“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
Doctors across Ontario are prescribing potent opioids to patients who may otherwise overdose and die on the street supply — and they are calling on other clinicians to do the same.
They’re part of the growing safe supply movement, made up of prescribers and harm reduction advocates in Canada who are calling for access to pharmaceutical opioids as an alternative to the illicit market that has become tainted with bootleg fentanyl and carfentanil.
“We have to be willing to step outside of our comfort zone and out of the medical establishment comfort zone and say that we need to keep people alive,” said Dr. Andrea Sereda, a family physician at the London Intercommunity Health Centre in Ontario.
For the last three years, Sereda has been prescribing take-home hydromorphone tablets to select patients who are currently relying on the illicit market, most of whom are homeless and inject drugs. The effort, which she refers to as “emergency safer supply,” started with three people and has since grown to 100.
Sereda says the results have been positive. None of the patients have fatally overdosed, half of them have found housing, and they have weekly contact with healthcare providers.
“It’s not just a prescription for pills, but it’s a relationship between myself and the patient and a commitment to make things better,” Sereda told Global News. “That involves me taking a risk and giving them a prescription, but it also involves the patient committing to doing things that I recommend about their health and us working together.”
Safer supply is not a replacement for methadone or suboxone, said Sereda. It’s an option for the subset people for whom methadone and suboxone don’t work, and it serves as a bridge for people who may not be ready for those treatments.
Hers is one of the only programs of its kind in Ontario, and she hopes to see more like it. Similar efforts include prescription injectable opioid programs in Vancouver for a subset of patients for whom opioid substitution therapies such as methadone and suboxone are ineffective. Last year, another Vancouver clinic began prescribing hydromorphone tablets for patients who consume them on site with medical supervision.
Dr. Nanky Rai is one of two physicians at the Parkdale Queen West Community Health Centre in Toronto who began prescribing hydromorphone tablets last November to patients who rely on the illicit opioid market. She now prescribes to around 10 patients and she has seen an improvement in their quality of life.
Rai said she was spurred to ramp up this type of prescribing in part because of the number of people she knew who were dying from opioid overdoses linked to the contaminated drug supply.
“I’ve had people who, literally, their urine is just all carfentanil,” said Rai in an interview. “That’s really what terrified me into action. Before that, I was doing it slowly building things up. If we don’t catch this, we’re never going to be able to prescribe any drugs that are meant for human consumption that could actually compete with and address what carfentanil is doing to peoples’ bodies — for those who stay alive.”
Rai also said that the focus on slashing opioid prescriptions as a solution to the overdose crisis has been harmful for some. Not only has cutting people off of their prescriptions forced many patients to turn to the dangerous street supply, it has also impacted those who need pain control for things like medical procedures, who now have more difficulty accessing them.
Rai said that she looks forward to having her prescribing program evaluated in the future. “We recognize that we’re building as we go,” she said. “But we can’t wait in order for more research to be done in order to stop people from dying.”
Addiction experts say that primary care providers have an important role to play in the face of governments that are slow-moving or unwilling to embrace certain harm reduction measures. Sanctioned supervised consumption sites exist only in B.C., Alberta, Ontario, and Quebec. And Alberta and Ontario have recently frozen or withdrawn funding for a number of sites.
But the overdose crisis has become even more urgent as death rates continue to rise across Canada. Nationwide overdose data released earlier this week by the federal government show there were at least 4,460 opioid overdoses in Canada in 2018, up 10 per cent from the year before.
New figures released this week from Ontario’s public health agency show that 388 people in the province died of an opioid overdose last summer, down slightly from the 414 deaths during the same time the year before.
“If 11 people a day were dying of any other reason, whether it was tainted lettuce or Ebola or a virus like SARS, I think we would be mobilizing at the community to do things differently to stop that epidemic,” said Sereda. “And I think just because it’s affecting a highly-stigmatized group like drug users doesn’t mean that doctors shouldn’t come together for that collective action on this issue.”
The federal government has expressed openness to safe supply measures. In May, Health Minister Ginette Petitpas Taylor said it had approved injectable hydromorphone to treat opioid addiction. However, it is not covered under the Ontario Public Drug Plan, as it is under the equivalent program in B.C.
