Patient Privacy in the Pharmacy (HIPAA)

Posted on April 19, 2019 by Pharmaciststeve

Patient Privacy in the Pharmacy

https://www.managedhealthcareconnect.com/content/patient-privacy-pharmacy

April 18, 2019

Patient privacy in the pharmacy made the headlines recently when a man sued a large chain drugstore for revealing to his wife that he had a prescription for an erectile dysfunction drug.

The Case

The plaintiff, MF, brought a prescription for eight 100-milligram sildenafil citrate (Viagra) pills into his regular CVS pharmacy to be filled. According to the plaintiff, he gave specific instructions to the pharmacist that he did not want his insurance billed for this prescription and that he would pay with cash. The pharmacist agreed and MF left.

Several days later, MF’s wife called the same pharmacy to check on one of her own prescriptions, and the chatty pharmacy employee on the other end of the phone decided to mention to her that her husband’s Viagra prescription had not gone through the insurance.

The plaintiff is claiming that this disclosure of the erectile dysfunction prescription to his wife caused a breakdown in his marriage. In a lawsuit filed against the drug chain, MF claims that the pharmacy violated his privacy under HIPAA. The lawsuit alleges that the pharmacy employee “without solicitation, improperly informed MF’s wife that his prescription for Viagra was not being covered by insurance.” In the court papers, MF refers to his wife as a “third-party” who had no right to be informed about the drug.

Does MF Have a Case?

The HIPAA Privacy Rule, part of the Health Insurance Portability and Accountability Act of 1996, was enacted to protect personally identifiable health information while allowing the flow of information necessary to provide quality healthcare. It requires covered entities, including pharmacies, hospitals, health plans, and healthcare providers, to treat protected health information (PHI) as confidential.

It’s important to understand that a HIPAA violation does not give rise to a private cause of action to sue. A patient cannot sue for a HIPAA violation. (This misperception is very common in the general public, however).

Patients do have a recourse in the event of a HIPAA violation. A patient can file a complaint with the Department of Health & Human Services (HHS). HIPAA provides both civil penalties and criminal penalties for the mishandling of PHI.  It’s the purview of HHS and states’ attorneys to enforce the penalties and to decide to fine the offender, prosecute or jail the offender (if it was criminal), or to order the entity to institute HIPAA training for employees.

So, if prior legal precedent holds, MF will have a hard time succeeding if he is trying to argue a violation of HIPAA. It is, however, possible to sue and obtain damages for violations of state laws (provided the patient can prove damages).

This case is currently inching through the court system. It may be dismissed or settled before it ever goes to trial (most cases are), but it will be an interesting one to follow.

Your Risks with a HIPAA Violation

If the HIPAA rule is violated, your biggest risk is not getting sued, it is losing your job. The odds of a lawsuit are slim, and when it does happen it is generally the employer (in this case the drug chain) that is sued, not the pharmacist/employee. However, the employee is likely to be fired.

Most large entities – hospitals, pharmacies, medical practices – have strict guidelines about HIPAA and are required to provide some training for employees. Employees are often required to sign documents acknowledging their understanding of patient privacy issues. Breaches of privacy are treated very seriously, and companies will fire employees in order to reassure investigators that the situation has been handled.

Protecting Yourself

In the pharmacy, the best way to protect yourself is to remember to disclose only the minimum amount of information necessary to achieve the purpose of your communication. Never share protected health information. This is where the pharmacy employee in MF’s case when wrong – when MF’s wife called to ask about her prescription, the employee should have answered only that question, and not volunteered any extraneous information.

This “minimum information necessary” holds true if you are calling a patient or leaving them a message to let them know a prescription is ready. It is not necessary to volunteer the name of the medication, its use, or personal information about the person getting it. Always use the minimum information necessary to convey your message.  

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The Real Headline From The CDC Report On Kratom Being Detected In Medical Examiner And Coroner Reports

Posted on April 19, 2019 by Pharmaciststeve

The Real Headline From The CDC Report On Kratom Being Detected In Medical Examiner And Coroner Reports

https://www.ptcommunity.com/wire/real-headline-cdc-report-kratom-being-detected-medical-examiner-and-coroner-reports

WASHINGTON, April 18, 2019 /PRNewswire/ — The American Kratom Association (AKA) released a response to the CDC report on kratom being detected by medical examiners and coroners in 91 toxicology records.  The rebuttal to the CDC report was authored by 5 independent experts who are recognized for their work in substance abuse and addiction issues, and each affirmed that the media headlines reported in the CDC analysis misstated the actual conclusions of that report.

