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Watch this before you waste your time contacting your elected official over a issue
Dr. Kline in Crisis Part 1 & Part 2
https://youtu.be/Li5fDlsZX4Y
https://youtu.be/8deCPp52x5Y
Dr. Kline and his patients . Suddenly, without any reason given, I was visited by two inspectors from the North Carolina medical board, who said they were there to have me surrender my federal narcoses licence. when i asked for the charges, I was told to talk to the board, and when I asked if I could continue my practice, They said to talk to the board. No reason, no evidence.
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At Walgreens, Complaints of Medication Errors Go Missing A Walgreens pharmacy in Times Square in Manhattan
At Walgreens, Complaints of Medication Errors Go Missing
Pharmacy employees at Walgreens told consultants late last year that high levels of stress and “unreasonable” expectations had led them to make mistakes while filling prescriptions and to ignore some safety procedures.
But when the consultants presented their findings at Walgreens’s corporate offices this month, there was no reference to the errors and little mention of other concerns the employees had raised.
That’s because senior leaders at Walgreens had directed the consultants to remove some damaging findings after seeing a draft of their presentation, a review of internal emails, chat logs and two versions of the report shows.
In one instance, Amy Bixler, the director of pharmacy and retail operations at Walgreens, told them to delete a bullet point last month that mentioned how employees “sometimes skirted or completely ignored” proper procedures to meet corporate metrics, according to the chat logs and the draft report.
A slide detailing “errors resulting from stress” was also removed. The consultants, a group from Tata Consultancy Services that was examining the company’s computer system for filling prescriptions, had included the slide among their “high level findings.”
Pharmacists in dozens of states have accused Walgreens, CVS and other major drugstore chains of putting the public at risk of medication errors because of understaffed and chaotic workplaces, The New York Times reported last month.
In letters to state pharmacy boards and in interviews with The Times, pharmacists said they struggled to keep up with an increasing number of tasks — filling prescriptions, giving flu shots, answering phones and tending the drive-through, to name a few — while racing to meet corporate performance metrics they characterized as excessive and unsafe.
The pharmacy chains have pushed back on the complaints, saying staffing was sufficient and errors were rare. Walgreens told The Times that its pharmacists knew “they should never work beyond what they believe is advisable.”
But the consultants heard similar complaints in interviews with workers at eight Walgreens pharmacies last year. Both versions of the consultants’ report noted “a widespread perception that there is not enough time to respond to all pharmacy tasks.”
In the deleted slide on stress-related errors, the consultants wrote, “We were told that pill bottles had been found to contain more than one medication.”
They said they “heard multiple reports of improper behavior” that was “largely attributed to the desire” to meet a corporate metric known as “promise time,” which ensures that patients get prescriptions filled within a set amount of time.
The Times reported last month that such metrics often factor into employee bonuses and performance reviews.
The final presentation was delivered about two weeks ago at the drugstore chain’s corporate campus in Deerfield, Ill. The consultants had been seeking approval of the research report from various departments at Walgreens. They have since moved to the next step in the project — improving the pharmacy’s computer system.
A Walgreens spokesman, Jim Cohn, said the Tata consultants had been helping the company get a “better understanding” of how employees used the computer system.
The draft report, he said, included “information gathered through informal engagement with staff at a handful of stores.” Changes reflected in the final version were intended “to help ensure that the report appropriately focused on the most relevant aspects of the technology and user experience,” he said.
Mr. Cohn added that Walgreens took “any concerns seriously to ensure the appropriate parties are aware and working to address them.”
A spokesman for Tata Consultancy Services, a major information technology firm based in India, declined to comment. The company recently announced it had signed a $1.5 billion deal to run Walgreens’s technology operations.
Like Walgreens, CVS — the country’s largest pharmacy chain — has disputed assertions from some employees and state boards that its drugstores are understaffed and overburdened.
In a statement posted on its website last month, CVS said, “We fundamentally disagree with the recent assertion in The New York Times that patient safety is at risk in America’s pharmacies.”
Since then, the Oklahoma State Board of Pharmacy released a complaint against a CVS pharmacy in Owasso, a suburb north of Tulsa, regarding a medication error made last year. The board took the rare step of citing the pharmacy in addition to the pharmacist involved in the error.
The Oklahoma board cited inadequate staffing in its investigation of the mistake, which involved a young man who received only one-fourth of his prescribed dose of anticonvulsant medication, according to the complaint.
The patient’s father discovered the error, but only after the young man had taken the incorrect dose for about 18 days, during which his seizures became more frequent and more violent, according to the complaint. His mother reported that during one seizure, he fell and gashed his forehead.