On Thursday, a group of more than 400 healthcare providers and researchers released an open letter to Ontario Premier Doug Ford to add high dose injectable hydromorphone to the plan so that it can be prescribed in a cost-effective way. The letter also called for the implementation of programs that provide safer drugs.
A spokesperson for the Ontario health ministry told Global News in an email that the province “takes the ongoing opioid crisis very seriously and is committed to helping people struggling with addiction to get the help that they need, when they need it.”
The province is also reviewing the federal injectable hydromorphone announcement, but that “no decisions have been made with respect to Ontario’s support for hydromorphone treatment.”
Former Liberal health minister Jane Philpott, who is currently an independent MP, was instrumental in implementing a number of federal measures to address the opioid crisis in Canada such as easing restrictions around opening supervised consumption sites.
Although health care is under provincial jurisdiction, Philpott told Global News in an interview that the federal government can be a champion for certain harm reduction approaches.
“As physicians and this entire system becomes more comfortable with the concept of safe supply,” said Philpott, “one of the things the federal government has already done and can do even more is make sure that the work that’s being done is well-documented and well-researched so that we can start to understand what best practice looks like.”
We have an estimated 40 million alcoholics and abt 100,000/yr die from the use/abuse of alcohol. That is a estimated TWENTY TIMES the number of opiate substance abusers and yet about half as many deaths as from the use/abuse of alcohol.
There is claimed that abt 1,000 people/yr die of alcohol toxicity ( OD )
Could this be that many alcoholics “know their limit” and they can always purchase their “drug of choice” and in a “pharmaceutical grade” purity ?
Logic would suggest that if we allow opiate substance abusers to have regular access to their pharmaceutical grade of opiates… would we have much fewer OD’s ? Some other countries like Portugal have tried this with great success of reduced OD’s and fewer opiate substance abusers.
Is the Portugal society that so much smarter than us… or … is our country just that PLAIN STUPID ?
A Drug Enforcement Administration database containing detailed information about the flow of opioids through the U.S. will be made available to The Washington Post and HD Media Co., the Sixth Circuit said June 20.
The DEA failed to show “good cause” for keeping the database confidential, the U.S. Court of Appeals for the Sixth Circuit said, reversing a trial court.
Nearly 1,300 states, counties, and others are plaintiffs in litigation against drug manufacturers, distributors, and sellers related to the opioid…
Kellie Martin and her husband Don were taking Christmas decorations down from the attic of their suburban Garland, Texas, home in late 2011 when their lives changed forever.
Kellie, 54, missed a step on a ladder and fell, resulting in a herniated disk in her back. After physical therapy and muscle relaxers, their family doctor recommended neurosurgeon Christopher Duntsch. The couple agreed to visit the doctor — a decision that will forever haunt Don and their two daughters.
The case of Duntsch is explored in the new Oxygen docu-series, “License to Kill,” premiering on June 23. The show, hosted by renowned plastic surgeon Dr. Terry Dubrow of “Botched,” chronicles the harrowing accounts of patients put into jeopardy by medical professionals’ insidious use of their expertise. It highlights interviews with families, medical professionals and law enforcement.
Don Martin participated in the Oxygen docuseries “License to Kill.” (Oxygen)
Duntsch was recently the subject of a true crime podcast earlier this year titled “Dr. Death” by Wondery — the same podcast network behind their hit series “Dirty John.”
“From the initial fall, it wasn’t that super great,” Don told Fox News about his wife’s injury. “It was a lingering pain. It never went away. We did all kinds of treatments to help alleviate the pain, but it just remained persistent. We were planning on going to an out of country trip, so we thought we might get this fixed before we did. And she was in more pain than she led on. I could see it. I didn’t want her to go through that if we could avoid it. That’s when we started exploring surgery options.”
The couple soon found themselves in Dr. Duntsch’s office scheduling surgery for during the elementary school teacher’s March 2012 spring break. Duntsch insisted the 45-minute procedure was routine and simple to do.
