“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
I’ve been trying to get this issue resolved since last week, but I guess since CVS doesn’t want to respond I’m guna post this.
You should get your flu vaccine. But maybe be careful getting it at CVS since they think putting clean gloves and syringes full of vaccines on the floor is acceptable. There were four people getting vaccines but when he put the stuff on the floor one person said never mind and walked away. I’ll make it public if CVS doesn’t respond by tonight. That’s just nasty, at least get a table.
Edit: I got an email from CVS apologizing for not reaching back out. They said the store manager reviewed video from surveillance and confirmed that what I said did in fact happen (since some people are saying he was just cleaning up a mess he dropped, which is not what happened).
However. Situation still not solved. They said, “He has spoken with the Pharmacy Manager about follow up and appropriate practices.” I still want to know what are appropriate practices and what was done to make sure this won’t happen again. I’ll update again when we get in touch again, I doubt they will reply before Monday so…
Less than 10 percent of overdoses from prescription pain pills in 2017 did not involve other drugs. File Photo by Stevepb/Pixabay
April 24 (UPI) — John Oliver is a brilliant comedian with a large platform, and he has been using it of late to demonize the pharmaceutical companies that produce opioids. Major targets of his attack are Purdue Pharma and its Sackler family principals, developers of OxyContin, which, until around 2010 was a drug of choice for non-medical users.
Like the tobacco companies in the 1990s, it is understandable to focus indignation at companies, driven by the profit motive, that purvey products that can cause harm and even death. It is reasonable to question and criticize their marketing ethics and aggressiveness.
But at the end of the day, extracting a pound of flesh from the Sacklers won’t stop the overdose rate from climbing. That’s because the standard narrative that overprescribing of opioids caused the overdose crisis is based upon misinformation — as is the belief that opioids have a high overdose and addiction potential.
Data from the National Survey on Drug Use and Health, as well as the Centers for Disease Control and Prevention, clearly show no correlation between the number of opioid prescriptions dispensed and “past month non-medical use” or “pain reliever use disorder” among adults over age 12. As high-dose opioid prescriptions dropped 58 percent from 2008 to 2017 and overall prescriptions dropped 29 percent in that time period, the overdose rate continued to climb. Decreasing the availability of prescription pain relievers for diversion into the black market only drives non-medical users to more dangerous heroin and fentanyl.
In 2017, heroin and fentanyl comprised 75 percent of opioid-related overdose deaths. Deaths from prescription pain pills also involved drugs like cocaine, heroin, fentanyl, alcohol and benzodiazepines 68 percent of the time. Less than 10 percent of overdoses from prescription pain pills in 2017 did not involve other drugs.
Opioids prescribed in the medical setting have been repeatedly shown to be safe. Researchers following over 2 million North Carolina patients prescribed opioids noted an overdose rate of 0.022 percent, and nearly two-thirds of those deaths had multiple other drugs in their system. A 2011 study of chronic pain patients treated in the Veterans Affairs system found an overdose rate of 0.04 percent. A larger population study found an overdose rate of 0.01 percent.
Researchers at Harvard and Johns Hopkins universities recently found a total misuse rate of 0.6 percent in over 560,000 patients prescribed opioids for acute and post-op pain between 2008 and 2016. Cochranestudies, highly regarded for their rigor, found addiction rates in chronic pain patients on opioids of roughly 1 percent.
People often mistakenly equate physical dependency with addiction. Physical dependency is seen with a variety of drugs, including antidepressants, anti-epileptics, and beta blockers. A person can be slowly weaned off these drugs. But addiction is a compulsive behavioral disorder with a genetic component featuring repeated use despite self-destructive consequences. The director of the National Institute on Drug Abuse points out in a 2016 paper that true opioid addiction “occurs in only a small percentage of persons who are exposed to opioids — even in those with pre-existing vulnerabilities.”
As researchers at the University of Pittsburgh recently demonstrated, non-medical use has been on a steady exponential increase at least since the mid-1970s and shows no signs of slowing down. The only things that have changed over the years are the drugs in vogue for non-medical use. It seems sociocultural factors are at play. In fact, young people seem more willing to engage in risky drug use than their predecessors. A 2017 study showed 33.3 percent of heroin users initiated with heroin.
At the end of the day, the drug overdose problem is the result of sociocultural dynamics intersecting with drug prohibition — and all the dangers that a black market in drugs present. Prohibition also presents powerful incentives to corrupt doctors, pharmacists and pharmaceutical representatives who seek the profits offered by the underground trade.