After the mistake was reported to the pharmacy board, an investigator for the state checked 200 prescriptions at the Owasso pharmacy for accuracy and found a 9.5 percent error rate, according to the complaint. Some errors were minor — like portions of directions that were missing — but others were more significant. A patient was told to take the wrong dose, for instance: one tablet instead of one-half.
The board wrote in the complaint that it had received “several letters of concern from various CVS employees regarding the lack of adequate staffing” at the company’s pharmacies.
Across the country, pharmacists who work at CVS and elsewhere have reported that their corporate offices have cut the hours of technicians who help behind the counter, and have pared back or eliminated shifts with overlapping pharmacists.
The Oklahoma investigator, who was at the Owasso CVS for three and a half hours, noted that the phone rang “almost constantly, with rarely a five minute break in between calls and several instances of more than one line ringing at a time,” according to the complaint.
The investigator also observed “almost constant foot traffic” in the store and a routinely packed drive-through.
The complaint states that on the day of the error involving the anticonvulsant medication, the pharmacist on duty was responsible for checking 194 prescriptions in a six-hour shift — about one every two minutes.
The store’s lead pharmacist told the state board that he had no control over staffing. He had complained about staffing to his district leader, but the district leader also had no power to make changes, according to the complaint.
He said that CVS had “almost completely eliminated pharmacist overlap” — meaning that only one is on duty at a time — and that pharmacists at his store worked about 20 to 30 hours per week unpaid so their colleagues were “not left in an impossible situation.”
He also said that internal reports for less severe errors were sometimes not completed because of a lack of time created by staffing issues.
CVS faces up to $75,000 in fines and possible suspension or revocation of the Owasso pharmacy’s license. The matter is scheduled for review at the pharmacy board’s meeting in May.
A CVS spokesman said the company looked “forward to addressing the allegations” at the upcoming hearing, adding that “our record of patient safety is outstanding and we are committed to continuous improvement.” CVS and other chains have declined to provide their error rates.
In a letter to employees after The Times’s article last month, Larry Merlo, the chief executive of CVS Health, said he was “deeply disappointed by the article’s portrayal of our company and industry.”
But this week, a company spokesman said that in response to the article, CVS planned to examine its metrics, both the quantity and how they are used to assess pharmacists.
A group called Pharmacist Moms, which says it represents 32,000 female pharmacists, also responded to the article, posting a letter on its website and social media accounts that said, “We feel strongly that patient safety may be compromised due to the overly stressful working conditions at chain pharmacies.”
The group’s founder, Suzanne Soliman, said in the letter, “Pharmacists work in difficult and demanding conditions and are often unable to voice concerns over patient safety.”
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pharmacists help people live their healthiest lives
Pharmacists for Healthier Lives Offers Perspective on Opioid Crisis
Pharmacists for Healthier Lives (PfHL) – a coalition of pharmacy and healthcare organizations raising awareness of how pharmacists help people live their healthiest lives – today announced the launch of a campaign designed to
educate consumers on the critical role pharmacists play in helping patients use prescribed opioids safely and effectively.
Naturopathic medicine іѕ a fоrm оf alternative remedy thаt focuses mоrе оn thе process оf prevention оr self-healing, rаthеr thаn cure. Thе method оf treating wіth naturopathic drugs involves certain natural therapies practiced bу naturopathic doctors. Thе centuries old scientific theories аnd philosophy goes іntо creating thіѕ fоrm оf drug wіth magical abilities thаt cure wіthоut harming wіth side-effects. Even thе vascular аnd interventional radiologists іn thіѕ area help intercede bеtwееn thе possible diagnosis stage usually mаdе bу thе general physician specialist tо thе specific condition оr disease state involved іn thе particular bodily process аѕ manifested bу thеѕе radiographic tests results аnd images. It’s important tо note thаt wіthоut thеѕе highly visual results thаt соmе оut frоm thе specific procedures, іt wоuld bе nearly impossible tо correctly make аn accurate diagnostic оr prognosis.
Modern researches hаvе proved thе efficiency оf therapeutic uѕе оf age-old supplements created frоm natural substances. You can check your health problems, by Kurated doctor.
Physicians practicing natural medicine believe іn primary аnd complementary mode оf medication аnd treatment. Durіng thе process оf treatment, thеу cooperate wіth doctors practicing conventional medical treatment аnd refer patients frоm аnd tо different disciplines оf thіѕ fоrm оf science whеnеvеr thеу think thаt іѕ required.
The campaign includes videos featuring coalition partners that will run on Facebook this month and can be found on the PharmacistsforHealthierLives.org website.