“He sounded very articulate,” reflected Don. “It sounded like he knew what he was doing. We figure it wouldn’t be an issue… He said it was a minor surgery, but that she would be OK after the procedure. A very simple, common procedure — that’s what we were hoping for. A quick recovery.”
But on the day of surgery, Don found himself waiting, not knowing what happened to Martin.
“About an hour later, I’m still sitting in the waiting room and I hadn’t heard from anybody,” he explained. “I asked one of the nurses to check and see what was going on. Then 15-20 minutes later, [Duntsch] came out. He tells me the surgery went well and she’s moving around, but was in obvious pain so they gave her more medicine. She may have to go up to the ICU or maybe stay overnight, but she was going to be OK… That’s when I called my daughters to come up to the hospital. That’s when I realized this is not good.”
The wait continued and Don agonized over Martin, wondering what was happening behind closed doors.
“I’m starting to freak out,” he said. “Something just wasn’t right because no one was telling me, ‘Hey, she’s recovering, you can come to see her.’ Instead, they’re continuing to work on her. This is going on now for two hours. My girls were holding on to hope, but I just knew something was seriously wrong.”
Don said the ICU physician, as well as Duntsch and the anesthesiologist, came to see him and the couple’s two daughters to deliver the devastating news — the beloved matriarch was dead.
“They told us they tried everything they could, but they couldn’t save her,” said Don. “That’s when the girls lost it. I lost it. That’s when the nightmare started… We didn’t get a chance to say goodbye to her. We went in there with good faith, believing in the doctors and the medical world so they could help us. Instead, they ended up turning our world upside down. It was pure misery. I was totally lost. My world just ended right then and there.”
Don Martin said he and his daughters are still trying to make sense of what happened to beloved matriarch Kellie Martin. — Oxygen
People magazine reported the medical examiner confirmed Don’s fears. It turned out Martin had bled to death after Duntsch sliced an artery. According to the outlet, Don also learned that Duntsch had earlier operated on one of the coroner’s office employees and left the man paralyzed. The Dallas County district attorney’s office would later learn that that out of 38 surgeries undertaken by Duntsch in less than two years, 33 had gone wrong. Two patients had died, one was rendered a quadriplegic and many were left with permanent injuries.
“I was angry,” said Don when he learned of Duntsch’s other victims. “I was angry at the medical world. If this doctor had previous bad outcomes, why did he still had the ability to do surgery? It was such a cover-up. As things progressed, I got angrier and angrier with the system. But by the grace of God, other doctors started voicing their opinions about [Duntsch]. But how was I going to survive? How am I going to live day by day now?”
Between 2011 and 2013, Rolling Stone previously reported, Duntsch was employed by four Dallas-area hospitals and nearly all of his patients, those who survived, came out in far worse shape than ever before.
Don Martin still wonders why Christopher Duntsch was able to get away for so long. (Oxygen)
During the trial, Dallas surgeon Randall Kirby, who assisted on one of Duntsch’s surgeries in 2012, told jurors he sent information to the Texas Medical Board, warning them of Duntsch’s botched procedures. D Magazine shared that despite receiving complaints dating back to 2012, the Texas Medical Board reportedly didn’t revoke Duntsch’s privileges until 2013. Texas Observer clarified that the Texas Medical Board is “limited” in its ability to investigate malpractice, which could have possibly resulted in the delay.
According to records, Duntsch was booked into the Dallas County Jail in 2015. He was charged with five counts of aggravated assault causing serious bodily injury and one count of injury to a child, elderly or disabled person.
D Magazine reported that in July 2016, the Dallas County District Attorney’s Office followed through and a grand jury returned five indictments of aggravated assault and one of harming an elderly person. Duntsch pleaded not guilty and alleged in emails that he was at the center of “a vast conspiracy to bilk money from the hospitals where he practiced.”
Dallas-based surgeon Christopher Duntsch was also the subject of a Wondery podcast titled “Dr. Death.” (Dallas County Jail)
The indictment accused Duntsch of wide-ranging malpractice, including improper placement of screws and plates along patients’ spines, a sponge left in one patient, and a major vein cut in another. Records also showed that Duntsch operated on the wrong part of a patient’s spine, damaged nerves and left one woman with chronic pain and dependent on a wheelchair.
