“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Looks the FDA is finally starting to pay attention to the MME system… I made this post on my blog a couple of weeks agoWas/is the CDC 2016 guidelines built on a “false foundation ” and created a covert genocide on a protect class of people ? and shared a article that would STRONGLY SUGGEST that the MME system had no double blind clinical study nor science behind it. I had to go down THREE LAYERS DEEP to find out who was participating in this PUBLIC WORKSHOP and in scanning over the participants … the workshop appeared to be “pretty heavy” on bureaucrats, people from academia, and groups that mostly deal with ADDICTION.
In my professional opinion, it will be IMPOSSIBLE to create any MME system that was highly accurate and results can be replicated, but I am sure that the FDA workshop will try to cobble something together that they can claim is based on science and is supported by some hypothetical clinical study/data.
In the short paragraph about the public workshop below, the word “discuss” is mentioned THREE TIMES. Probably just more SMOKE & MIRRORS
Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse
The Food and Drug Administration (FDA or Agency) is announcing the following public workshop entitled ‘‘Morphine Milligram Equivalents: Current Applications and Knowledge Gaps, Research Opportunities, and Future Directions.’’ The purpose of the workshop is to bring stakeholders together to discuss the scientific basis of morphine milligram equivalents (MMEs) with the goals of providing an understanding of the science and data underlying existing MME calculations for opioid analgesics, discussing the gaps in these data, and discussing future directions to refine and improve the scientific basis of MME applications.
When did CORPORATIONS have “personal beliefs” ? The LGBTQ+ community not withstanding, So the SC state legislature exempts all parts of the SC medical system is going to be exempted from civil rights discrimination of disabled under the Americans with disability act and civil rights act ? This appears to be in the same category as a few states passing laws that is supposedly going to protect prescribers from the DEA coming into the state and enforcing the Controlled Substance Act from prosecuting a prescriber that they believe has violated the law.
Can you imagine that a insurance/pbm company refusing to pay for opiate pain management because they fear that a pt could become addicted and they neither wish to cause a person to become a addict, nor be responsible for the cost of treating a pt for addiction. Basically, their beliefs that prescribing opiates could affect their BOTTOM LINE. Since a insurance/pbm company does not have a DEA license – unless they have a mail order pharmacy… they have neither the legal authority to prescribe nor dispense controlled substances, so any denial of paying for opiate/controlled meds would have to be for a concern of their bottom line.
Of course, this article indicates that this bill has just passed the SC House and has yet to be taken up by the SC Senate and even if passed by both Houses, it could be vetoed by SC governor, but both SC Houses have at or near a super majority of <R> so it could be possible for the SC legislature to over ride the Governor’s veto.
South Carolina House passes bill for doctors to deny care that violates ‘conscience’
The bill would excuse medical practitioners, health care institutions and health care payers from providing care that is inconsistent with their personal beliefs.
Legislators in South Carolina on Friday passed a bill which would allow healthcare providers to deny care based on their personal beliefs. It would also apply to insurance companies, which may be entitled to refuse to pay for care.
The bill would also protect those who decline to provide medical services from civil, criminal or administrative liability.
Some say the bill, known as the “Medical Ethics and Diversity Act,” would disproportionately affect the LGBTQ+ community, as well as women and people of color.
South Carolina lawmakers on Friday passed a bill allowing medical professionals and insurance companies to deny care based on personal belief. Some say the legislation, which now heads to the state Senate for consideration, would disproportionately impact LGBTQ+ people, women, and people of color.
Under the bill, titled the “Medical Ethics and Diversity Act,” South Carolina law would be altered to excuse medical practitioners, health care institutions and health care payers from providing care that violates their “conscience.” It would also shield those who decline to provide medical services to patients from civil, criminal or administrative liability.
Dozens of state residents in February testified against the bill, calling it vague and overbroad. They also shared concerns that the legislation would disproportionately impact marginalized communities.
