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http://www.cantonrep.com/news/20180624/cvs-cut-payments-to-community-pharmacies-after-aetna-merger
Some pharmacists question the timing of the reimbursement reductions and say they think it was no coincidence. They question whether CVS Caremark used that reduction to help raise $70 billion to merge with Aetna and create a health conglomerate that would include CVS Caremark, the nation’s No. 2 pharmacy-benefit manager; Aetna, the No. 3 health insurer; and CVS Pharmacy, the nation’s largest retail pharmacy chain.
It happened in Ohio, New York, Iowa, Arkansas, New Jersey and possibly other states. Pharmacy middleman CVS Caremark suddenly cut the reimbursements it paid community pharmacies for drugs, some of them far below pharmacists’ costs for potentially life-saving medications.
Each of the cuts happened late last year or early this year — all within a few months of when CVS Health announced a merger with health insurer Aetna.
In a Columbus Dispatch review of data collected from 40 pharmacies, the numbers back up what lawmakers and critics said happened in the fourth quarter of 2017: CVS Caremark sharply reduced payments to pharmacies.
In the first quarter of 2017, CVS Caremark received $370,000 in taxpayer dollars from those transactions. In the fourth quarter of the same year, CVS Caremark’s portion was $522,000, according to the data. The data represent less than 1 percent of the $3 billion Medicaid paid for prescriptions in 2017. CVS Caremark handles the prescriptions for four of the state’s five managed care plans.
CVS Health, parent company of both CVS Caremark and CVS Pharmacy, reported a net revenue of $34.2 billion in the fourth quarter of 2017, according to its website. That is a $3 billion increase compared to the fourth quarter of 2016.
Timing questioned
Some pharmacists question the timing of the reimbursement reductions and say they think it was no coincidence. They question whether CVS Caremark used that spending reduction to help raise $70 billion to merge with Aetna and create a health conglomerate that would include CVS Caremark, the nation’s No. 2 pharmacy-benefit manager; Aetna, the No. 3 health insurer; and CVS Pharmacy, the nation’s largest retail pharmacy chain.
“Dramatically, within days (of the merger announcement), reimbursements for many mental health generics dropped through the floor; below anyone’s ability to buy the product and provide it to the patient,” New York Assemblyman John T. McDonald III said in a legislative hearing earlier this month.
CVS officials say emphatically there was no relationship between the reimbursement cuts and the proposed merger.
“That’s absolutely not true,” Mike DeAngelis, CVS’s senior director of corporate communication, said Tuesday when asked about questions raised by some pharmacists and lawmakers.
Last fall, CVS Caremark cut so deeply the reimbursements for Suboxone, an important drug in the fight against Ohio’s opioid epidemic, that some pharmacists said they were forced to stop stocking it. The Ohio Department of Medicaid intervened with CVS officials and the company quickly increased reimbursements.
Ohio Medicaid Director Barbara Sears on Wednesday said along with Suboxone, her department received complaints about big cuts in reimbursements for hundreds of other drugs.
At the same time, CVS was sending letters to pharmacies citing their likely financial woes stemming from declining reimbursements and offering to buy out its retail competitors.
Complaints dismissed
Complaints also came to the Ohio Department of Insurance, which provides some oversight to the actions of pharmacy benefit managers — companies that negotiate prices with drug companies, help decide which medications are covered by health insurance plans and set reimbursement rates to pharmacies.
The department received 40 complaints about CVS Caremark from independent and large-chain pharmacists in 2017, according to state records.
Of those, 35 were filed in the fourth quarter. In all but two instances, the state sided with CVS Caremark in the dispute.
Department of Insurance officials said they are enforcing the law as written, and the statute doesn’t allow them to address pharmacy benefit manager reimbursements.
“Our authority with respect to PBMs is very narrow, and we cannot take action if there is no violation of the law,” said Chris Brock, spokesman for the insurance department.
In two instances, the complaints were referred to the Ohio Department of Medicaid.
“CVS Caremark just seems to make up their own price,” said Joel Wolfe, a pharmacist for Dave’s Pharmacy in Cleveland, in his complaint. “When you call CVS Caremark … no one will tell you what is going on.”
One of Wolfe’s complaints was for the generic version of Suboxone.
“On 10/30/2017 we were paid $18.88. On 9/30/2017 we were paid $23.50 and on 10/31/2017 were paid $5.09,” Wolfe wrote.