At the time, Duntsch was struggling financially and had racked up a series of arrests, including stealing Walmart merchandise.
During the trial, prosecutors said Duntsch’s hands and surgical tools amounted to “deadly weapons,” and contended that he “intentionally, knowingly and recklessly” harmed up to 15 of his patients. Prosecutors also claimed that in a 2011 email to a girlfriend, Duntsch said he would “become a cold-blooded killer.”
Dallas surgeon Randall Kirby says his former colleague, Dr. Christopher Duntsch, managed to commit crimes so heinous that patients everywhere are still struck by fear when they hear about the case for the first time. — Oxygen
However, Duntsch’s attorneys argued that he was not a criminal but just a lousy surgeon committing malpractice in chaotic operating rooms in hospitals in Dallas and its northern suburbs. They also said the tone of the email in question was unclear and could have been meant as sarcasm.
The New Yorker reported Duntsch was ultimately stopped after the combined involvement of the Dallas Country district attorney, an attorney, a journalist, and the state medical board with the efforts initiated by Kirby and Dr. Robert Henderson, a veteran surgeon at the Dallas Medical Center.
In 2017, a jury sentenced Duntsch to life in prison for maiming patients who had turned to him for surgery to resolve debilitating injuries. The decision came almost a week after the Dallas County jury convicted Duntsch of first-degree felony injury to an elderly person.
But life for Don and his family still isn’t easy.
“I’m not gonna lie, I think this puts a strain on our relationship a little bit,” said Don about his daughters. “We were such a close-knit family. It was difficult for them. It was difficult for all of us. They were trying to be careful around me, trying not to say anything or do anything that will upset me. My whole lifestyle has changed. Everything is different now. I look at life differently totally differently. Life is just too precious, too short. We can’t take the little things for granted. We’re just trying to make the best of each day.”
Don hopes viewers will be compelled to conduct no-nonsense on any physician or surgeon they’re considering — and to never take any kind of procedure for granted.
“Get a second opinion no matter what,” he said. “Evaluate everything to make sure you really want to do this surgery. Explore all options. And realize that no surgery is a routine, simple surgery. Everything can be a life or death situation.”
“License to Kill” premieres June 23 at 7 p.m. on Oxygen. The Associated Press contributed to this report.
A shill, also called a plant or a stooge, is a person who publicly helps or gives credibility to a person or organization without disclosing that they have a close relationship with the person or organization. Shills can carry out their operations in the areas of media, journalism, marketing, confidence games, or other business areas.Wikipedia
Medical marijuana legislation widening access for military veterans was shelved Friday in the face of federal opposition.
Rep. Earl Blumenauer, Oregon Democrat, withdrew an amendment from an annual spending bill that would have allowed Department of Veterans Affairs doctors to recommend pot to patients in states that have legalized the medicinal use of marijuana.
Explaining his decision on the House floor, Mr. Blumenauer said the VA “has not been as helpful as it should be” in terms of providing veterans with greater access to medical marijuana, which is prohibited under federal law but legal in most states.
“All of a sudden the VA has decided, well, they would be putting their doctors at risk,” said Mr. Blumenauer, the founder and co-chair of the Congressional Cannabis Caucus.
“I hope that we’ll be able to work together to fix this little quirk to make sure that VA doctors can do what doctors everywhere do in states where medical cannabis is legal and be able to work with their patients,” he said.
The VA did not immediately return a request for comment over the weekend.
Thirty-three states have legalized medical marijuana to varying degrees, providing patients in most of the country with a route for obtaining and using pot in spite of its status as a Schedule 1 drug federally prohibited under the U.S. Controlled Substances Act.
Addressing lawmakers on Capitol Hill last month, a top VA official said the agency would look for the U.S. Drug Enforcement Administration for guidance as long as pot remains on the government’s list of controlled substances.
The DEA “advised VA that no provision of the Controlled Substances Act would be exempt from criminal sanctions as a VA physician who acts with intent to provide a patient with means to obtain marijuana,” testified Dr. Keita Franklin, national director of suicide prevention for the department’s Office of Mental Health and Suicide Prevention.