In a statement on Friday, Human Rights Campaign Legal Director Sarah Warbelow said she finds it “disturbing” that politicians in South Carolina are prioritizing individual providers’ beliefs over the wellbeing of patients.
“This legislation is dangerously silent in regards to the needs of patients and fails to consider the impact that expanding refusals can have on their health,” she said. “Religious freedom is a fundamental American value that is entirely compatible with providing quality, non-discriminatory healthcare. It is not a license to deprive others of their rights simply because of personal beliefs.”
Warbelow said the bill sends a message to patients with non-medical views inconsistent with that of their doctors that they are “not equal members of society entitled to dignity and respect.”
“Let’s call this what it is – a vicious, discriminatory attack on vulnerable patients, including those who care for LGBTQ+ people,” Warbelow said.
According to the HRC, the bill could enable administrative staff to decline to submit insurance claims or health care providers to override patients’ end of life directives. Receptionists may also be entitled to turn away patients and medical researchers could refuse to publish the results of a state-funded study because the scientific evidence is inconsistent with their personal beliefs.
The South Carolina bill is just one of more than 320 pieces of legislation under consideration in state legislatures which discriminate against LGBTQ+ people, according to the HRC, which tracks such legislation.
Information for new patients! Tests from OCTOBER 2019 and retested JANUARY 2020! BTW Morphine held up to all the standard test as well as Prialt which explains why they are FDA approved and Hydromorphone and Fentanyl are not but very effective in proper dosing
The FDA does not recommend that pharmacy compounded meds be used in implanted pumps. in fact there is only one commercially available opiate that is approved by the FDA to be used in implanted pump. Infumorph (Morphine). Medtronic has done stability studies of Infumorph in their pumps in vivo (in the body)… and their studies shows that Infumorph will retain at least 90% of originally potency at SIX MONTHS.
Barb has been using infumorph in her pump since having the first one was implanted in 2006 and her 40 ml pump allows her to only needing her pump refilled abt every 6 months. Without any noticeable change in her pain management. Another one my concerns – as a pharmacist – every time that a pt’s pump is refilled, there is a risk of the sterile field being contaminated and it is possible, if this happens, the pt may end up with dealing with meningitis.
Here is an real horror stories about how non-sterile/contaminated products being injected in the intrathecal spinal fluid and the “bad outcomes” that can happen to pts
AARP Services connects companies to people by helping bring experiences, products and services that matter to them as they move through specific life stages. This work includes providing AARP members with access to quality member benefits in the form of products and services. These AARP-branded products and services cover a wide range of member’s needs and are managed with four key principles in mind: Value, Quality, Put the Member in the Middle, and Ease of Access.
Since >50% of independent pharmacies are located in areas of < 20,000 population. So it would appear by this lawsuit that the AARP is endorsing an insurance company that is “stealing” from pharmacies that are primarily serving rural areas
UnitedHealth Tries to Stop Lawsuits From Mom-And-Pop Drugstores
The dispute is over more than $100 million in drug payments
Pharmacies say Optum Rx unit has underpaid them for years
Hundreds of small, independent drugstores are accusing UnitedHealth Group Inc. of short-changing them by more than $100 million, and the health-care giant is trying to head off a lawsuit before it goes to court.
UnitedHealth’s Optum Rx unit filed more than 200 legal cases this week in federal court in California to force the cases into individual arbitration processes, rather than allow a joint lawsuit to go forward, according to legal filings.
At least 1,000 independent U.S. pharmacies are challenging payment practices at Optum Rx, UnitedHealth’s pharmacy benefits management unit that negotiates drug prices for health plans and companies, according to Mark Cuker, a lawyer representing the drugstores. About 500 are involved in the current dispute, while others have already filed cases in different courts. Making each of them enter arbitration is costly and limits the information they could gather through discovery, Cuker said.
“They want each of these pharmacies to have a separate arbitration, 500 separate arbitrations,” even though the pharmacies are raising common issues, Cuker said. Optum Rx is “gaming the system,” he said.