A copy of the report can be found at http://www.americankratom.org/images/Reply_to_CDC_-_Unintentional_Drug_Overdose_Deaths_with_Kratom_Detected.pdf

“The CDC report supports the AKA position that more regulations need to be in place to deny market access to unscrupulous bad actors who spike natural kratom with dangerous adulterants, including fentanyl, heroine, and morphine,” stated Dave Herman, Chairman of the AKA.  “The CDC report also supports the AKA position that medical examiners and coroners are reporting ONLY that they have detected kratom in toxicology reports, and they often incorrectly report that kratom was involved in or the actual cause of death.”

The five independent experts concluded in their report that the CDC data does not report whether the decedents ingested pure, unadulterated kratom in conjunction with dangerous substances or used an adulterated kratom product. The National Institute on Drug Abuse (NIDA) has documented that polydrug use or adulterated kratom product deaths are properly attributable to the toxicity of the multiplicity of co-consumed drugs or adulterants present whether intentionally consumed as a consequence of an individual’s addiction or the result of unknowingly using a product adulterated with a toxic dose of a dangerous substance.

“It grossly misleads the public and the millions of kratom users in the United States,” said Herman.  “We need evidence to document the danger of any substance, and right now the FDA is inflaming anti-kratom rhetoric with false information, deliberate overstatements of the facts, and conclusions about kratom that are unsupportable with any credible science.”

The independent report concluded that the consequences of inaccurate data on kratom-associated deaths clearly has contributed to the FDA’s persistent attacks on kratom; the decisions of 6 states who have banned kratom; the decision by some local jurisdictions to impose local bans on kratom; and the rampant misinformation disseminated to the public about the alleged risks of kratom use.

“The AKA is working hard with the states to enact responsible regulation to prevent adulteration and ensure kratom consumers have good labels, so they know they are purchasing a pure kratom product,” concluded Herman.

ABOUT AKA
The American Kratom Association (AKA), a consumer-based non-profit organization, is here to set the record straight about kratom and give a voice to those who are suffering and protect their rights to possess and consume kratom. AKA represents tens of thousands of Americans, each of whom have a unique story to tell about the virtues of kratom and its positive effects on their lives. www.americankratom.org

View original content to download multimedia:http://www.prnewswire.com/news-releases/the-real-headline-from-the-cdc-report-on-kratom-being-detected-in-medical-examiner-and-coroner-reports-300834810.html

SOURCE American Kratom Association

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Prior Authorization Bill Expected in Congress This Summer

Posted on April 19, 2019 by Pharmaciststeve

Prior Authorization Bill Expected in Congress This Summer

Two House Republicans and a Democrat working on a draft

https://www.medpagetoday.com/practicemanagement/reimbursement/79314

WASHINGTON — Bipartisan legislation to ease the burden of prior authorization is expected to be introduced in the House this summer, a Republican staffer said.

“We’ve been working with [Reps.] Mike Kelly (R-Pa.) and Suzan DelBene (D-Wash.) on prior authorization,” said Charlotte Pineda, healthcare advisor to Rep. Roger Marshall, MD (R-Kan.), an ob/gyn, during a conference on free-market healthcare here earlier this month.

“It’s important to work across the aisle because you can actually get stuff done,” she continued. “It’s one thing to introduce a bill and another thing entirely to introduce it with members of the committee on which the bill has jurisdiction. So the three members hopefully will be introducing that later this summer.” Kelly and DelBene are remembers of the House Ways & Means Committee, which would likely have jurisdiction over any prior authorization bill.

Naida did not say what the bill might contain, and she was unavailable for comment at press time. However, during the last Congress, Kelly introduced the Prior Authorization Process Improvement Act, which was referred to the Ways & Means committee but got no further. That bill required the Secretary of Health and Human Services to submit a report to Congress within a year “on the feasibility of Medicare Advantage organizations and providers and suppliers of services … using certain technologies to facilitate the administration of prior authorization requirements under Medicare Advantage (MA) plans offered by such organizations.”