Mr. Blumenauer’s amendment would have prohibited the VA from “interfering with a veteran’s participation in a state medical cannabis program, denying a veteran who participates in a state medical cannabis program from being denied VA services and interfering with the ability of VA health care providers to recommend participation in state medical cannabis programs.”
“The VA ought to give their patients, our veterans, the same consideration to be able to have these conversations with the doctors who know them best,” he said prior to withdrawing the amendment.
Another measure preventing the Department of Justice from using federal funds to enforce marijuana prohibition advanced in the House of Representatives earlier this week, meanwhile. Co-sponsored by Mr. Blumenauer, the amendment was agreed by a vote of 267-165 and slated to be included on the full appropriations bill funding the Justice Department’s budget for the next fiscal year.
“This has been a very important week in the evolution of the federal policy to end the failed policy of prohibition on cannabis,” he said Friday. “This is remarkable progress that we have seen, but it is just an effort by Congress to catch up to where the rest of the American public is.
Michael is a 65-year old veteran, educated and successful, yet lack of care by his doctors forced him to move to Thailand for care.
1976. Army. On duty in Fulda Gap. Jeep flipped over on my back.
I was a tough kid, so I put up with it. After decades of lower back pain, it finally became too much. In 2008 I went to a spine specialist and surgeon at Kaiser in San Jose, CA. While there, the doctors told me I would need metal support surgery in my lumbar and cervical spine. Lumbar surgery went OK, but didn’t alleviate my pain there, in fact it increased it. Cervical surgery was so complicated it became three different surgeries and a ton of new pain.
I joined a Pain Management program, dosed with MME (morphine milligram equivalent) around 240 for the following year. I learned and tried all the pain management techniques, tried all the alternative methodologies, including injections.
Then out of nowhere my pain doctors decided to titrate my meds down over the next six months. They didn’t stop until I was completely off the pain meds. I just fell apart. Total lack of care. Went on disability. Fell into depression. Less than a year later I was suicidal.
THE LACK OF CARE IN AMERICA
After talking over the situation with my wife, she agreed that it looked like I had little recourse, she suggested we leave America, and try living overseas. We went to Thailand. I was still suicidal, but we tried seeing specialists in Chang Mai. There was nothing they could do regarding the surgeries, but they turned me on to Bangkok Hospital’s Pain Management Clinic. Their approach – total pain support.
They started me on an initial MME of 240, but when that wasn’t effective enough, they raised it to 360. MS-Contin, long acting, with additional immediate-release 10mg pills in case of breakthrough pain. The rest of the program included physical therapy 3 x week, massage 3 x week, psych counseling, and social programs. Wonderful program, the best I’ve experienced. NO shame, NO guilt, just help. Over six years, MME was raised to 600.
COMING HOME
In February 2018, we returned to Lodi, California to live near our new grandkids. I was in great shape, and thought, with the documentation I carried from Bangkok Hospital, and the wonderful results therein contained, doctors here would continue the treatment. WRONG.
Michael in Thailand
Over the last year doctors have cut my MME down to 90 per day. I am in terrible pain. Constant bad breakthrough pain. All my other support (psych, social) is gone. Physical Therapy here is not as thorough as it is in Thailand. massage? Forget about it. Lectures on the opioid crisis however, are unrelenting. Doses of shame, guilt, plentiful. My doctors know little about MME, or the difference between the meds, or interventional radiology. When I try to explain, I’m ignored, and receive another lecture about the horrors of addiction.
WHEN YOUR COUNTRY ABANDONS YOU
This is my life in the land of the free. Liberty? Government and doctors refusing care. Lectures on the opioid addiction mess. A mess not of my making, has nothing to do with me. I have never overdosed or used street drugs. Until this last year, I have never taken more pills than those prescribed. Now? What’s a man to do? Lay in a dark room in pain, ignoring his family, ignoring social interaction? I’m fast slipping back into depression, and again considering a move back to Thailand, if my wife and I can stand to leave our grand kids.
I’m sixty-five years old. A veteran. I have advanced education and have been successful in my career. And my doctors shame me and treat me like a troubled child. America, do better.
