Ohio’s largest Medicaid provider cuts ties with Walgreens

https://www.dispatch.com/news/20191025/ohios-largest-medicaid-provider-cuts-ties-with-walgreens

More than half of Ohio’s Medicaid recipients will lose access to Walgreens pharmacies on Jan 1. CareSource, Ohio’s largest Medicaid provider, is cutting ties with the state’s second-largest pharmacy retailer.

Walgreens, Ohio’s second-largest pharmacy retailer, will no longer service the state’s largest Medicaid provider as of Jan 1, raising concerns about creating pharmacy “deserts” in parts of Ohio.

The news, which wasn’t announced by the Ohio Department of Medicaid, comes a week before open enrollment in the insurance program is to begin.

It also raises worries about access for Medicaid patients and about the health of the marketplace. And it raises questions about how well the administration of Gov. Mike DeWine has reformed the way the state Medicaid department reimburses Ohio pharmacies as it spends $3 billion a year on drugs.

“CareSource has decided to move forward with a network that does not include Walgreens for Ohio managed Medicaid patients in 2020,” Walgreens said in an email Friday, referring to Ohio’s largest Medicaid managed-care organization, which serves more than a million recipients. Walgreens remains in the networks of two other managed-care plans: the UnitedHealthcare Community Plan and Paramount Advantage.

State Sen. David Burke, R-Marysville, chairman of the Senate’s Health, Human Services and Medicaid Committee, said the move sends a “very strong signal” that serving Medicaid patients is a money-losing proposition for Ohio pharmacies.

Burke said he has known for weeks that Walgreens was departing.

In a Friday email, state spokesman Kevin Walter said, “Ohio Medicaid has been made aware of a potential change in the CareSource contract, but the change is still under evaluation.”

Dayton-based CareSource serves 1.2 million of the 2.2 million Ohioans who are enrolled in Medicaid managed-care plans. The company also serves Medicaid patients in Indiana, Kentucky, West Virginia and Georgia.

Despite promises by CareSource earlier this year of transparency, the company didn’t say whether Walgreens was departing its pharmacy network. It also wouldn’t say how many of its Ohio clients use Walgreens as their pharmacy. Nor would it say whether Walgreens was leaving its networks in other states.

“CareSource continuously evaluates our provider network to ensure we are offering members excellent access to quality care,” Stephen Ringel, president of CareSource’s Ohio Market, said in an email after news of Walgreens’ departure broke. “We are in the process of reviewing our future plans with Walgreens with the Ohio Department of Medicaid and remain committed to meeting and exceeding all network-access standards while also being good stewards of taxpayer dollars.”

Since last year, The Dispatch has written numerous stories raising questions about whether CareSource’s current pharmacy-benefit manager, CVS Caremark, was providing lowball reimbursements to the corporation’s retail competitors, including Walgreens. In April, CareSource announced that it was dumping CVS Caremark in all the states where it operates and instead was hiring Express Scripts to provide pharmacy benefit manager services such as billing for drugs, reimbursing pharmacies, establishing lists of covered drugs and negotiating rebates from drugmakers.

Despite long-standing complaints that Medicaid reimbursements were so low that they were driving independent pharmacists out of business, Express Scripts in June sent out proposed contracts offering to pay them a dispensing fee of only 15 cents per prescription. The state’s own surveys showed that pharmacists needed $10 to break even. Express Scripts quickly withdrew the proposed contracts. The company declined to comment for this story.

A study commissioned by the state determined that in 2017, PBMs CVS Caremark and OptumRx billed the state $244 million more for Medicaid drugs than they paid to pharmacists.

Time is short to notify patients that they need to find a new pharmacy home, and the Medicaid population can be difficult to contact; some are homeless, some move frequently, some frequently switch phone numbers, and some have no phone, said Antonio Ciaccia of the Ohio Pharmacists Association.

And Sen. Burke, who is a pharmacist, said Medicaid patients tend to be sicker than the general population, so if they stop taking their medicines, they are likely to end up in the emergency room or a hospital bed, which can cost orders of magnitude more than their medicines.

“Those people will be blindsided” by Walgreens’ departure, Burke said.

It’s unclear what might have caused the rupture between Walgreens and CareSource. But if it’s because CareSource’s new PBM, Express Scripts, isn’t offering what Walgreens wants in dispensing fees, that’s an ominous sign for pharmacy access in Ohio, Burke said. Community pharmacies, particularly those with a large Medicaid clientele, have been closing in recent years, often blaming reimbursements that are so low that they’re losing money.