As the medication experts on a patient’s healthcare team, pharmacists can identify health problems associated with pain management and addiction. – emphasis on ADDICTION !
They are specially trained to provide counsel and set a course of action to ensure best patient outcomes, thus reducing the risk of addiction and you can read more information about health on Health Blog.
“When it comes to information about pain management and the risks involved with taking opioids
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Restore Patient Rights to Treatment for Pain
https://www.change.org/savepainmanagement
Because of years of government intrusions into the medical profession’s legal opioid prescribing for patients suffering pain, these are our concerns and the dire consequences we implore you to bring to an end:
1. The “Opioid Crisis” is an “Illegal and Illicit Drug Crisis” falsely blamed on legal prescriptions.
2. Millions of Americans Forcibly Tapered:
Intractable Pain Patients (IPPs), in unceasing pain, are suffering on ineffective low doses of their years-long, even decades-long well-working opioids. Many die prematurely from cardiac and neurologic effects of forced taperings. These tortures and murders must cease Stat!
3. Millions of Americans Suddenly Cold-Turkeyed:
Intractable Pain Patients, long-stabilized on prescribed opioids, abandoned to never-ending pain, are suffering severely, many committing suicide.
4. Millions More Sick and Dying Americans Denied Opioids Prescribed Safely for Over a Century in:
a. Cancer Care . Palliative Care . Hospice Care
b. End-of-Life Care . Acute Injuries and Illnesses . Postop Pain
c. Sickle Cell Crisis, causing death
Because of years of government intrusions into the medical profession’s legal opioid prescribing for patients suffering pain, these are our concerns and the dire consequences we implore you to bring to an end:
1. The “Opioid Crisis” is an “Illegal and Illicit Drug Crisis” falsely blamed on legal prescriptions.
2. Millions of Americans Forcibly Tapered:
Intractable Pain Patients (IPPs), in unceasing pain, are suffering on ineffective low doses of their years-long, even decades-long well-working opioids. Many die prematurely from cardiac and neurologic effects of forced taperings. These tortures and murders must cease Stat!
3. Millions of Americans Suddenly Cold-Turkeyed:
Intractable Pain Patients, long-stabilized on prescribed opioids, abandoned to never-ending pain, are suffering severely, many committing suicide.
4. Millions More Sick and Dying Americans Denied Opioids Prescribed Safely for Over a Century in:
a. Cancer Care . Palliative Care . Hospice Care
b. End-of-Life Care . Acute Injuries and Illnesses . Postop Pain
c. Sickle Cell Crisis, causing death
d. Acute ER Diagnoses . Dental Pain and Surgeries
e. Children in Serious Pain .
f. Even Pets, Postop Cats and Dogs
5. Countless American Veterans Forcibly Cold-Turkeyed:
Veterans Administration anti-opioid dictates prevent pain relief in amputees, andother battle-injured and retired soldiers leading to almost daily suicides the VA falsely attributed to PTSD.
6. The Horrendous Suffering and Even Death of Patients with Sickle Cell Anemia:
The denial of National Institute of Health (NIH) standard of care treatment guidelines by emergency room and hospital providers, using CDC guidelines to excuse “medical manslaughter” and “black genocide”
7. Hundreds of Innocent Clinicians Imprisoned for high-quality care of patients in pain:
Clueless DEA police and DOJ prosecutors presume to prescribe, either blanket denial of essential opioids or one-size-fits-all MMEs (Morphine Milligram Equivalents) so low they wouldn’t relieve the pain of a flea. And they scare, raid, and imprison physicians.
8. The Disproportionate and Discriminatory Prosecution of ethnic minority and independent physicians by the DOJ, DEA, Criminal Justice System, and State Medical Boards:
Minority physicians are brought into the US for slave labor in medical schools and residencies, then the hospitals are in collusion with the government to attack these doctors once in practice in order to fill prison cells for money and repeat the revolving door.
9. 49 State Medical Boards Collude with the DEA and DOJ by Intimidating Opioid Prescribers:
Except for brave Washington State’s Washington Medical Commission supporting its pain patients and physician opioid prescribers, shame on all other state medical boards for colluding with DOJ and DEA renegades, non-MDs practicing medicine unlicensed, deciding MMEs, forcing abandonment of pain patients to zero analgesic help, forcing good doctors to retire.
State Boards Must Support Physicians Stat!
10.Violation of Medical Providers’ Constitutional Rights:
a. 4th amendment through illegal search and seizure, use of warrants without just cause.
b. 5th amendment through lack of due process
c. 6th amendment rights of a speedy and public trial, an impartial jury, the right to be informed of the charges, the right to confront and call witnesses, and the right to an attorney.
d. 14th amendment through loss of property. A provider’s profession is his property.