State courts have rejected other attempts to compel private arbitration over similar claims he’s brought against Optum Rx, Cuker said.
“Optum Rx is focused on delivering affordable access to prescription drugs,” the company said in a statement. “The more than 67,000 retail pharmacies in Optum Rx’s networks are important partners in these efforts, and we continue to work with them to balance the need to fairly compensate pharmacies while managing costs.”
The pharmacies involved in the cases say Optum Rx reimbursed them less than required and clawed back payments, according to UnitedHealth’s filings. They also said Optum Rx sometimes called medications brand-named drugs when dealing with health plans but considered the same medicines lower-cost generics when paying pharmacies. Cuker estimated the total value of payments from Optum Rx that his clients are disputing exceeds $100 million over almost a decade.
Optum Rx received notice of the dispute from more than 500 pharmacies in December and said that the pharmacies’ lawyer would only resolve the dispute in court. The pharmacies have not yet filed litigation against Optum Rx.
Lumbar epidural steroid injections (LESIs) are associated with a heightened risk for infection after lumbar spine decompression surgery, a new meta-analysis shows.
In a review that included more than 174,000 total patients, those who received a LESI within 6 months before their lumbar spine decompression surgery had more than a twofold risk of developing an infection postoperatively compared with patients who did not receive such an injection.
“Many patients with compressive lesions, such as foraminal stenosis or spinal stenosis, have significant pain, and it’s not uncommon for them to receive an epidural steroid injection prior to an elective operation,” lead author W. Michael Hooten, MD, president of the American Academy of Pain Medicine (AAPM) and professor of anesthesiology at the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News.
“However, as our study shows, receipt of that injection is associated with over twice the risk of developing a postoperative infection,” Hooten said.
The findings were presented this month at the AAPM 2022 Annual Meeting in Scottsdale, Arizona.
Greater Risk Closer to Surgery
Hooten and his team conducted a literature search and identified four studies that reported on the association of preoperative LESIs with postoperative infection.
The studies included 24,191 patients who received LESIs and 149,942 patients who did not. The latter served as the control group.
The analysis showed that risk for infection was greater when injections were given closer to time of surgery.
The incidence of postoperative infections was significantly greater in patients receiving LESIs less than 1 month prior to lumbar spine decompression surgery vs the control group (P = .01).
Similarly, the incidence of postoperative infections was significantly greater if patients received their injections within 1-3 months before their surgery compared with members of the control group (P = .05).
No significant difference in postoperative infections was observed in patients receiving injections within 3 to 6 months of their surgery (P = .07).
Nevertheless, overall, patients receiving LESIs anytime within the 6-month period before their lumbar spine decompression surgery were 2.24 times more likely to develop postoperative infections compared with those who had not received the injections (P = .0003).
Long Half-Life, Immunosuppression
The risk for infection is most likely due to the immunosuppressive effects of steroids, Hooten noted.
He added that in his team’s previous research, they reported the half-life of epidural administration of triamcinolone is over 253 hours, “which is substantial.”
In addition, immunosuppression “is a known effect of steroid administration,” whether taken orally, intravenously, or, as the current analysis suggests, administered epidurally.
“The steroids are in the lumbar spine for a very long period of time, so this is the most likely mechanism for the occurrence of infection,” said Hooten.
This risk should be considered in patients who may be planning to go for elective lumbar spine decompression surgery, he added.
Hooten noted the purpose of the analysis was to raise awareness about this type of complication, not only among pain medicine practitioners but also among spine surgeons.
“If I see somebody in the clinic today who has a lumbar spine stenosis, I can give an epidural for pain relief but I don’t know if that person will go to see a spine surgeon in the next 30 to 60 days, who will then do an operation. But if the spine surgeon is aware of this risk, they could suggest delaying the operation as long as possible, especially as the risk seems to reduce or decline over time,” he said.
Clinically Important
Commenting on the study for Medscape Medical News, Ann Hansen, DVM, MD, a pain and internal medicine specialist in Ketchum, Idaho, agreed it is important for clinicians to be aware of the associated risks of steroid epidural injections.
