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DEPUTY AUSA KENETH POLITE, MGHW, “The Supreme Court reined in overzealous prosecutors who arrested doctors for treating their patients as individuals rather than conforming to law enforcement’s accepted standards.”
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CVS Health Corporation’s second-quarter results reported growth for earnings and revenue expectations, however, its latest focus on healthcare services means continued cost-cutting measures and layoffs.
In the wake of news about Ohio regulators’ findings at severely understaffed CVS pharmacies, numerous current and recent CVS workers in Ohio and elsewhere have said the problems are not limited to the nine stores the Ohio Board of Pharmacy has issued reports on.
Meanwhile, Ohio Attorney General Dave Yost called the findings in the reports “very concerning” and said that his office is “collecting information” about whether some CVS practices have violated state antitrust laws.
On July 7, the Capital Journal reported on eight Ohio CVS stores where the Board of Pharmacy found rampant turnover due to understaffing in inspections that took place between 2020 and last year. Inspectors found hundreds of problems, including dirty conditions, lack of controls over dangerous drugs and wait times as long as a month for prescriptions. They also found adulterated and expired drugs on CVS pharmacy shelves.
A ninth inspection report obtained a few weeks later found similar conditions at a ninth CVS store — this one in Willoughby — and that 1,800 doses of controlled substances couldn’t be accounted for. In addition, inspectors found an instance in which a patient was made ill by being given the wrong medication.
In responses to questions for both stories, CVS called them “isolated incidents.” But in their response to the stories, many current and recent CVS employees in Ohio and other states said the problems were far from isolated.
Most current employees asked to remain anonymous. But one went on record to say that short staffing at CVS is not always due to a lack of qualified people to work at the stores. Minimal staffing is a conscious policy imposed on stores from above, she said.
“Understaffing is pretty deliberate from our upper and middle management,” Iggy Aleksick, a pharmacy technician at a CVS in Bowling Green, said last month. “It’s not that we don’t have people to work, it’s that we’re not allowed to be scheduled. Even in the past couple weeks, my pharmacy manager was told to cut 36 hours from her week and it was a Thursday. It wasn’t possible for her to do.”
Others said that the district and regional managers imposing such orders get bonuses based partly on savings from limiting employee hours. When asked if that were the case, a CVS spokesman didn’t answer directly.
“Patient safety is our highest priority, and decisions about staffing, labor hours, workflow process, technology enhancements and other operational factors are made to ensure we have appropriate levels of staffing and resources in place in our pharmacies,” spokesman Matthew Blanchette said in an email.
On Tuesday, CVS announced it was laying off 5,000 employees, but it said they would be “non-customer facing positions,” CNN reported. Even before the announcement, all of the current and former CVS employees who spoke to the Capital Journal described overwork in stressful conditions that made them worry about patient safety — no matter how careful they tried to be.
Amy Gilmore was a pharmacist at CVS store No. 4401 in Centerville from 2018 until last October. She described how things grew steadily worse until she finally left.
CVS, the largest pharmacy chain in the United States, for years has been buying out competitors, closing those stores and moving their prescriptions to the nearest CVS pharmacy.
It’s unclear if the Centerville pharmacy was affected the same way, but a pharmacist at another Dayton-area CVS told Board of Pharmacy inspectors that her store absorbed prescriptions from two other pharmacies without increasing its staff. That came after CVS in 2021 announced that it was closing 300 stores a year through 2024 — including least four in the Dayton area — and in many cases moving prescriptions at those stores to the closest CVS.
In any case, the staff at Gilmore’s Centerville CVS was so overloaded that it was in a constant scramble to catch up. She said she was faced with so many tardy prescriptions that it fell to patients to tell staffers when their needs were acute.
“We were triaging thousands of prescriptions that were all in the system as being overdue but we sadly didn’t know who needed what until the patients came,” Gilmore said. “We were trying to be transparent with our patients and told them if you need something, you have to call us because our system is not functioning the way it should because we’re so overloaded. There were other stores that weren’t that transparent with their patients, so those patients didn’t know what was going on.”
Working 14-hours days with few breaks in such a situation made Gilmore worry that she couldn’t do her job properly.