The bill called for the secretary to consult with an advisory panel of MA organizations, providers and suppliers of services, beneficiary representatives, and technology vendors in preparing the report. Among other things, the report would include “recommendations on how to improve the administration of such requirements through the use of technology.”

While the three lawmakers work on that bill, other activities related to prior authorization are continuing. In March, the eHealth Initiative, a coalition of provider and healthcare industry organizations, issued a paper on “Considerations for Improving Prior Authorization in Healthcare.” The document included four central points:

  • Transparency of payer policy and evidence-based clinical guidelines available at the point of care may, in many cases, reduce the need for prior authorization and minimize care delays.
  • Reducing the overall volume of services and drugs requiring prior authorization could decrease administrative burdens and costs for all stakeholders.
  • Payers, healthcare professionals, and vendors should use existing, industry-endorsed standards whenever possible and explore incorporating new electronic standards that have the capability to improve the prior authorization process.
  • Payers and healthcare professionals should explore alternative payment models that promote bundled authorization for procedures, medications, and durable medical equipment that are associated with a particular episode of care.

Over at the Centers for Medicare & Medicaid Services (CMS), the agency is participating in two different workgroups for its Document Requirement Lookup Services Initiative, which is aimed at making it easier for Medicare fee-for-service providers to find out what documentation is required in order for Medicare to approve a particular service for coverage.

“One workgroup is a private sector initiative hosted by Health Level Seven International (HL7), the Da Vinci project,” the agency explained on the initiative’s webpage. “The second workgroup, convened by the Office of the National Coordinator for Health Information Technology (ONC), is the Payer + Provider (P2) Fast Healthcare Interoperability Resource (FHIR) Taskforce.” FHIR (pronounced “fire”) is a common programming interface that is used in many health information technology applications.

Through working with those two efforts, “CMS is helping define the requirements and architect the standards-based solutions,” the agency said. “In parallel, CMS is preparing to support pilots testing the information exchanges for Medicare fee-for-service programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR-based solutions.”

On the insurer side of the equation, America’s Health Insurance Plans (AHIP), a trade group here for health insurers, is coordinating a demonstration project to automate prior authorization. “We expect to launch the demonstrating project later in 2019 in a manner that is scalable and as integrated as possible with provider workflow,” an AHIP spokeswoman said in an email to MedPage Today. “We will engage an independent organization to evaluate the impact of automation and release a final report in early 2020.”

She noted that only about 15% of healthcare services require prior authorization, which she said was “an important, safe care tool adopted by health plans and government-sponsored health care programs to help ensure patients receive the best results, better outcomes and better efficiencies.”

Specifically, prior authorization “prevents the overuse [of care], misuse [of care], or unnecessary (or potentially harmful) care and offers consistency and value to the patient, when there could be a wide variation provider performance, cost of the drug, and/or utilization within a clinician’s practice,” the spokeswoman said. “[It also] ensures care is consistent with evidence-based practices.”

But there is still work to be done to improve the process, she said, adding that AHIP “supports legislation that is designed to streamline and standardize electronic prior authorization, improve transparency, and encourage best practices that improve care coordination and reduce provider burden.”

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Please do not take this final act! National Suicide Prevention Lifeline PLEASE CALL: 1-800-273-8255

Posted on April 18, 2019 by Pharmaciststeve

https://youtu.be/PTzFiywn0c0

In recent days there have been a series of coordinated attacks against me. I don’t know or understand why but they are making some very serious allegations. Please take a moment to hear me out and if you still have questions, please call me: 423-794-8241 “And now these three remain: faith, hope and love. But the greatest of these is love.” 1 Corinthians 13:13

Filed under: General Problems | 3 Comments »

DOJ/DEA/SWAT and their theatrics when they raid a prescriber’s office

Posted on April 18, 2019 by Pharmaciststeve

A year ago I left a review  I was shocked to find a reply after a year. The patient who replied to my review replied with her very detailed description of the DEA raid IN HER DOCTOR’S OFFICE. Read and learn for if or when it happens to you.

https://www.facebook.com/DEAHQ/

This is the reply to my review:

This is slightly lengthy but it tells of the RAID by the FBI & DEA at my pain clinic. It is my unofficial deposition. Remember this was done when the government was shut down. I’m 61 and the youngest patient I have noticed is approximately 45ish. Some have canes and others have portable oxygen. Far cry the crack head pill mill they thought they would find!

