“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
January 1 the PBM for your plan changed from Medimpact to Express Scripts. It has come to our attention that they have been contacting our patients and trying to persuade you to leave your home town pharmacies to use mail order. This is not legal. It’s called patient steering. You have the right to use the pharmacy of your choice. If you are an OGB member and have been contacted either by mail, phone, or email by someone who has implied or suggested that you should or need to change your pharmacy, please report it to the number listed below. Companies that are awarded state contracts must be held accountable for following the laws in the states that win the bids in.
When your insurance company insists or mandates that you must you a particular provider for some service/test/procedure that they are going to pay for… maybe you should check on who owns the company/provider that you are being mandated to use… Are you being referred to that particular provider because they are the best provider in the area or because their is a financial incentive to who is referring you ? Like they own the provider ?
On January 27, 2022, the US Court of Appeals for the 1st Circuit, Chief Judge Jeffrey Howard, ruled in “US Dep’t of Justice v. Jonas, No. 19-1243,” that the DEA (Drug Enforcement Administration) can “legally” access New Hampshire’s prescription drug database via an administrative subpoena, not a warrant. This is despite New Hampshire and United States laws to the contrary.
While 48 states have submitted to maintaining a networked prescription database (Prescription Drug Monitoring Program / PDMP), most people would argue that their personal medical and prescription records are protected by the 4th amendment (“no warrants shall issue, but upon probable cause.”) Personal healthcare and medical information is generally protected under doctor-patient confidentiality laws and is regarded as almost sacrosanct in the healthcare world (think HIPAA.) In this case, confidentiality was further supported by the 4th amendment to the US Constitution.
Overwhelming Support From the Liberty Community
Michelle Ricco Jonas, manager of the New Hampshire PDMP in 2018, refused the DEA’s request to fork over 2.5 years’ worth of prescription data of a “person of interest.” After being subpoenaed she argued that the records belong to the state, not an individual person. Since March 12, 2019, when the notice of appeal was docketed, Michelle Jonas and New Hampshire state received an outpouring of support from the ACLU of California, Maine, Massachusetts, New Hampshire, New York, Puerto Rico, and Rhode Island – in other words, all the districts represented by the 1st Circuit Court.
Over the past two grueling years of appeal, the ACLU supported Jonas, and questioned whether issuing a subpoena to a state employee is within the bounds of the district court. They argued that medical records, for all intents and purposes, are considered private information. While the DEA has the ability to subpoena an individual, the ACLU asked if that gave them the right to subpoena a representative, or employee, of the state. They also argued that the 4th Amendment requires law enforcement “to obtain a warrant based on probable cause only to secure records over which there is a reasonable expectation of privacy.” The ACLU argued that medical records warrant an expectation of privacy.
The prescription records at issue in this case reveal intimate, private, and potentially stigmatizing details about patients’ health, including details of those patients’ underlying medical conditions. For that reason, as with other medical records, people have a reasonable expectation of privacy in them.” – Summary of Argument, US Dep’t of Justice v. Jonas, No. 19-1243
So What Was the Loophole?
In a nutshell, the “third-party doctrine” was the loophole the DEA used to secure a “victory” in this appeal. Basically, if you voluntarily share information with a third party (say a pharmacist at CVS who fills your prescription), you magically lose your right to the 4th amendment because you voluntarily shared your private information.
Now, I know what you’re thinking. You have to share that private information in order to receive your prescription medications through lawful means. If you wanna live, if you wanna beat that disease, you have to give your name, address, phone number, and all the information they need so you can just get your pills. Right? So what exactly is the alternative? The grey market? Street drugs? A life of crime?
The Feds Will Stop at Nothing to Support the Prison-Industrial Complex
It seems obvious that personal medical information is personal. We share that information with medical professionals with the expectation that their oaths of ethics and doctor-patient confidentiality will keep it that way. Everywhere we go we see “HIPAA” emblazoned there, telling us how seriously our personal medical information is treated, at the risk of sanctions, medical license removal, and prison time. Medical professionals have an entire course in this topic, and it’s included in their jurisprudence board exams.