She tried to come up with a system of doublechecks to avoid mistakes, “but a lot of times I was getting interrupted. I try not to make any errors — I have an eye for detail — but as I was getting more fractured, things started happening where I was like, ‘Oh, I should have caught that.’ Thankfully, no harm came to my patients because of it.”
In its inspections, the Board of Pharmacy found several ways that understaffed CVS pharmacies might not have proper controls to ensure that employees weren’t stealing — or “diverting” — controlled substances such as narcotics.
In one, the pharmacy staff was too busy to retrieve a drug delivery from the front of the store for nine hours. And in a Toledo CVS, they found negative numbers suspiciously entered into the inventory system, and they couldn’t know if the purpose was “to mask the diversion of drugs received on that day,” the report said.
Gilmore said that she saw some other ways dangerous drugs could be diverted from overworked pharmacies. One was by not frequently doing physical checks — “cycle counts” — against the inventory system for single-usage painkillers that are often prescribed in the emergency room or by urgent-care centers.
“At stores that weren’t keeping up with supply management, they weren’t keeping up with cycle counts, so no one was seeing that the cycle counts were off so they couldn’t tell the system that it was off,” said Gilmore, who also served as a “floater,” or pharmacist who filled in at other CVS stores.
Another way to lose track of dangerous drugs, Gilmore said, is when they sit too long in bins waiting to be picked up. Those waits can be long, other pharmacy workers said, because CVS aggressively pushes autofill for patients who often don’t need refills yet.
Gilmore explained that at the Centerville CVS where she worked there were 144 bins for scripts and each script was assigned a bin number. But sometime after 14 days if that prescription hasn’t been removed “that bin number falls off,” she said.
When that happened, the only way to track prescriptions was to manually go through all the bins and pull all the scripts with fill dates more than two weeks earlier, Gilmore said. That’s daunting enough in a store with 144 bins, but Gilmore has subbed at stores that have 320.
“So there’s 320 bins that could have overdue narcotics that somebody could divert from,” she said, explaining that that is especially a risk if employees are aware that nobody’s really keeping track.
Asked specifically about that possibility, CVS again didn’t respond directly.
“We’re also committed to a strong culture of compliance regarding our inventory and record-keeping obligations,” Blanchette, the spokesman, said.
Several current and former CVS staffers said that even as they lack time to properly consult with patients and keep them safe, constant dictates come out of corporate for them to take on new tasks, such as calling people and asking them to come pick up prescriptions or get vaccines.
“A lot of these calls are basically nonsense,” said Aleksick, who as of last week still worked at the CVS in Bowling Green.
Simon Souhrada left his job as a technician at the CVS in Mount Vernon in June. That pharmacy absorbed prescriptions from Lonsinger Pharmacy 12 miles away in Danville after buying and closing it in 2017.
The Board of Pharmacy reported mass departures by pharmacy employees at several other CVS stores. Souhrada joined one with about eight other technicians who left in frustration — and he said he expected their pharmacy manager to follow them shortly.
“The part that did it for me was just not being able to take care of the patients; getting yelled at, but also kind of deserving it because they had reason to be mad,” Souhrada said. “Patient safety was my main issue. I don’t want to be responsible for something bad happening. I know it’s a catch 22 if I leave and make it worse.”
He said a huge frustration was that the district manager didn’t provide the help they needed, but was always foisting new tasks on them.
The tasks might be related to the corporate drive to close almost 10% of its stores and turn many of the remaining ones into “HealthHubs,” which would offer traditional pharmacy services, and “have an expanded selection of products to choose from, including more products to help with chronic conditions like diabetes.” But Souhrada said employees were drowning under the traditional pharmacy tasks they already had to perform.
His district manager “had this weird focus on all of these corporate metrics, none of which helped get medications to patients,” he said. “It was all calling people, trying to sell them on vaccines and we would get daily emails demanding that we go faster and faster on these things while the queue (of unfilled prescriptions) was piling up and there was no one to fill it. She just focused on all the wrong things and didn’t do anything to help.”
Similarly, Gilmore, the former pharmacist at the Centerville CVS, said she was made responsible for setting up CPAP machines to treat sleep apnea.
“I had no idea how to do any of that,” she said. “CVS saw it as money signs — like, ‘Hey we can get money to do this,’ — but it didn’t back up or train anybody on how to do it. It was a mix of greed from the top and information not trickling down.”
