“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
Liability claims and incidents involving pharmacists have risen in individual cost, according to a new industry report.
The Healthcare Providers Service Organization worked with the American Pharmacists Association and the Institute for Safe Medication Practices to compile data on pharmacist malpractice claims and license defense cases.
When pharmacists are defending an alleged infraction to their state pharmacy board, the average cost is $7,650 — which is a 43% increase from 2018, and more than twice as expensive as the average expense in 2013, the report found.
The top five most common allegations that cause a pharmacist’s license to be in jeopardy are wrong drug, wrong dose or strength, wrong patient, failing to consult with a practitioner about a concern, and an error in calculation or preparation.
The Centers for Medicare and Medicaid Services (CMS) announced the monthly Medicare Part A and B premiums for 2024 on Thursday, with the costs set to go up by 6 percent next year.
The premiums would increase by $9.80 from $164.90 to $174.70 in 2024 and the annual deductible for Medicare Part B beneficiaries will go up from $226 to $240 as well. This price increase comes after Medicare Part B premiums went down for the first time in more than 10 years in 2023.
Medicare Part B covers medically necessary services and preventive services, which include mental health services, some outpatient prescription drugs, ambulance services and durable medical equipment.
The premium announced Thursday falls in line with what the Medicare Board of Trustees estimated the 2024 premium would be earlier this year.
“The increase in the 2024 Part B standard premium and deductible is mainly due to projected increases in health care spending and, to a lesser degree, the remedy for the 340B-acquired drug payment policy for the 2018-2022 period under the Hospital Outpatient Prospective Payment System,” the CMS said.
The 340B Drug Pricing Program, established in 1992, requires that pharmaceutical manufacturers participating in Medicaid provide outpatient drugs at significantly discounted prices to eligible health care organizations.
Before 2018, the Medicare reimbursement rate to eligible hospitals for Part B-covered outpatient drugs was the average sales price of a product plus 6 percent. In 2017, however, the CMS changed the payment rate to the average sales price minus 22.5 percent, saying this more accurately reflected the cost that 340B-eligible hospitals incur.
This updated rate was in effect from 2018 to 2022 before the Supreme Court ruled it was unlawful due to the federal government not conducting a survey of hospitals’ acquisition costs beforehand.
As part of the remedy in response to the suit, the CMS proposed a one-time lump sum payment to hospitals affected by the new payment policy from 2018 to 2022. The agency estimated these entities received about $10.5 billion less than they would have, $1.5 billion of which providers had already received by the time the remedy was proposed. As such, it was proposed that the remaining $9 billion be divvied out to the 340B-eligible entities that were affected.
What is it with bureaucrats, they seem to like to “play games” with people’s lives. Congress screws around with passing annual budgets and this year.. LAST MINUTE that passed a 45 day continued resolution to post pone the job that they knew was due since everyone claim to office. There was the threat of many of the 2 million people who work for the Fed bureaucracy – would not get paid – but just like all the other times that Congress did this.. they could come around after the “financial crisis” was over and pay all the employees the paid that they were due, and got nothing more/less than a extra paid vacation.
Now here we are again with the DEA playing with pt’s quality of life issues and just putting ANOTHER BANDAID on the issue. Practitioners and staff can’t budget long term, pts never knows when the DEA is going to take some sort of action and turn their Quality of Life issues upside down.
With a November cutoff looming, the United States Drug Enforcement Administration has for a second time extended temporary rules allowing prescription of controlled medications via telehealth.
These rules, established during the Covid-19 pandemic, are an exception to the conditions of a law known as the Ryan Haight Act, which require at least one in-person medical examination before a doctor can prescribe a controlled medicine, including stimulant medications for attention-deficit hyperactivity disorder, benzodiazepines for anxiety, and drugs for opioid use disorder, sleep or pain, said Dr. Shabana Khan, chair of the American Psychiatric Association’s Committee on Telepsychiatry, in a previous interview with CNN.
