Part of the solution: NACDS’ opioid abuse-prevention work

https://www.drugstorenews.com/insights/part-of-the-solution-nacds-opioid-abuse-prevention-work/

NACDS members are meeting at the 2019 NACDS Annual Meeting amid rapid change. Throughout the event, NACDS will update the industry on public policy priorities. These issues have a profound impact on the operating environment in which members are conducting business and serving consumers.

Many of our policy discussions will focus on direct and indirect remuneration, or DIR, fee relief; addressing immediate and long-term pharmacy reimbursement issues; enhancing pharmacy’s scope of business; and serving as part of the opioid-abuse solution. Because NACDS hears from senior leaders of chains and suppliers that they are interested in the association’s opioid abuse-prevention work — as part of a larger community engagement platform — I am dedicating this space to an update on this issue.

NACDS’ opioid abuse-prevention work reflects chains’ ongoing commitments in the areas of compliance programs; drug disposal; patient education; security initiatives; fostering naloxone access; helping to stop illegal online drug sellers and rogue clinics; philanthropic programs; and more. It also reflects extensive work on the part of NACDS associate members.

NACDS’ ongoing engagement in federal and state policymaking reveals the complexities associated with the opioid abuse epidemic. NACDS and our state partners continue to advance sound policies that approach a comprehensive solution, and we also are working to prevent misguided policies. All of this is occurring amid a national discussion of opioid-related issues that continues to evolve, along with the understanding and perspective of policymakers, thought leaders and citizens.

One thing remains clear: NACDS remains focused on advancing the public policy recommendations that we established, based on pharmacists’ firsthand experiences on the front lines of health care and on collaboration with health and enforcement agencies. As I write this, 18 states have enacted NACDS-supported electronic prescribing legislation to help prevent fraud and abuse. Legislation continues to advance in other states as well. These results build on the momentum of federal electronic prescribing legislation enacted in 2018. At the federal level, legislation (S. 724/H.R. 1614) now has been reintroduced to limit to seven days a patient’s first opioid prescription prescribed for temporary pain. NACDS also remains focused on advancing our recommendations regarding prescription drug monitoring plans.

Also of vital importance, NACDS works to prevent harmful policies that, in the name of opioid abuse prevention, would do harm to patients, to pharmacies and to communities. NACDS is collaborating with our state association partners to confront proposed “opioid taxes,” which are taxes on patients, pharmacies, hospitals and others. In addition, we are battling mandatory drug take-back proposals as well, even while noting the importance — and pharmacy’s commitment to — effective and flexible drug-disposal solutions.

Throughout NACDS’ work on all of these issues, a trend is becoming apparent: More and more government leaders, reporters and citizens are starting to key into the notion that illegally manufactured and trafficked fentanyl and heroin comprise a significant part of the drug-abuse epidemic. NACDS is contributing to this discussion and helping to advance such solutions as the enhanced availability of overdose antidotes. The results of the national Morning Consult survey that NACDS commissioned in January suggested that the public understands the different forms of drug addiction that exist. When asked if legal prescriptions or illegally trafficked fentanyl is a bigger contributor to the opioid epidemic, one-third identified illegally tracked fentanyl; 40% said both; 10% said legal prescriptions; and 16% did not express an opinion. The media are dedicating increasing coverage to the notion that illegal fentanyl presents a significant portion of the challenges.

NACDS’ work is entirely consistent with pharmacies’ commitment to serve as the face of neighborhood health care, and to the context of members’ discussions at the 2019 NACDS Annual Meeting.

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Aetna settles suit alleging claim-denying medical director never read patient’s records

https://www.cnn.com/2019/04/26/health/aetna-settlement-california-investigation/index.html

“The matter has been resolved to the parties’ mutual satisfaction,” said Scott Glovsky, the attorney representing plaintiff Gillen Washington, who has a rare immune disorder and was a college student when he was first denied coverage.