February 23, 2019
To Whom It May Concern,
I am a chronic pain patient and have been one in excess of 15 years and on permanent disability for 8 years. Prior to Dr. Ronald Moon I had to use Family Medical Care. That clinic became my primary care center. I was able to use the clinic for my routine medications such as hypertensive medication, anxiety medication well as my pain medication. I was able to use the clinic for approximately 3 years until their policy changed and they were no longer allowed to practice as a primary care doctor and chronic pain patient were no longer to be seen. I was forced to find a PCP and a Pain Specialist. I was given a list of primary care doctors as well as some pain clinics.
• I have been a patient of Dr. Moon for over 7+ years. My chronic pain is as follows: I have fibromyalgia, M.E., diabetic neuropathy in my feet and intention tremors in both hands. In addition I also have degenerative disc disease in my spine, spinal arthitis and buldging discs. I have had spinal surgery with metal rods and cadaver bone in my spine. The pain in my lower back travels down my right leg. I continue to experience chronic lower back pain. Severe headaches and at least once every 2-3 months I get blinding migraines. I have stiffness in my neck radiating down across both shoulders and extending up my neck to the base of my head. I do have PTSD, anxiety, depression, panic attacks and social anxiety which are being handled by another doctor that specializes in those areas.
• When I first came to Dr. Moon is as barely mobile even using my cane. I was homebound with the exception of my doctor visits. I was apprehensive of seeing another doctor due to the fact unless an medical issue can be visually seen or proven by diagnostic tests it did not exist. Dr. Moon through a system of questions, blood work, urinalysis and my presented systems gave me hope. Did he say he could cure me? NO. He told me that there were medications that could help make my chronic pain tolerable. Throughout the years with Dr. Moon I have had CT scans, MRIs, nerve conduction tests, nerve blocks, and a few other tests. I firmly believe that he is a conservative doctor than tries to locate the cause or root of the pain and DOES NOT hand out pain medication on a whim. In my experience he is careful to prescribe pain medication at the lowest dose that he believes will help the pain become manageable. Next visit if it’s not producing the desired results he reevaluates the situation and adjusts medication aa he sees necessary. Random urine drug screens are not uncommon. There seems to be no pattern in the randomization of the tests. Also if I am seen my another doctor or dentist for any reason and I am prescribed and narcotics I must have that prescribing doctor complete a Medical Disclosure Form. It has been this way since day one. Dr. Moon is a very caring, supportive, compassionate doctor that “talks TO me and not AT me.” There is a huge difference! Just as there is a difference between being dependent on pain medication and being addicted to pain medication. Even today I am unable to walk or stand for any length of time. If I have to go anywhere that requires walking or standing I have no choice but to use my wheelchair.
When he had to discontinue accepting BCBS insurance because of how the they wanted him to run his client and record keeping from what I could figure out.
• That Tuesday (Feb. 5th)morning at 6 a.m. while my husband and I were in the exam room waiting to be seen we both heard a loud commotion in the hall. All of a sudden my room door bursts open and 3-4 heavily armed agents entered the room. The red laser dot from the rifle was placed on my forehead and quickly to my husband’s forehead. They were loudly yelling “Search Warrant” as they burst into the room. This scared me to death! Having PTSD, anxiety and anxiety attacks this was extra stressful for me. I am so grateful my husband was with me to help me remain as calm as possible. Glen saw me begin to panic and he was able to keep me calm and thus avoiding a full blown panic attack.
• To my best guess there were +40 agents from multiple government agencies present. It was extremely intimidating! We each had to give our full name, address, date of birth, social security number and if relevant our work information. The FBI and DEA agents went through the office and each exam room like they were raiding a crack house.
• An FBI agent told me to follow him. We walked into an exam room followed by a DEA agent. I sat on the exam table, DEA agent sat at the small desk while the FBI agent stood in front of the only door to the room. I felt boxed in. I was asked approximately 6-7 typed pages of predetermined questions. I have very poor memory recall due to the fibromyalgia, brain fog and at that point increased anxiety. I answer their questions the best to my ability and informing them both I have had 2 small strokes and my memory wasn’t the best. I also let them know that my husband was out in the lobby and I asked if he could come in the room and help fill in the missing pieces of memory information they needed. I mentioned that on 3 separate occasions and I was told “no” and that I was “ answering the questions just fine.” I no concept of time and my best guess the 3 of us were in the small exam room for about an hour.
• Later I found out that the interview I had just finished was voluntary. At no time was I informed that I didn’t have to go with them and answer all of those questions. It was presented to me as mandatory that I follow them and answer their questions while the FBI agent standing with his back against the door. Yes I felt trapped and intimated. In found out that every patient chart was removed from the office. My private medical history was taken without my consent or prior knowledge. The results of my bone density scan is in my chart. Dr. Moon has not reviewed the results or gone over it with me. My latest blood work and test results are now gone. Yes I do feel my right to privacy have been violated. I do not have any idea as to who is looking at my private records or personal information.
• Having the agents burst into the exam room where we were with their automatic rifles pointed at me has caused my anxiety level to remain high. I have an increased difficulty falling and staying asleep. My prescription medication for sleep does very little to help. The bursting into the exam room so heavily armed and traumatizing me replays over in my head.
This was completely unnecessary. Dr. Moon follows the guidelines and gives me as well as his other patients no choice but to follow the rules. I appreciate the way he looks for the cause of the pain, attempts to remedy the root cause via tests and referrals to other doctors when needed while trying to keep my pain at a tolerable level. I truly believe he has my best interest in mind with every visit. I trust him completely and yes I have referred him to others and I will continue to do so.