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As the pandemic public health emergency that allowed for the exception neared its May 11 end date, the DEA received more than 38,000 public comments on two proposals designed to keep some flexibility in the telehealth framework moving forward, Khan said. The proposals would allow telehealth practitioners to prescribe one 30-day supply of buprenorphine — a medication for opioid use disorder — or Schedule III-V non-narcotic controlled medications, without doing an in-person exam first. A patient would have to do an in-person exam before the second prescription of either type of medication, according to those proposals.
The DEA and the Substance Abuse and Mental Health Services Administration announced May 9 that the temporary rules would be extended through November 11, while the DEA and HHS considered the public comments and any revisions to the proposals — buying more time for telehealth patients who might have otherwise experienced a disruption in care.
Now, after holding two days of public listening sessions on the rules in September, the DEA and HHS have further extended the flexibilities through December 31, 2024.
Some medical organizations have praised the decision.
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American Medical Association president Dr. Jesse M. Ehrenfeld said in a news release that the organization is “grateful the DEA recognizes patients being treated with these medications … often have challenges securing and traveling to in-person appointments, and that the agency is committed to avoiding lapses in their care.”
The latest extension also applies to all patient-practitioner relationships conducted over telehealth, not just those started before, or on, November 11.
“We are thrilled that the DEA is taking such a thoughtful and thorough approach to creating the right rules around the prescription of controlled substances,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, in a news release. “This is a critical issue for millions of individuals and their families, as well as clinicians wanting to provide care to their patients, wherever and whenever they need it.”
Timothy E. King, MD “The Rat King Mother of All Fraud” Dr. King’s assertion that prescriptions of opioids should be deemed illegitimate if there is no objective evidence of functional improvement among patients. This premise, however, fails to account for the inherently subjective nature of pain – a critical factor in assessing the effectiveness of pain management.
DR. TIMOTHY MUNZING, MD,, the prosecutors have retained these so-called experts listed below, Munzing, Sullivan, Patel, et al., because they are more than willing to say whatever was needed as long as they are paid millions of dollars for their biased and prejudicial testimonies.
I don’t know if they do it any more, but one of the large chains use to give people a “gift card” when they “pitched a fit” – while waiting in line to get their Rx filled or their Rx(s) where not ready WHEN THEY THOUGHT THAT THEY SHOULD BE. Guess what the other people waiting in the Rx line to get their Rx(s) filled learned? Pts who “pitch a fit” may get enough on a “gift card” to pay for the copay(s) on their prescriptions.
Retail pharmacists and technicians around the country say they’re overworked, underpaid and fed up.
Now some are walking off the job.
Pharmacy staff at Walgreens locations across the country called out of work on Monday to protest harsh working conditions, leaving some stores closed or critically understaffed. Organizers told CNN that hundreds of workers participated in the organized action, which is expected to last through Wednesday.
The walkouts come just two weeks after dozens of pharmacy employees at CVS, America’s largest retail pharmacy chain, walked off the job in Kansas City.
Here’s what pharmacy workers fighting for:
Patient safety
Monday’s walkout wasn’t easy for Walgreens’ employees.
Employees understood that they could be leaving customers without immediate access to some medications and that they were canceling long-scheduled vaccination appointments.
But this was their last-resort option, workers told CNN. They said increased demand for prescriptions, shots and other services without sufficient staff to fulfill the orders made it nearly impossible to do their jobs properly and created potentially unsafe conditions for customers.
“They didn’t feel confident that they could provide care in a safe environment,” said Michael Hogue, CEO of the American Pharmacists Association, who traveled to Kansas City to meet with CVS executives, Walgreens leadership and walkout organizers last week.
A 2022 National Community Pharmacists Association survey showed that nearly 75% of respondents felt they did not have enough time to safely perform clinical duties and patient care.
Stores often operate with just one pharmacist behind the counter for a 12 hour shift.
“Pharmacists are so overwhelmed and worried that they’re going to make a mistake. It’s so easy to make a mistake under those conditions,” said Shane Jerominski, a pharmacy labor advocate who spent a decade working at chain pharmacies including Walgreens and now manages an independent pharmacy.
Representatives from CVS and Walgreens did not immediately respond to requests for comment.
Walgreens on Monday said it understands “the immense pressures felt across the US in retail pharmacy right now,” according to Fraser Engerman, senior director of external relations at Walgreens. The company is “engaged and listening to the concerns raised by some of our team members.”