When Portugal decriminalized all drugs in 2001, it saw a 75 percent drop in its population of heroin addicts by 2015, and now has the lowest overdose rate in Europe, at 6 per million population (compared to 312 per million in the United States). Along with Portugal, most of the developed world has put an emphasis on harm reduction strategies over restrictionist, prohibitionist approaches, one reason they have lower death rates than the United States. These strategies include medication-assisted treatment with drugs like methadone and buprenorphine; safe injection facilities; needle-exchange programs; and making the overdose antidote naloxone more available.
None of this is meant to defend the conduct of a few pharmaceutical companies or those who work for them. It is meant to refocus energy and anger where it belongs.
The real villain is the war on drugs. Yet it’s getting off scot-free.
Dr. Jeffrey A. Singer is a general surgeon in Phoenix and a senior fellow at the Cato Institute.
April 24 (UPI) — John Oliver is a brilliant comedian with a large platform, and he has been using it of late to demonize the pharmaceutical companies that produce opioids. Major targets of his attack are Purdue Pharma and its Sackler family principals, developers of OxyContin, which, until around 2010 was a drug of choice for non-medical users.
Like the tobacco companies in the 1990s, it is understandable to focus indignation at companies, driven by the profit motive, that purvey products that can cause harm and even death. It is reasonable to question and criticize their marketing ethics and aggressiveness.
But at the end of the day, extracting a pound of flesh from the Sacklers won’t stop the overdose rate from climbing. That’s because the standard narrative that overprescribing of opioids caused the overdose crisis is based upon misinformation — as is the belief that opioids have a high overdose and addiction potential.
Data from the National Survey on Drug Use and Health, as well as the Centers for Disease Control and Prevention, clearly show no correlation between the number of opioid prescriptions dispensed and “past month non-medical use” or “pain reliever use disorder” among adults over age 12. As high-dose opioid prescriptions dropped 58 percent from 2008 to 2017 and overall prescriptions dropped 29 percent in that time period, the overdose rate continued to climb. Decreasing the availability of prescription pain relievers for diversion into the black market only drives non-medical users to more dangerous heroin and fentanyl.
In 2017, heroin and fentanyl comprised 75 percent of opioid-related overdose deaths. Deaths from prescription pain pills also involved drugs like cocaine, heroin, fentanyl, alcohol and benzodiazepines 68 percent of the time. Less than 10 percent of overdoses from prescription pain pills in 2017 did not involve other drugs.
Opioids prescribed in the medical setting have been repeatedly shown to be safe. Researchers following over 2 million North Carolina patients prescribed opioids noted an overdose rate of 0.022 percent, and nearly two-thirds of those deaths had multiple other drugs in their system. A 2011 study of chronic pain patients treated in the Veterans Affairs system found an overdose rate of 0.04 percent. A larger population study found an overdose rate of 0.01 percent.
Researchers at Harvard and Johns Hopkins universities recently found a total misuse rate of 0.6 percent in over 560,000 patients prescribed opioids for acute and post-op pain between 2008 and 2016. Cochranestudies, highly regarded for their rigor, found addiction rates in chronic pain patients on opioids of roughly 1 percent.
People often mistakenly equate physical dependency with addiction. Physical dependency is seen with a variety of drugs, including antidepressants, anti-epileptics, and beta blockers. A person can be slowly weaned off these drugs. But addiction is a compulsive behavioral disorder with a genetic component featuring repeated use despite self-destructive consequences. The director of the National Institute on Drug Abuse points out in a 2016 paper that true opioid addiction “occurs in only a small percentage of persons who are exposed to opioids — even in those with pre-existing vulnerabilities.”
As researchers at the University of Pittsburgh recently demonstrated, non-medical use has been on a steady exponential increase at least since the mid-1970s and shows no signs of slowing down. The only things that have changed over the years are the drugs in vogue for non-medical use. It seems sociocultural factors are at play. In fact, young people seem more willing to engage in risky drug use than their predecessors. A 2017 study showed 33.3 percent of heroin users initiated with heroin.
At the end of the day, the drug overdose problem is the result of sociocultural dynamics intersecting with drug prohibition — and all the dangers that a black market in drugs present. Prohibition also presents powerful incentives to corrupt doctors, pharmacists and pharmaceutical representatives who seek the profits offered by the underground trade.