“This is a timely meta-analysis focused on a clinically important topic,” said Hansen, who was not involved with the research.
“Given the widespread application of spinal interventions, it is important for primary care providers, surgeons, and pain specialists to understand the risks and benefits of these procedures,” she added.
Hansen noted LESIs are frequently performed for therapeutic purposes or in the context of preoperative diagnostic algorithms — and are generally considered to be safe when administered by specialists following modern standards of care.
“We recognize that intra-articular steroids are contraindicated within 3 months prior to joint surgery, but it is still accepted practice to instill epidural steroids prior to planned lumbar spine decompression surgery,” she said.
“And, as this meta-analysis documents, there is an increased risk of infection in patients receiving the steroids within 6 months of surgery. Further research is warranted to assess the impact of variables and to substantiate the conclusion,” she added.
Hansen noted the cornerstone of high-quality patient care includes shared decision-making, including a forthright discussion of the clinical diagnosis, treatment options, potential outcomes, and known complications.
“An educated, informed patient is empowered to make the most appropriate personal health decisions and to engage in longitudinal care with a trusted provider. Pain specialists must have a good understanding of the entire spectrum of multidisciplinary pain care to best advise their patients,” she concluded.
Hooten and Hansen have disclosed no relevant financial relationships.
American Academy of Pain Medicine (AAPM) 2022 Annual Meeting. Presented March 19, 2022.
Biden just tried to regulate CVS, United Health, and Cigna. Cigna struck back, and is now trying to wipe out independent pharmacies and harm patients. Plus, antitrust enforcers are getting real.
Welcome to BIG, a newsletter about the politics of monopoly. If you’d like to sign up, you can do so here. Or just read on…
First some good news. Last week, I reported on how a bad judge dismissed an important antitrust suit against Amazon. Well the state Attorney General involved, Karl Racine, just said he will be filing a motion for reconsideration, which is basically an appeal. Yay!
Ok, onward. Today I’m writing about what happens when a monopolist gets mad. In this case, it’s health giant Cigna taking revenge on rural pharmacies and patients after the Biden administration tried to slightly reduce the firm’s profits from Medicare prescription drug benefits.
I’ll also show how antitrust enforcers have stopped being polite and are starting to get real. The FTC’s Lina Khan is going after TurboTax maker Intuit for false and deceptive practices, and the Antitrust Division’s Jonathan Kanter blocked a big but obscure merger of port crane producers.
And now…
Express Scripts CEO Tim Wentworth discusses his new strategy with independent pharmacist representative Robb Stark.
The most famous episode of the HBO hit series Game of Thrones was The Rains of Castamere, otherwise known as the ‘Red Wedding.’ The Red Wedding is perhaps the ugliest and most disproportionate sense of revenge ever aired on TV. In it, a regional warlord named Robb Stark attends a wedding of one of his vassals that is supposed to help patch up a minor dispute with a fellow warlord, Walder Frey. The wedding is at Frey’s castle, and Frey invites Stark, his family, and his soldiers to feast. For a time, everyone makes merry, but towards the end of the evening, Frey has his troops ambush Stark and his now-drunk band. Frey has everyone massacred, and even has one of his soldiers stab Stark’s pregnant wife in the belly to ensure he kills the unborn child.
The message from Frey to all future rivals was crystal clear. Don’t mess with me. Though fictional, Game of Thrones draws from medieval history, and such tales of vengeance are not unusual. English history, French history, and many empires of conquest pursued such a strategy of brutalizing subjects so viciously they wouldn’t consider fighting back in the future. These strategies are common because they work. For instance, Mongol empire had many cities surrender without a fight, due to fear that the Mongols would massacre everyone inside should they put up an inch of resistance.