Blanchette, the CVS spokesman, said the company is trying to stay on the forefront of healthcare.
“As the practice of pharmacy rapidly evolves, our pharmacists are keeping patients healthy through providing immunizations, adherence coaching, and clinical interventions,” he said. “To support our pharmacy teams’ ability to focus on patient-centric work, we continue to invest in technology and automation while being a leading advocate for states to increase pharmacy technician-to-pharmacist ratios.”
Aleksick, the tech at the Bowling Green CVS, doesn’t see it that way.
“I try my best to give good customer service, because that’s what my job is,” she said. “But my company does not prioritize me performing that well as part of my actual job. I’m just a profit generator for them. Which kind of sucks in a healthcare setting.”
In an interview late last month, Yost, the Ohio attorney general, said he had been keeping up with problems the Board of Pharmacy found at some CVS stores.
“It’s very concerning,” he said. “That’s why we have a pharmacy board. These kinds of things do happen all the time and they happen in all kinds of pharmacies and pharmacy chains. Like everything with human behavior, mistakes get made and controls are not observed.”
But, Yost added, “The question is, does CVS rise to a different level from the kind of background level of mistakes that we would typically expect to see and I don’t have the answer to that.”
The attorney general’s office acts as lawyer for the pharmacy board and Yost said his office will play that role in the board’s enforcement actions against the CVS stores in which it found problems. The board will hold a hearing on Nov. 7-8 into problems found at a Canton CVS, and the board could decide to fine the store or even to revoke its license. Other hearings haven’t been scheduled yet.
But, Yost said, his office is “gathering information” on another aspect of the matter.
“There’s the whole question of the competitive marketplace and antitrust,” he said. “Healthcare is especially fraught right now in this area because as a lot of industries have previously gone through, healthcare is going through a lot of consolidation and vertical integration.”
The attorney general said it isn’t feasible to try to turn the clock back 30 years and a changing economy probably would have spelled doom for some community pharmacies even if CVS wasn’t there, trying to buy and close them.
“But on the other hand, when you buy up so many — and close them when so many were going to close anyway for economic reasons — you ought to be able to still service the patient base that you acquired through that acquisition,” Yost said. “If you buy 10 pharmacies and that represents 100,000 lives and you’re going to close all those, I would expect that the acquiring pharmacies have the ability to care for 100,000 (additional) lives.”
He added, “If they fail to do that, that is at least some evidence that this was not a market-driven issue, but predatory. It’s not dispositive and it’s not a bright line, but it’s something I’m concerned about and it’s something that we are taking measures to get information and have a better sense of what’s going on.”
Adding to antitrust concerns are long-standing allegations by community pharmacists that CVS has an inherent conflict because it owns the largest retail chain and the largest pharmacy benefit manager. The latter company, also called a PBM, decides what drugs are covered by insurance and how much to reimburse its own and its competitor pharmacies for them.
CVS maintains that it has strict firewalls between its business units. But competitor pharmacies said they saw a steep drop in CVS Caremark reimbursements in late 2016 and early 2017, followed by a flurry of letters from CVS Acquisitions offering to buy the competitors out.
Yost stressed that his office is only gathering information at this point and he didn’t discuss what an antitrust action might look like. But his office in March announced an antitrust suit against several companies, including Express Scripts, another of the big-three pharmacy benefit managers.
CVS spokesman Blanchette said the company wants to hear its workers’ complaints.
“We value the feedback of our employees and provide numerous resources for them to share their suggestions and concerns, anonymously if they choose, as part of our commitment to continual improvement.”
But to many current and former pharmacy employees, those assurances ring hollow.
Souhrada, the former tech at the Mount Vernon CVS, referred to the corporation’s purchase of and closure of the Danville pharmacy in 2017 — without adequately staffing the store where it transferred the prescriptions.
“CVS is moving in and not helping the people,” he said. “It was the Mount Vernon CVS putting (the Danville pharmacy) out of business, and now people can’t get their scripts at the Mount Vernon CVS.”
And Aleksick, who as of last week still worked at the Bowling Green CVS, said it’s obvious to her what CVS’s priorities are.