CVS representatives told CNN on Saturday that their “leaders are actively engaged with our pharmacists to directly address concerns they have raised.”
More time
CVS, Walgreens, Walmart, Amazon and a number of other stores are encouraging customers to seek non-emergency care at their locations. That’s gaining traction, according to Wolters Kluwer’s Pharmacy Next survey. More than 80% of respondents said they trust a pharmacist, nurse, or nurse practitioner to diagnose minor illnesses and prescribe medications to treat them.
“There’s been tremendous consumer demand for those services,” Dr. Peter Bonis, the chief medical officer at Wolters Kluwer Health, told CNN.
That means there’s a lot of money to be made.
But retail pharmacies haven’t done much to address the evolving demands on employees, he said. That puts a tremendous amount of strain on the existing staff.
“I’m not wholly surprised that there is this burnout phenomenon,” he said.
Some CVS and Walgreens employees told CNN that an increased focus on vaccinations from management has added to their workload and made it more difficult to focus on filling prescriptions and customer care.
“Walgreens and CVS have turned into a vaccination clinic first and a pharmacy second,” said Jerominski. “Because immunizations are so profitable, filling prescriptions is almost an afterthought.”
One Walgreens technician told CNN that they now spend their entire day in the “shot room” jabbing arms. h
“That’s the one thing that’s driving us absolutely bonkers,” they said, “the fact that management cares way more about us giving vaccines than anything else.”
The technician is the only immunizer on staff and earns less than $20 per hour.
More staff and better pay
It all comes down to staffing, said Hogue.
There are currently about 30,000 open retail pharmacy technician positions in the United States and about 7,500 open pharmacist positions, he estimated.
“Part of it is that pharmacy technician pay is abysmal,” said Hogue. “In some states pharmacy technicians are making minimum wage, and it’s a very stressful environment.”
That means that young people don’t see pharmacy tech as a viable career path and turnover is high.
The problem isn’t a lack of pharmacists. Pharmacy schools have expanded rapidly over the past few years, producing plenty of new graduates. Plus, a recent posting for a pharmacist role at a VA hospital in Kansas brought in about 700 applications, Amanda Applegate with the Kansas Pharmacists Association told CNN.
The problem, she said, is that many pharmacists don’t want to work for a retail pharmacy.
Every pharmacy needs at least one pharmacist on staff to open, he said, and because staffing is so limited, it’s not uncommon for a pharmacy location to shut down entirely when a pharmacist falls ill or isn’t able to make it in. But amidst these challenges, job security remains a concern for many. If you find yourself in a situation of losing employment for no apparent reason, it’s crucial to seek help from an employment lawyer. Have you been fired unjustly in Boston, MA? A wrongful termination lawyer from Sweeney&Merrigan can help!
Customer relations
Pharmacy staff gets yelled at. A lot.
The pharmacy desk is often the final port of call for patients navigating a confusing and frustrating medical system.
The American public and the average patient doesn’t really understand what goes in to filling a prescription, said Jerominski.
“They just think we’re taking pills from a big bottle and putting them into a little bottle,” he explained, channeling a famous Jerry Seinfeld joke. But pharmacists also have to assess what medications a customer is taking, make sure there will be no interactions and advise them about side effects and best practices, he said.
When that’s rushed through or done haphazardly by an exhausted employee “a lot can go wrong,” he said.
High prices, long waits and medicine shortages don’t help the situation, either.
But pharmacists say that management sets them up for negative interactions with customers by stretching them thin and taking away time that should be spent on customer care.
To be heard
When pharmacy workers bring their complaints to management, they sometimes fall on deaf ears, found a survey conducted last year by the American Pharmacists Association the National Alliance of State Pharmacy Associations.
“There is no open mechanism for pharmacists and pharmacy personnel to discuss workplace issues with supervisors and management; if they try, the discussion is not welcomed or heard,” the groups wrote.
“The sad part is it came to this,” the organizer of the CVS walkouts told CNN. “I’ve been asking and asking for more support for 10 years and no one listened. We had to stop asking and take drastic measures to force the issue.”