The point of these stories isn’t just about geopolitics, but what happens when humans have too much power over other humans. Which brings me to the problem of monopolies, and what some of them do when they are even slightly challenged. A few months ago, the Biden administration put out a rule to regulate the pharmacy benefits management business, an opaque but massive part in the pharmaceutical drug supply chain. PBMs handle the drug benefit piece of insurance plans. They maintain a list of drugs for insurance companies, they negotiate drug prices, and they manage reimbursements to pharmacies.
The original idea behind PBMs is they would be able to get enough bargaining power by representing multiple insurance companies that they could negotiate to bring down drug prices. And accumulate bargaining power they did, merging until three PBMs control 80% of the insurance market. They are also vertically integrated with insurance companies and drug store chains. The top three PBMs are owned by CVS, United Health, and Cigna.
Unfortunately, because of an exemption from anti-kickback laws, PBMs don’t use their bargaining power to reduce consumer prices. Instead, they force pharmaceutical firms to compete over who will give the PBM the biggest kickback, which in the industry is known as a rebate. Take insulin. In 2013, Sanofi gave a 2-4% kickback to PBMs to prefer their product to customers. In 2018, that number went up to 56%. In other words, more than half of the price of insulin is going to a middleman who does nothing more than push around paper.
The many bad practices of PBMs are legendary. PBMs often force customers to buy more expensive drugs over their generic counterparts, likely because they get kickbacks when customers do so. This ends up making this obscure group of firms a lot money. The combined revenue of the top three firms, who comprise just a small part of the U.S. health system, is larger than the entire amount France spends on all medical care for its entire population.
It gets worse. PBMs all own mail-order pharmacies, and they are increasingly mandating that patients use those mail-order pharmacies instead of the local pharmacy around the corner. Moreover, PBMs now have so much power they are able to claw back money randomly from pharmacies months after a drug was dispensed, using something called a Direct and Indirect Remuneration fee. (DIR fees are only used for Medicare plans, but that is still 37% of the market.) For independent pharmacies, DIR fees are impossible to plan for, they are opaque, and they end up raising prices for consumers.
PBMs are particularly bad for independent pharmacies, who are a critical lifeline in many underserved parts of America. 77% of independent pharmacies serve communities with fewer than 50,000 people. In these places, the independent pharmacist often is the health care infrastructure. Seven in ten do free home delivery, a service which is virtually non-existent with chains. The amount that PBMs have been reimbursing these pharmacists has been going down for years, to the point that many are losing money depending on the medicine they are filling for customers. To put it differently, it’s the equivalent of Amazon raising fees on third party sellers, or Tyson cutting the amount they pay to cattle ranchers.
A few months ago, the Biden administration proposed eliminating most DIR fees, which would get rid of a good, but not critical, profit center for giant PBMs. It looked like a nice win for the anti-monopolists, patients, and independent pharmacies. Last week, however, a contact passed me a new contract from Express Scripts, the giant PBM owned by Cigna.
BIG is a reader-supported newsletter focused on the politics of monopoly and finance. This is journalism and advocacy that challenges power, so please consider a paid subscription. You can always get lies for free. The truth costs a few bucks, but in the long run it’s much cheaper.
Cigna has about a quarter of the PBM market, which means that one out of every four people who goes to a pharmacy to get drugs is using Cigna insurance. There’s regional variation, so in some places Cigna won’t have much market share, while in states like Georgia, something like 50% of the Medicare drug plans are Cigna plans. As one pharmacist put it to me, “If you don’t sign these contracts, then a third of patients won’t come to me because they won’t be able to get their services through their insurance benefits.” In other words, pharmacists can’t turn away a third of the people who come into the store, so they tend accept whatever terms Cigna offers.
And as it turns out, Cigna’s offer to pharmacists just got a lot worse. PBM pricing is insanely weird and complex, so I’ll try to explain it to you. The short story is Express Scripts is cutting revenue to partners so significantly that any independent pharmacist who accepts Express Scripts customers – which can be up to half of all customers depending on the region – will now lose money going forward on Express Scripts customers.
Here’s the contract. First, take a look at the intro page.