As pharmacies with lots of Medicaid patients close, pharmacists fear that those patients will move to surrounding pharmacies, plunging them into the red and causing a cascade that will result in pharmacy deserts — places where people with transportation challenges would find it difficult if not impossible to see a pharmacist. With Walgreens no longer serving most of its Ohio Medicaid patients, the problem will become far worse, Ciaccia said.

“The patients don’t disappear; they go to other pharmacies,” he said. “My fear is that the independents are taking on too much water and are about to get hit by a tidal wave.”

Because of network-adequacy rules, Burke said that Walgreens’ departure from CareSource might also leave CVS in a position to dictate the prices it wants for Medicaid drugs.

“I don’t know where we’re going to be five years from now,” he said.

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New Florida bill could require a prescription for most sunscreens

https://www.pharmacist.com/article/new-florida-bill-could-require-prescription-most-sunscreens

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Hy-Vee pharmacies implement new opioid prescription policy

https://www.channel3000.com/news/hy-vee-pharmacies-to-limit-quantities-of-opioids/1135442312

WEST DES MOINES, Iowa – Hy-Vee pharmacies will limit opioid prescriptions for treatment of acute pain to seven days starting Thursday, according to a news release.

Hy-Vee Grocery Stores said ​​​​​​the new seven-day limit “does not apply to chronic pain; pain being treated as a part of cancer care, hospice or other end-of-life care; pain being treated as part of palliative care practices; and medications used to treat opioid addiction.” Where state law or a third-party payer requires it, the limit will be less than seven days.

“We want to be part of solution, while continuing to provide needed care for customers,” senior vice president and chief health officer at Hy-Vee Kristin Williams said in a news release.

Hy-Vee said it also offers naloxone, which is used to reverse narcotic overdoses, without a prescription in all eight states where it operates pharmacies: Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin. Naloxone is stored behind the counter and cost varies, the company said.

Hy-Vee also announced that it will be putting drug takeback containers in all 276 of its pharmacies by Nov. 7. The containers give customers a secure place to dispose of unused medications, including controlled substances.

The policy change Thursday comes months after Hy-Vee announced in January that its pharmacies would no longer allow a subsequent fill of a Schedule II controlled substance, or a refill of a Schedule III or Schedule IV controlled substance, more than 72 hours early without authorization from the prescriber.

One of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy and when that change involves a controlled substance it is a violation of the controlled substance act if the licensed prescriber has not done a IN PERSON PHYSICAL EXAM…

According to this https://pharmacy.uiowa.edu/directory/person/kristin-williams-0  senior vice president and chief health officer at Hy-Vee Kristin Williams is just a pharmacist who has worked her way up thru the ranks of the chain pharmacy Hy-Vee and according to this press release she may have been the driving force behind Hy-Vee decision to override the pt’s prescriber determination of what a particular pt’s needs for a controlled substance for acute pain.

Maybe it is time for pts who are affected by such corporate policies start filing complaints with the state’s board of pharmacy and the state’s medical licensing board and maybe the DEA…  Because there seems to be several potential breaking/violations involving the state’s pharmacy practice act, the state’s medical practice act and the Controlled Substance Act.

It would appear from this article and William’s corporate title, she is the person behind this corporate policy, but their is also at each Rx dept a PIC ( Pharmacist in charge) that is responsible to the state’s pharmacy board for the legal operation of the Rx dept…as well as the pharmacist that actually filled a controlled Rx and followed corporate policy to REDUCE the quantity on a pt’s prescription if they exceeded the corporation’s policy on absolute limits on a pt’s prescriptions for no more than 7 days for acute pain… regardless of the pt’s prescriber’s wishes.

Their statement also seems to imply that unless the chronic pain pt is being treated as a part of cancer care, hospice or other end-of-life care; pain being treated as part of palliative care practices; and medications used to treat opioid addiction… not all chronic pain pts are part of palliative care… but of course, those receiving medications for the treatment of opiate addiction… gets a automatic “pass” on days supply limits.

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Fentanyl is the deadliest drug in the US, but in some places, meth kills more

https://www.cnn.com/2019/10/25/health/fentanyl-deadliest-drug/index.html

Fentanyl remains the deadliest drug in the United States. But in some areas of the country, methamphetamine kills more people.