When Portugal decriminalized all drugs in 2001, it saw a 75 percent drop in its population of heroin addicts by 2015, and now has the lowest overdose rate in Europe, at 6 per million population (compared to 312 per million in the United States). Along with Portugal, most of the developed world has put an emphasis on harm reduction strategies over restrictionist, prohibitionist approaches, one reason they have lower death rates than the United States. These strategies include medication-assisted treatment with drugs like methadone and buprenorphine; safe injection facilities; needle-exchange programs; and making the overdose antidote naloxone more available.
None of this is meant to defend the conduct of a few pharmaceutical companies or those who work for them. It is meant to refocus energy and anger where it belongs.
The real villain is the war on drugs. Yet it’s getting off scot-free.
Dr. Jeffrey A. Singer is a general surgeon in Phoenix and a senior fellow at the Cato Institute.
After hundreds of chronic pain patients begged the Drug Enforcement Administration (DEA) to reconsider its proposed cuts to opioid production, the agency told Newsweek it’s not responsible for their inability to get prescriptions.
If the DEA adopts the cuts, they would reduce production of some of the most commonly prescribed opioids in the United States for the fourth year in a row, drastically cutting fentanyl and oxymorphone, by 31 percent and 55 percent, respectively, as well as hydrocodone (19 percent), hydromorphone (25 percent) and oxycodone (9 percent).
These cuts should have no bearing on the decisions made by caregivers and their “legitimate pain patients,” according to the DEA.
It’s possible patients are getting caught in the crossfire from a flurry of recent federal policies aimed at culling illegal abuse of the drugs, but it’s not clear which policy, if any, is at fault for their reported lack of access.
Tablets of oxycodone from a prescription. A recent DEA proposal would reduce production of some of the most commonly prescribed opioids in the United States for the fourth year in a row.Eric Baradat/Getty images
In proposing the aggregate production quota, the DEA looks at the total amount of substances needed to meet the country’s medical, scientific, industrial and export needs for the year, including dispensed prescriptions, the DEA told Newsweek in a statement. That means the agency’s production limits should match, not control, demand.
The DEA “does not regulate the practice of medicine. We do not get between a doctor and his or her patient,” a DEA spokesperson said. “We also want legitimate pain patients, their families and caregivers to know that DEA does not seek to limit or take away their vital prescriptions.”
The cuts over the past few years are an attempt to change course after the DEA allowed drugmakers to ramp up opioid production between 2003 and 2013, the same period when more than 140,000 people perished from overdoses in the United States.
The Department of Health and Human Services (HHS) and the surgeon general have implemented their own agenda to combat the opioid epidemic, issuing strict guidelines for doctors prescribing the drugs in 2016. On October 10, the Trump administration told physicians to use more caution in applying the guidelines, following widespread reports that people were cut off their prescriptions or even turned away, according to The New York Times.
It’s possible the guidelines, or the general stigma now associated with prescription painkillers, have led to the tapering off of supply reported by many chronic pain patients to the DEA. One patient, a stroke survivor, said he took prescription opioids without problems until 2017, when he said federal regulations made the drugs too hard to obtain. Since then, medical cannabis has helped but became less effective when his condition deteriorated. Now, he can’t travel or leave his home much because of the pain.
In 2018, an investigation by former Missouri Senator Claire McCaskill exposed financial ties between some of the world’s biggest producers of painkillers and third-party advocacy groups. Purdue Pharma, Mylan, Janssen Pharmaceuticals and other major drugmakers donated more than $10 million to patient advocacy groups like the National Pain Foundation, the American Geriatrics Society and the American Chronic Pain Association.
What a bunch of CRAP… the quote from the DEAthe agency told Newsweek it’s not responsible for their inability to get prescriptions.
Has no one else noticed that the DEA has moved from the number of “dead bodies” associated with a medical practice to the number of millions of doses that a prescriber has prescribed to raid a practitioner’s practice ?
Sometimes that not only post the time frame where they come up with these “millions of doses” and make the mistake to state the number of pts involved. Often they claim that the prescriber is ILLEGALLY PRESCRIBING opiates when the average dose in ONE DOSE/DAY for each one of the pt.. When acceptable standard of care and best practices would suggest that a intractable chronic pain pt could take UP TO SEVEN DOSES A DAY.
What seems to be happening is that the Supreme Court recently questioned the constitutionality of the Civil Asset Forfeiture law… so it would seem that the DEA has changed its tactics as declaring a prescriber’s Rx written as illegal… so that they are going after “clawing back” all the payment made by Medicare and Medicaid to the prescriber and that may well be their “goose laying golden eggs” future of the DEA when the Supreme Court eventually declares Civil Asset Forfeiture act TOTALLY UNCONSTITUTIONAL !