Express Scripts is very clear that this new contract is done entirely because of the new regulation, and the new terms are “intended to offer participating Providers the same financial value” as the old one with DIR fees. So that’s clear enough. But that’s not all. In the last paragraph, Express Scripts writes, “No action is needed to accept participation in this Network. Should you wish to decline participation, you may so so within the time allotted under your Pharmacy Provider Agreement.” For most contracts under Express Scripts, that time allotted is ten days. In other words, Cigna is sending an important new contract to its partners, and if they don’t say no in ten days, they have said yes. Contracts usually are two way agreements by both parties, so this strikes me as an abusive way of conducting business.
And the reason why is that the pricing has changed.
Pricing in this industry is weird and insane, but I’ll try to make it as simple as possible. (If you want to understand it for real, here’s an hour and a half-long podcast teaching you the language of pharma pricing.) Pharmacists buy branded drugs at a rate based on something called the Average Wholesale Price (AWP), minus roughly 20%. To make a profit selling a branded drug, a pharmacist needs to be reimbursed at a higher rate than that amount. Under the new contract, for a prescription of less than 30 days, pharmacists will now get the average wholesale price minus 26.3%, and for filling one of more than 30 days, they will get the average wholesale price minus 31.30%. In other words, every branded drug through Express Scripts means that the independent pharmacist loses money. (In case you’re wondering why pharmacists don’t just raise prices to cover the extra cost, they can’t. They have no power over prices, everything works through reimbursement amounts set by contracts with PBMs.)
As a specific example, filling one prescription of Trelegy Ellipta, which is an asthma medication, using the 2023 rates would result in one pharmacist losing $248. And that’s just on one drug. In other words, these contracts are designed to make it so that independent pharmacists can no longer accept Express Scripts customers without losing money.
Such an action is quite ugly for a monopolist, to take umbrage at a slight harm to their profit and decide to salt the earth in response. It may also be illegal, as Medicare part D plan offers must actually have a network of pharmacies that is convenient for 90% of their Medicare customers, and kicking most rural pharmacies out of a network will likely do that. But that’s not the Red Wedding part of this situation, because there is also real physical harm, not just economic damage, occurring as a result. What CVS, Cigna, and United Health are all doing is pushing customers to order medicine from their mail-order pharmacies, which brings them higher profit margins. These mail-order pharmacies, in order to generate high margins, are often poorly run, with little customer service and frequent mistakes.
What happens to the patients? Well back in February, the Federal Trade Commission opened up a docket for public comments on this topic, and here are a few of them.
My insurance companies uses Express script. As a cancer patient my meds never arrived on time, overheated from improper packing which caused them to be not viable. Also I would get the runaround multiple times for trying to get the medication‘s. This was a life-saving drug and I’ve never had anything but problems. Because of a lot of express scripts in competency, my medication failed to work and my disease mutated which resulted in me having to take a different course of action in order to save my life. I think you need to look into the corporate greed of this company and all that they do in regards to providing people with life-saving medication’s.
Large pharmacy benefits managers like have become a nightmare to deal with. My daughter suffers from epilepsy and has been on several medications over the years, generally with 2-3 at the same time. First, it starts with pushing you to generic medications, which they source from the lowest cost providers with no consistency. One month the pills are tiny, the next they are large for the same medications. Then they drop coverage for certain medications mid year. Then, they punish you with ridiculous fees if you don’t use a preferred provider for monthly maintenance medications. What do you know, they are the only preferred provider. Generally I get to use our local pharmacy for 2-3 months before the crazy fees start. With constant medication adjustments to my daughters meds, I am unable to make quick adjustments with these 3 month scripts. Then, I hold my breath to make sure nothing is messed up with shipping.