The office of the California Department of Insurance said it could not comment because its investigation of Aetna is ongoing. Commissioner Ricardo Lara took over this year from Dave Jones, who launched the inquiry in February 2018.

At the time, Jones told CNN that he found it troubling “if the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records.”

When insurance wouldn’t pay, parents funded cancer patient’s $95,000 lifesaving treatment

“It’s hard to imagine that, in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones said.

News of the settlement raised eyebrows in the legal community. “In my experience with Aetna, they don’t settle cases easily, despite their public pronouncements in the media,” said Doug Terry, an Oklahoma attorney who won a $25 million verdict against Aetna last fall over a “bad faith” case in which a cancer patient was denied coverage.

Arthur Caplan, the director of medical ethics for New York University’s School of Medicine, said he and others in the medical community hoped the settled case would shed light on the way Aetna’s medical directors make coverage decisions.

“Given the importance of how benefits determinations are made by Aetna and other companies, I would hope we could get more transparency of their procedures,” Caplan said. “I thought it might come out of this case, but sadly it doesn’t appear so.

“Hopefully, they’ll be more willing to be transparent on down the road. They should be.”

Washington sued Aetna for breach of contract and bad faith in 2015, saying he was denied coverage for an infusion of intravenous immunoglobulin (IVIG) when he was 19. His suit alleged that Aetna’s “reckless withholding of benefits almost killed him.”

In court filings, Aetna rejected the allegations, saying Washington failed to comply with its requests for blood work. Once his blood was tested, Aetna said, the insurer resumed covering his infusions.

The California insurance commissioner’s investigation revolves around the deposition of Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015.

During his videotaped deposition in October 2016, Iinuma acknowledged more than once that he did not look at medical records, saying he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.

At one point, he even went out of his way to correct Glovsky, the patient’s attorney. Glovsky had begun to ask about the need to see medical records during a case review when Iinuma corrected him, saying, “the first part of this question was ‘I’d have to review medical records,’ and that’s not true, because the nurse preparing the case would look through the medical … records and provide me with the information required, such as lab values. So that’s why I had to make a little correction there.”

The doctor also said he knew next to nothing about Washington’s condition and wasn’t sure what the drug of choice would be for people with his disorder.

$91 million case against nation’s largest insurer is a ‘clear win’ for patients

“How would you decide on your own when to actually review the medical records versus relying on what the nurse at Aetna had prepared for you?” Glovsky said.

“What percentage?” Iinuma asked.

Glovsky: “I mean, like, did you ever look at medical records or basically whenever –“

Iinuma: “No, I did not.”

Glovsky: “OK. So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?”

Iinuma: “Correct.”

Glovsky: “Instead of actually looking at yourself the medical records?”

Iinuma: “Correct.”

Glovsky: “And was that throughout your — your years at Aetna?”

Iinuma: “My tenure, yes.”

Glovsky: “Was that how you were trained to do it when you joined — first joined Aetna?”

Iinuma: “To my recollection, yes.”

When Iinuma had a chance to amend his comments after reviewing the deposition transcript, he signed an “errata sheet” on November 30, 2016, in which he didn’t change those remarks and accepted them, under penalty of perjury, as “true and correct.”

Shortly after CNN reported on the deposition and the investigation by the California insurance commissioner, Aetna released a new sworn statement from Iinuma in which he appeared to indicate that he misunderstood Glovsky’s questions. Glovsky was not present when the new statement was taken.

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“When I stated at the deposition that I never looked at a ‘medical record’ while at Aetna, I understood the term ‘medical record’ to refer to the entirety of a patient historical file containing all charts, doctors’ notes, laboratory tests, and any other report generated by a treating provider for that patient,” Iinuma said in the statement.

“In my mind, and based on my experience, this is the definition of a patient’s ‘medical record’ — a record of their treatment and medical history. Not only is a patient’s medical record generally a very large file or files, in my experience neither patients nor providers submit the entirety of a patient’s medical record to Aetna. Patients and providers submit only portions of a patient’s medical record for Aetna’s review.”