Some states have passed laws that their judicial system cannot seize assets without the person being found guilty… but… it is claimed that when there is assets that could be seized…the state’s legal system will call in the DEA for assistance – so that they can seize the assets and SOMEHOW… some of those seized assets tend to find their way back to the state’s judicial system… either thru a “back door” or “under the table”…
Loveline co-host talks about Dr Drew’s on-air drug-taking – Daily Mail
Last night Dr. Drew admitted ‘I did drugs and alcohol when I was 22, 23 years old…I went round denying it because my kids were younger.’ But he neglected to say that he came forward after Daily Mail Online asked for comment after its exclusive investigation into Pinsky’s drug use. The HLN star has misled tens of millions of people about his drug past. According to friends, the former Celebrity Rehab and Sober House hostsnorted thick lines of cocaine on a weekly basis on hit KROQ radio show Loveline in the 1980’s (at right with former co-host DJ Jim ‘Poorman’ Trenton), snorted the drug from album covers and mirrors in the studio and once shared lines of coke with a teenage girl and her friends. Pinsky has been quick to judge drug users over their behavior. In an HLN discussion of addict Toronto Mayor Rob Ford, he said: ‘His denial and obfuscation is classic alcoholic behavior.’ Original Article: http://www.dailymail.co.uk/news/artic… Original Video: http://www.dailymail.co.uk/video/news… Daily Mail Facebook: http://facebook.com/dailymail Daily Mail IG: http://instagram.com/dailymail Daily Mail Snap: https://www.snapchat.com/discover/Dai… Daily Mail Twitter: http://twitter.com/MailOnline Daily Mail Pinterest: http://pinterest.co.uk/dailymail Daily Mail Google+: https://plus.google.com/+DailyMail/posts Get the free Daily Mail mobile app: http://dailymail.co.uk/mobile
Rhonda Cree has diabetes, significant vision loss, and high blood pressure. Cree, 61 years old, is one of 65 million Americans who relies on Medicaid to cover her prescriptions and other healthcare costs. But Cree lives in the town of Logansport in north-central Indiana. Unlike most states, Indiana requires her to pay monthly premiums for Medicaid.
Last November, Cree and her husband were going through a particularly difficult time financially, and she was unable to pay her full monthly premium. The state stopped her coverage and barred her from reapplying for six months. During that time, Cree was forced to skip prescribed injections, and suffered more vision loss as a result.
Mike Pence’s plan is working exactly as he hoped.
Before Pence ascended to the national stage as Vice President and he recruited his longtime ally Seema Verma to lead the Center for Medicare and Medicaid Services, they together crafted a unique Indiana approach to Medicaid. Their goal was to reshape the 54-year-old program into something far smaller and more punitive. The Healthy Indiana Plan, they promised, would demand “skin in the game” from enrollees like Rhonda Cree.
Medicaid works as a federal-state partnership, with the federal government paying most of the cost and the states agreeing to follow guidelines set at the national level. All U.S. states have agreed to the terms, and Medicaid accounts for almost one-fifth of the country’s personal healthcare spending.
The platform for Pence and Verma’s ambitious remodeling of Medicaid was provided by the Affordable Care Act of 2010’s invitation to states to significantly expand their Medicaid coverage. Under the ACA, all adults in households whose income is less than 133% of the federal poverty level, a little under $17,000/year for an individual, would be eligible for Medicaid. But, in 2012, the U.S. Supreme Court in the case of National Federation of Independent Business v. Sebelius ruled that Congress did not have the authority to demand that states expand Medicaid, although states could do so if they wished. For Republican state officials like then-Indiana governor Pence, the ruling created a dilemma.
On one hand, Pence was a vocal opponent of the ACA and Medicaid. “We are going to use every means at our disposal to oppose this (ACA) government takeover of health care,” he said. Of Medicaid, he pronounced, “The sad truth is that traditional Medicaid is not just broke, it is broken.” But the ACA included a tantalizing offer for Indiana and other states: if they expanded Medicaid coverage as the new law called for, the feds would pay the full cost of the initial expansion, and 90% of the cost after that. Pence’s constituents, most notably the well-connected leaders of Indiana hospital systems that would benefit from more of their patients being covered by Medicaid, pushed him to accept the deal.