Editor’s note: Michael reached out to us through What’s Your Story, and he and I corresponded back and forth a few times. We’re not sharing Michael’s last name because people with chronic pain are concerned with retribution. With patients being forced off pain meds, excessive policing by government agencies and the lack of care in the pain field, who can blame them. That’s the state of chronic pain in America and it’s shameful.
As the Director of Patient Content at Patients Rising, Jim works very closely with the people who have healthcare war stories to tell. As a Columbia University trained writing consultant Jim has worked closely with writers of all levels of skill to help them find and refine their voices. Jim is a writer, editor, author and medical assistant with over 20 years of experience in healthcare. He’s spent over two decades in clinical care and research at some of New York’s biggest health institutions doing hands-on nursing, education and advocacy for rare disease patients.
PHOENIX — A pain management specialist and a patient suffering from chronic pain say that access to opioids is necessary to people who need them to manage their conditions.
As Arizona and other states work to place more rules on opioid prescriptions, some patients are afraid they are being lumped in with addicts, according to pain management specialist Dr. Tony Bui.
“For the chronic pain patients, it’s been very difficult for them because … they feel pretty marginalized from the restrictive action that the state has taken,” Bui told KTAR News 92.3 FM’s Bruce St. James & Pamela Hughes Show on Thursday.
“We’re talking about people who are not … (experiencing) addiction, but more like dependent on these medications, only because they have pain.”
Lori Cutter, one of these patients, suffers from fibromyalgia, degenerative disk disease and neuropathy.
She told Bruce & Pamela that she spent $14,000 last year out of pocket and went to over 200 doctor’s appointments trying to find ways to manage her pain.
“To get the kind of care that I need, that helps me thrive, I don’t want to just go to the pill,” she said.
She said at one point she was on four to five medications before she and her doctor decided to stick with hydrocodone, a well-known opioid.
Bui said it’s common for people taking these types of pills to have exhausted all other options.
“With the opioid medications, it’s usually for the person who has tried various other medications, or other modalities like injections, or beyond, that haven’t worked for them and they still find themselves very dysfunctional from an activity standpoint,” he said.
Cutter said she has sometimes struggled to find a provider who will write her a prescription for the potentially addictive drug.
“That’s a legitimate fear inside me sometimes … because I don’t know long my doctors will continue to fill that,” she said.
Without the drug, she said, “I don’t think I would be functioning as highly as I am. … There’s days I probably wouldn’t be able to get out of bed or sit at my desk very long.”
Bui said his patients often feel like they are automatically labeled as addicts and are looked down on by society.
Cutter said she feels that stigma every time she reaches for her pill bottle.
“I’m hearing these words, ‘abuser,’ ‘addict,’ because that’s what the media and everything is blowing up right now,” she said.
“I think we need to be celebrated that we are managing life as best we can.”
Tune in to KTAR News 92.3 FM’s Bruce St. James & Pamela Hughes Show each day this week at 10 a.m. for special coverage of Arizona’s opioid epidemic.
To reach the Arizona Opioid Assistance and Referral Line, call 1-888-688-4222, or visit the website for more information.
Health-care companies have said they are not threatened by Amazon.
But in a recent lawsuit, CVS argues that Amazon could pose a threat by negotiating directly with insurers, bypassing its lucrative pharmacy benefits manager, or PBM, business.
Kyle Walsh | CNBC
When word spread that Amazon would move into health care in 2017, health-care executives had a ready answer: We are not afraid.
“I honestly don’t believe that Amazon will be interested in the near future in the next few years in this market,” Walgreens’ CEO Stefano Pessina told investors in an earnings call in July 2017.
“I think we have a lot of capabilities and a value proposition that can compete effectively in the market,” CVS CEO Larry Merlo said back in August.
But recent legal actions tell a different story.
In April, CVS filed a lawsuit against John Lavin, a former senior vice president in charge of CVS Caremark’s retail pharmacy network, after Lavin told the company he was leaving to take a job at Amazon’s pharmacy arm, PillPack. The judge this week ruled in CVS’ favor, preventing Lavin from taking immediate employment at PillPack.
