I have always had a concern about mail order pharmacies.. first of all… all medications have temp storage requirement typically in the mid-50’s to mid-70’s. These storage requirements have to be met by the pharma, wholesaler & the pharmacy.  But, when a pharmacy hands off a packaging of Rx meds to a delivery service… NO ONE has a obligation to maintain those storage requirement.   Normally, if a pharma, wholesaler, pharmacy allows Rx meds to be outside of the required temp range for > 24 hrs the product is consider adulterated and NO LONGER SALEABLE.

From this article and others that I have read, Amazon appears to be “pushing ” paying cash for Rxs.  If this Amazon pharmacy has a contract with your health insurance and you pay cash… it won’t applied to your deductible and highly possible if you submit your cash receipts to your insurance company they will not reimburse you and apply to your deductible because Amazon pharmacy has a contract to bill the insurance for the pt.

Encouraging pts to PAY CASH the Amazon pharmacy will not have to deal with the BS from insurance companies in getting a Rx claim thru the system and with a charge card .. Amazon will get their money in – at most – a couple of days instead of having to wait 2-3 weeks for the insurance company to pay and then reconcile their payment against what was billed and won’t get docked with those unpredictable DIR fees.

If this Amazon pharmacy functions like most mail order pharmacies, filled Rxs may not reach the pt for up to TWO WEEKS and what does their statement mean that they “will offer commonly prescribed medications“… Does that mean NO CONTROLLED MEDS ?  The DEA states that it is RED FLAG for a pt to pay cash for a controlled substance if they have insurance.

Amazon opens online pharmacy, shaking up another industry

https://www.foxbusiness.com/retail/amazon-opens-online-pharmacy-shaking-up-another-industry

The company opened an online pharmacy Tuesday, giving Amazon shoppers the chance to buy their medication and order refills on their phones and have it delivered to their doorsteps in a couple of days, just like a book or toilet paper.

The move propels Amazon into a new business, potentially shaking up the pharmacy industry as it has done to everything from book sellers to toy stores and grocers. Big chains like CVS and Walgreens rely on their pharmacies to bring them a steady flow of shoppers who stop by frequently to pick up their medications.

Amazon said it will offer commonly prescribed medications starting Tuesday, including creams, pills, as well as medications that need to stay cold, like insulin.

Shoppers have to set up a profile on Amazon’s website and have doctors send prescriptions to the Seattle-based e-commerce giant.
ONLINE SHOPPING SURGE COULD LEAD TO HOLIDAY DELIVERY DELAYSMost insurance is accepted, Amazon said. But Prime members who don’t have insurance can also buy generic or brand name drugs from Amazon for a discount.Amazon has eyed the health care industry for some time. Two years ago, it spent $750 million to buy online pharmacy PillPack, which organizes medication in packets by what time and day they need to be taken. Amazon said that PillPack will continue, focusing on shipping medication to people with chronic conditions.

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And something that not many doctors are talking about lately is one of those that apparently is a symptom caused by some vaccines. And it is that although within the study impotence is not taken into account as a determining factor within vaccines, the trend seems to indicate the opposite. That is why at UK Meds they take this problem very seriously and try to deal with it by offering the most effective product against this problem, being one of the best sellers in the United Kingdom.

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Click on the link below to listen to a 32 minute pod cast that details how a ultra fast metabolizer intractable chronic pain pt was forced to decrease his dose OVER 75% and he ended up committing suicide… evening behind a young wife with FOUR KIDS.

http://standandfight.buzzsprout.com/359756/2002150-stand-and-fight-podcast-darleen-h-palmer-pain-managment-vs-addiction

In this episode Darleen shares the story of her husband Adam. He caught a rare disease from a tick called Rocky mountain spotted fever which left him dependent on pain meds to function. The problem became dealing with the insurance companies and his struggle to find common ground with them. In the end her husband took his own life. Now she is her to tell his story and to help other families in need. She is now a single mother of 4. Sometimes we don’t think about the 1% who live with an insane amount of pain on a daily basis. They need medication just to function. Myself being a recovering addict i always fight for everyone to be drug free but this conversation helped me with the other patients who actually need it. A voice clip of the husband’s suicide goodbye message is on this podcast so if you are vulnerable or feel you might be triggered please don’t listen or listen with a friend.