A new report from the US Centers for Disease Control and Prevention’s National Center for Health Statistics found that fentanyl is the drug most commonly identified in fatal overdoses. In 2017, fentanyl was associated with 38.9% of all drug overdose deaths, an increase from 2016, when it was associated with 29% of all fatal overdoses. This is the second year that CDC analyzed fatal overdoses in this way.

In 2017, heroin was associated with 22.8% of all fatal overdoses. Cocaine, a stimulant, was involved in 21.3% and methamphetamine, also a stimulant, was involved in 13.3%.

Other drugs linked to overdose deaths were benzodiazepines; diphenhydramine, an antihistamine; and gabapentin, an anticonvulsant.

While fentanyl was the most common drug involved in fatal overdoses nationally, there was a geographic divide, the report said. Fentanyl was the drug most likely to be involved in overdoses in states in the eastern United States, but methamphetamine was the drug most associated with overdoses in the western half of the country.

According to the CDC, overdoses death rates involving psychostimulants, including methamphetamines and cocaine, have been rising since 2010. In 2017, the number of people dying from overdoses involving psychostimulants rose above 10,000, an increase of 37% from the year before.

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Methamphetamine was the drug most frequently involved in overdose deaths in the regions that include Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming, Arizona, California, Hawaii and Nevada and Alaska, Idaho, Oregon and Washington.

Typically, fentanyl, along with white powder heroin, has been more common east of the Mississippi River, and Mexican black tar and brown powder heroin has been more commonly found west of the Mississippi.

In 2017, the latest year for which complete data is available, more than 70,000 people died from drug overdoses. Opioids such as fentanyl and heroin represented about 68% of those deaths.

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https://www.congress.gov/bill/115th-congress/house-bill/6/all-actions?overview=closed&q=%7B%22roll-call-vote%22%3A%22all%22%7D

DEA Channels Stalin: ‘Suspicious Orders’ of Opioids? Just Say Nyet

https://www.acsh.org/news/2019/10/25/dea-channels-stalin-suspicious-orders-opioids-just-say-nyet-14356

Filed under: General Problems | 25 Comments »

DEA Is About to Demonstrate “How Little They Know About What They Imagine They Can Design”

https://www.cato.org/blog/dea-about-demonstrate-how-little-they-know-about-what-they-imagine-they-can-design

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New technologies have potential to prevent HAIs

https://www.healio.com/infectious-disease/nosocomial-infections/news/print/infectious-disease-news/%7B521b9799-cd2c-4872-b444-b34ced54ee6b%7D/new-technologies-have-potential-to-prevent-hais

Curtis J. Donskey, MD, and colleagues at the Louis Stokes Cleveland VA Medical Center had a novel idea to prevent some infections in their facility.

During influenza season, patients entering the hospital coughing and sneezing can use one of the many available touchscreens to check in.

“Dozens of people in the course of the day will be touching the same screen and they are very seldom practicing hand hygiene after doing that. And what we asked is if we could come up with some automated way to decontaminate the screens with each use — that could be a useful technology,” Donskey, an infectious disease physician at the hospital and professor of medicine at Case Western Reserve University, told Infectious Disease News.

The idea inspired the creation of an automated device that uses ultraviolet C light as a disinfectant to clean the touchscreens. A prototype of the device was designed by a scientist and then tested by Donskey. In his experiments, Donskey found that the UV-C device, which was designed to automatically scan the touchscreen after patient use, reduced the transmission of viruses from contaminated screens to fingertips in simulations.

Curtis J. Donskey

The UV-C touchscreen cleaner is just one of many new technologies that have been developed and tested recently to prevent health care-associated infections (HAIs).

‘One jumbo jet’s worth of people’

Although the prevalence of HAIs in hospital patients in the United States decreased from 4% in 2011 to 3.2% in 2015, they remain a significant issue for patients and health care facilities.

Each year, about 2 million Americans contract an HAI and between 75,000 and 100,000 die from one, Michael G. Schmidt, PhD, professor of microbiology and immunology at the Medical University of South Carolina, told Infectious Disease News. Broken down, that means almost 300 Americans may die every day from an HAI.

“If one plane, a jumbo jet, crashed each day in the United States, would anybody fly? The answer is no. That is precisely the number of U.S. citizens who die each day from a health care-associated infection. One jumbo jet’s worth of people,” Schmidt said.

Additionally, he noted the large financial burden, observing that HAIs may cost taxpayers an estimated $150 billion per year, according to a study published in the Journal of Medical Economics.

“Imagine what we could do if we just cut that rate by 10%,” Schmidt said. “What could we do with $15 billion?

