E14: Interview With Jemela Williams About Sickle Cell Disease
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Rapp report: Interview With Jemela Williams About Sickle Cell Disease
Posted on July 8, 2020 by Pharmaciststeve
Legal Causation
Posted on July 8, 2020 by Pharmaciststeve
Storyline – TV show BULL Season 4 Episode 1
As Bull prepares for fatherhood, his work at TAC suffers without his top attorney, Benny, who quit in reaction to Bull’s romantic reconnection to his ex-wife and Benny’s sister, Isabella (Yara Martinez). In addition, the team faces a difficult time in court as they mount a defense for a young bartender on trial for involuntary manslaughter.
https://legal-dictionary.thefreedictionary.com/causation
High blood pressure dangers: Hypertension’s effects on your body
The basic story line of this episode is that on new year’s eve a bartender sold a patron too much alcohol, left the bar, drove to his ex-wife’s house and killed his ex-wife and 3 friends at the house and he either committed suicide or was kill by the police. In the interim the bar closed/went out of business and the relatives of those that died was suing the bartender for serving the person too much alcohol before he killed everyone.
The Bull legal team defended the bartender with the concept that there was no causation between being served “too much alcohol” and him killing four people… of course Bull’s law firm WON…
As I heard the legal term “causation” … my mind started connecting the dots… as causation would apply to the chronic pain community.
I have listed above the link to the bad health consequences to a pt with elevated blood pressure and a table that lists all the complications to comorbidity issues for under/untreated pain.
I can’t count the number of times that pts have told me that when their pain meds were cut/eliminated… their blood pressure goes up dramatically and into unsafe levels.
If a pt’s blood pressure had been at normal/safe levels and starts going up when their meds are cut back/discontinued… and the prescriber doesn’t attempt to treat the pain nor unable to get it back to acceptable/safe levels… You can refer to the above link as to the potential consequences to the pt for under/untreated elevated blood pressure.
It is typically considered “bad medicine” to add medications to a pt’s therapy to deal with side effects of their other medications… IMO, putting a pt on up to 5 different anti-hypertensive medications to treat their high blood pressure because their pain medication has been reduced/eliminated… should also be considered “bad medicine”
The medical records that a prescriber keeps on a pt should document this cause/effect of the pt’s pain management meds being lowered/discontinued. Likewise, those same records should document what the prescriber did – if anything – to try to lower the pt’s blood pressure.
Once again, if the prescriber’s prescribing policies and procedures are being dictated by the prescriber’s employer… then the causation could be directed at the “deep pockets” of that employer.
Could those same records be used as documentation when “going after” those people who served on the CDC opiate dosing guidelines and created those same guidelines knew or should have known that they were going to cause pt harm and a path to legal actions against those individuals and/or legal case to get those guidelines revoked ?
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Does this explain why medical errors are the third highest reason of deaths?
Posted on July 8, 2020 by Pharmaciststeve
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Pharmacies Wanted for Lawsuit Against Optumrx
Posted on July 7, 2020 by Pharmaciststeve
Pharmacies Wanted for Lawsuit Against Optumrx
Over 500 independent pharmacies have already sued OptumRx for violating the law by:
- setting MAC prices below a pharmacy’s acquisition cost;
- paying higher MAC prices to large chains and mail order than to independent pharmacies;
- collecting brand prices from health plans while paying generic MAC prices to independent pharmacies.
The firm bringing this case—Jacobs Law Group– is willing to represent pharmacies in new lawsuits against OptumRx on a fully contingent basis. This means pharmacies would not have to advance any money to participate in the case.
Make a call and find out what you can do to fight back against PBM abuse.
Please contact:
Mark Cuker or Conor McCabe at Jacobs Law Group
(215)-531-8512(office)
215-266-5717 (cell)
www. https://www.jacobslawpc.com/practice-areas/independent-pharmacy-legal-actions
MARK R. CUKER
Cuker Law Firm
215.531.8512 – Direct Dial
215.531.8522 – Main Dial
Please note new address
130 N. 18TH ST
One Logan Square, Suite 1200
Philadelphia, PA 19103
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attorneys who have expressed an interest in possibly taking legal action against pharmacies
Posted on July 7, 2020 by Pharmaciststeve
I have spoken with attorneys who have expressed an interest in possibly taking legal action against pharmacies that are refusing to fill, as written, legitimate prescriptions for opiate medication for patients suffering from chronic pain lasting 3 or more months, or suffering from pain associated with a cancer diagnosis, sickle cell disease, or palliative or nursing home care, or which are adding additional requirements in order to get those prescriptions filled.