Thank you for your time.

When reading this… mental images of  gestapo tactics that I have heard about under Hitler’s dominance of Germany and other parts of Europe that he attempted to conquer.  I would hope that all of the S.W.A.T. theatrics, those police officers had their guns on locked and just using the red laser target lights were just for EFFECT…  “scare the shit out of people in the waiting room effect”  

I am not an attorney, but as was stated in the article all of the theatrics was totally just that – THEATRICS – and the pt did not have to conform with what was going and and being demanded.

I have seen some attorneys who have legally challenged law enforcement when they are “playing games” … all you have to ask is “Am I being detained ?” That is a simple YES/NO question… if they don’t say YES… then you politely tell them that “we are thru here and I am leaving”

If they say YES… ask them what they are charging you with and that you need to talk to your attorney … and don’t say another word or do anything that they request.

 

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Andrew Kolodny Rips National Pain Report For Unfair Reporting

Posted on April 18, 2019 by Pharmaciststeve

Andrew Kolodny Rips National Pain Report For Unfair Reporting

www.nationalpainreport.com/andrew-kolodny-rips-national-pain-report-for-unfair-reporting-8834556.html

Dr. Andrew Kolodny has criticized the National Pain Report for what he calls “its unfair and false reporting” on him.

He said it is “absolutely false” that he is “aggressively pushing the idea of restricting or eliminating opioid usage” as we indicated this week.

“I have never pushed for a policy that would restrict or eliminate opioids,” he said. “I believe opioids play an important in both the treatment of pain and addiction.”

What he is for, he said, is responsible prescribing.

Kolodny also believes we should avoid referring to the crisis as an epidemic of drug abuse.  As he said on the Brandeis University website: “Calling it an abuse problem suggests the cause is bad behavior—people abusing dangerous drugs to get high. While it’s true that some people got addicted from recreational use, many also became addicted taking opioids exactly as prescribed by doctors. Once addicted, people aren’t using heroin or pills because it’s fun. They need to keep using opioids to avoid feeling awful.”

Kolodny, who in addition to his work at Brandeis University is also executive director of Physicians for Responsible Opioid Prescribing, started working on the issue about 15 years ago for New York City’s health department.

Kolodny has been in the news recently urging the Trump Administration to move faster to address the issue of overprescribing and addiction.