I am forced by my insurance company to get my prescription through Optum Rx; if I go through them, it’s covered, and if I go to the pharmacy (which I’d prefer), it’s not. Why? The prescription is supposed to be covered, and I should get to choose my pharmacy. Instead, I’m forced to refill well ahead of time, to allow for unpredictable shipping times, and then I have to worry about the effectiveness of the pills because the packaging doesn’t protect against the weather. I live in Texas, where many months out of the year, my mailbox (not to mention the mail truck) is like an oven. It’s hard to believe the medication isn’t damaged by that. It should be illegal for companies to risk people’s health this way just for a profit.
I work in a cancer center. I am trying to help my patient access Ibrance for her breast cancer. Her copay is ~$2000. I have found a pharmacy who has an internal grant fund that she qualified for and they will cover her copay. However, she cannot use this pharmacy because her insurance / PBM mandates she use CVS Specialty pharmacy. Therefore, she will not be able to afford her life-saving/prolonging medication. We are attempting to get her signed up for free drug through the manufacturer; however, in the meantime, until she is approved, she is going without. All because her insurance/PBM mandates she fill with CVS Specialty.
There are hundreds of comments on the docket, and these are a drop in the bucket. You can check out the awful reviews for Accredo, a mail-order specialty pharmacy owned by Express Scripts, if you want more. People are being hurt, badly, and probably dying, because PBMs are directing more people to their mail order pharmacy business. (In case you’re interested in why this is legal, it’s because economists at the Federal Trade Commission argued since the 1980s that this practice is efficient.)
What Express Scripts is doing wouldn’t matter if large PBMs didn’t have market power or engage in practices to get kickbacks, because then pharmacists could negotiate on a more equal level and reject contracts that forced them to lose money, and PBMs wouldn’t have the incentive to play administrative and financial games with people’s lives. Everything would be a lot more straightforward, and pharmacists would get paid for dispensing the medication people need at a reasonable price. But Express Scripts does have market power, and pharmacists have a really tough time saying no and losing access to their customers.
For now, it seems like Express Scripts is the only large PBM taking this approach. But if the other two dominant PBMs follow along, and I expect they will, then independent pharmacies will basically no longer be able to accept Medicare prescription drug plans. And that’s a large chunk of their business. A lot of people will then be forced to get their medicine through the mail, and be on hold when those poorly run specialty pharmacists get their orders wrong. That’s not fun when you are ordering clothing. It can be deadly when it’s the medicine you need to stay alive.
This could get interesting, especially for those people who live in a rural area. Medicare part D and Medicare Advantage prgms are both provided by FOR PROFIT INSURANCE COMPANIES… where the FEDS pay them so many $$$ per pt per month. The PBM’s “negotiate” discount/rebates/kickbacks from the Pharmas… on some meds that can be has high as 75% of the Average Wholesale price and basically that means that the particular med is on the PBM’s approved med list and no prior authorization required. Currently, those “negotiated” med prices discount … typically goes into the coffers of the PBM, not shared with the pt.
I think that if you go up to the top 5 PBM Part D & Advantage prgms… it would include abt 90% of all Rxs would be controlled by those 5 and “controlled” means what meds they will pay for and how much the pharmacy gets paid and how much copay the pt pays.
All of these PBM’s have highly automated/computerized mail order pharmacy , that will fill more Rxs in ONE HOURS that a retail community pharmacy will fill in a week or two. I am sure that the PBM’s will try and convince Congress that they have met the convenient for 90% of their Medicare customers with the claim that their mail order pharmacy is as close as the pt’s mailbox.
Unfortunately, if you look at your OTC medications, most say state to store at room temp, some Rx meds I have the storage requirements is 68-77F… others have 36F – 77F …. Few/none of the mail order pharmacies ship a pt’s Rxs in containers that will maintain the required storage temp as required by the FDA, USP, NF. Unfortunately, no federal oversight entity worries about mail order firms not meeting those storage requirements nor attempts to enforce them meeting those temperature storage requirements.
Also, the first of this year the USPS announced that they were extending the expected time for a package to move from shipper to final destination.
I can just imagine, a mail order pharmacy refusing or requiring that they will not accept a C-II to be filled until the pt is down to 2 days supply on hand and the shipping could take 3-4+ days. They may even refuse to ship a C-II by USPS and require the pt to find a local pharmacy that is in the PBM network.