If you are interested or just want to share your story with them, you can contact them at www.justice4painpatients.com.
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Independent Pharmacies Sue Major Pbm Over Illegal Price Discrimination And Below Cost Reimbursements
Posted on July 6, 2020 by Pharmaciststeve
Independent Pharmacies Sue Major Pbm Over Illegal Price Discrimination And Below Cost Reimbursements
Pharmacies Allege OptumRx Knowingly Paid Them Less Than Large Retail Chain Pharmacies
PHILADELPHIA, PA (May 1, 2020) – — The newest litigation against a major pharmacy benefit manager comes from a most likely source: their small business victims. Unwilling to tolerate the low reimbursements which threaten to drive them out of business, more than 50 independent pharmacies have sued pharmacy benefit manager (PBM) OptumRx, a division of UnitedHealth Group, charging the company violated state laws governing pharmacy claims reimbursement.
The lawsuit alleges that OptumRx ignored state legal requirements, unlawfully paid local pharmacies substantially less than it paid large chain retail pharmacies like CVS or Walgreens and far below what the company paid its own mail order pharmacy for the same prescriptions. The lawsuit further alleges that in many cases OptumRx knowingly reimbursed local pharmacies below their wholesale cost to acquire generic prescription drugs necessary for their patients.
PBMs administer the prescription drug portion of health insurance and self-insured plans, acting as a middleman between the insurance plan and the pharmacist. Over the last 20 years these companies have accumulated immense, unregulated power – the three largest PBMs controlling up to 80% of the healthcare market – and have utilized that power to increase prescription drug costs, decrease competition and restrict patient choice.
The PBM practice of below cost reimbursements to independent pharmacies is likely one reason why OptumRx is the most profitable component of UnitedHealth Group; the world’s largest health insurance company, with over $225 billion in annual revenues.
Plaintiffs involved in the lawsuit allege that:
- PBMs dictate reimbursements without notice or negotiation, and the dictated rates are often grossly unrelated to the pharmacies’ actual wholesale costs to acquire the drugs for their patients.
- Optum charges health care plans brand prices while paying pharmacies the lower generic price for each prescription. Thus, the pharmacies allege the company is arbitraging prescriptions merely by changing their classification.
- Optum built a wall of secrecy around its conduct by forcing network pharmacies into confidentiality agreements that conceal the truth about Optum’s business practices – specifically how much Optum is paid by insurance plans for prescriptions, how much Optum receives in rebates from drug manufacturers, and how little Optum pays to pharmacies who actually deal with patients and dispense the drugs.
The survival of independent pharmacies in America’s healthcare system is seriously threatened by the unethical, predatory business practices of PBMs. The lawsuit brought forth by this group of small-business pharmacies seeks to break this wall of secrecy and hold Optum accountable.
The pharmacies are represented by Mark Cuker and Neal Jacobs of the Jacobs Law Group, which represents over 400 pharmacies in lawsuits pending in Federal Court in Pennsylvania. For more information about the lawsuit, contact Mark Cuker at (215) 531-8512.
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Needle jockey: Doctor refused to up my dad’s pain meds even tho he told them he was suffering
Posted on July 6, 2020 by Pharmaciststeve
RIP Gravestone
My dad was a chronically I’ll patient. He was 75 and underwent multiple back surgery’s and nerve decompression along w recently broken hip and spine. He fought like hell to live but his family doctor told him due to the FDA guidelines his pain meds had to be controlled by a pain doctor. After months of waiting to get into a pain doctor he was able to get his medicine but the following visit his doctor cut him down to a 1/4 of his dosage, he was not cut down slowly. My dad suffered, he went back to see doctor the following week and doctor was only interested in giving pain shots which don’t work for my dad due to scar tissue. Doctor refused to up my dad’s pain meds even tho he told them he was suffering. Here rothwelldouglas is another interesting article for you people.