The story was shared far and wide by doctors, patients and others in the medical community.

Angered by the media glare after CNN’s story, the California Superior Court judge delayed the trial start last year. After more delays, the trial was set to begin this spring.

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Parents want ban on energy drinks for minors after son’s death

https://www.msn.com/en-us/news/us/parents-want-ban-on-energy-drinks-for-minors-after-sons-death/ar-BBWmmAV

A bill that would ban the sale of energy drinks to those under 18 years of age passed a subcommittee of South Carolina lawmakers Friday. 

The bill, H.4352, was filed by Representative Leon Howard (D-Richland) and Representative Chip Huggins (R-Lexington. It’s also being supported by Sean and Heidi Cripe, two Midland parents who lost their son after he drank too much caffeine. 

Two years ago Davis Cripe, 16 at the time, drank a coffee, soda, and limu drink within two hours. He collapsed in class, and later died. 

RELATED: Excessive Caffeine Led to Death of Midlands Teen, Coroner Says

“He loved life. He lived it loud,” said Sean Cripe as he spoke with the NBC affiliate in Columbia, WIS-TV. “He had drank an energy drink before class and he had gotten sick really quick. Within a matter of minutes, he had lost his life.”

A Richland County coroner ruled Davis died from a caffeine-induced cardiac event. 

His parents are wanting to keep other families from enduring their tragedy. 

However, not everyone agrees, including medical professionals.

“Fatal caffeine overdose from energy drink ingestion is impossible,” said Dr. Ashley Roberts as he testified before the subcommittee. 

“Diagnosis of death caused by a drug is a diagnosis of exclusion. You need to make sure everything else is okay. The heart is okay, the kidney is okay and then you need to look at the drug,” added Dr. Donna Seger, an emergency physician and medical toxicologist.

The Cripe family disagrees. 

“It’ll be huge. Not only for our son Davis but knowing that here on out other kids will be protected,” said Heidi Cripe. 

The bill now moves to full committee. 

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Joint Meeting of the Drug Safety and Risk Management Advisory Committee and the Anesthetic and Analgesic Drug Products Advisory Committee; Notice of Meeting; Establishment of a Public Docket; Request for Comments

https://www.regulations.gov/document?D=FDA-2019-N-1646-0001

Dates

The meeting will be held on June 11, 2019, from 8 a.m. to 5 p.m. and June 12, 2019, from 8 a.m. to 5 p.m.

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CVS Introduces Limit on Glucose Strips

www.nbcnewyork.com/on-air/as-seen-on/CVS-Introduces-Limit-on-Glucose-Strips_New-York-509231382.html

According to this report… CVS has decided to only allow 3 glucose test strips for Insulin dependent pts and it is being billed to Medicare Part B. Even though Medicare Part B will reimburse for 4 tests strips a day.

According to this article, the news reporter reached out to CVS and their response was that they suggested that this pt get her glucose test strips at another pharmacy.

I would hope that this woman takes ALL OF HER PRESCRIPTIONS TO ANOTHER PHARMACY and hopes that her doctor suggests to all of her pts that they find another pharmacy to take care of their medication needs.

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PRESS RELEASE from Nealy Tynes, President, International OPERATION PAIN RELIEF

www.nationalpainreport.com/press-release-from-nealy-tynes-president-international-operation-pain-relief-8839697.html

PRESS RELEASE
4-28-19

In 2010 the Department of Defense told us there were 18 vets of foreign wars dying by suicide everyday in Washington state.  That is approximately 6,570 per year.

Now, it’s 2019 and the suicide rate is increasing dramatically in Washington state each day, not only by the vets of foreign wars, but include cancer patients, fibromyalgia patients, RSD/CRPS patients, etc., who are all untreated for their pain.