There’s really no way to “logic” around this ruling; it’s pretty cut and dried. The DEA will stop at nothing to reach their quotas, to perpetuate the prison-industrial complex, and to erode our Constitutional rights. Unfortunately this is one of many similar rulings in the United States.
It’s up to us to continue fighting for freedom, liberty, and our Constitutional rights. It’s up to us to determine if this is acceptable or whether it’s about time we stand up against this onslaught and say, “I’m not gonna take this anymore!”
I want you to get up right now. Sit up. Go to your windows. Open them and stick your head out and yell – ‘I’m as mad as hell and I’m not gonna take this anymore!’ Things have got to change. But first, you’ve gotta get mad! You’ve got to say, I’M AS MAD AS HELL, AND I’M NOT GOING TO TAKE THIS ANYMORE! Then we’ll figure out what to do about the depression and the inflation and the oil crisis. But first, get up out of your chairs, open the window, stick your head out, and yell, and say it: I’M AS MAD AS HELL, AND I’M NOT GOING TO TAKE THIS ANYMORE!” – “Network” movie, 1976
Side Note
As of January 27, 2022, the exact date upon which this appeal was concluded, the presiding 1st Circuit Judge Jeffrey Howard announced his early retirement at the age of 66. This was the last case he will hear, and thankfully, the last case he will rule on.
Some people have noticed that post from my blog… has not been showing up on FAKE BOOK and/or some have tried to share my posts on FAKE BOOK… are getting a notice that their post share is against their community standards. It would seems that a person who claims to be a chronic painer… got pissed at me… because I called him out back in Jan 2020 as a “virtual panhandler”, con artist, scammer…
In Oct of 2021, he demanded that I take down a post on my blog from Jan, 2019… that he believe was about him – while no names were mentioned in the blog post..
I was not sure what he was up to, so I turned the post from “public” to “private” and put a password on it… apparently not “destroying” the post… must have really pissed him off… Either that, or I have been told that he went to some “legal aid group” – I guess because he is on Medicaid and food stamps – and wanted to sue me… and apparently he was told that “he had NOTHING !”
What I have been told, this “gentleman” RICHARD MARK – stirred up his harem/tribe of minions to file untold number of complaints with FB that my blog was a SPAMMER… Here is a link that claims that FAKE BOOK had to admit – while under oath in court – that their FACT CHECKERS is mostly THEIR OPINIONS https://www.facebook.com/pharmaciststeve/posts/10226586244631590
So apparently FAKE BOOK just took all those complaints that have no basis in fact, but apparently FACTS don’t really mean anything to FAKE BOOK. ONLY THE PERSONAL OPINIONS OF THEIR FACT CHECKERS !
To date, FAKE BOOK has removed at least 300 posts and comments with hyperlinks to my blog from FAKE BOOK.
I have been told that even at least one of the more visible female chronic pain advocates aligned herself with Mark in getting my blog labeled as a spammer..
My blog is still ALIVE AND WELL… because I own the domain that it is on and NO ONE can censor/delete my blog posts, for now, I am sharing my blog posts on Twitter and experimenting with some 2-3 minute videos
CVS Health Corporation CVS reached a new 52-week high of $107.61 on Jan 27, before closing the session marginally lower at $106.79.
The company’s shares have charted a solid trajectory in recent times, appreciating 49.1% over the past year, ahead of the 28.7% rise of the industry it belongs to and 17.5% surge of the S&P 500 composite.
Over the past five years, the company registered earnings growth of 8.1%, ahead of the industry’s 6.1% rise and the S&P 500’s 2.8% increase. The company’s long-term expected growth rate of 7.8% compares with the industry’s growth projection of 6.1% and the S&P 500’s estimated 11.7% increase.
CVS Health has been registering robust growth across three of its operating segments. The company’s retail/long term care (LTC) business witnessed a substantial recovery in front store sales, raising investors’ confidence. Strong potential in the specialty pharmacy space also instills optimism. A good solvency position is another plus.
Zacks Investment Research
Image Source: Zacks Investment Research
Let’s delve deeper.