“They’re really concerned with efficiency and their bottom line,” she said. “I know that those people like to say, ‘Oh, we care about our patients/customers,’ but actions speak louder than words. They do not give us enough time to give good, attentive care to people who are coming into the pharmacy.”
Gilmore, the pharmacist who left the Centerville CVS last October, said corporate practices there made her question her career choice.
“I didn’t feel I had completed a good job. Even though I’d go in, work a 14-hour day and be working the entire time without breaks, I didn’t feel like I had accomplished anything. I didn’t feel like I had an impact,” she said. “It wasn’t why I went into pharmacy. It was surviving, not thriving. A lot of times at CVS, I didn’t feel like I was doing any kind of patient care beyond hopefully checking a prescription that they needed and allowing them to have that.”
CVS its critics say the company has made careers in pharmacy less appealing. It to have had that effect on Gilmore.
“If I knew what I know about pharmacy now, I probably wouldn’t have made the choice to go to pharmacy school,” she said.
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The war on drugs/pts has seemingly taken a dramatic change in direction. The SCOTUS with a 9-0 vote in the Ruan/Kahn case in June 2022 that told the DEA that they could no longer use objective criteria when evaluating how a practitioner is treating pts dealing with subjective diseases ( pain, anxiety, depression, ADD/ADHD & large spectrum of mental health issues) So apparently so that it would not appear that the DEA was involved, the 50 state AG’s & others, sued the 3 largest drug wholesalers – covers about 80% of Rx meds to pharmacies and the 3 largest chain pharmacies (CVS, Walgreen, Walmart). Apparently did not even go to trial, all just settled with paying BILLIONS IN DOLLAR FINES and also agreed for the wholesalers to sell LESS control meds to ALL PHARMACIES and those chain pharmacies to dispense LESS CONTROLLED RXS.
Pts are reaching out to me with with horror stories about their pain meds being dramatically reduced or in one case on the west coast with a Independent pharmacy that was told one day that EFFECTIVELY IMMEDIATELY, their drug wholesaler would no longer sell this pharmacy ANY MORE CONTROLLED MEDS. I am told that, this particular pharmacy had 1500 pts being prescribed controlled meds.
In the last month, I have heard about independent pharmacies that are insisting that the pt’s prescriber reduce pain meds they have been on for a long time and filling at the same pharmacy for up to decades. More of these horror stories in the last month that I have heard from the 11-12 yrs that I have had my blog. The DOJ and others have got Krogers to part with billions in fines and I have not seen the terms of that agreement, but expect it to follow the terms of other agreements with other chains.
Morris & Dickson’s Controlled Substance License Revoked this article is about the DEA intention to revoke this drug wholesaler’s DEA license at the end of Aug 2023. It is claimed that this drug wholesaler is the 4th largest USA wholesaler.
Then there is this whistleblower lawsuit, initiated by 3 former Rite Aid Pharmacist with the DOJ and a attempt to claw back Medicaid/Medicare money from a six year period starting in 2014. Rite Aid maybe on financially “thin ice” about 5 yrs ago Rite Aid had a 20:1 reverse stock split to keep their stock from being DE-LISTED, then they sold about half the 5,000 stores to Rite Aid. At the beginning of 2021 their stock was worth about $25.00… it closed today (08/01/2023) was $1.71. and losing $17.24 per share
What is unknown – or at least I have not seen anything about this – will the control meds allocated to that wholesaler be re-allocated to other within the Rx distribution system or just “disappear” from the system. Likewise, if the Rite Aid chain is sold or liquidated as a “fire sale” and the controlled meds allocated to those stores be re-allocated or just “disappear” from the Rx med distribution system ?
Regardless, if fewer control meds are sold by the wholesalers and few controlled meds filled by pharmacies. The DEA may have stats that would give them justification to cut pharma production quotas of controls once again .
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When Congress pass the Americans with Disability Act, they INTENTIONALLY made the law VERY VAGUE, their intention was that the ADA would be defined in our court system. Since Congress is typically 40% attorneys, the ADA could also be called … make law firms more money act. The agency that was put in charge of enforcing the ADA was created within the Attorney General Office – the same Presidential Cabinet position that the DEA is under. I may have missed it, but I have never seen ADA agency going after some medical vendor because they denied to treat or under treat chronic pain pts.