11.Misuse of the Forfeiture Statute:
Everything a provider owns is confiscated by the government, sometimes even without a trial or charges placed.
Demands:
1. We demand EXONERATION for medical providers in prison, including insurance fraud as that is just a door-opener. IMMUNITY from prosecution for all opioid prescribers Stat!
2. Medical providers have their licenses and DEA certificates immediately restored.
3. The investigation of the DOJ/DEA by the U.S. Congress for the prosecution of physicians through the illegal application of the Controlled Substances Act.
4. Prosecution of government prosecutors/agents who used illegal means to convict innocent medical providers.
5. Compensation of medical providers who have been attacked or denied DEA certification without cause as remuneration for their loss of their 14th amendment rights.
6. Stop asset forfeitures in any case prior to conviction.
7. Investigate National Data Banks for publishing false allegations against medical professionals. Information should not be public until proven
We will be watching for your positive actions toward restoring legal opioid treatments to pain patients nationwide without CDC, VA, DOJ, or DEA interferences. We are 60 million American patients deprived of the opioids medically known to best treat our pain. Others of us are pain management physicians. We are watching your legislative and related actions on these pain-related prescription opioid issues. We intend to vote out of office anyone who won’t help restore ours and our doctors’ rights to utilize legal opioids according to medical exigencies.
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PLEASE REACH OUT TO THESE ATTORNEY’S IMMEDIATELY!!!
Any Chronic Pain Patients who have had any PHARMACY OR PHARMACIST REFUSE TO FILL A LEGITIMATELY WRITTEN PAIN PRESCRIPTION PLEASE REACH OUT TO THESE ATTORNEY’S IMMEDIATELY!!! Here we go people, Here We Go!!!!
https://seekingjusticeforpainpatients.com/
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CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 1
CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 1
CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 2
CVS is Destroying the Profession of Pharmacy – PART 3*
CVS is Destroying the Profession of Pharmacy – Part 4
CVS is Destroying the Profession of Pharmacy: Part 5!
CVS is Destroying the Profession of Pharmacy: Part 6
https://pharmacistactivist.com/2020/February_2020.shtml
As much as I wish it wasn’t true, I can’t deny that CVS/Caremark/Aetna/O
mnicare/etc. has become the most dominant and powerful force in health care! Its resources and influence far exceed those of all the national pharmacy organizations combined. One could even conclude that CVS is even more powerful than the government. When the government has information regarding illegal or otherwise inappropriate programs and actions of CVS, the corporation always has enough millions to obtain a settlement in which it is able to claim “no wrongdoing.”
CVS has had an exceptional and unprecedented opportunity to greatly improve the quality and safety of health care and drug therapy for patients, to be a powerful advocate for the professional role of pharmacists, and to be a trusted and respected employer for its thousands of pharmacists, pharmacy technicians, and other employees. However, because of corporate greed and an obsession with even greater profits and pleasing shareholders, the programs and actions of CVS have had exactly the opposite consequences.
Consequences
The consequences include denying millions of consumers the counseling and other services that pharmacists are in a position to provide, thereby placing them at risk of serious adverse events and even death as a result of errors and other drug-related problems. The risk exists not only for consumers who use the huge network of CVS stores, but also for those who use its Caremark mail-order pharmacies and the thousands of other pharmacies who must participate in CVS/Caremark-administered prescription plans that compensate pharmacies below drug product cost or otherwise in amounts that are insufficient to provide needed services. With its ownership of one of the largest chain pharmacies, health insurance companies (Aetna), PBMs (Caremark), and long-term care pharmacies (Omnicare), CVS exerts vast power and influence not only within its own operations, but also on the other companies and individuals who must “compete” with the negative forces of the CVS entities.
A second consequence of the policies and decisions of CVS is the devaluation of the services pharmacists have the ability to provide. Community pharmacists are the face of the profession of pharmacy for the public. However, when CVS management-imposed metrics, quotas, staffing reductions, and harassment make it difficult for its pharmacists to even greet, let alone provide consultation for patients, its pharmacists have little or no time to communicate with patients. The result is that the knowledge and skills of pharmacists that should be applied for the benefit and safety of their patients are denied and essentially unknown to their patients. As one of the largest employers of pharmacists, CVS management suppression of the use and visibility of the knowledge of pharmacists devalues their abilities, damages the standards for pharmacy practice, and is destroying the role of pharmacists in assuring appropriate and safe drug therapy. This destructive impact is not limited to CVS stores, as inequitable CVS/Caremark programs impose economic and service-diminishing restraints on thousands of other pharmacies.