Dear Public, the pharmacy world is on fire right now and you might wonder why.
You see, for more than a decade, working conditions at your local CVS Health ,Walgreens , RITEAID PHARMACY and others have been unsafe. But with COVID, what was once a house on fire , became an entire neighborhood or even city on fire! Community Chain Pharmacists, Technicians and Pharmacy Students were tasked with the great honor to vaccinate the entire country. We took, this call with pride, because we were and are still are the very heart of public health and what we do for the public at large, can NOT be explained in one post !
We are the most accessible individuals. We are often the first person you see before headed to your doctor. And the last person . While everything was shutting down, we were present. We held you in the moments of the lonely quarantine. We celebrated with you. We mourned with you . And we did all of that while still expected to continue to fill prescriptions, meet company profits driven goals among other things.
And yet, our burdens were not matched with the proper physical, emotional and even financial support. But we did it. We burned ourselves to the ground because we chose this profession. Meanwhile, companies like those big corporations, pocketed the revenues and made no attempt to meet simple requests such as less demands on us, better staffing, patients centered values or even better pay for our technicians who were and are still very much underpaid.
We have come to work with fear in our hearts because every prescription we touched, felt like an error! We became sick, physically and emotionally. Some turned to substances and other things just to make it through. We became the pilot with no flight attendants and yet still being asked to handle bags, drinks and snacks while flying the plane .
And today, it is still happening. This is very much alive in your Walgreens, CVS and others.
Now do you understand why we are on fire? We do not feel safe for you! The very people we took an oath to protect… your life is being endangered by those corporations and they do not care about you and us.
So no, we are not asking for more money like they say in the news. There is not a shortage of us. They are lying so much, it is like breathing air for them.
What we want is safety for you! What we want is to take care of you. What we want is to know your name and take time to know you.For them, you are just a prescription number. To us, you are so much more!!
We don’t want to pass snacks and drinks. We want to fly you to safety!
We have always seen you. But now, do you see us? Do you see why many are walking out in protest? Do you see why they are putting their reputation And livehood on the line ?
Patient Safety should be the number goal of any healthcare system. It is ours as Pharmacists, Technicians and Pharmacy Students. We strive for it! But to them, those giants… it is NOT!
Disclaimer: those thoughts are my own.
Right now, Pharmacy, Pharmacists & Pharmacy technicians are in a crisis. This did not happen over night, but the COVID-19 pandemic did accelerate a crisis that was already building.
What man-hours were added to a Rx dept during the COVID-19 vaccines and testing… as soon as the demand for COVID-19 vaccines, it was just as as Flu vaccines “season” was just starting and most/all the chains cut back on the man-hours in the various Rx depts. This was seemingly the “straw” and I know many chain pharmacies around us, were experiencing Rx dept staff – calling in sick and/or just “giving notice”
I suggest you read the above post and pay particular attention to the response of the attorney representing CVS, questioning why the chain was being fined $10,000. They apparently accept no responsibility of the BAD OUTCOME(S) of under staffing.
LAS VEGAS (KLAS) — Timika Thomas does not come from a large family. So, as an adult, she decided to make one and had four lovely, healthy children. She and her husband, in 2019, decided to have one more.
Progressing into her thirties, Thomas was having trouble getting pregnant. She had two ectopic pregnancies, which led to Thomas having her fallopian tubes removed. And even though they weren’t insured for the costs they would endure, they decided to pay for invitro fertilization – IVF.
Doctors sedated Thomas, inserted two eggs inside her body and sent her home with prescriptions, one of which would trick her body into producing enough hormones to kickstart her pregnancy.
“You have to make yourself think it’s pregnant,” Thomas told the 8 News Now Investigators. “We’re taking a lot of supplements to make our bodies think it’s pregnant.”
In previous attempts, Thomas had taken a shot to her buttocks in order to trigger that hormone inside of her, but injecting herself was emotionally trying and she wanted to give her “butt cheek a rest,” she said.
Her doctor prescribed a vaginal suppository in place of the injections. Thomas went to her CVS branch at W. Craig Road and Camino Al Norte in North Las Vegas. She took two of her required doses and knew something was wrong.
“I started cramping really bad,” Thomas said.