New technologies

Different types of technologies aimed at decreasing the risk for HAIs have emerged in recent years, Hilary M. Babcock, MD, MPH, president of the Society for Healthcare Epidemiology of America and professor of medicine at Washington University School of Medicine, told Infectious Disease News.

“These technologies definitely have the potential to transform care for our patients,” she said.

Hilary M. Babcock

Many of the newer technologies use environmental decontamination to prevent the transmission of pathogens, Donskey said. Efforts have focused on developing novel disinfectants and delivery methods, no-touch devices and antimicrobial surfaces.

Bleach and quaternary ammonium disinfectants are the standard cleaning products used in hospitals. However, quaternary ammonium does not inhibit Clostridioides difficile, and bleach — while effective — can damage surfaces and irritate some patients, according to Donskey. Peracetic acid-based disinfectants have been developed as a modified solution and have been found to be effective at destroying spores and less harmful to surfaces, he said.

Because wiping down surfaces mechanically is not efficient for disinfecting irregular surfaces or an entire room, new delivery methods have been investigated, Donskey said. For example, electrostatic spraying devices might allow for more rapid and effective decontamination, he said.

Moreover, no-touch technologies are gaining traction, the most common of which are UV devices, according to Donskey. Many different UV devices have been created to decontaminate patient rooms and equipment, such as CT tables, tablets, keyboards and stethoscopes, and have demonstrated efficacy in reducing pathogens. One study published in The Lancet showed that adding UV-C light to standard terminal cleaning strategies reduced the likelihood that patients would acquire the same infection as the previous patient by 30%.

Antimicrobial surfaces also have been shown to be useful in helping rid hospital rooms of pathogens, Schmidt said. One study demonstrated that placing copper surfaces on significant touch points in the patient care environment decreased the rate of HAIs by 58%, he noted.

Many more technologies have demonstrated the ability to prevent the spread of pathogens, including novel sink drain covers, electronic hand hygiene monitors — including voice-based monitors that remind clinicians to sanitize their hands — antimicrobial catheters and antimicrobial textiles, such as surgical scrubs, hospital curtains and bed linens.

“All of these technologies are intended to prevent a wide range of infections, from common bacterial pathogens, such as C. difficile and MRSA, to fungal infections, such as Candida auris, that may be associated with contaminated surfaces,” Donskey said.

Implementation within hospitals

The move to implement new technologies in hospitals has been gradual, but more and more facilities are using them, especially UV room decontamination devices, Donskey said. In fact, a survey of health care facilities in the U.S. and 11 other countries showed that, in 2018, 37% of facilities reported using UV light for environmental cleaning.

Babcock said most infection preventionists are aware of the new technologies. The companies that manufacture them will often exhibit them at hospitals and conferences. Hospitals will consider the devices and their claims for prevention and purchase them if they are well suited for their specific needs, she said.

“One of the challenges for a lot of these technologies is to show a direct link between the use of that device and an actual decrease in infections in patients. A lot of these kinds of technologies clearly do decrease the amount of bacteria on a surface, but it can be difficult to prove that using this kind of device or technology can actually decrease infections in patients,” Babcock said.

Plus, not every hospital is in need of these types of new technologies.

“If a hospital has already done a lot of work with preventing infections after surgery then maybe they don’t need a special dressing to prevent this problem in their patients,” Babcock said.

Whether the new technologies have a significant benefit compared with emphasizing standard infection control measures is also up for debate, Donskey said. A great deal of effort goes into introducing any new technology into a hospital. Costs go up, and training health care workers to use them can be time consuming, he said. Hospitals may see a comparable reduction in infections by investing the same amount of time in improving standard infection control strategies than they would in implementing a new technology, he noted.

Regardless, the No. 1 thing that physicians and patients can do to prevent HAIs is wash their hands whenever they go in and out of a hospital room, Schmidt said.

“Simple things like practicing good hand hygiene make all the difference in the world at reducing the rate,” he said.

Infection prevention mostly relies on health care providers doing things correctly while providing care to patients, Babcock said.