The 40 pharmacies that provided data to The Dispatch showed the same wild swings in reimbursements for the same quantities of the drug.
In the first quarter of 2017, CVS Caremark was paying the pharmacies an average of $1.06 per pill less than what the PBM got from the state, according to the data from the 40 pharmacies.
In the fourth quarter, the pharmacy payments plummeted to $21.23 per pill below what Caremark was receiving from the state. In other words, from October-December, Caremark was taking in $21.23 for every pill sold to help troubled Ohioans overcome their opioid addiction.
Mimi Hart, owner of Hart Pharmacy in Cincinnati, said CVS Caremark drastically cut the price of the generic for Antivert, an antihistamine used to treat motion sickness and dizziness. Hart said CVS Caremark paid her 54 cents per pill, when the cheapest she should find it from a wholesaler or manufacturer was 95 cents.
Other pharmacies complained of similarly large price swings for drugs that treat incontinence, seizures, ulcers and mental health.
“Wake up legislators,” said Rick Marlin, a pharmacist for 46 years and director of pharmacy for Allen’s Pharmacy in Youngstown. “PBMs are doing whatever they want, whenever they want.”
CVS Caremark’s response to pharmacists’ complaints often was the drug could be purchased at the lower price from drug wholesalers McKesson or Cardinal Health. The state accepted that argument when telling pharmacists why they agreed with CVS Caremark.
“What the state doesn’t seem to understand is that there are three major wholesalers, and normally a pharmacy only contracts with one of those three,” Marlin said. “So you can’t buy from the other ones, and we check with our colleagues that do have contracts with those other wholesales and they say there’s no way I can buy it at that price either.”
Widespread cuts
Antonio Ciaccia of the Ohio Pharmacists Association said he doesn’t know whether the reimbursement cuts were tied to the Aetna merger, but “there’s a lot of strange coincidences that are piling up.”
CVS officials said some pharmacies saw reimbursement cuts late last year, but most did not. However, if only a small number of them felt the reimbursement cuts, it was a very vocal one. Consider:
• In New York, Kathy Febraio, CEO of the state’s Pharmacists’ Society, said the CVS reimbursement cuts didn’t stop with the mental health drugs McDonald complained about. “It did not end there. It was very widespread,” she said. “If this went on, it was going to impact patients’ access to medications.”
• In New Jersey, Elise Barry, CEO of that state’s Pharmacists Association, said CVS reimbursement cuts initially were reported Oct. 25 — a day before they started in Ohio and New York. “It was somewhat coincidental,” she said of the fact that the cuts took place just as CVS was about to announce the Aetna merger. “We have suspicions about that.”
• In Arkansas, Scott Pace, CEO of that state’s Pharmacists’ Association, said in February during a news conference that “on Jan. 1, the health insurers and their pharmacy-benefit middlemen dramatically cut the reimbursements to the pharmacies that provide care around the state. These cuts resulted in many patients being turned away at the pharmacy counter. It was not because the pharmacists didn’t want to serve them, but because the insurance reimbursements simply didn’t cover the cost of the medication.”
Arkansas Attorney General Leslie Rutledge now is conducting an investigation into CVS Caremark’s reimbursement practices, saying they “hurt Arkansans in every community across the state.”
Company’s position
In a meeting with Dispatch reporters on Tuesday, four CVS executives said there was no conscious plan to cut reimbursements so the company could raise extra cash. Instead, they said the company’s reimbursements are determined by a secret algorithm that is based on a “maximum allowable cost” list for drugs.
“We don’t manipulate the algorithm,” DeAngelis said.
Michael D. Sargent, CVS Health’s senior director for regulatory and policy affairs, acknowledged some pharmacies suffered cuts, but he said it was because of the kinds of drugs they sold. He added most pharmacies didn’t experience the swift, deep cuts.
“Our sense was, based on the pricing changes that were made in the fourth quarter, that there was some variability based on drug mix,” he said. “But on the whole, pharmacies — chain and independent — were kind of in the middle and there weren’t these wide spikes or drops in reimbursements … across the board. We did see some some spikes and we made adjustments in the fourth quarter of 2018.”