No stranger to the IVF process, she expected cramping, but this was not the pain she anticipated.
“My cramping went beyond that,” she said. “It was extreme. It was painful.”
Thomas checked the bottle, looked up the name of the prescription on the label, and the results of her internet search began a yearslong process of mourning.
“The first thing I read is it’s used for abortions,” Thomas said.
Documents obtained by the 8 News Now Investigators outline how two technicians and two pharmacists made a series of errors that led to Thomas being given the wrong medication, which essentially terminated her budding pregnancy on the spot.
“They just killed my baby,” she said to herself at the time. “Both my babies, because I transferred two embryos.”
Timika Thomas looks at a prescription bottle as she describes her ordeal. (KLAS)
Among the series of mistakes, those documents say one technician – incorrectly believing she knew the generic name for the brand prescribed by the doctor – entered the wrong name into the prescription. One pharmacist did not catch the error, and another pharmacist failed to counsel Thomas when she came to pick up her medication.
“It [the error] would have been caught because then they would have had to have the medicine in their hand,” Thomas said. “And they would have said, ‘Oh, this is Misoprostol or Cytotek, have you taken this before?’ And I would have said ‘no.’ ”
Thomas lodged a complaint with the Nevada State Board of Pharmacy, which met in September. After she gave heartbreaking testimony about her horrifying experience, the two pharmacists were fined and had their licenses suspended provisionally. If both pharmacists avoid disciplinary action over the next 12 months, pay fines and take continuing education credits, their licenses will be reinstated, according to pharmacy board documents.
The CVS pharmacy on the northeast corner of Craig Road and Camino Al Norte. (KLAS)
CVS, in response to inquiries from the 8 News Now Investigators, provided the following statement:
“We’ve apologized to our patient for the prescription incident that occurred in 2019 and have cooperated with the Nevada Board of Pharmacy in this matter. The health and well-being of our patients is our number one priority and we have comprehensive policies and procedures in place to support prescription safety. Prescription errors are very rare, but if one does occur, we take steps to learn from it in order to continuously improve quality and patient safety.”
The pharmacy board fined CVS the maximum amount allowed by statute — $10,000.00 – for its vicarious liability of the pharmacists’ errors.
At the hearing, the attorney for the retail behemoth distanced his client from its one-time employees.
“To suspend or take action against a pharmacy license when they really didn’t do anything wrong [it] wasn’t pled they did anything wrong,” the attorney said prior to the board imposing the fine. “The only allegation is that they had these pharmacists.”
Thomas was insulted.
“I felt like that was not okay because he should have took initiative for the company as a whole.”
Both pharmacists apologized.
“It’s a human error,” one pharmacist testified, in between heaving sobs. “It was just a human error and I’m so sorry.”
But sorry barely softens any of the heartache or sorrow Thomas feels even some four years later.
“All I got was a sorry,” she said. “It will never be good enough.”
I hope a lot of chain Pharmacists read the comment from the attorney representing CVS before the NV Board of Pharmacy. The chains don’t have their back. In reality, most/all chains have something in their policies & procedures manuals that all employee must follow/obey any/all Fed/State laws, rules & regulations. The fact that Rx dept staff makes a Rx mis-fill , which is a violation of the State’s Pharmacy Practice Act and thus the chain can claim that the employee(s) violated the chain’s policies & procedures… thus the chain has no responsibility – financial liability for the employees’ actions.
While the attorney representing CVS at the NVBOP meeting .. did not state the employees violated the chain’s policies and procedures…but…The pharmacy board fined CVS the maximum amount allowed by statute — $10,000.00 – for its vicarious liability of the pharmacists’ errors.
At the hearing, the attorney for the retail behemoth distanced his client from its one-time employees.
“To suspend or take action against a pharmacy license when they really didn’t do anything wrong [it] wasn’t pled they did anything wrong,” the attorney said prior to the board imposing the fine. “The only allegation is that they had these pharmacists.”
I hope that all chain Pharmacists, understand that they really need to personally have their own professional liability insurance, because the chains really don’t have their back and will use situations – such as this – they will try to dodge any lawsuits over the damages caused by their employees in the Rx dept.