Caught between his ideology and political pressure, Pence turned for help to Verma, a former Indiana hospital administrator who had launched her own consulting firm. Verma had already gained a reputation for taking a conservative approach to public healthcare systems, earning contracts from multiple state agencies and private companies. She earned praise for avoiding the “fatal mistake of making everything free,” as Pence’s predecessor Mitch Daniels put it.
At Pence’s request, Verma took the lead in crafting a version of Medicaid expansion that would look less like a government program than a high-deductible insurance plan offered by the for-profit insurance industry. The Healthy Indiana Plan, Pence promised, would be a “hand-up, not a hand-out.” It would demand healthy behaviors and personal responsibility from low-income Hoosiers, or they would face dire consequences.
Premiums, Lockouts, and Copayments
Under the Medicaid Act, the U.S. Secretary of Health and Human Services can waive some Medicaid requirements for states that wish to experiment with new approaches, as long as those approaches promote the objectives of the overall program. In 2014, Pence and Verma asked for a federal waiver to implement their reimagined version of Medicaid.
Indiana wanted to accept the ACA Medicaid expansion offer of near-total federal funding, they said, but only if the state could require enrollees to pay monthly premiums to private insurance companies that contract with the state, and terminate non-compliant enrollees like Rhonda Cree, and lock them out of coverage for failure to pay. Pence and Verma also wanted to demand copayments, even for emergency services and even from the lowest-income persons on Medicaid.
Past Medicaid waivers had been granted to states seeking to make small tweaks to the program, but the Indiana terms were something far more sweeping. The Pence-Verma plan ran counter to decades of Medicaid practices, and to the research consensus that cost sharing for healthcare was often quite harmful, especially to persons with chronic illnesses. Imposing user fees on the poor has proven to be “a prescription for death,” says physician and Harvard Medical School instructor Adam Gaffney.
Now it was the Obama administration that faced a dilemma. After the Sebelius ruling, many other Republican-led states were refusing to expand Medicaid. Seventeen states still have not done so. Even the Healthy Indiana Plan’s restricted version would expand coverage to hundreds of thousands of people in the state. Indiana healthcare advocates did not like the punitive Healthy Indiana Plan approach, but told federal administrators that the Pence-Verma half-loaf was better than none. The Obama administration approved the waiver.
The Pence-Verma version of Medicaid fulfilled each side’s predictions. The Healthy Indiana Plan has covered as many as 400,000 persons, most of whom otherwise would not have healthcare coverage at all. But, in the first two years of the program, over 70,000 people who failed to make premium payments were either kicked off coverage or never able to start coverage at all. Amber Thayer, a homeless Indianapolis mother of an infant child, was removed from coverage after her premium payment went to the wrong insurance company. Thayer was forced to spend weeks buying her medication one dose at a time, a new purchase every day, because that was all she could afford.
Next week: In Part Two of two, Pence and Verma ascend to the national stage, and push their Indiana version of Medicaid to be the national model, adding in restrictive work requirements to an approach designed to undercut the Affordable Care Act their boss has vowed to destroy.
Nearly every day I check “Memories” that FB posts on my page… and I see names of people who have “liked” my page and/or started following me… and many of the names I don’t have a clue who they are or they never interact with my FB page at all.
I see the same couple of dozen people posting on FB and I notice that many people “like” the comment but few SHARE… or I see the same person posting the same thing on multiple FB pages… Nothing makes me more happy than go thru FB notices to only find the same post over and over from the same person. To “like” a comment only allows FB to collect data points on you for their database… that they are selling to anyone who wants to put up the money.
Does this suggest that we have TOO MANY FB pages devoted to trying to deal with pain ?
Many of these FB groups are “CLOSED/PRIVATE” and they made a post and suggest that it be SHARED….YOU CAN’T SHARE FROM A CLOSED GROUP !!!
One chronic painer asked me the other night if we should post something about supporting some doc that is getting drug thru the DEA swamp… and my immediate response is why aren’t the doctors financially supporting the defense of their colleagues ?
It has been stated that there are some 100 million chronic pain pts and that 80% are struggling financially because of their inability to work, the other spouse took off and/or the cost of their therapy.
So does that mean that there is 20% of the chronic pain pts may have a few dollars to spare… that would be 20 million ? I see on TV a lot of non profit groups asking for JUST $19/month for their cause… Doesn’t anyone realize just what JUST $10/month from 20 million could do for a legal defense fund ?
Start hiring a PR firm, Lobbyists and law firms to get the message out that our government is actively participating in a covert genocide and suiting those healthcare corporations that are supporting this genocide.