Today marks 33 years since the signing of the Americans with Disabilities Act (ADA). This sweeping legislation protects people with disabilities from discrimination by state and local governments and employers. It ensures equal access to healthcare, social services, transportation, telecommunications, and other critical services. The ADA guaranteed disabled people the right to live the lives they want to live, with equal access to all our country has to offer.
Passing the ADA was a significant victory in the fight for disability rights. In the years since it was passed, our country has made strides toward the ADA’s promise of true inclusion. Unfortunately, far too many people with disabilities are still unable get the services and supports they need to live in their communities. Lack of accessible housing and transportation creates insurmountable barriers to independence and equal opportunity for many. Bias still closes doors, threatening access to vital services like health care.
I started my career as a legal aid attorney helping people with mental health disabilities and advocating for disability rights – and I have continued this work for nearly four decades. I am proud of the work HHS is doing to address the health disparities of people with disabilities, expand home and community-based services, ensure equitable access to health care, and more.
In his proclamation marking the ADA anniversary, President Biden calls for action to expand access to home and community based services and accessible transportation, improve employment opportunities, protect voting rights, and more. We must challenge ourselves, and our nation, to accelerate our progress and make inclusion and equal opportunity for people with disabilities a reality. The fight for disability rights continues, and we at HHS remain committed.
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People with disabilities are valued and vibrant members of communities across the country. As we mark the anniversary of the landmark Americans with Disabilities Act legislation – which makes it possible for so many of our loved ones to go to school, work, and enjoy life – we must all double down on our ongoing commitment to build a more inclusive America.
– HHS Deputy Secretary, Andrea Palm
The passage of the ADA was an important milestone in the fight for disability rights, but 33 years later, its promises remain unfulfilled for far too many disabled people. Making the ADA’s powerful provisions a reality for everyone will require a concerted, committed effort from all of us. ACL is proud to continue the fight – alongside people with disabilities and their families, our networks, and partners across the country – until disabled people truly have equal access to all of our country’s opportunities.
– Administration for Community Living Acting Administrator, Alison Barkoff
The Americans with Disabilities Act embodies our nation’s commitment to ensuring that disabled Americans have the same rights to live, work, and flourish in their communities—and to control their own lives and choices—as anyone else. Although we have not yet fully realized the promises of that law, HHS works every day to advance equality, opportunity, and community living for Americans with disabilities. It is our great honor at the Office of General Counsel to support and advance that work.
– General Counsel, Samuel R. Bagenstos
On this 33rd anniversary of the ADA, the Office for Civil Rights remains committed to enforcing its promise of equal opportunity and full inclusion for people with disabilities in all aspects of society. We will continue our work to combat inequality in health and human services through ensuring compliance and investigating complaints to fulfill the ADA’s purpose: eliminating discrimination against people with disabilities.
– Office for Civil Rights Director, Melanie Fontes Rainer
Relentless advocacy resulted in the passage of the Americans with Disabilities Act 33 years ago. Today, that advocacy continues so children and adults with disabilities in our nation have their rights protected in how they live, work and learn.
– Administration for Children and Families Assistant Secretary, January Contreras
The Americans with Disabilities Act was a breakthrough for people with disabilities in the fight for civil rights, but 33 years later the struggle isn’t over. The COVID-19 pandemic exposed the gaps that Americans with disabilities experience in access, quality, safety, and appropriateness of healthcare, and we need to work together as a nation to reduce fragmentation in care and not lose further ground. Much more work is needed to ensure that the promise of the ADA is fulfilled.
– Agency for Healthcare Research and Quality Director, Robert Otto Valdez, Ph.D., M.H.S.A.
At the Advanced Research Projects Agency for Health, we know the toughest challenges can’t be solved without all of us working together and our mission to accelerate better health doesn’t end until we reach everyone. The Americans with Disabilities Act marked a huge step forward. We know there is still much more to be done to achieve the promise of ADA, and we at ARPA-H are committed to making our agency, and our nation, a place where all can thrive.
– Advanced Research Projects Agency for Health Director, Renee Wegrzyn, Ph.D.
As we commemorate the 33rd anniversary of the Americans with Disabilities Act, we remember the protections this bi-partisan law has afforded millions of Americans with disabilities. We also know there is much more work to be done, and I look forward to working with Congress and leaders across the Department towards fulfilling the law’s promise.