A third consequence of the policies and actions of CVS management is the destructive effect on the morale and performance of its own pharmacists and pharmacy technicians. I know of no other organization in which management is reviled and resented to the extent that it is at CVS. I do not seek out criticisms of CVS – they are forwarded to me by CVS pharmacists and others who know that I am concerned and sympathetic to their dilemma of demeaning and stressful working conditions in a position in which they must stay because employment elsewhere is not available. I do not participate on social media websites, in part because I can’t keep up with emails, even in “retirement”. However, many of the comments that do appear on those sites are forwarded to me, often in descriptive language that I don’t condone and won’t print. “Hate” is not an overstatement of the attitude of thousands of CVS employees toward its management, but they don’t have options and they are trapped. If this is the situation that exists among the employees who best know the working conditions and their resultant risks for patients, the circumstances must be exposed and the public must be on guard for its own safety.
“Chaos at Chain Pharmacies”
On January 31, 2020, a bombshell investigative report was published in The New York Times (Ellen Gabler; page A1) titled, “Overloaded Pharmacists Warn They’re Making Fatal Mistakes: How Chaos at Chain Pharmacies is Putting Patients at Risk.” Ms. Gabler’s very thorough investigations, interviews, and reporting include specific examples of errors, quotes from CVS and other chain pharmacists voicing concerns regarding working conditions and increased risks for errors, and interviews with concerned physicians and officials of medical associations and others. Because of fear of retaliation and being fired, at least one of the CVS pharmacists agreed to be interviewed only following assurance that his identity would not be revealed.
I urge you to read the entire story. Examples of specific comments of pharmacists and others that are included in the story are provided below:
“I am a danger to the public working for CVS.” (Please also see my editorial in the May, 2019 issue of The Pharmacist Activist).
“We are afraid to speak up and lose our jobs. PLEASE HELP.” (a response of a pharmacist to a Missouri Board of Pharmacy survey)
“(Pharmacists) struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies…all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.”
“My fellow pharmacists and pharmacy technicians are at our breaking point. Chain pharmacy practices are preventing us from taking care of our patients and putting them at risk of dangerous medication errors.”
“Metrics put unnecessary pressure on pharmacy staff to fill prescriptions as fast as possible, resulting in errors.”
“Any dissent perceived by corporate is met with a target placed on one’s back.”
“I certainly make more mistakes. I had two misfills in three years with the previous staffing and now I make 10-12 per year (that are caught).”
“We are forced to harass patients at checkout to fill unnecessary meds, request unnecessary refills, and to enroll in automatic fill programs that result in dangerous duplications and meds to be filled that were intended for single-time use.”
“We are being asked to do things that we know at a gut level are dangerous. If we don’t or can’t do them, our employers will find someone else who will, and they will likely try to pay them less for the same work.”
“I am expected to make 50-100 phone calls in addition to answering phone calls, consultations, vaccinations, and prescription verification. This has resulted in dispensing errors.”
“Many unwanted refill requests are generated by automated systems designed in part to increase sales. Others were the result of phone calls from pharmacists, who said they faced pressure to reach quotas.”
“…we are overwhelming doctors’ office staff with constant calls, and patients are often kept on medication that is unneeded for extended periods of time.”
(experience of a psychiatrist with concerns about recurring requests to prescribe 90-day supplies of medications) “He started stamping prescriptions, ‘AT MONTHLY INTERVALS ONLY.’ Despite those explicit instructions…he received faxes from CVS saying his patients had asked for – and been given – 90-day supplies. …it was a ‘baldfaced lie’ that the patients had asked for the medication, providing statements from patients saying as much. ‘I am disgusted with this,’ said the psychiatrist who worries that patients may attempt suicide with excess medication. ‘There are going to be people dead only because they have enough medication to do the deed with.'”
During her extensive investigations Ms. Gabler sought information/clarification from CVS and other chain pharmacies regarding what she had learned from their pharmacists and others. The following are some of the responses (or more accurately non-responses) from CVS:
“Patient safety is of utmost concern, with staffing carefully set to ensure accurate dispensing. Investment in technology such as e-prescribing has increased safety and efficiency. They (CVS and others) denied that pharmacists were under extreme pressure or faced reprisals.”
“When a pharmacist has a legitimate concern about working conditions, we make every effort to address that concern in good faith.”
“Errors, the companies said, are regrettable, but rare; they declined to provide data about mistakes.”
(in response to the reporter’s question about a CVS form for staff members to report errors that asks whether the patient is a “media threat”): “CVS said in a statement it would not provide details on what it called its ‘escalation process.'”