The PBM’s ability to make such adjustments — despite what DeAngelis said about not manipulating the algorithm — raises suspicion by pharmacists. Those concerns stem from how the state allows PBM’s to cover their costs and make a profit: The middlemen keep the entire difference between what they get from the state and what they pay to pharmacies, a total of more than $223 million in the past year for CVS Caremark.
Since, as the CVS executives pointed out, much of what a pharmacy benefit manager receives from the state is fixed by contract (via managed-care companies hired by the state), the only significant variable is how much the PBMs choose to pay Ohio pharmacies.
CVS hit pharmacies from another direction on Friday by increasing transaction fees, charged each time a pharmacist checks a price or fills a prescription. The increase will generate an estimated $1.2 million for CVS annually.
The Ohio Medicaid analysis of CVS pricing released last week found no evidence of anti-competitive practices, but state officials said the analysis looked only at whether CVS was paying competitor pharmacies less than it was paying its own.
“We haven’t seen other factors that we ourselves would claim as anti-competitive behavior, but we are not ruling out the possibility that there is information we don’t have,” said Greg Moody, director of the Governor’s Office of Health Transformation. “If folks have evidence of anti-competitive behavior, of course we’d pay attention to that.”
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https://www.theatlantic.com/health/archive/2018/06/opioid-epidemic/563576/
Three factors led to those numbers, Nora Volkow, director of the National Institute on Drug Abuse, a part of the National Institutes of Health, said at the Aspen Ideas Festival, which is cohosted by The Aspen Institute and The Atlantic. First, the epidemic was started by a healthcare system that sought to minimize pain and suffering. Physicians were taught that those with pain wouldn’t get addicted to pain medication, she said. “Unfortunately, those beliefs were completely wrong,” she said. What it resulted in was “an overprescription of opioids,” Volkow said.
Second, Volkow said, this overprescription coincided with a massive flood of heroin in the 2000s from Mexico. Deaths from heroin overdoses had been consistent for years—about 2,000 people died of overdoses from the drug each year, but in 2016 that number spiked to 15,000.
Thirdly, she said, heroin began to be laced by drug dealers with synthetic opioids, which are not only relatively easy to produce, but also stronger than heroin. Fentanyl, for example, is 50 times more potent than heroin. Carfentanil, another synthetic opioid, is 500 times more potent than heroin. Both synthetic opioids are pain relievers, but are also sold illegally as drugs. They are so powerful, Volkow said, that they get into the brain quickly. First responders are often unable to save those who have overdosed.
Indeed, 2 million Americans are believed to be addicted to prescription or illicit opioids. The Trump administration has made tackling the crisis a centerpiece of its domestic policy agenda, designating it as a national health emergency. Many of the most-affected areas, which are also some of the most impoverished places, voted heavily for Trump in 2016. These areas tend to be rural, poor, and overwhelmingly white, which brings up another aspect of the opioid crisis: It has disproportionately affected white Americans.
Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, told NPR last year that one reason for this is unconscious bias on the part of doctors who prescribe painkillers.
“Something that we do know is that doctors prescribe narcotics more cautiously to their non-white patients. It would seem that if the patient is black, the doctor is more concerned about the patient becoming addicted, or maybe they’re more concerned about the patient selling their pills, or maybe they are less concerned about pain in that population,” Kolodny said. “But the black patient is less likely to be prescribed narcotics, and therefore less likely to wind up becoming addicted to the medication. So what I believe is happening is that racial stereotyping is having a protective effect on non-white populations.”
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Nicole Arteaga was looking forward to the birth of her second child.
Already a mom to a 7-year-old son, Arteaga, 35, was nine weeks pregnant when her doctor delivered the worst news she could hear. Her unborn baby had stopped growing and had no fetal heartbeat.
She would have a miscarriage.
The doctor gave Arteaga three options: undergo a medical procedure to remove the lifeless fetus, wait for nature to take its course or take prescription medication to help her body let go of the deceased unborn baby.
After a day of thinking, she opted to take the medication. The drug, Misoprostol, causes a woman’s uterus to contract and allows the fetus to come out.
Arteaga, who lives in Phoenix, Arizona, received an email Wednesday evening, saying her Misoprostol was ready for pickup at her local Walgreens. But, when she went to pick it up Thursday night, the pharmacist on duty refused to give her the drug.
She stood, humiliated, as the pharmacist said he would not give her the prescription because of his own ethical beliefs. Her 7-year-old son and a group of other customers were all listening.