– Acting Assistant Secretary for Legislation, Melanie Egorin
ASPE is committed to ensuring that HHS’ policies and programs enhance the well-being of people with disabilities and are informed by the strongest evidence. To achieve this, we recognize that people with disabilities must be central to the evidence development process, and that our work must reflect their diverse perspectives and needs.
– Deputy Assistant Secretary for Human Services Policy, Miranda Lynch-Smith
When disaster strikes, no one should be left behind. At ASPR we are committed to ensuring that people with disabilities have access to the information and resources they need to stay safe in a disaster or public health emergency.
– Assistant Secretary for Preparedness and Response, Dawn O’Connell
While the ADA broke down barriers to inclusion, the work is far from over. We know people with disabilities continue to face discrimination and stigma. At CDC, we are committed to helping the disability community thrive.
– Centers for Disease Control and Prevention Director, Mandy K. Cohen, M.D. MPH
The Americans with Disabilities Act (ADA) was historic and affirmed the inherent dignity of people with disabilities. At CMS, our goal is to support all enrollees in getting the care they need through the three “M’s” of CMS – Medicare, Medicaid and the Children’s Health Insurance Program, and the Marketplaces. These programs serve more than one in three Americans, including millions of people with disabilities – and thanks in part to the ADA’s landmark advancements, our programs support the goals of people with disabilities to live and thrive in their communities.
– Centers for Medicare and Medicaid Services’ Administrator, Chiquita Brooks-LaSure.
The Americans with Disabilities Act affirmed that disability rights are indeed human rights and paved the way for an inclusive and equitable society. However, we must continue to defend these hard-fought rights and strive to close the gap between legislation and lived reality, thus further ensuring that we fulfill the promise of the ADA.
– Departmental Appeals Board Chair, Constance B. Tobias
Inspired by the Americans with Disabilities Act and its supporters, we at the FDA are committed to ensuring equal opportunities for individuals with disabilities. We aim to foster an inclusive work environment that values diversity and empowers every individual to participate and contribute to their fullest potential. To achieve this, we actively promote a culture of inclusiveness, eliminate barriers to fair treatment and equal employment opportunities, and ensure accessibility and reasonable accommodations. Furthermore, we seek to educate our workforce about the advantages of diversity, equity, and inclusion; provide a platform to address allegations of discrimination; and facilitate the resolution of workplace grievances. Thirty-three years later our work implementing the ADA continues and will continue as we help seek to make it possible for people with disabilities to participate in the everyday commercial, economic, and social activities of American life.
– Food and Drug Administration Commissioner of Food and Drugs, Robert Califf, M.D.
This Disability Pride Month, we commemorate the Americans with Disabilities Act and honor those who have made strides to ensure that every person is treated equally and empowered to have a healthy, successful life. At HRSA, we’ve taken important steps to ensure that every child who has a chronic physical, developmental, behavioral, or emotional condition gets the services they need, that those with HIV receive whole-person care in a supportive and stigma free environment, and that our HRSA-funded health centers continue to provide accessible primary care services, with supports like sign language services, insurance eligibility assistance, and transportation services to reduce barriers to care and improve health outcomes. We also recognize there is more work to be done. Today, and every day, we recognize all the things that make us unique and recommit our agency to challenging misconceptions about disabilities and providing the best possible care to everyone.
– Health Resources and Services Administration Administrator, Carole Johnson
Every person deserves equal access to healthcare, regardless of their abilities. The Americans with Disabilities Act has been instrumental in ensuring that individuals with disabilities have the same opportunities to receive quality medical care. Let’s mark the anniversary of ADA by continuing to advocate for inclusive and accessible healthcare for all.
– Intergovernmental and External Affairs Director, Marvin Figueroa
The Indian Health Service is committed to improving the health of people with disabilities and building cultural competency and an inclusive environment across Indian Country. In the unwavering pursuit to defend the rights protected by the Americans with Disabilities Act, we reinforce our efforts to fulfill the promise of equality and encourage our partners and collaborators to become allies in the movement toward acceptance and appreciation of all people within the communities we serve, regardless of ability.
– Indian Health Service Director, Roselyn Tso.