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https://youtu.be/5WZCh3TeTa0

RSD/CRPS is a condition that needs much attention. Charles saw this dire need and wanted to contribute to get that need filled. Charles has talked to many, heard scores of stories and researched the condition; with this knowledge, his heart was moved to get involved and become an advocate for the condition through the love of his mother and the heartfelt for the countless others suffering. This moving piece takes us on a journey that will impact the perspective of how we view healthcare and the caregivers of those suffering daily. We walk with Charles as he helps his mother through her own treatment and life changes. We will also meet others fighting to stay alive from this deadly disease. We will fight to help this project move the health care system to figure out ways to help those who need the funding or the health care coverage to get the needed treatment to allow them to live. We will expose what at times seems like Guinea pig-type of treatments that at times can do more harm than good. This is a story that needs to be told and this documentary will open the eyes of many around the world that never knew of this condition and bring hope to those with CRPS. For more info on Charles and his work visit. To work or book Charles visit http://charlesmattocks.com PLEASE SUBSCRIBE TO THE CHANNEL AS WE ARE LOOKING AT DOING ANOTHER FILM BASED ON CRPS AND RARE DISEASE, GET THE LATEST UPDATES. All rights and music belong to our company.

https://www.youtube.com/watch?v=5WZCh3TeTa0

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I have Kaiser SoCal but prior to the last two years I had a private dr in Texas and took pain medication, 6 mg of Xanax & ambien for 7 years. No overdose no narcan required. I moved back to Ca after surviving a brutal attack now having anxiety so bad I am having psychogenic blackouts and the ambulance is coming to my job. Kaiser refuses to give me more than 2mg of Xanax even though it’s become physically dangerous s they also refuse to properly diagnose the blackouts as well as the very obvious adhd I’ve always had. If it involves controlled medication you won’t get diagnosed , they also lie on your chart and black ball you from all care of you switch DRs. I have fought them like crazy for proper care and they refuse to do anything stating I refused their treatment plan which is a lie. I already take gabapentin and have tried hydroxozine which is a joke for anxiety at my level, increased gabapentin is not going to stop the severe stress skyrocketing my cortisol and me passing out. I can’t believe there aren’t major groups fighting Kaiser for their horrific treatment.

I realize that not all readers of my blog read all the comments… but this is not the first time that I have received a similar comment – or email – from a pt that has health insurance from Kaiser Permanente telling about similar denial of care from them.

Kaiser Permanente is considered a HMO

Health Maintenance Organization (HMO)

and the definition of a HMO:

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

HMOs often provide integrated care and focus on prevention and wellness.

Does the care that this pt is claiming to be receiving has a focus on PREVENTION & WELLNESS ?

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Read on to *2, you’ll see great news! Share this far and wide Please!
Also there are a few links about a briefing for stopping the barriers for vital pain medications.
PUBLIC HEALTH
COVID-19 policy recommendations for OUD, pain, harm reduction
Updated Nov. 2, 2020

The AMA is providing the following policy recommendations to help states and others with specific policy recommendations amid the COVID-19 global outbreak. These recommendations are to help guide policymakers reduce the stress being experienced by patients with an opioid use disorder (OUD) and pain as well as support efforts to continue harm reduction efforts in communities across the United States. Read about examples of these efforts.

Featured updates: COVID-19
Track the evolving situation with the AMA’s library of the most up-to-date resources from JAMA, CDC and WHO.
“2. Protecting patients with pain
Adopt DEA guidance (PDF) authorizing physicians to prescribe opioid medications to existing patients without an in-person evaluation; authorize the prescription to be sent to the pharmacy via telephone.
Waive limits and restrictions on prescriptions for controlled substances, waive for the period of state and national emergency the restrictions on dose and/or quantity as well as refills.
Waive requirements for electronic prescribing of controlled substances, including requirements for an in-person evaluation for patients requiring a refill; provide liability protections for physicians who prescribe controlled substances for current patients the physician believes in good faith is stable and compliant with taking his or her medications.
For patients with chronic pain, waive testing requirements and in-person counseling requirements for refills; allow for telephonic counseling to fulfill state prescribing and treatment requirements.
Enhance home-delivery medication options for patients with chronic pain.
Issue brief: Reducing barriers to vital pain medication during the COVID-19 pandemic (PDF): The AMA is strongly urging legislators, regulators, governors and policymakers to remove additional barriers to pain treatment to help ensure that patients with pain have access to the treatments prescribed by their physician while remaining safe, reducing travel and unnecessary exposure to potential infection.”
https://www.ama-assn.org/delivering-care/public-health/covid-19-policy-recommendations-oud-pain-harm-reduction

Click to access issue-brief-reducing-barriers-vital-pain-medication.pdf

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For those of you who read my blog and are disabled… if this part of the President-elect team – his coronavirus  adviser – gets his way… your are going to be put way down the list of getting a COVID-19 vaccine… NO MORE AMERICA FIRST ?