Key Drivers
Segmental Growth: The market is upbeat about enhanced third-quarter revenues across three of CVS Health’s operating segments. Within pharmacy services, growth outperformed the company’s expectations, delivering 9.3% revenue growth and strong operating income growth. The retail/LTC segment reported above-market growth and exceeded the company’s expectations with 10% revenue growth. Meanwhile, in the health care benefits arm, CVS Health registered 9.5% revenue growth, strongly driven by growth in the government business.
Retail on a Growth Track: Over the last few quarters, CVS Health’s retail/LTC business has been registering revenue growth after several quarters of a drag. In the third quarter, the segment’s pharmacy sales and prescriptions filled increased 8% year over year, largely driven by COVID-19 vaccine administration and core pharmacy services. The company also witnessed a solid rebound in front store sales on strength across all categories, with health and wellness products driving nearly two-thirds of growth. The company’s patient satisfaction scores remained high, with nearly 90% satisfied with their experience in CVS Health locations.
Specialty Pharmacy – A High-Growth Avenue: The soaring demand for specialty pharmacy, especially in the ongoing decade, is likely to accelerate growth for CVS Health. In the third quarter, specialty pharmacy revenues increased 8.7%, reflecting integrated offering with in-store, mail order and specialty services growth. The company also saw continued growth within specialty pharmacy capabilities. Furthermore, CVS Health’s investments in high-growth areas of specialty pharmacy, adding businesses such as Coram and Novologix, raise our optimism.
Strong Solvency: CVS Health ended the third quarter with cash and cash equivalents of $9.8 billion compared with $10.13 billion at the end of the second quarter. Total debt came up to $58.39 billion, much higher than the corresponding cash and cash equivalent level. Yet, the near-term payable debt of $1.5 million is significantly lower than the short-term cash level, indicating good news in terms of the company’s solvency level. The company is holding sufficient cash for debt repayment, at least for the year of economic downturn.
Downsides
A host of factors have been deterring CVS Health’s rally of late.
The ongoing difficult pharmaceutical reimbursement scenario in the pharmacy services and retail/LTC segments, and escalating drug prices are hampering the demand for CVS Health’s offerings. Further, the company is faced with stiff competition, especially in the pharmacy segment, as other retail businesses continue to add pharmacy departments and low-cost pharmacy options become available.
Zacks Rank and Key Picks
Currently, CVS Health carries a Zacks Rank #3 (Hold).
A few better-ranked stocks in the broader medical space are Baxter International Inc. BAX, Hologic, Inc. HOLX and Cerner Corporation CERN.
Baxter, currently carrying a Zacks Rank #2 (Buy), has a long-term earnings growth rate of 9.5%. Baxter’s earnings surpassed estimates in the trailing four quarters, delivering a surprise of 10.2%, on average. You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.
Baxter has outperformed the industry over the past year. BAX has gained 9.7% against a 17.4% decline of the industry in the said period.
Hologic, carrying a Zacks Rank #2 at present, has a long-term earnings growth rate of 7.4%. HOLX surpassed earnings estimates in three of the trailing four quarters and missed in another occasion, delivering an average surprise of 29.2%.
Hologic has declined 10.1% compared with the industry’s 13% drop over the past year.
Cerner, carrying a Zacks Rank #2 at present, has a long-term earnings growth rate of 12.8%. CERN’s earnings surpassed estimates in three of the trailing four quarters and met estimates on another occasion, delivering an average surprise of 3.2%.
Cerner has gained 13.3% against the industry’s 57.6% slump over the past year.
The meth epidemic has taken a backseat in national attention because of the spotlight on opioids, but a new type of methamphetamine has created a spike in meth use. It’s known as P2P (phenyl-2-propanone) meth, and it’s the subject of recent debate: What makes P2P meth different from other forms of methamphetamine? What are its effects and dangers? How does it effect a person’s mental health? Can it cause serious mental illness?
To find the answers to those questions and more, read on.
Let’s cover the basics. What is methamphetamine?
Methamphetamine, usually referred to by its shorthand “meth,” is a central nervous system stimulant. Meth can be snorted, smoked, injected or taken orally, and its highs are characterized by an increase in energy and an elevated mood state. It is closely related, in both chemical structure and effect, to amphetamines, but meth has stronger effects and is usually manufactured illegally.