(in response to the resignation of a pharmacist [Wesley Hickman in North Carolina who now runs an independent pharmacy] following a 13-hour shift as the only pharmacist who filled 552 prescriptions with no breaks for lunch or dinner): “CVS said it could not comment on the ‘individual concerns’ of a former employee.”
(Editor’s note: CVS knows exactly how many prescriptions were filled in that pharmacy that day. I have to think that if 552 prescriptions had not been filled, even 551 or 553, CVS would have accused the pharmacist of lying.)
“Metrics are meant to provide better patient care, not penalize pharmacists.”
(in response to concerns about calls to patients and prescribers about 90-day supplies and automatic refills): “CVS says outreach to patients and doctors can help patients stay up-to-date on their medications, and lead to lower costs and better health.” “CVS said it continued to ‘refine and enhance’ the program.”
(in response to concerns about 90-day supplies of medications for patients with mental health problems): “CVS has created a system to address the issue.”
CVS response to NYT article
The New York Times investigation and report clearly hit a nerve in CVS management. On the same date (January 31) the article was published, CVS issued a press release that includes the following comments; my Editor’s notes/observations are added in parentheses:
CVS – “We fundamentally disagree with the recent assertion in The New York Times that patient safety is at risk in America’s pharmacies.”
(Editor’s note: CVS must have anointed itself as America’s pharmacy. The NYT investigation specifically applied to chain pharmacies, and primarily CVS.)
CVS – “Patient safety is our highest priority.”
(Editor’s note: As they say in the direct-to-consumer ads for prescription medications, “Your experience may vary.” I will have more to say about this claim in Part 2 of this series.)
CVS – “Despite our excellent safety record, we are committed to continually improving. We’ve made important strides, including using technology to enhance accuracy, regularly measuring the quality of our pharmacy services and, most importantly, listening to and valuing the feedback of our pharmacists.”
(Editor’s advice: Pharmacists should have another job offer in hand prior to providing “feedback.”)
CVS – “We are fierce advocates for expanding the number and role of pharmacy technicians at our stores. Qualified and trained pharmacy technicians allow pharmacists to have more time to provide patient care, answer questions about medications and serve as true health care counselors.”… “As part of our continued commitment to safety and to supporting our pharmacy teams, CVS Health has been on the forefront of advocating for states to increase pharmacy technician to pharmacist ratios. By allowing additional pharmacy technicians behind the counter, we are able to ensure that we are safely and effectively filling prescriptions, and most importantly, that pharmacists are able to provide more effective patient care and counseling.”
(Editor’s note: In addition to closing “poor-performing” stores, CVS is reducing pharmacist hours and technician hours, a reality that can’t be reconciled with its claims. Increasing pharmacy technician to pharmacist ratios is NOT the answer to safety concerns, and would only further add to the supervisory responsibilities and stress of pharmacists for whom “more time” will supposedly be provided. Many CVS pharmacists currently work numerous hours “off-the-clock” to finish basic responsibilities, and have little or no time to speak with patients.)
CVS – “Measurement = Improvement.” “Quality health care must be safe, effective, and efficient for patients to achieve their best possible health outcomes, which is why we measure the quality of services our pharmacists provide. Accountability for our pharmacists is important.”
(Editor’s questions: I understand that “safe” and “effective” are criteria for quality health care, but what is the basis for CVS identifying “efficient” as a criterion, and what are the parameters for demonstrating efficiency? What are the specific “services” that pharmacists provide for which CVS measures quality? Counseling of patients? No! Potential allergic reactions identified and prevented? No! Intervention on behalf of a patient that results in a prescription that would place a patient at risk not being dispensed? No – unless it is a negative evaluation because one less prescription was dispensed and valuable time was consumed without any payment.)
CVS – “We constantly monitor prescription volume and make changes to our staffing levels as volume changes.”
(Editor’s question: Is it just a coincidence that the number of reductions in staffing levels is far greater than the number of increases in staffing levels?)
CVS – “We value the feedback of our pharmacists and take individual, legitimate concerns seriously.”
(Editor’s interpretation: “Management reserves the right to define “legitimate.”)
CVS – “We have a firm non-retaliation policy in place for any employee, including our pharmacists, who want to voice a concern.”
(Editor’s interpretation: Management will not take action that might be viewed as retaliatory based on the specific concern a pharmacist identifies. However, it is often able to allege a violation of some obscure policy, or inefficiency because of advancing age to discipline or fire a pharmacist.)
CVS – “Last year, we conducted a survey of all of our pharmacists to gauge their perspective on the culture of patient safety in their pharmacies, and the overwhelming majority of responses were positive.”