That follows another case from January of this year, where insurance giant UnitedHealth sued one of its employees for attempting to join a different Amazon initiative. That was Haven, Amazon’s joint employer health venture with Berkshire Hathaway and J.P. Morgan.
These lawsuits suggest incumbents are more concerned than they’re letting on in public.
The underlying concern: Amazon going directly to insurers
Amazon has said almost nothing in public about its health-care strategy.
But Amazon could disrupt the space dramatically by negotiating directly with insurance companies on drug pricing, cutting out the existing pharmacy benefits managers, or PBMs. All of that could potentially lower health-care costs for consumers.
Among other functions, PBMs help insurance companies negotiate lower drug costs. Manufacturers arrange discounts, called rebates, with the benefits managers so they can fix a spot for their products on a PBM’s list of preferred drugs. It’s a huge business — CVS’ PBM business represented approximately 60% of its overall revenues in 2018, or around $116 billion, according to a person familiar with CVS’ business.
Amazon PillPack CEO TJ Parker, in a deposition in the Lavin case, admitted to the court that the company had “explored a number of different things.”
But he said the company had “no immediate plans” to compete with CVS Caremark’s core offering, its PBM.
CVS certainly seems to think differently, according to the lawsuit to prevent Lavin from working for PillPack.
“Given its robust infrastructure, operational capacity, and distribution reach, Amazon-PillPack is uniquely positioned to negotiate directly with payers (insurers) and displace CVS Caremark’s mail-based services,” CVS argued in support of its motion for a preliminary injunction.
In other words, CVS worries that Amazon is hiring Lavin to approach its clients — insurance plans — for deals that could undercut its PBM.
In particular, CVS said PillPack is already approaching Blue Cross Blue Shield. (CNBC reported talks between PillPack and the insurance network in May.)
“Most recently, Amazon-PillPack engaged in direct discussions with Blue Cross Blue Shield, a federation of 36 health insurance plans that cover more than 100 million Americans, to provide its members with prescription home delivery,” CVS’ motion reads.
Lavin, who has extensive background working with payers, would be well positioned if Amazon PillPack did decide to take that step toward direct contracting over time.
According to Jefferies’ analyst Brian Tanquilut, who also reviewed the legal documents, there’s a real threat that Amazon could chip away at CVS Caremark’s business over time by going directly to insurers. “The lawsuit shows that pharmacy benefits managers are now also at risk of being dis-intermediated,” he wrote.
To that assertion, a PillPack spokesperson responded: “It is important to keep in mind that what’s being reported here is another company’s speculation about our business strategy for a lawsuit to which neither Amazon nor PillPack is a party.”
“PBMs are going to be more protective of their mail pharmacy business than ever and less welcoming to outsiders like PillPack,” said Stephen Buck, a drug supply chain expert who previously worked at McKesson.
For his part, Lavin said in communications to his former employer that he would not be competing head-on with them but would be negotiating from the opposite side of the table.
“I’ll be … handling [PillPack’s] negotiations with PBMs … in other words, it’ll be the opposite of what I did for CVS,” he noted in an email to CVS’ human resources department that was disclosed during the case.
The judge disagreed and granted CVS’ motion to enforce the noncompete agreement and block Lavin from working for PillPack for 18 months.
In his ruling, Judge John J. McConnell wrote, “Mr. Lavin will also negotiate and build relationships with private Payers and public Payers, both of whom are current CVS clients.” McConnell wrote, “It also appears that PillPack will be looking to negotiate directly with the insurers and others on the Payer level.”
CVS, in a statement to CNBC, denied any claim that it is working to block competition and said that it will continue to work with new players.
“We remain focused on delivering innovative solutions to transform the health care experience, but there is always room for new players in health care, as competition can help lower overall costs for payers and patients,” said a spokesperson for CVS Caremark.
war stories to tell. As a Columbia University trained writing consultant Jim has worked closely with writers of all levels of skill to help them find and refine their voices. Jim is a writer, editor, author and medical assistant with over 20 years of experience in healthcare. He’s spent over two decades in clinical care and research at some of New York’s biggest health institutions doing hands-on nursing, education and advocacy for rare disease patients.