What’s the history behind meth and amphetamines?
Amphetamines have a long history of abuse that predates World War II, and soldiers on both sides allegedly abused the drug to help with fatigue. After the war, amphetamines were introduced and popularized across the United States when they were commonly prescribed by doctors to treat a variety of health conditions. In fact, amphetamines are still prescribed for ADD and ADHD, and less frequently for narcolepsy and weight loss.
When the crackdown on legally prescribed amphetamines began, the production of meth ramped up. The Comprehensive Drug Abuse Prevention and Control Act of 1970 limited people’s access to amphetamines, unintentionally creating a larger market for illegally manufactured methamphetamine.
Is this when the epidemic began?
Yes, the meth epidemic informally began in the 1970s when legislation limited the prescription of amphetamines. The production and use of illegal methamphetamine slowly traveled across the United States, starting on the West Coast and eventually, in the 1990s, finding a home in central and eastern parts of the country.
What did the illegal manufacturing of meth look like?
Also known as speed and glass, methamphetamine was initially cooked in home-grown laboratory set-ups, using cold medicine products that contained ephedrine. Meth made from ephedrine was readily available in the majority of the United States until the past decade when pharmacies became required by law to limit the sale of products containing ephedrine. Eventually, the Mexican government joined in outlawing ephedrine, thereby forcing drug traffickers to reinvent the process used to create methamphetamine.
What makes P2P meth different? Let’s look at the chemical makeup.
Since the crackdown on ephedrine-based cold remedies, the production of meth has changed, giving rise to newer chemical makeups like P2P meth. Replacing ephedrine, meth is now produced with chemicals like:
Acetone
Cyanide
Lye
Mercury
Sulfuric acid
Hydrochloric acid
Nitrostyerence
Racing fuel
Beyond just the ingredients, P2P meth also has a higher concentration of the isomer called d-methamphetamine. For reference, there are two forms of meth: d- and l-methamphetamine. Both are methamphetamines, obviously, but the two often come in different forms. The d-isomer is found in prescription drugs, whereas the l-isomer is found in over-the-counter products. And street drugs contain both, but generally contain more of the d-isomer because of its enhanced effects.
So what are the effects of this d-isomer in P2P meth?
The d-isomer produces the high, and the l-isomer affects the body. So P2P, with its heavy concentrations of d-isomer, creates a different and very intense high for its users.
Methamphetamine produced from ephedrine generally prompts those using it to stay up and socialize, sometimes for days, due to lower levels of the d-isomer. Whereas users of P2P meth experience very different effects, including severe mental illness, psychosis, the desire to isolate, and hallucinations or delusions.
The incalculable danger of P2P meth
Because the manufacturers of P2P meth often produce the drug in unhygienic environments and because the producers aren’t professional chemists, the consumers often suffer from additional and significant side effects. Street manufacturers’ main priority is making money, and they don’t generally worry about delivering a quality product.
Put simply, this new type of meth is more dangerous, and users have an increased likelihood of developing severe mental illness and other adverse mental health effects. P2P meth tends to be laced with other drugs like fentanyl, and users who seek help for their addiction have reported a detox process of nearly six months. Additionally, a person who uses P2P meth will likely experience a rapid decline in physical health, including liver failure, after even short periods using the substance.
Symptoms and side effects of P2P methamphetamines
Symptoms and side effects of P2P meth are similar to those of ephedrine-based meth. Meth changes the physiological and psychological functioning of the body and brain. Meth abuse causes heightened blood pressure, heart rate and respiratory rate. Psychological signs that a person might be using meth include temporary euphoria and energy, and increased levels of anxiety, paranoia, aggression, hallucinations and mood disturbances when dopamine levels taper off after use.
How to get help for an addiction to methamphetamines.
Treatment and recovery are available to all. There are specialized treatment services and programs to help with meth addiction, and there is a hopeful path forward from here. But it’s essential that you be evaluated by a medical professional before you begin the detoxification process. Seek an assessment for in-patient or outpatient treatment, and attend groups like AA, NA or other peer-driven recovery support groups. Addiction is not the end. If you are concerned about your own meth use or someone else’s, reach out for help today.