“There really isn’t anything this (federal) commission is going to figure out that we don’t know already,” Dr. Andrew Kolodny, told the New York Times. “What we need is an enormous federal investment in expanding access to addiction treatment, and for the different federal agencies that have a piece of this problem to be working in a coordinated fashion.”

“Policymakers wanted to stop so-called ‘drug abusers’ but were ignoring the problem of overprescribing. It was all focused on preventing kids from getting into grandma’s medicine chest, but no one was looking at why every grandma now had opioids in her medicine chest.”

Kolodny indicated he would think about writing a column talking about opioids and chronic pain for the National Pain Report but said, “Had you approached me before you did this false reporting, I might have been more inclined to do it.”

 

See the source image

The day has come when I AGREE with Andrew Kolodny  Kolodny also believes we should avoid referring to the crisis as an epidemic of drug abuse. 

On JUST ONE THING… substance abuse/addiction is not a EPIDEMIC… because the word EPIDEMIC suggests that something is CONTAGIOUS and substance abuse/addiction is a mental health problem, not a moral issue and both our current and previous Surgeon General and new head of the CDC agrees with that statement.

Doesn’t anyone really wonder that only 5% of so called “addicts” that go to a sobriety clinic  stay “clean” ?  Maybe that is because they were never really addicted but was prescribed opiates and was not properly weaned off and had become dependent and experienced withdrawal symptoms and when they are properly weaned off… SURPRISE … no longer addicted.

I read this article several times and not ONCE did Kolodny mentioned that substance abuse/addiction is a MENTAL HEALTH ISSUE.

I had a Logic professor in college whose favorite quote was , “.. never say never and never say always… because someone will always prove you wrong… because there is no absolutes in life “

So this statement is patently UNTRUE  It was all focused on preventing kids from getting into grandma’s medicine chest, but no one was looking at why every grandma now had opioids in her medicine chest.”

I hope that Ed Coghlan will not let him make any posts… this statement shows he is interested in the liberal distribution of controlled substances:  “I have never pushed for a policy that would restrict or eliminate opioids,” he said. “I believe opioids play an important in both the treatment of pain and addiction.”

Since the medications that are used in a chemical rehab are both controlled substances  a C-II Methadone and a C-III Suboxone.  So apparently Kolodny and the members of his Physicians for Responsible Opioid Prescribing are very supportive of the prescribing of controlled substances/opiates… but mostly limited to those who are dealing with substance abuse/addiction.  Apparently a pt being dependent on one of those meds is perfectly fine, but .. those suffering from chronic pain should only get “responsible doses”  Whatever in the hell that is ?

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Asked to pass this along – 04/17/2019

Posted on April 17, 2019 by Pharmaciststeve

Please join our state pain advocacy groups and work together at the state and federal level to facilitate real change. We have members going to Town Hall meetings right now before they return to Congress to pass health care legislation soon. Members are meeting with policy makers and media in each state and creating real change. We have advocates, patients and medical personnel meet in with policy makers – home bound patients can call in to take part and we have a team of medical personnel to call in and share their side and what’s happening to their patients. They have to see people with 5, 10 or 20 different conditions, as many think we bumped our elbows and hopped on medication.

 

Tamera Stewart, the new C-50 Director has killed bad bills and gotten good ones passed in Oklahoma. We are losing our window, please work with others in your state before it’s too late


Alabama-


http://bit.ly/AlabamaC50


Alaska-


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Arizona-


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Arkansas-


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Calif-


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Colorado-


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Connecticut-


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Delaware-


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Florida-


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Georgia-


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Hawaii-


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Idaho-


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Illinois-


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Indiana-


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IOWA-


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KANSAS-


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KENTUCKY-


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LOUISIANA-


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MAINE-


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MARYLAND-


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MASSACHUSETTS-


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MICHIGAN-


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MINNESOTA-


http://bit.ly/MinnesotaC50


MISSISSIPPI-


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MISSOURI-


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MONTANA –


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NEBRASKA-


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NEVADA-


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NEW HAMPSHIRE-


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NEW JERSEY-


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NEW MEXICO-


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NEW YORK-


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NORTH CAROLINA-


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NORTH DAKOTA-


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OHIO-


http://bit.ly/OhioC50


OKLAHOMA-


http://bit.ly/OklahomaC50


OREGON-


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PENNSYLVANIA-


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RHODE ISLAND-


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SOUTH CAROLINA-


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SOUTH DAKOTA-


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TENNESSEE-


http://bit.ly/TennesseeC50


TEXAS-


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UTAH-


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VERMONT-


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VIRGINIA-


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WASHINGTON-


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WEST VIRGINIA-


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WISCONSIN-


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WYOMING-


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As seen on the web… law firm interested