(Editor’s note: Presumably management knows the identity of the pharmacist and the particular pharmacy for which survey responses are provided. Is it surprising that a majority of responses were positive when pharmacists anticipate that a negative response would result in management holding them responsible for the negative culture and impose disciplinary action?)
CVS – “There is no profession or industry that is immune from having dissatisfied employees.”
(Editor’s note: This statement is true, but it faults the employees who voice concerns and demeans the validity of concerns.”)
CVS – “Another factor that indicates job satisfaction among CVS pharmacists is our extremely low turnover rate, which has decreased over the last 3 years.”
(Editor’s note: Other jobs for pharmacists are not available in many parts of the country. A current CVS pharmacist has provided the best response to management’s flaunting a low turnover rate: “The turnover rate at CVS for pharmacists with another job offer is nearly 100%.”)
Other responses
The New York Times article immediately went viral and has elicited thousands of responses from pharmacists, consumers, and many others. The CVS press release response has also resulted in many responses, primarily from CVS pharmacists and pharmacy technicians who are highly critical of CVS management for the lack of credibility of its “defense.” Some of these comments, as well as my recommendations, will be included in Part 2 of this series in the March issue of The Pharmacist Activist.
As difficult as it is to have one’s employer criticized in the media, common sentiments of CVS pharmacists and technicians have been encouragement and appreciation to reporter Ellen Gabler and the New York Times for the awareness, understanding, and communication of the risks for patients and the working conditions experienced by CVS employees. As one CVS pharmacist states: “Thank you for this article.”
danandsue3@verizon.net
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Express Scripts signs 3 yrs contract and then wants to renegotiate (lower) reimbursements in the third year.
Notice that Express Scripts (ESI) specifically mentions the recent law that no longer allowed this PBM and others PBM to “gag” pharmacist from telling pts that they could PAY CASH for the Rxs and pay less than the PBM would charge the pt.
Now the pharmacist may initiate the discussion with the pt that there is a less expensive way to purchase their prescriptions. Before this new law, the PBM contracts PROHIBITED a pharmacist from doing this.. they were only allow to discuss this with a pt – IF THE PT ASKED ABOUT THE PHARMACY’S CASH PRICE.
Of course, if a prescription is not processed – billed to the PBM – the PBM will not receive a discount/rebate/kickback from the pharma for the medication provided the pt.
Healthmart pharmacies are franchisees, so they are basically independent pharmacies and there are over 3500 such stores in the USA. I suspect that this group of pharmacies are not the only ones that got such a letter about reducing the reimbursement and profits of independent pharmacies.
There have been reports – prior to this letter – that are forced to go out of business because they were getting reimbursed LESS THAN THE COST OF THE MEDICATION TO THE PHARMACY (wholesale price) on 25% or more of all prescriptions filled by a pharmacy.
NO BUSINESS – especially small businesses – can remain viable when they are selling 25% of their sales/transactions at up to 25% less than they were able to purchase the product(s) from the manufacturer or wholesaler.
Since the PBM industry came to be in 1969-1970… in their negotiating a contract with a pharmacy… it is presented on a “take it or leave it ” basis… if the pharmacy doesn’t take/sign the contract – AS IS – the PBM will make sure that those people – pts of the pharmacy – will LEAVE – take their prescriptions/business – to one of your competitors and/or the PBM will attempt to coerce the pt to get their prescriptions from the PBM owned mail order pharmacy.
If more than one pharmacy tries to negotiate with a PBM about their reimbursement rates the DOJ will step in and threaten to charge the pharmacies involved with “price fixing”, but the PBM and insurance industry are exempt from Sherman Antitrust Act… so they can LEGALLY “fix prices” without any consequences.
About ten years ago, Walgreens – with abt 10,000 stores tried to negotiate with a PBM (Medco) and refused to sign their low reimbursement contract and after abt six months … Medco continued to refuse to budge on the offered reimbursement, and Walgreen had to cave and sign the contract. At the time Medco was the SECOND LARGEST PBM and Walgreen refusal to sign the contract … those Medco pts were forced to use a pharmacy that was not their first choice.
Because of the tactics of the PBM industry, many small/rural towns/areas no longer have a local pharmacy many of these pharmacies are independent pharmacies because the local population is not large enough to financially support a large chain pharmacy.
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Robbery is suppose to be ILLEGAL – except for the insurance/PBM industry ?