“He had it in his hand and refrained from giving it to me,” Arteaga explained. “…I was completely shocked. I couldn’t believe what was happening.”
Arteaga said she left Walgreens in tears.
“Having a miscarriage and having to deal with this is like a double dose of terribleness,” she said.
The pharmacist arranged for her to pick up the Misoprostol the next day at another Walgreens located 20-minutes away.
James W. Graham, senior manager of media relations for the pharmacy chain, confirmed what happened and issued a statement on behalf of Walgreens.
“After learning what happened, we reached out to the patient and apologized for how the situation was handled. To respect the sincerely held beliefs of our pharmacists while at the same time meeting the needs of our patients, our policy allows pharmacists to step away from filling a prescription for which they have a moral objection. At the same time, they are also required to refer the prescription to another pharmacist or manager on duty to meet the patient’s needs in a timely manner. We are looking into the matter to ensure that our patients’ needs are handled properly.”
But, Arteaga said the corporate statement wasn’t entirely true. According to her, Walgreens didn’t reach out to her. Arteaga said she reached out to them.
And, if the policy calls for another pharmacist or manager on duty to help in a situation like hers, Arteaga said there were other workers available who should have processed the transaction. According to her, there were two other employees in the pharmacy at the time — both of whom were assisting other customers. And, even if they refused too, she said there was surely a manager at the store to help.
“I was not given the option to have someone else in that store give me the prescription,” Arteaga said. “…Those guidelines were broken.”
Arteaga filed a complaint with the Arizona State Board of Pharmacy. And, she wants a law in place that would require pharmacies to fill prescriptions approved by doctors. Currently, Arizona law allows pharmacies to refuse to process prescriptions for religious or moral reasons. Pharmacists aren’t legally obligated to refer customers to another pharmacy. Although, companies like Walgreens have adopted their own policies for employees.
Despite all the trouble, Arteaga said she was thankful for all the support she has received after sharing her story on social media. She said multiple other women have since shared similar pharmacy experiences.
“It was a difficult situation. And, looking back at those comments, it’s nice to know that people understand the situation and what I’m going through,” Arteaga said.
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Earlier this month, Teamsters Local 727 Secretary-Treasurer John Coli, Jr., wrote letters to 25 executives at CVS detailing the disrespectful and upsetting manner in which local Company representatives and CVS’s chief negotiator have handled ongoing negotiations with the Union.
“It has been over two years since contract negotiations began, and the Company has used every delay tactic in the book while seeking to limit wages, force longer work hours to already overworked pharmacists and remove PICS from the bargaining unit by replacing them with non-union managers,” wrote Secretary-Treasurer Coli. “It seems that CVS has no interest in being fair or reasonable.”
CVS management has dragged its feet throughout negotiations, ignoring requests for meeting dates, rejecting proposed meeting dates, refusing to discuss and explain outstanding proposals, or produce a last, best, and final offer. Coli requested CVS’s top leaders reach out to the negotiators and instruct them to cease wasting time and money on unrealistic proposals and come prepared to reach a fair contract when the Parties meet this week.
“These are not the actions of a corporation committed to its workforce, its investors, or the public,” Coli stated in his letter. “CVS should be eager to invest in their workers and improve working conditions for the employees whose hard work keeps customers coming back.”
The Union will continue to demand a fair collective bargaining agreement for its pharmacy members. “These hardworking pharmacists deserve a respectable contract. We won’t stop fighting until they get one,” said Coli.
Teamsters Local 727 will inform pharmacists of all updates following the June 21, 2018 bargaining session.
If you have questions, contact Local 727 Business Representative Melissa Senatore at (847) 696-7500 or melissa@teamsterslocal727.org.
Nothing in this article should be read as the union’s waiver of any legal argument, position or additional grievance. The union does not forfeit its right to make any and all supplemental arguments.
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http://www.courant.com/news/connecticut/hc-news-cvs-lawsuit-wrong-cream-20180622-story.html
A Clinton man has filed a lawsuit against CVS Pharmacy for giving him the wrong cream to rub on his groin area that caused bleeding and a serious infection.
In a lawsuit filed in U.S. District Court in New Haven this week Warren Schumack said he went to his local CVS Pharmacy in October 2017 to fill a prescription for Floucinonide, a steroid cream his dermatologist had prescribed for him previously to combat a fungal condition in his groin area. The lawsuit said that Schumack is a longtime customer of the store and had gotten the prescription filled there previously.