There are other political parties besides Democrats and Republicans and it only takes about 65 million votes to get a person elected President… abt HALF the number claimed chronic pain pts… not counting their spouses and kids old enough to vote.
IMO… the chronic pain community needs to get their act together… that includes their dollars and their votes… In the EIGHT YEARS of my blog.. things have not gotten any better and in reality probably got a lot worse and we are near the end… because many of you are still breathing and having the healthcare system spend money on your treatments.
Get you head out of the sand and quit all the whining… bitching .. and moaning…
Many years ago, Bay Area TV commentator Wayne Shannon — remember Wayne Shannon? — told us he supported the dumping of vast quantities of nuclear waste into the ocean just off San Francisco, into the Farallones National Marine Sanctuary.
Offended viewers responded en masse. But they were missing the point.
Shannon’s rationale was that someone had to be in favor of dumping nuclear waste into a wildlife sanctuary — because, you know, we did that.
So, your humble narrator supports California’s cunning plan to bankrupt local pharmacies and, in the process, deprive patients of medications for AIDS, Hepatitis-C, psychotic disorders and other maladies — leading to a potential humanitarian crisis and, likely, costing far more money than the state stands to save in the short-term.
Someone has to be in favor of that. Because, you know, we’re doing that.
On a recent weekday morning at Mission Wellness Pharmacy, all appears well. It’s a shade chilly, immaculately clean, and there is, understandably, a dry, medicinal odor in here befitting a place with prescription bottles stacked nearly eight feet high.
Mission Wellness isn’t an old-school pharmacy in the soda fountain and Norman Rockwell sense, but it does offer anachronistically extensive counseling and individualized day-by-day packaging of patients’ complicated multi-drug doses. And it does it all in several languages for, on this day, a guy who looks like he stumbled in from street — because he probably did.
This pharmacy has a contract with the Department of Public Health to provide patients — often indigent patients on Medi-Cal — with the complex and expensive drugs it takes to fight AIDS and Hep-C; Mission Wellness also provides mental health patients with injectable antipsychotic medications.
Separate and apart from basic human decency — helping people suffering from preventable and treatable diseases — there is a bottom-line, cost-saving motivation here. It’s cheaper to keep people healthy and treated than to deal with them, repeatedly, in the Emergency Room.
And yet all is not well here. Mission Wellness is hemorrhaging money. Its proprietor, Maria Lopez, informs me that the state summarily sucked some $30,200 out of her account in May. This is money that isn’t going toward helping indigent patients or buying medications but paying back a debt the state claims Lopez — and scads of other independent pharmacists — now owe the government.
“For a small business, that’s a big hit,” Lopez confirms. And this was just the first of many proposed payments to the state.
Maria Lopez, Pharm.D, at Mission Wellness has been forced to subsidize AIDS, HIV, Hep-C, and other patients out of her pocket for months. This, she says, is not a tenable situation. Photo by Joe Eskenazi.
This is happening because, after two years of analysis, the state has determined it will reimburse pharmacies, like Lopez’s, at a lower rate than pharmacies pay for wholesale “specialty drugs” for complicated maladies.
According to numbers provided by the California Pharmacists Association, an advocacy and lobbying group, a pharmacist providing a Medi-Cal patient with the HIV drug Atripla will now lose $123 a year, per patient. A pharmacist providing a Medi-Cal patient with the schizophrenia/bipolarity drug Ziprasidone will lose $533 per year per patient. And a pharmacist providing the injectable antipsychotic drug Aristada will lose $816 per year per patient.
San Francisco General Hospital alone refers some 1,200 patients to Mission Wellness.
So this is — by design — a losing proposition. Pharmacists are clearly incentivized to cease carrying these drugs and/or providing them to Medi-Cal patients — which, in turn, makes it that much harder for people in need to obtain them.
But wait, there’s more: The state, which has been mulling these changes since 2017, is demanding pharmacists retroactively pay back the higher reimbursement rates they received over that two-year period — hence that $30,200 clawback from Mission Wellness in May.
When asked how much longer she can subsidize scads of AIDS, HIV, Hep-C, and mental health patients out of her own pocket, Lopez is frank: “Not much longer.”
Will our erstwhile mayor forsake us?
Why do this? In a word: “savings.” The state stands to save some $60-odd million by reimbursing druggists less for these drugs.
Now, $60 million is a good amount of money. But, in the context of the California budget, which is about $209 billion, there’s a term for savings like this: Budget dust.