Here is another article about CVS/Caremark padding their own pockets and paying their competitors “pennies” over what they were paying their own CVS pharmacies. The survey was on over 250 different common medications and when a state employee had a medication filled at at a CVS .. .the CVS store was paid a AVERAGE of $60 more for the same medication/strength/quantity.
https://www.pharmaciststeve.com/?p=25784
Ohio has found CVS/Caremark that handled all but one of their Medicaid/HMO programs were keeping/taking money that they were not entitled to.
W Virginia has dumped their unnamed PBM for their state Medicaid program and is saving TENS OF MILLIONS every year
South Dakota has managed their Medicaid prescriptions for years because the could do it at a lower cost that any PBM
KY is looking into what they are being charge by the PBM for their Medicaid system.
The PBM industry came to be in 1969-1970 and the average Rx price back then was $4 -$5 and today the after Rx price is in the low $70 range. In 1970, 95% of all Rxs were brand name and today 90%+ are now generics.
If we were still at 95% brand name and applying the CPI/COLA to the 1970 price it would suggest that the Rx price today would be in the mid $30 range… If one tries to adjust for today’s 90% generics that average could be in the $25 range..
The question is why is there nearly a $50 difference from what it is and what it should be ? The PBM industry now control the prices of abt 90% of all prescriptions filled and that – in and of itself – could be some of the answers.
But since the insurance industry is claimed to have one of the largest/deepest “pots of money” to pay for lobbyists… there is little question as to why these Rx price have increased and continue to increase at a rate above the CPI rate.
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Dr. Greenspan violated nine laws and/or the American Medical Association Code of Ethics and agreed to disciplinary action
Portsmouth pain doctor reprimanded by state board
https://www.seacoastonline.com/news/20190710/portsmouth-pain-doctor-reprimanded-by-state-board
PORTSMOUTH — An American Pain Institute physician agreed with the state Board of Medicine to accept a reprimand, get additional medical education and pay a fine for medical misconduct related to his discontinuing treatment for a pain patient.
The physician, Joshua Greenspan, agreed to the discipline, according to an agreement published by the medical oversight board, which distributed a copy to the media. A message left for Greenspan was not returned Wednesday.
The settlement agreement states Greenspan was licensed in 2006 to practice medicine, is board certified in anesthesiology and pain management and practices at the American Pain Institute at 14 Manchester Square in Portsmouth.
The board reported it received a June 2018 complaint from a former Greenspan patient who claimed his pain medications were reduced, after being the same for years, leading to pain, anxiety and suicidal ideations. The patient also reported Greenspan “failed to treat his new and/or worsening symptoms over a period of years.”
According to the agreement, the board conducted an investigation and Greenspan agreed that if a disciplinary hearing were held, the board could find Greenspan “engaged in professional misconduct.” It reports the investigation involved one patient who suffered chronic pain “for many years” due to a fall, a crash and surgeries.
The patient began treatment in 2014 with Greenspan who prescribed Ocycontin and Oxycodone at the same levels for years, during which there were monthly appointments. The patient was also taking Klonopin, prescribed by his primary doctor for anxiety, after the FDA in 2016 issued a “strong warning” against combining that type of drug with opioids, the Board of Medicine notes.
The agreement states there’s little evidence in the doctor’s records that there was ever a review as to the use and/or levels of opioids during the four years of treatment, until April 2018, when Greenspan began reducing the dosages. The agreement states Greenspan told the patient that Medicare had issued new guidelines, effective Jan. 1 2019, that only allow 90 mgs of morphine equivalents daily. Citing that guideline, Greenspan reduced the patient’s dosage by 13%, the agreement with the state Board of Medicine states. However, the report notes, the Medicaid rule did not set an upper per-day dosage limit, but did require a pharmacist filling prescriptions above the threshold to “document a discussion with the prescribing doctor.”
Twice the patient complained about pain due to the reduced dosage, on one occasion going to the hospital for emotional duress, the settlement agreement states. Greenspan, according to the agreement, “made no referrals or recommendations regarding these issues, but instead reduced the patient’s dosage by another 20 mgs.
The patient later failed a random pill count and was admitted to a hospital after threatening suicide unless he was given a higher dosage of the opioids, the agreement reports. Greenspan in turn discharged the patient from his practice, ordered the person a prescription for withdrawal medication, reported the patient to the police and the primary care doctor, it reports.
According to the agreement, Greenspan violated nine laws and/or the American Medical Association Code of Ethics and agreed to disciplinary action. He endorsed the agreement which calls for 12 hours of continuing medical education, in the areas of pain management and record keeping, to pay a $1,000 fine and bear all costs associated with the settlement. He is also required, for a period of one year, to provide a copy of the agreement to any employer. The agreement states it halts any further disciplinary action but may be considered should further misconduct occur.
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