But instead of giving him the steroid cream, a CVS employees gave him Fluorouracil, which is an anti-neoplastic cream used during chemotherapy to aggressively exfoliate skin cells on cancer patients.
Schumack began applying the cream to his groin area and immediately began experiencing pain, swelling, redness and ultimately bleeding in and around his testicles, the lawsuit said.
When he returned to his dermatologist he discovered that the wrong cream had been given to Schumack at the pharmacy. His groin area became infected within weeks and had to be treated.
As a result of the injuries caused by the wrong prescription he suffered loss of consortium, loss of sleep and physical and mental anguish, the lawsuit said. He also was unable to work.
The lawsuit seeks more than $15,000 in monetary damages from the Woonsocket, R.I.-based company. The lawsuit was originally filed in state court in Middletown but was transferred to federal court at the request of CVS attorneys because the pharmacy’s corporate offices are located out of state.
In a motion to transfer the case to federal court, Bridgeport attorney Beck S. Fineman, who represents CVS, estimated that damages could exceed $75,000 including medical expenses and lost wages.
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I routinely get phone calls and I just never know who is going to be on the other line.. other than those who wish to help me lower my credit card interest rate.. of which I don’t have any outstanding balances on them 🙂 And then there are the ones from the “IRS” that is going to come out in 24 hrs if I don’t call them back because of some unpaid tax debt… surprisingly.. I have hung up on every one of those and I am still a “free man”.. they have never showed up at by door to arrest me..
Yesterday I got a call from a person on the west coast, a mid-aged male… who had did something stupid in his teens or 20’s and ended up with intractable chronic pain in his back…
For THIRTY YEARS, he had been patronizing a CVS store near where he lived, but recently he and his wife had moved about 75 miles to a more affordable housing area.. He kept seeing the pain management prescriber that he had been seeing for 10 + yrs and he took a prescription to the local CVS near where he now lives…
So he now takes a new C-II prescription for Fentanyl to a CVS store near his new home. He described that the pharmacist on duty at this CVS was a YOUNG FEMALE FLOATER…
This pharmacist apparently didn’t bother to check the CVS computer system … apparently she started down the path of looking for a reason not to fill this Fentanyl prescription… she first stated that the date on the prescription appeared to be in a “slightly different shade of ink” than the signature on the prescription..
Of course the pt didn’t know that the only thing that the physician has to physically do to a C-II prescription is sign it in indelible pencil or with a pen that is “liquid ink”… they can’t use rubber stamps or be signed by office nurse/agent… however the office nurse/agent can fill out the entire prescription – including the date – according to federal statue.
The directions on the prescription was for the pt to swap out a patch every 2-3 days.. .but.. the pharmacist stated that the FDA guidelines was for EVERY 3 DAYS… of course… apparently this YOUNG PHARMACIST did not learn out of her academic books that those requires – clinical trials – were done before we knew much about CYP-450 enzyme system and how these 50 odd liver enzymes can affect opiate metabolism and that some pts are slow, some are normal, some are fast and some or ultra fast metabolizers.. and those who metabolize opiate faster with Fentanyl patches can often start going into withdrawal around 60 hrs of having the patch on..
That brings up one of my favorite sayings… “…knowledge is knowing the rules… experience is knowing the exception to the rules ” It would seem to be that this pharmacist falls under the first part of that saying … and you can guess where I fall ?
End of this story… this pt had to do without his Fentanyl for THREE DAYS… because of this pharmacist’s apparent starting looking for a reason not to fill this particular pt’s C-II Rxs… if for no other reason than he was new pt to this particular store and she was not interested in looking into the pt’s prescription history in CVS’ computer system.
And while on the phone with this pt… he look on my website and found http://www.ncpanet.org/home/find-your-local-pharmacy and had found a INDEPENDENT PHARMACY near him that he was going to reach out to. This pt also indicated that he has some law background and indicated that he could file charges against this particular pharmacist on his own…
I hope that this pt can get the attention of this particular “by the book & by the numbers” pharmacist…” Maybe he can change some of her “book smarts” … into “knowing about the exceptions to the rules” Time will tell… but one thing that this pt can count on… he has my cell number and I am on his side 100% and more than happy to draw him a “road map” to show this pharmacist as to the path that she should be taking with chronic pain pts.