Posted on April 17, 2019 by Pharmaciststeve

Chronic Illness Advocacy & Awareness

April 15 at 10:10 AM

Hi everyone! We have an important question:

Have you been unable to get your medication (or as much medication as your doctor prescribed) due to your pharmacy/insurance declining or giving you the runaround? Please post here and we will PM you. We’re talking to reps for a big law firm who may be interested in working with us to bust up the types of mergers that impact us (between CVS and Caremark, or Cigna and Express Scripts, for instance).

Filed under: General Problems | 14 Comments »

Three Veterans in Five Days Die by Suicide at VA Facilities – RIP

Posted on April 16, 2019 by Pharmaciststeve

Three Veterans in Five Days Die by Suicide at VA Facilities

https://www.military.com/daily-news/2019/04/13/three-veterans-five-days-die-suicide-va-facilities.html

WASHINGTON — Three suicides occurred during a five-day period on Department of Veterans Affairs properties, prompting reaction this week from Capitol Hill.

Two veterans died by suicide in Georgia, one April 5 at a parking garage at the Carl Vinson VA Medical Center in Dublin and the other April 6 outside the main entrance to the Atlanta VA Medical Center in Decatur, the Atlanta Journal-Constitution reported.

On Tuesday, a veteran shot himself in the waiting room at a VA clinic in Austin, Texas, according to KWCX-TV.

“Those deaths did not go by me without noticing them, nor has it gone by me that we have a job to do,” Sen. Johnny Isakson, R-Ga., said Wednesday during a Senate Veterans’ Affairs Committee hearing.

Though it wasn’t the intended subject of the hearing, multiple senators asked VA officials on Wednesday about the recent suicides.

Richard Stone, executive in charge of the Veterans Health Administration, said there have been more than 260 suicide attempts on VA property, 240 of which were interrupted and prevented. He didn’t specify a time period for the attempts.

According to a Washington Post report, 19 suicides occurred on VA property between October 2017 and November 2018.

“Every one of these is a gut-wrenching experience for our 24,000 mental health providers and all of us that work for VA,” Stone said.

In response to reports of the three suicides, Rep. Mark Takano, D-Calif., chairman of the House Committee on Veterans’ Affairs, said he would schedule a hearing on the issue later this month.

“Every new instance of veteran suicide showcases a barrier to access, but with three incidents on VA property in just five days, and six this year alone, it’s critical we do more to stop this epidemic,” Takano said in a statement. “I have called for a full committee hearing… to hear from VA about the recent tragedies and spark a larger discussion about what actions we can take together as a nation.”

According to the latest VA data, 20 veterans die by suicide every day. Of those deaths, 14 are not receiving VA health care.

Suicide among veterans continues to be higher than the rest of the population, and younger veterans are particularly at risk. VA data released in September showed the rate of suicide among veterans ages 18 to 34 had significantly increased.

The VA hasn’t identified the veterans who died by suicide in Georgia, nor described the circumstances of the deaths. In Austin, a still-unidentified veteran shot himself in front of hundreds of people in the waiting room, KWTX reported. Weapons are prohibited in VA clinics, but the Austin facility didn’t have metal detectors.

Stone told senators Wednesday that veteran suicide was a societal problem that needed a nationwide approach. He noted an executive order that President Donald Trump signed in March creating a Cabinet-level task force that he promised would “mobilize every level of American society” to address veteran suicide. VA Secretary Robert Wilkie was selected to lead it.

“I wish it was as simple as me saying I could do more patrols in a parking lot that would stop this epidemic,” Stone said. “Where we as a community and society have failed that veteran is a very complex answer.”