“HAIs kill more people than HIV and breast cancer combined,” Schmidt said. “If we had tools like UV light, copper and hand hygiene monitors to alleviate breast cancer and HIV, we’d be out there cornering the market to end those diseases.” – by Alaina Tedesco

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Medical Board Corruption is violating Your Constitutional Rights!

https://www.change.org/p/dr-arnold-feldman-medical-board-corruption-is-violating-your-constitutional-rights

Feldman v Federation
                                               Patient Petition

              For Patients and their families, friends and loved ones
 
 
We, the undersigned, submit this petition in support of the above lawsuit, filed by Drs. Feldman and Kaul. We are the patients, the people without whom the American healthcare system would not exist, and the people for whom the system was intended to serve. We all suffer from chronic debilitating pain, that has had devastating and tragic consequences on our lives, and those of our fathers, mothers, brothers, sisters and children. We, the voting public, the people of this country, have been forgotten by the politicians, the insurances companies and healthcare corporations, who have raped our healthcare system for profit, mercilessly and behind their faceless corporations, have, through their predatory pricing deprived us of life saving care. We are dying and no one cares, except our doctors, healers like Drs. Feldman and Kaul.
 
Within at least the last five years, our access to life saving treatment has been either severely reduced or completely eliminated. This is a direct consequence of rampant corruption within state medical boards and reckless, evidentially unsupported policies propagated by politically motivated state and federal bureaucrats. These agencies and the people who work within them do not care for our welfare, our lives and the unrelenting pain in which we now live, because of their own selfish economic and political agendas. We wake in pain, we live in pain, and when we can actually go to sleep, we know that our relief will be short lived. Many of us think about suicide every day. At least in death we will have relief from the excruciating agony that now plagues our existence, because corrupt medical boards have taken away the licenses of our doctors, and deprived us of care. For some of us, our doctors have been sent to jail for life, for simply doing their job, that of healing our pain. We are shocked, saddened and find it hard to believe we live in America, the supposed land  of the free and the brave. Well those brave enough to treat our complicated and debilitating pain have been mercilessly thrown into concrete cages, had their careers destroyed and left to rot, while we, and there are now many of us, have been abandoned by the profiteers and opportunists who now run our healthcare system. At the center of this cesspool of corruption are the state medical boards, who claim to “protect the public”. This is a massive lie.
 
These agencies abuse their power, unregulated, unsupervised and existing not to help the public, but to exploit and profit from the public, us. They use us as their excuse, their cover, to perpetrate their crimes against humanity. Their crimes contribute to the epidemic of physician suicides in the United States, reported as four hundred a year, although the number is likely much higher, and they kill patients, by taking away our doctors, jailing our doctors and causing them to commit suicide. Corrupt medical boards have permitted corrupt insurance companies, pharmaceutical companies and healthcare corporations to financially rape the American public, dictate local healthcare policy, and revoke the licenses of our doctors in the most cruel and arbitrary manner, with no regard for due process or the law. All of these events have caused us and our families immense suffering, and for too long we have suffered in silence, hoping that eventually sense would prevail, that our doctors would start to take care of us once again, without fear of jail or license revocation. We now see that hope in the lawsuit that Drs. Feldman and Kaul are about to file. We see two dedicated, courageous and committed men, whose fight is a righteous one, one for the people, for us, the American people, the people who pay taxes, who vote and who power, we are convinced, will cause Drs. Feldman and Kaul to prevail in their landmark case to end medical board corruption.
 
We will be victorious in our fight for justice.

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Study: Chocolate chip cookies as addictive as cocaine

https://www.wowktv.com/news/u-s-world/study-chocolate-chip-cookies-as-addictive-as-cocaine/

BORDEAUX, France (WIAT) — Having a hard time staying away from the cookie jar? According to the smart cookies behind a recent study, there’s a reason you can’t deny your sugar cravings.

Researchers at the University of Bordeaux say the combination of ingredients in a traditional chocolate chip cookie trigger the same addictive response in your brain as cocaine or marijuana.

“Overall, this research has revealed that sugar and sweet reward can not only substitute to addictive drugs, like cocaine but can even be more rewarding and attractive,” the study’s abstract posits.

Like your cookies with a dash of salt? Your brain does too. Salt consumption activates the brain’s reward centers, compounding the already addictive effects of these chocolaty treats.

So the next time your cookie cravings compel you to act against your better judgment, don’t beat yourself up about it. It’s basically a natural human response, the study shows.

Chocolate chip cookies account for about a fifth of the global cookie market, which is expected to become a $38 billion industry by 2022.

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Last-ditch opioid settlement in Ohio could open door for much larger deal

https://www.washingtonpost.com/health/ohio-counties-drug-firms-reach-260m-settlement-averting-trial/2019/10/21/c9ac1dd4-f39f-11e9-ad8b-85e2aa00b5ce_story.html

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