5 days after that visit my dad committed suicide.
I blame the doctor as well as whoever decided to play God and not allow proper dosages of pain meds to chronically sick people.
ANONYMOUS
** They need to hear from people WITH intractable pain and WHO are not getting the medicine they need.
We are are own best spokes person. Write your governor and legislators Personally as others have done.
Also, the articles you see in the magazines at doctors offices are full of misinformation and lies. Few people like you and me know what real protracted pain is and can do to a person or the family of the one suffering.
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Temple U must be so proud of this pharmacy student ?
Posted on July 5, 2020 by Pharmaciststeve
Citing declining reimbursements, longtime Indiana, Pa., pharmacy closes
Posted on July 5, 2020 by Pharmaciststeve
Citing declining reimbursements, longtime Indiana, Pa., pharmacy closes
Independent pharmacists and PBMs clash over the impact on the industry
On the day before her Indiana, Pa., pharmacy closed its doors for good, Stephanie Smith Cooney filled a customer’s prescription for life-saving insulin — and lost $30 on the transaction.
It had become an all-too-familiar pattern, she said Monday as she and her staff of 11 at Gatti Pharmacy filled prescriptions and said goodbye to longtime patients one last time. In the past year, she said, fully 80% of the prescriptions they filled had generated a reimbursement payment less than the pharmacy’s cost of dispensing them.
This spring, Ms. Smith Cooney — who took over the pharmacy 10 years ago from William Gatti, son of founder Louis, and Ms. Smith Cooney’s father, David Smith — came to a crushing conclusion:
“We can’t afford to stay in business anymore.”
Like most pharmacists, Ms. Smith Cooney contracts with pharmacy benefit managers, or PBMs, who act as a middleman between a consumer’s insurance company and the pharmacy. Both UPMC Health Plan and Highmark, for example, use the Express Scripts PBM to administer their drug plans.
In January, Auditor General Eugene DePasquale echoed his earlier calls for greater transparency in how PBMs operate, asking the Pennsylvania Senate to pass legislation that would help rein in costs associated with the managers. Mr. DePasquale had previously reported that Pennsylvania taxpayers paid $2.86 billion to pharmacy benefit managers for Medicaid enrollees in 2017, a 100% increase in four years.
“Because PBMs operate as subcontractors,” his office said in a release, “they can shield important information, such as how they select which drugs are covered and whether community pharmacists are reimbursed the same amount as their affiliated chain pharmacies for the same drugs.”
For independent pharmacies like Gatti, a PBM can wield tremendous power in negotiating contracts, dictating reimbursement rates and prices the pharmacy can charge for medications.
But refusing to contract with a pharmacy benefit manager is not a practical option, as that typically means losing access to many, if not most, of their customers.
Without those contracts, “I would be selling used cars somewhere,” said pharmacist Dave Cipple, who owns seven independent pharmacies in Clarion and Armstrong counties.
Until last December, Mr. Cipple owned an eighth pharmacy in Shelocta, Indiana County, which he closed after seeing a sharp decline in reimbursement payments.
“We don’t have the clout to negotiate any reimbursements that are favorable with these folks, so that’s what happens,” he said.
He did get the final word, though: Today, a giant sign outside his vacated storefront on Route 422 shouts, “PBMs WRECKED THIS PHARMACY!”
Greg Lopes, spokesman for the PBM trade group Pharmaceutical Care Management Association in Washington, D.C., disagrees that pharmacy benefit managers are forcing independent pharmacies to close.
“Now more than ever, pharmacy benefit managers are the advocates for Pennsylvania’s consumers and health plan sponsors in the fight to keep prescription drugs accessible and affordable, and are not responsible for independent pharmacy closures,” he said.
“The fact is that there has been an increase in the number of independently owned pharmacies in Pennsylvania over the last 10 years.”
Mr. Lopes cited a March 2020 report done by two Penn State political science professors that said from 2010 to 2019, Pennsylvania saw a 14% increase in the number of independent pharmacies, to a total of 1,058 pharmacies statewide.
Not only are there more independent pharmacies nationally, the report concluded, but also as a group, their prescription profit margins had “increased slightly” between 2017 and 2018.