Saving $60 million off a $209 billion budget is akin to saving a quarter off a $1,000 purchase.
But, as noted above, this is a dubious way to save money. Psychotic people acting out in the street and being hospitalized (or worse) or AIDS and HIV patients suffering healthwise will, invariably, result in increased expenditures (though — and this is key — likely not at the state level).
Despite the term “specialty medications,” by the way, these are not extravagant or cosmetic drugs. “These aren’t luxury medications; this isn’t your expensive weekend Viagra,” says Dr. Annie Leutkemeyer, an infectious disease specialist at San Francisco General Hospital and UCSF. “These are life-saving medications which you cannot interrupt. If a patient misses even one dose, it could be catastrophic.”
People’s lives will be ruined and the back-end costs will soar. And places like Mission Wellness will struggle to stay in business, which is also a net loss for the community.
And while San Francisco often advocates for twee, independent businesses for emotional and altruistic reasons, that doesn’t apply here. Independent pharmacies are often the only ones willing to accept indigent people’s health plans — hence the Mission Wellness contract with the Department of Public Health. “My patients don’t go to Safeway,” says Leutkemeyer, who works out of General Hospital. “They have to go somewhere that accepts their insurance.”
And this leaves Sen. Scott Wiener troubled. Gov. Gavin Newsom recently signed into a law a Wiener-penned bill that enables Californians to buy HIV-prevention drugs without a prescription. It is, simply, both the humanitarian choice and cost-beneficial to get these drugs into people’s hands.
So Wiener is confused why, under that same governor’s watch, a move is underway to render it more difficult for people to get HIV medications — and bankrupt local pharmacies to boot.
“What the state is doing here is terrible,” he says. “It’s going to harm people and it needs to change. This is not rational.”
Mission District Supervisor Hillary Ronen agrees: “This is so bizarre. This is so weird. There is no scenario under which this decision makes any sense.”
Ronen and Wiener likely also agree with one another that it’s a bad idea to mix beer and wine or drive on the railroad tracks (or both). But, by and large, they don’t agree on all that much.
So, if Ronen and Wiener both tell you something is a bad idea and you should stop — it’s probably a bad idea and you should probably stop.
If Hillary Ronen and Scott Wiener both tell you something is a bad idea and you should stop — it’s probably a bad idea and you should probably stop.
Again, why is this happening? Nobody thinks it’s a conspiracy to bankrupt the local pharmacies or deprive Medi-Cal patients from their life-saving drugs. That’s not the intent. Yet that stands to be the outcome.
Under Gov. Jerry Brown, the state began searching for ways to save money. A consulting firm was contracted to undertake a survey that would help determine Medi-Cal reimbursements.
That survey was faulty, complains the California Pharmacists Association (CPA), which filed suit against the state in May. That legal action froze the retroactive “clawbacks,” like the $30,200 appropriation Maria Lopez experienced earlier this year.
Arguments are complete regarding that suit, according to CPA executive director Jon Roth; a judge’s ruling could come any day. Either the state will be forced back to the drawing board or it could begin once more demanding dollars from affected pharmacies.
In the meantime, Roth is hoping Newsom can intervene. “If he were inclined to direct the Department of Healthcare Services to make the change, that would presumably happen,” Roth says. “They work for him.”
Ronen agrees. And, again, so does Wiener.
“This was a move by the Brown administration, so we’ve been waiting to see if the Newsom administration keeps with that same approach,” he says. But it may be time to stop waiting.
“I think the LGBT caucus will get involved. The last thing we need is for community pharmacies that serve people with HIV to either go under or stop providing HIV medication. It’s really upsetting to me that the state has taken this approach.”
Someone has to be in favor of the common-sense, decent, and bottom-line beneficial thing to do. Because, you know, we’re not doing that.
“My employer tells me how to answer the phone.” “My boss tells me to use certain words when I make the offer to counsel.” “I got written up for discussing religion with a customer.” “I was threatened with termination for voicing my opinion about the governor’s race.” “My employer tells me to lie to patients with X insurance because we lose money on a lot of its prescriptions.”
Do pharmacists have the right of freedom of speech in the workplace? And if not, just how far can employers go in infringing/abridging that right? The short answer is that employers may abridge/infringe on that right in the workplace.