This month we commemorate the 33rd anniversary of passing the Americans with Disabilities Act. This piece of legislation served as a landmark moment of progress in civil rights history – but it was just the beginning of ensuring disability rights. People of color, LGBTQI+ people, and other marginalized groups with disabilities face discrimination and difficulty accessing necessary health care. This disability pride month and every month, we work towards an equitable future where all Americans — including those with disabilities — can lead happy and healthy lives.
– Assistant Secretary for Health, Adm. Rachel L. Levine
ONC is continually working to advance the use of data to represent social needs and the conditions in which people live, learn, work, and play. The United States Core Data for Interoperability, which ONC updates annually, includes ‘disability status’ as a standardized data element so that relevant information about patients with disabilities can be recorded and shared as appropriate to their care.
– National Coordinator for Health Information Technology, Micky Tripathi, Ph.D., M.P.P.
The anniversary of the Americans with Disabilities Act commemorates a landmark legislation that broke down barriers and incorporated inclusion for millions of individuals. SAMHSA honors the diversity and uniqueness of each person who has a disability, including those with behavioral health disabilities. We are committed to ensuring that the promise of the ADA is fulfilled as we continue the work to fully realize its potential.
– Substance Abuse and Mental Health Services Administration Assistant Secretary for Mental Health and Substance Use, Miriam E. Delphin-Rittmon, Ph.D.
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The top 5 PBM’s are now owned by the top 5 insurance companies, so those two industries are the largest creator of “pharmacy deserts”
If you spent any time in a pharmacy on July 10 or 11, you may have noticed prescriptions were delayed, and the staff seemed even more stressed than usual.
CVS Caremark, the pharmacy benefit manager (PBM) component of CVS Health, was non-operational for multiple days, meaning when the pharmacy tried to electronically submit a claim to insurance, it did not process. Pharmacy staff were unable to determine whether any prescriptions would be covered, or what patients’ co-pays would be.
If America had a robust, competitive PBM market, perhaps this outage would have not been particularly disruptive. Unfortunately, like many markets these days, instead we have an oligopoly, and Caremark alone processes about one-third of all prescriptions in the country.
The first CVS Pharmacy in Minnesota opened in the fall of 2004, which coincidentally is exactly when I was starting pharmacy school at the University of Minnesota. As a result, I have had a front row seat to witness the effect the now sixth-largest corporation in the country has had on our state.
Earlier in 2004 in other parts of the country, CVS had already acquired rival pharmacy chain Eckerd, which continued a long pattern of CVS buying other pharmacy chains using cheap debt, most notably Revco in 1997.
Minnesota apparently did not have a local chain of pharmacies amenable to purchase by CVS, so the company was forced to expand into the state via organic growth. CVS needed to hire pharmacists to work in their new stores, so I and all my classmates were aggressively recruited as we completed our studies. The personal highlight of my recruitment store tour of the Grand Avenue location in St. Paul was a pharmacy software system that still ran on MS-DOS in 2007.
This time period also represents a clear shift in corporate strategy, as CVS began to pursue vertical integration, acquiring Minneapolis-based MinuteClinic to gain some control over prescribers of medication. But the major paradigm shift came when CVS acquired Caremark, a leading PBM negotiating prescription drug coverage and pricing for millions of insured patients. After the merger, CVS was able to control payments to their pharmacy competitors, and require insured patients covered through Caremark to use pharmacies owned by CVS.
Using this market leverage, CVS spent the intervening years consolidating its power. The most obvious local manifestation of that power was the CVS takeover of Target Pharmacy in 2015. I received so many texts and social media alerts from concerned pharmacists the day it was announced that my phone battery died before I left work. Several of my classmates had previously worked for CVS, and sought a better work environment at Target, only to be re-absorbed.
Working conditions inside CVS Pharmacies — never ideal — have steadily declined to the point of harming workers’ and patients’ health. An entire labor movement called #PizzaIsNotWorking has arisen in protest. Underpayment from Caremark has caused many non-CVS pharmacies to close, creating “pharmacy deserts” in many urban neighborhoods and rural areas.
Other alleged abuses of power by CVS include contributing to the opioid epidemic, stealing money from state governments, overcharging patients’ insurance companies, abusing federal government programs, and wasting valuable local real estate.