Patricia Epple, CEO of the Pennsylvania Pharmacists Association in Harrisburg, isn’t buying it.
“We have seen closure after closure.”
She noted the March report used data from the National Council for Prescription Drug Programs, an Arizona-based nonprofit that develops standards for pharmacy services.
The council routinely attributes a greater number of pharmacies in the state than are listed with the state board, she said. “So I am not sure if NCPDP is not removing old ones or exactly what, but something seems to be off.”
An annual digest put out by the National Community Pharmacists Association last year said Pennsylvania had 963 independent pharmacies in 2018, 95 fewer than the Penn State report had.
Ms. Smith Cooney believes she knows what’s behind the discrepancy, at least in part.
“In my experience just today, I was instructed to leave my NCPDP status active even though my status with the state board and DEA are now inactive,” she said Wednesday. “If my case is similar to others, NCPDP status would be a poor way to measure pharmacy numbers.”
Closing the pharmacy has been much more than a numbers issue for Ms. Smith Cooney.
As a young girl, she would do odd tasks at the store where her father was a pharmacist. She did her training there as a pharmacy student, then became a partner after earning her pharmacy degree and bought the business — which was founded in 1936 — in 2010.
The pharmacy offered services such as Gatti’s AutoSync RX program that allowed patients to get all of their prescriptions at one time with a phone reminder when it was time to pick them up. It also tracked late and missed refills.
“They deliver a personal service that you don’t always see in this day and age,” said Linda Mitchell, executive director of the nonprofit Downtown Indiana Inc., which works to keep the corridor of shops and restaurants vital and appealing.
Ms. Smith Cooney said they’d kept costs under control, and annual revenue had grown 10% the past year. “For all intents and purposes, we should be thriving.” But the increased revenue was not enough to offset the reduced reimbursements and still cover the pharmacy’s staffing and overhead costs.
Instead, the 2,000-square-foot storefront at the west end of Indiana’s core business district has gone dark, with the Gatti store inventory and patient files now transferred to the local Rite Aid.
“It’s definitely the end of an era for Indiana,” said Ms. Mitchell.
Steve Twedt: stwedt@post-gazette.com or 412-263-1963.
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At Walgreens: the bottom line is the ONLY LINE THEY CARE ABOUT ?
Posted on July 5, 2020 by Pharmaciststeve
https://youtu.be/JCn48O9Q48E
I am sure that a lot of pharmacists are glad they are working in a “right to work state” … there are some 25 states with this law on the books.. Businesses can fire you for any reason – or no reason – without consequences.
Pharmacists have not been paid $35 – $40/hr since the late 90’s or early 2000’s. There was a period of time 2000- 2010 when there was a severe shortage of pharmacists.. at its peak they claimed that there was 6,000 empty job slots that there was no pharmacists to fill them.
At about the same time the profession went from a 5 yr degree to a 6 yr degree program so on top of everything else we had almost NO GRADUATES ONE YEAR.
New Pharmacy schools started opening and they were getting 5-6 applicants for every available pharmacy school slot. we went from 80 odd schools till today we have abt 140 schools…. and they are now graduating 3 pharmacists for what maybe 2 available job slots..
During this time, the feds increased the limit on what students could borrow for college and in turn the colleges raised their tuition.. so students were coming out of college with larger and large student loan balances… not unusual for pharmacy grads to have $100,000 + student loan balances… of course when they started pharmacy school they were expecting to make 100,000 – 120,000/yr when they become licensed.
So now we have pharmacists – that all but the Pharmacy manager are lucky to get 30 hrs/week … so now they have a student loan more than many people have loans on their houses and going to be grossing MAYBE $60,000/yr.
So many of the pts dealing with subjective diseases and trying to get controlled substance Rxs filled and run into many of these newly graduated pharmacists with a whole lot of “book smarts” and little/no real clinical experience.. I would not be surprised for a lot of these pts to get “I’m not comfortable” filling your controlled Rxs..
But there are always independent pharmacists … where the pt will typically be dealing with the Pharmacist/owner and won’t be someone fresh out of school with the ink still wet on their license here is a link to help you find one by zip code. https://ncpa.org/pharmacy-locator
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