A little civics lesson first. Constitutional rights are not rights granted by the government. Check the wording of the Bill of Rights: “Congress shall not….” These rights already exist in some form; the Constitution merely prohibits the government from abridging those rights. AND it turns out, when there is a compelling interest, the government may make a case and infringe upon rights. You cannot utter words that constitute “a clear and present danger” (Justice Holmes) or create “an imminent danger of imminent harm.” In short, if the government can come up with a good (compelling) reason to abridge free speech, it can do so.
So can employers. The Constitution is a restriction on government, not employers. And employers need only a rational basis, not a compelling interest, to abridge speech in the workplace. However, it is not absolute. Employers can usually prohibit speech that: 1) can harm the reputation of the business, 2) causes economic harm to the business, and 3) causes offense to the usual and customary clientele of the business.
Example of 1) Employers can prohibit employees from speaking to patients or others about an impaired pharmacist discovered working at another location.
Example of 2) Employers can limit speech about products in the store to positive elements of those products
Example of 3) Employers can tell employees they may not voice derogatory comments about the Medicaid population
To show that employer prohibitions are not absolute, Example 2) is not enforceable when a not-so-positive element of an in-store product could be detrimental to the patient’s health. The pharmacist may then discuss product negatives with no fear of discipline or termination.
But this issue is not clear-cut, no matter how much PLS or other commentators try to make it. The gray area is much greater than the black and white. An example often encountered is political speech. Most employers ban political speech in the workplace. Some pharmacists pretend to agree with whoever is speaking, others just smile and nod, others yet will refuse to comment as it is against company policy. But a number of employers these days ban political speech by employees but express their own views. Since it is the employer’s store, can she do this? If this is in the employee handbook and explained that is the situation at the time of hiring, it may well be legal. But what if it is an “ELECT SO-AND-SO FOR THIS” sign in the pharmacy? Does the pharmacist have a right to at least dissociate from candidates she does not support? Can the pharmacist hang another sign or wear a button featuring an opposing candidate? Depending on the circumstances, the answer to these questions could either be “yes” or “no.”
As to specific phrasing for answering the phone or offering to counsel, employers have usually conducted research and communicated with legal counsel to determine language that meets the law, is inviting to patients, and is as unoffensive as possible. Unless pharmacists can find a foundation for variation based on the exceptions listed below, employer designed language can be required.
As to lying to patients, this is a growing issue in the profession. The basis for this is that ogre of the industry: shrinking reimbursement. A number of medications are not reimbursed by third party plans to the price paid for the drug, much less cost plus dispensing fees, much less making any profit. Many employers tell their pharmacists to lie to the patient and say that the medication is unavailable, rather than saying the pharmacy will not stock it as it loses money every time it is dispensed. Pharmacy employers do not want patients to get the idea that it is profit over health care.
So, pharmacists are told to lie about drug availability. Like above, this issue is not clear-cut. Pharmacist should not lie; if they are caught in a falsehood, this harms the reputation of the pharmacy and the pharmacist. At the same time, in the current environment of politicians and people seeking universal healthcare, many balk at the concept of profit over health care. Bad publicity from refusing to accommodate a patient by purchasing the drug and taking the loss is likely to result. Pharmacists should tread carefully here.
When may an employer NOT abridge a pharmacist’s right to speech? 1) In any situation where pharmacy or drug law applies; 2) where the pharmacist’s professional judgment should dictate her words; 3) in any situation where patent health and safety are concerns. Employers almost always temper policies—regarding speech as well as others—by stating the policy is not to be followed if applicable law states otherwise. Similarly, patient health and safety issues are almost always left to the pharmacist. However, professional judgment is being questioned more and more. “In my professional opinion” is being argued more often, usually by supervisors who are also pharmacists. Bottom line here: the dispensing—thus the responsible–pharmacist should stick to her guns and not bend to another’s opinion.
A direct result of shrinking reimbursement and the pharmacist glut is that employers have the upper hand currently in how pharmacies are run. This includes controlling the speech uttered by pharmacists in the workplace (and out. Derogatory speech made to others about employers at social functions or on social media has been found to be actionable for employers). Pharmacists do owe employers a modicum of loyalty and a duty to follow legal and sensible policies designed to protect and/or build business. At the same time, restrictions on speech in the workplace must be scrutinized to respect applicable law and professional responsibilities as seen by the pharmacist.
The chain pharmacies fear “bad press” or “bad word of mouth” … The “service” that you are provided may be part reality… part illusion or mirage at the pharmacy counter. Unless your insurance has you locked into a particular pharmacy… you are going to pay the same price at any store so any “bad press” could cause pts to move their prescription(s) to a competitor.