Even if he doesn’t get his way… it would seems that those “high risk individual in the general pouplation” will be about THIRD in line… to get the COVID-19 vaccination… and it is to be given in two shots – one month apart…  So if everything goes well… immunity should come up to full effectiveness sometime late spring – early summer.

Biden coronavirus adviser wants US to distribute vaccine globally before it’s available to all Americans

https://www.foxnews.com/politics/biden-coronavirus-adviser-emanuel-vaccine-distribution

Oncologist Dr. Zeke Emanuel, one of 10 advisory board members named to Democratic President-elect Joe Biden’s coronavirus task force, has pushed the U.S. and other countries to not hoard a coronavirus vaccine.

Emanuel, who served as a key architect of the Affordable Care Act under the Obama administration, co-authored a paper in September in which he encouraged officials to follow the “Fair Priority Model,” which calls for a “fair international distribution of vaccine,” rather than what he and his co-authors characterized as “vaccine nationalism.”

The model allows the country that produces the vaccine to hold onto enough of a supply to keep the transmission rate below 1%, but says that beyond that, the vaccine should be distributed internationally. That means giving away or selling doses of the vaccine before it’s available to every citizen in that country, Emanuel explained to Scientific American.

“Reasonable national partiality does not permit retaining more vaccine than the amount needed to keep the rate of transmission (Rt) below 1, when that vaccine could instead mitigate substantial COVID-19–related harms in other countries that have been unable to keep Rt below 1 through ongoing public-health efforts,” the Science magazine article titled “An ethical framework for global vaccine allocation” argues.

“Associative ties only justify a government’s giving some priority to its own citizens, not absolute priority,” Emanuel wrote with his co-authors.

The Trump administration had said that the U.S. will share any coronavirus vaccine it develops with other countries after American needs are met and that the U.S. will not coordinate with the World Health Organization (WHO) on distribution.

“Our first priority of course is to develop and produce enough quantity of safe and effective FDA-approved vaccines and therapeutics for use in the United States,” Health and Human Services Secretary Alex Azar said during an August visit to Taiwan.

“But we anticipate having capacity that, once those needs are satisfied, those products would be available in the world community according to fair and equitable distributions that we would consult in the international community on,” Azar said.

Congress approved nearly $10 billion for the Trump administration’s Operation Warp Speed, which is working with private companies to produce and distribute a vaccine in the U.S.

On Monday, Pfizer and BioNTech’s coronavirus vaccine moved a step closer toward approval, with the company announcing 90% efficacy in its phase 3 clinical trial.

Emanuel and his co-authors argued against a proposal by the WHO to distribute vaccines globally at a rate proportional to each country’s population, and dismissed the belief that high death toll could be avoided by providing vaccines to countries based on “the number of frontline health care workers, the proportion of population over 65, and the number of people with comorbidities.”

The WHO proposal fails to consider the fact that death is not the only form of harm, Emanuel argued, and that prioritizing seniors at higher risk would mean sending a disproportionate amount of vaccines to wealthier countries, where average life expectancies tend to be longer.

Instead, Emanuel and his co-authors advocated for focusing on preventing premature death, the consequences of school and business closures and reducing general transmission of the virus.

Emanuel came under focus over the weekend after a 2014 essay he wrote, in which he outlines why he doesn’t want to live past 75, resurfaced. 

Emanuel, 63, wrote that “by 75, creativity, originality and productivity are pretty much gone for the vast, vast majority of us” in his essay titled “Why I Hope to Die at 75.”

“Since 1960, however, increases in longevity have been achieved mainly by extending the lives of people over 60. Rather than saving more young people, we are stretching out old age,” Emanuel wrote.

Biden is 77.

Other coronavirus task force advisory board members selected by Biden include Rick Bright, who said he left his position at NIH under President Trump over the administration’s embrace of hydroxychloroquine, and Dr. Atul Gawande, former CEO of Haven, a health care venture founded by Amazon, Berkshire Hathaway and JPMorgan Chase in 2018.

Emanuel did not respond to Fox News’ request for comment at this time. 