This article is written by Nikki Wentling from Stars and Stripes and was legally licensed via the Tribune Content Agency through the NewsCred publisher network. Please direct all licensing questions to legal@newscred.com.

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It’s time to reform accessibility to prescription drugs

Posted on April 16, 2019 by Pharmaciststeve

It’s time to reform accessibility to prescription drugs

https://thehill.com/blogs/pundits-blog/healthcare/350091-its-time-to-reform-accessibility-to-prescription-drugs

Too many Americans can’t readily access or afford their prescription drugs. Pharmacy benefit managers (PBMs) play a central role in creating this dynamic.

PBMs are hired to administer prescription drug benefits, but these middlemen face little accountability. Increasingly, PBMs extract considerable profit from drug manufacturer rebates, administrative fees on pharmacies and spread pricing (the profit they take from the difference between what they bill the plan sponsor for a medication and what they reimburse the pharmacy).

Since the three largest PBMs emerged in the late 1980s, prescription drug benefit costs have risen 1,010 percent — despite PBM claims that they reduce costs. In addition, too many patients have to wade through the bureaucratic mess of prior authorizations, step therapies or mandatory mail order just to access their prescriptions.

If PBMs were an automobile, you might say they have engine troubles. Their model isn’t running properly. We all have a hunch what is wrong, but we have to look under the hood to verify. PBMs operate like that car, but they’ve put a padlock on the hood.

They won’t allow plans to know what they’re paying pharmacies on the other end, so the plan sponsor often has little idea of the profit the PBM is keeping for itself. Those problems can’t be fixed until the padlock is removed. The veil of secrecy puts health plan sponsors, patients, drug manufacturers, policymakers, and pharmacies at a disadvantage.

Legislation can certainly help. The U.S. Congress should pass legislation that increases transparency and patient access — bill’s like the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act; the Prescription Drug Price Transparency Act; and the Ensuring Seniors Access to Local Pharmacies Act.

But moving legislation through our gridlocked Congress takes time.

We don’t have to wait. We can make improvements while we press lawmakers to act. Alternatives to the traditional PBM business model do exist. If companies and organizations want to upend the status quo in their benefit plan design process, they should take the wheel instead of riding shotgun.

That’s what Caterpillar, the world’s leader in manufacturing construction and mining equipment, did. In “Caterpillar Breaks New Ground Managing the Prescription Drug Supply Chain,” a 2010 American Journal of Pharmacy Benefits article, Caterpillar’s compensation and benefits manager Todd Bisping explained how the company sought to reverse an increase of 14 percent in its annual prescription drug spending from 1996 to 2004.

Caterpillar created direct-to-pharmacy agreements that cut PBMs out of the equation. The arrangements emphasized volume for margin when it came to the prescriptions they dispensed, were subjected to competition as opposed to exclusivity agreements, worked under a new pricing model, and were audited to ensure the methodology was properly applied. By 2009, Caterpillar’s total drug costs were down 6.8 percent, and yearly member costs were 13.8 percent lower.

Independent community pharmacies, which are often located in underserved areas, can enhance these efforts by ensuring adequate patient access to prescription drugs and pharmacist counseling services.

Finding more innovative and cost-effective ways to deliver prescription drug benefits is a growing phenomenon. More than 40 major corporations, from American Express to Verizon, have formed the Health Transformation Alliance. HTA is dedicated to reducing the more than 30 percent of waste that bloats health care spending.

When it comes to prescription drugs, their relationships with PBMs have been reimagined to include “full financial disclosure, financial disclosure auditing rights, and participation in the development of formularies.” It is an ongoing process where the best practices will be applied.

The time has come for PBM reforms like these, not only for Fortune 500 companies, but also — and especially — for Medicare and Medicaid. Common-sense reforms could actually save our federal government billions of dollars.

Henry Kaiser once said, “Problems are only opportunities in work clothes.” All of us — policymakers, insurers, pharmacists, and even PBMs — must roll up our sleeves and create better, more cost-effective prescription drug benefit plans for Americans.

B. Douglas Hoey is a licensed pharmacists and CEO of the National Community Pharmacists Association CEO.

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