For those pts who are patronizing a chain pharmacy and not happy with the service level that they get, just wait until they have to deal with a pharmacy that is 100’s or 1000’s of miles away and your only way to contact them is via phone call or email .
Dear CVS Health , you are the epitome of bullying:
Today, I attended Oklahoma Board of Pharmacy meeting. I would say that our board has been particularly very involved in the discussion of working conditions and was one of the very states to put together a short staffing form which will be updated soon. It is amazing and encouraging.
And the board is asking pharmacists to fill that form and so am I. But I have known for a while that Pharmacists were struggling with the fear of being retaliated against and rightfully so.
And today, I stand here, with a much public disappointment and even disdain of what CVS Health is doing . A totally abuse of power! A mental and emotional abuse of pharmacists who are trying to keep their head above water!
CVS is asking their pharmacists to notify them before they fill the short staffing form. And because they are who they are, they will come back with reasons and excuses to validate this. Or deny it! Don’t worry, it has been very much confirmed!
But please don’t tell me this not a display of bullying and abuse!!!
How do we expect pharmacists to report short staffing, abusive working conditions?
And I know you think that pharmacists don’t have to follow this demand from CVS Health . But just the simple ask from them is enough to kill any hope pharmacists have.
I don’t know what the board plans to do once they get this information ( which has been confirmed).
But let it all be known that this company and its culture is killing our profession and the very essence of freedom we have as practitioners and I hope every pharmacy entity , association , board of pharmacy is putting something in place to protect our voices!!! And we pharmacists who are not affected by this, should all bind together and stand up for our fellow pharmacists, technicians, students and get involved and support our associations and board of pharmacy and be the voices for others!
More than 100,000 people have signed a nationalpetitioncalling for clemency in former nurse RaDonda Vaught’s criminal case.
Ms. Vaught was convicted March 25 of criminally negligent homicide and abuse of an impaired adult for a fatal medication error she made in December 2017 while working as a nurse at Vanderbilt University Medical Center in Nashville, Tenn.
As of March 29 at 9 a.m. CT, more than 123,000 people had signed the petition hosted on change.org. The petition comes as nurses nationwide have spoken out against the conviction, saying it sets a dangerous precedent for the profession.
“We are deeply distressed by this verdict and the harmful ramifications of criminalizing the honest reporting of mistakes,” the American Nurses Association and Tennessee Nurses Association said March 25.
The Nashville District Attorney’s Office has stood behind the conviction, saying it is not an indictment against the nursing profession or medical community but a response to Ms. Vaught’s “gross neglect.”
Ms. Vaught’s sentencing is scheduled for May 13. She faces up to eight years in prison.
The Indiana State Nursing Board discriminates against nurses with opioid use disorder and must work with the Justice Department to end the civil rights violations, the U.S. Justice Department concluded in a recently released investigation.
The investigation, published March 25, was prompted by a complaint from a nurse alleging that she was denied participation in the Indiana State Nursing Assistance Program because she takes medication to treat opioid use disorder.
Investigators found the board violated the Americans with Disabilities Act by prohibiting nurses taking this medication to participate in the program, which rehabilitates and monitors nurses with substance use disorders, and is often required to maintain an active license or have one reinstated.
A letter detailing the findings asked the board to work with the Justice Department to resolve the identified civil rights violations.
Looks the FDA is finally starting to pay attention to the MME system… I made this post on my blog a couple of weeks ago Was/is the CDC 2016 guidelines built on a “false foundation ” and created a covert genocide on a protect class of people ? and shared a article that would STRONGLY SUGGEST that the MME system had no double blind clinical study nor science behind it. I had to go down THREE LAYERS DEEP to find out who was participating in this PUBLIC WORKSHOP and in scanning over the participants … the workshop appeared to be “pretty heavy” on bureaucrats, people from academia, and groups that mostly deal with ADDICTION.