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DEA Pursues Vast Expansion of Patient Surveillance

https://filtermag.org/dea-expand-patient-surveillance/amp/

The Drug Enforcement Administration (DEA) is looking to expand its anti-diversion surveillance infrastructure by being able to search and analyze myriad patient behaviors for the vast majority of controlled and scheduled drug prescriptions—all accompanied by a rapid process for legally unveiling personally identifying information.

In early September, the agency requested proposals for the creation of software capable of searching at least 85 percent of all US residents’ controlled-substance prescriptions for certain patient behaviors, as well as prescriber and pharmacist practices.

The Pharmacy Prescription Data system would cede patient-level data to the federal drug-war agency to a far greater extent than comparable existing databases.

According to the agency’s request for proposal (RFP), the DEA is interested in its agents having “unlimited access to patient de-identified data” on re/filled prescriptions, daily supply, payment type, dosing information and gender, among other characteristics, until at least 2025.

At publication time, the DEA had not responded to Filter‘s request for comment. This article will be updated if comment is received.

The Pharmacy Prescription Data system, as the RFP calls it, would cede patient-level data to the federal drug-war agency to a far greater extent than comparable existing databases. The current Automated Reports and Consolidated Orders System (ARCOS), created by the Controlled Substances Act alongside the DEA itself, only monitors controlled substances’ manufacture, supply chains and distribution.

RFP for DEA’s Prescription Data Software

The DEA’s desired ability to search controlled-substance prescriptions to this degree targets seemingly mundane behaviors—like the number of times a patient paid in cash for a Schedule II substance like Adderall or OxyContin, or the geographic distances between patients and their prescribers and pharmacies.

But it also subjects people prescribed medications for opioid use disorder (OUD) to even more surveillance than is currently the case. In particular, the Pharmacy Prescription Data system would allow the DEA to track patients by their “Number of Opiate and Buprenorphine combinations.”

Buprenorphine patients’ records have already been available to some state law enforcement, if such agencies operate a state’s prescription drug monitoring program (PMDP). As of August 2020, a new federal regulation permits patients’ methadone records to be entered into state PMDPs by providers.

PDMPs’ capabilities are a patchwork in comparison to the streamlined Pharmacy Prescription Data system requested by the DEA. For example, PDMPs’ data refresh at varying intervals by state, ranging from real-time to daily to weekly updates, as Dr. Peter Kreiner, a senior scientist at Brandeis University’s Institute for Behavioral Health, explained to Filter. The DEA’s software would involve data refreshed each day.

“The impact of including buprenorphine will be appalling for people’s health.”

Scrutiny of OUD treatments will also be applied to prescribers and pharmacists. For the former, the DEA will be able to scrutinize their “percentage of patients receiving an Opioid and Buprenorphine together,” and, for the latter, the “Number of Oxycodone and Buprenorphine within an overlapping window” and “Percentage of scripts that are Oxy Buprenorphine within an overlapping window.”

“The impact of including buprenorphine will be appalling for people’s health,” Dr. Hannah Cooper, the chair of substance use disorder research at Emory University, told Filter. Applying more scrutiny to an already stigmatized medication could deter patients from accessing it and pharmacists from providing it, she said. That would add onto pharmacists’ existing hesitations, or oughtright refusal, to supply buprenorphine, which has been linked by Cooper and colleagues to existing DEA regulations.

Although the Pharmacy Prescription Data system will track individual patients with unique “encrypted identifiers,” the chosen contractor must be able to facilitate a three-business-day retrieval of personally identifying patient information when served with an administrative subpoena by the DEA.

The DEA has a history of exploiting administrative subpoenas to build a mass surveillance apparatus. Pre-dating—and outlasting—the National Security Agency’s infamous bulk telephone metadata collection revealed by whistleblower Edward Snowden, one DEA program, launched in 1992 and apparently still kicking, gathers international phone call data en masse.

The drug-war agency used its administrative subpoena power, according to a 2019 DEA inspector general report, to “collect data in bulk without making a prior finding that the records were […] ‘relevant or material’ to any specific defined investigation”, and it failed to develop “a robust legal review” of its practices. The watchdog agency called the DEA’s conduct “troubling.”

“The idea that patient-level data is available to the DEA is quite frightening. We don’t want to make people worry that their decisions will be monitored by this highly punitive federal agency,” said Cooper. “If you’ve been inhabiting a space where you’ve been persecuted by the federal government for some time, and they now have access to your private medical information, there will be tremendous consequences for population health and health equity.”

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