being pulled a thousand different directions at any given time,” said technician Heidi Strehl, who worked for Rite-Aid in Pittsburgh for 16 years before quitting in disgust. “You’re far more likely to make a mistake and far less likely to catch it.”
Strehl told NBC News that low wages, few raises, and rude customers were just too much.
“I always thought I would retire from that place,” Strehl said. “But all of the parts of my job that I truly enjoyed over the years had slowly just gone away.”
She’s not alone. The more than 400,000 pharmacy technicians in America work in jobs with little training, even though they are working with serious medications where mistakes can threaten and cost lives Most are paid very little, get few if any raises and have meager benefits.
In Floyd, Dollar General is often closed early or sometimes even all day because of employee shortages, COVID-19, and other problems. Those trying to shop at Dollar General on North Main Street just outside the town limits found a hand-written sign on doors that were locked tight.
The retail chain is facing worker revolts throughout the country. One of Dollar General’s managers in Florida posted a series of Tik Toc videos
INC reports:
Employee hours were severely limited by the company, she said, leading to her or another employee often working alone in the store. Shipments arrived unexpectedly, and with no staff to unpack them, she was forced by company policy to leave boxes stacked up in the aisles, blocking the store shelves and leading to customer complaints.
Sound familiar? The aisles are often blocked in the Floyd Dollar General while some shelves are empty. A call to the company was not returned. Neither was an email request for comment.
Need a prescription or a loaf of bread? Best to call and see if the stores or pharmacy or other retail operation is open.
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Armed Feds Pay a Visit: Amish Farmer: for practicing his religious freedom to grow and prepare food according to his religious beliefs
Posted on August 22, 2022 by Pharmaciststeve
This farmer uses NO FERTILIZER…. NO PESTICIDES … MAYBE NO DIESEL TRACTORS
Armed Feds Pay a Visit: Amish Farmer Faces Hundreds of Thousands in Fines
https://www.westernjournal.com/armed-feds-pay-visit-amish-farmer-faces-hundreds-thousands-fines/
Amos Miller, an Amish farmer who runs a holistically managed small farm in Bird-In-Hand, Pennsylvania, grows and prepares food in tune with nature, the way he believes God intended. This seems like a sound idea to the approximately 4,000 customers who purchase Miller’s meat, eggs and dairy products from his private, members-only food club.
The federal government, however, appears to disagree. A federal judge recently ordered Miller to cease and desist all meat sales, Our Organic Wellness reported. U.S. marshals were deployed to search Miller’s property. They inventoried his stock to assure he doesn’t sell or slaughter more animals. In other words, the feds shut Amos Miller down.
Miller claims he is being persecuted by the federal government for practicing his religious freedom to grow and prepare food according to his religious beliefs.
“To believe your own thought, to believe that what is true for you in your private heart is true for all men, — that is genius.” So wrote American philosopher Ralph Waldo Emerson in his influential 1841 essay Self-Reliance. Once upon a time, Americans respected the notion of self-reliance. It was at the heart of the American mythos. Not anymore.
In March, George Lapsley, a court-appointed expert, was to receive “unimpeded access” to Miller’s farm to inspect the facilities, according to Food Safety News. On March 11, Lapsley reported that Mr. Miller did not fully cooperate and requested assistance from the U.S. Marshals Service.
Federal Judge Edward G. Smith of the Eastern District of Pennsylvania then ordered that the USMS was authorized to use whatever reasonable force was necessary to gain entry into the facilities it is authorized to inspect.
Furthermore, according to Food Safety News, the court’s order permited Lapsley to make unannounced visits to Miller’s farm. Presumably, this meant anytime, day or night. Never mind God, Big Brother is here.
If this isn’t an escalation, I’m not sure what would qualify as such.
Why is the USMS authorized to use force on an Amish farmer? The USDA contends Miller is slaughtering meat and poultry animals at these locations and distributing them to other states without federal inspection.
To be fair, in 2016 the U.S. Centers for Disease Control and Prevention reported that an outbreak of listeria had been traced to unpasteurized raw milk produced by Miller’s Farm, as reported by CBS News. The incident occurred in 2014. The “outbreak” impacted two people, one in California and one in Florida. One of them died.
At the time, Miller told CBS News that he was not aware of any health problems. “I don’t know that it was proved it’s on the farm here,” he said. It’s not clear why it took the CDC two years to conclude that it was.
Whatever the case, that was then. This is now.
In the summer of 2021, Miller was ordered to pay $250,000 for “contempt of court.” He was also told to pay the salaries of the USDA investigators assigned to his case. To avoid going to jail, he was ordered to pay $50,000 upfront as a gesture of “good faith,” as reported by Our Organic Wellness.
The notion of self-reliance can be dangerous. “To believe that what is true for you in your private heart is true for all men,” can be a green light to nightmare land. The 20th century was full of monsters like Mao, Stalin, Hitler and Pol Pot, who believed they were doing the right thing. Villains don’t often see themselves as the bad guy. They think of themselves as heroes.
All the monsters mentioned above, however, have one thing in common — they vied to replace God with government.
Amos Miller isn’t so audacious. He’s simply trying to do what he believes God intends — be a steward of the earth by growing and naturally preparing food. There’s nothing far-fetched or crazy about that. One might go so far as to say it’s good old common sense.
Miller practices rotational grazing. His cattle are raised on organic pastures, with the chickens following behind to eat bugs from the droppings. Whey-fed pigs then trample the fertilizer back into the earth.
Again, there’s nothing sinister going on on Miller’s farm. He just wants to be left alone to go about his business. He just wants to be self-reliant.
Why would the feds resort to force and heavy fines to bring Amos Miller into compliance? Why is his private business any of their business? If Millers’ customers were getting sick from his products, he’d know about it, because they’d either sue him, make a big stink or quietly spread the word. His business would suffer.
It’s fair to ask if the feds are attempting to squeeze religious belief out of the marketplace. They’ve managed to all but banish it from our public schools. During the pandemic, they attempted to selectively clamp down on churches. There’s a pattern here.
One of my readers shared this today
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