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My Name is XXX XXX and I got your Email Address off the Web Site when I
Was searching for Pharmacist Whom would not fill My Prescription, I will tell you A little bit about myself
And what I have been going through in the last couple of years in RE: To My Prescription. The
Nightmare, Embarrassment, and the turn downs on not filling my Prescription, .
As a Child I can remember having severe Headaches, So as I got older my headaches got worse, I had been to so so many Drs. And they could not find out
What was causing these severe Headaches, so my Family Dr decided to do a spinal tap, well hmmm
Pressure on my brain was 420, Very high, so I was sent to neurosurgeon, Dr Dusseau in turn had diagnosed me with Hydrocephalus/Arnold Chari, So my Dr said that I needed a Shunt in my brain to drain the Fluid, okay let’s do this when hmmmm one week later I end up in the Emergency Room
I could not Stand the pain, to make a long story short, I ended up having 12 Shunt revisions on my Brain because the Stunts just would not work on my Condition (Sad) my last and final shunt had gotten infected some how so I was in Intensive Care for 48 hours to drain the infection off my Brain,
So I said No more Stunts I will try and Love with the pain, (And just take pain medication), On top of all this I was in motorcycle acct at young age and lost my left heel, so after all these years not able to walk right due to No Heel it has caused so much back pain, I have RA Arthritis and so many more problems,
So my question is why in the World do I get treated like I’m a Junkie, I take one Medication for my Pain not 2-3-4, One, I’m sorry I’ve had to take A 12 hour med this last Month because I cannot get my Prescription filled, My Pain Management Dr has been sending Electronic Prescription to Publix every 2 weeks because they will not fill one Month Supply, I had gone to Walgeens last month to get my
Prescription Filled and the Pharmacist re fused my script and said not only will I not fill your script but No other Walgreens will fill it either, I said what are you the spokes person for Walgreens, I’m crying because I’m just beside myself that I’m getting treated this way, ,So I thought well I have humma Ins
I will have my Dr sent script by Mail Order, so I wait wait no Prescription came so I called the Pharmacist
To see what was going on with my Prescription and the Tech says the Pharmacist has used his Judgement not to Fill your Prescription, I was like the Pharmacist has what he is not my Dr this is a legit Script he really has No right to make that Judgement Call, Mr Steve I could continue to type you more but I think that you get what I’m saying, These Pharmacist are playing Dr and they do not have a License to do this, they are wanting Patience to take a 12 hour med that Cost triple and then they want you to take 4 hour med like 1 per day, and the cost of 4 hour med cost pennies compared to the 12 hour Med.
How in the World can they get away with this & treating people who need there Medication every month,
I have been told that WALGREENS has provided their pharmacists a means to “black ball” a pt in Walgreen’s pharmacy computer system and that it applies to all 10,000 of their stores. If this is true, it would suggest that Walgreen’s has a high degree of confidence in the opinions of their employed pharmacists… and/or they could care less if their pharmacists fill any controlled medication prescriptions.
I have also been told that the only one who can remove that “black ball” is the pharmacist that put that flag on the pt’s records in the Walgreen’s pharmacy software system.
I routinely question why pts – who have been treated poorly by a chain pharmacist – that they want to continue to patronize that same chain.. Personally, it doesn’t matter the type of business… I refuse to BEG some business to let me give them my money. If they don’t seem to want or appreciate my business I have always been able to find some other business that will be more than willing to respect me and treat me like they appreciate my patronage.
As always, here is a link to find a independent pharmacy by zip code for those pts who are tired of being treated more like a inconvenience to the employees of a business http://www.ncpanet.org/home/find-your-local-pharmacy
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File a complaint against ICE with Office for Civil Rights & Civil Liberties, within Dept. of Homeland Security 202-401-1474Call the RNC and blast them for trying to blame their policy on the Dems, as they engage in horrific cruelty. Let them know we’re on to their lies. 202-863-8500Call the White House Comment line. Speak your mind as you choose. 202-456-6213Call the DOJ Comment Line. Tell Jeff Sessions how you feel about separating children from parents at our border 202-353-1555Call the United Nations, and tell them they must intervene, in any way they can 1-212-963-1234
Please call and share.
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