Washington state was considered the first “Pilot Project” state in America, back in 2010.  Now there are 6 pilot project states in the union.

Whatever passed in Washington state, passed nationwide.  Blame ESHB 2876, sponsored and written by Jim Moeller (House Rep), in 2010.

I read it.  There were no facts, or findings of law in Jim’s Bill.  It was simply hearsay, and a story.  No proof of what he wrote was backed up by any documentation.

ESHB 2876 was about a story of children getting into their parents medicine cabinets, finding pill bottles, overdosing, while their parents were not at home.

And, that my friends, became law.  It was merely a story.

I interviewed each of the House of Representatives in the Washington state, Olympia, legislators’ offices.  Each and everyone of them had a ‘boiler plate’ answer to me.  They said:  “I was told to not read it, and to not research it, but to sign it and send it up the governor’s office.”  Governor Christine Gregoire then passed it into law.

I found out later, during my investigation, that the FDA pressured the legislators into signing ESHB 2876.

I confronted the FDA, and told them they have no jurisdiction over our Washington state legislators, and they need to get the hell out of our state, and don’t ever come back.

In the meantime, the doctors started leaving our state in droves.  There were none to be found who would take chronic pain patients, and the suicide rate climbed even further.

I was sad.  I was angry.  I was in shock.  I felt helpless.

But, God had a plan for me, and I kept advocating anyway, to the best of my ability.

Then I became empowered by FACEBOOK.  A whole new world opened up for me, and now I am on fire, and grateful.

Please share this PRESS RELEASE.

Signed, Nealy Tynes
President, International OPERATION PAIN RELIEF
Email:  opr.1@juno.com

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Oregon Pain Action Group

Published on Apr 3, 2019

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Express Scripts won’t cover Eli Lilly’s new generic insulin

https://www.axios.com/express-scripts-wont-cover-eli-lilly-insulin-lispro-37c347da-9383-425c-b3f2-8af755f7a1ae.html

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What Is Your State Doing About Pain?

www.nationalpainreport.com/what-is-your-state-doing-about-pain-8839662.html

The Federation of State Medical Boards is meeting in Fort Worth, Texas this weekend—and the “opioid” crisis is on the agenda.

“The State Medical Boards must lead the effort on regulation of the opioid crisis. The DEA and other federal agencies must work with the Medical Boards to avoid confusion with physicians legitimately taking care of their patients.”

Sherif Zaafran, MD, tweeted out his comments made as the Federation meeting got underway.

Dr. Zaafran is the head of the Texas Medical Board and a member of the HHS Pain Management Best Practices Inter-Agency Task Force and a very important voice

Saturday, he will also moderate a discussion of nationally recognized leaders who will “discuss new steps in the effort to address the nation’s opioid crisis. Included on that panel is Vanila M. Singh, MD, MACM, who is the chair of the Pain Management Task Force that calls for patient-centered approach to improve treatment of pain.

That Task Force Draft Report received some 6,000 public comments and the HHS group will gather again in May to adopt it.

“The action is at the state level,” said Terri Lewis, Ph.D. “Pain patients and physicians need to ask their state medical boards, what are you doing now?”

Just this month, two federal agencies eased some previous guidance on opioid prescribing.

The Centers for Disease Control and Prevention said many physicians have misapplied the 2016 guideline that resulted in a serious reduction on opioid prescribing.  The CDC tacitly acknowledged many physicians’ responses to the opioid crisis went too far.

Earlier this month, the FDA issued a safety announcement that it said “identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.”

These agencies have been receiving blowback—and plenty of it—from medical professionals who believe that the reaction to the “opioid crisis” tilted dangerously toward those who become addicted from opioids versus the million of chronic pain patients who were adversely affected by the physicians, insurers and state regulators reaction.

Here’s one of the National Pain Report stories on it.

The question now is what will the state medical boards do with this new information?

The answers may begin to come this weekend in Texas.

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