Prescription drug cost is one of the few issues everyone can agree needs addressing, yet very few politicians seem able to abandon party-line rhetoric to confront the issue. Wealthy corporate campaign donations are now overriding basic common sense when it comes to reining in obvious systemic problems. Like climate change, we see political party leaders making promises, pointing fingers, but ultimately doing nothing. It’s as if no one can get out of their own way to focus on what’s really important — American patients.
It doesn’t help that the prescription drug industry itself seems more concerned with protecting trade secrets than allowing for actual transparency and issue resolution. From protecting formulas to hiding formularies, the prescription drug sector of America’s vertically-integrated oligarchy of a healthcare system is far closer to the steel and railroad monopolies of the early 1900s than an industry model for the 21st century.
Drug prices are high, so pharmacy benefit managers (PBMs) negotiate “rebates” — which are actually kickbacks — to include their drugs on plan formularies. Insurance companies claim they put patients first but maintain lucrative (for them) relationships with the PBMs.
Prescription drug costs are known to be among the highest healthcare spending points for employers. Local doctors, pharmacies, and hospitals are being taken over by PBM/insurance conglomerates, and those who hang their medical shingle as “independently-owned” face higher barriers to entry than in nearly any other industrial sector.
Where is the breaking point?
If our elected leaders could step above the fray for a moment, they would see it’s easy to draw a direct correlation between PBMs, skyrocketing prescription drug prices, and American healthcare degeneration. America is the only nation in the world that includes PBMs in healthcare, yet we have the highest prescription drug prices in the world.
Does anyone else see the common problem here?
The FTC and the DOJ are currently examining vertical integration legalities. It’s a good start, but it’s not enough. Unless our government is willing to kick healthcare campaign contributions to the curb and focus on what’s best for American patients, nothing will ever be solved.
I implore federal and state governments to mandate full transparency on EVERY aspect of the U.S. healthcare system from campaign contributions to how patient care costs are calculated. The people of this great nation deserve better, and are far more valuable than Wall Street dividends.
In these unprecedented times, I ask you to immediately investigate closure decisions by corporate chain pharmacies, leading to long wait times and poor patient care. This directly and urgently impacts the health of my family and me. In the midst of a global pandemic, we don’t need more people in the hospital due to inaccessible medications. Such investigations should be required by law and immediately enforced due to the current high risk to public health.
In the last few months, I have experienced extremely long wait times in person and on the phone at a local chain pharmacy. Many have closed or have reduced hours, making it unpredictable and highly difficult to get medicines for myself and/or my loved ones. These medicines are important to maintain our health, or prevent events like a blood clot that could put us in the hospital. Imagine a day without necessary insulin. It is unsafe to go days without needed medicine, and extremely stressful and difficult to hunt around for an open pharmacy and call my doctor to transfer the prescription. The chain pharmacies seem constantly understaffed, often only having 1 or 2 people working behind the counter helping customers, answering phones, working the drive thru, and also giving COVID shots AND tests. This is not sustainable for the pharmacy staff, and THAT puts me and my family’s lives at risk.
Veneta’s only pharmacy closed on January 5th, leaving the township of over 5,000 without a convenient way to fill their prescriptions.
91-year-old Derek Humphry has nine prescriptions he needs to fill regularly, including heart medication. He’s been a resident of Veneta for 32 years.
Last year, when Bi-Mart’s pharmacy was acquired by Walgreens, 56 counters closed in three states, including the only pharmacy in Veneta.
Humphry tried several others in the area and was turned away without explanation. He was within two days of running out of his blood-thinning medication when his doctor directed him to a Walmart in Eugene, significantly further away.
“A person like me doesn’t drive,” Humphry said. “I have to get other people to take me to the pharmacy. So it’s quite inconvenient.”
Bi-Mart spokesperson Don Leber attributes their exit from the pharmacy business to Oregon taxes on pharmaceuticals and increased fees implemented by insurance companies and pharmacy benefit managers.
“Those two elements have made it so we can no longer operate our pharmacies and make any profits,” Leber told KLCC.