CVS Health has been able to achieve and abuse its power through a series of mergers and acquisitions. Had our existing antitrust laws — such as the Clayton Act — been enforced correctly, this consolidation should never have been allowed.
Unfortunately, beginning in the Reagan administration, legal ideology about corporate mergers significantly changed, oriented around the thought that larger corporations would achieve “efficiencies,” which would lower prices for consumers.
The past 40 years have provided ample evidence of the dangers of unchecked corporate power, however, resulting in a new political movement to restore enforcement of our antitrust laws to their original intent when they were written and passed by Congress. Minnesota’s own Sen. Amy Klobuchar, recently published a great book on the subject.
Two of the movement’s leaders are Lina Khan and Jonathan Kanter, head of the Federal Trade Commission and the Antitrust Division of the Department of Justice, respectively. These agencies have recently proposed to update the official merger guidelines, which if adopted would make mergers and acquisitions that lessen competition — like the many that created CVS Health — less likely.
You can participate in the process.
Click here, and then select “Comment,” to send your own personal message to the FTC and DOJ on how you have been affected by any mergers and acquisitions.
These comments can be informal and are important to help law enforcers understand the issue, and guide their actions to prevent harmful monopolies.
This is not limited to CVS Health.
Did Ticketmaster charge you pointless fees for your Taylor Swift tickets at the Vikings stadium?
Did airline service and prices get worse when Delta bought Northwest Airlines?
Are you annoyed that the Gophers football stadium is named for a bank headquartered at ground zero of Buckeye fandom?
Clearly, Minnesota is at least starting to understand anticompetitive mergers, given the backlash to the proposed Sanford Health merger with Fairview Health Services.
Your life has likely been negatively affected by a monopolistic merger or acquisition. This is your chance to help prevent any industries you care about become even more dominated by one or a small group of corporations.
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I found this little gem online. Thank you for this excellent piece.
While media attention might not solve this, the more people are aware of the truth, the easier the fight. State and federal lawmakers must step in.
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https://www.thedailybeast.com/fentanyl-crackdown-is-bound-to-fail-like-all-prohibitions
Lawmakers are right to want to do something that stops the rise in overdose deaths. But adding one category of opioids to the list of Schedule 1 drugs is an exercise in futility.
Overdose deaths recently reached a record high of 109,000 Americans, with roughly three-quarters involving opioids and 90 percent involving illicit fentanyl. As a result, lawmakers have decided to rearrange the deck chairs on the Titanic, passing toothless laws that will make little difference in reducing harm.
Drug cartels make illicit fentanyl using several simple, readily available chemicals. As law enforcement cracks down on illicit fentanyl, it merely induces cartels to synthesize more potent analogs of fentanyl, called fentanyl-related substances (FRSs), which can be easier to smuggle in smaller sizes and subdivide into more units to sell.
One recent example is para-flourofentanyl, which is increasingly found in combination with or in place of fentanyl.
This is what economists call the iron law of prohibition: the harder the enforcement, the harder the drug.
Recently, the U.S. House of Representatives passed the HALT Fentanyl Act, which would place all FRSs, including those not yet invented, on the list of Schedule 1 drugs, which means they have “no currently accepted medical use and high potential for abuse.” The bill awaits action in the Senate, and although its changes to the law may seem sensible, the legislation is, in reality, nothing but political theater.
It is not going to work any better in controlling FRSs than it has in controlling the 100-plus existing Schedule 1 drugs, three dozen of which are FRSs, already on the list. Others include heroin, marijuana, and psychedelics.
Furthermore, much like Schedule 1 classification hampered cannabis and psychedelics research, declaring as-yet-undiscovered drugs as having “no accepted medical use” may deprive people of crucial new drug innovations, such as analgesic drugs with improved efficacy, tolerability, and perhaps even a lower abuse potential.
Legal fentanyl has existed since the 1960s, and doctors widely use it for anesthesia and pain management. It is on the World Health Organization’s list of essential drugs. The Drug Enforcement Administration classifies fentanyl as Schedule II, meaning it has a medically approved use, but has a high potential for abuse. For years, doctors have safely used more potent fentanyl-related substances for anesthesia. These analogs, such as alfentanil, sufentanil, and remifentanil, are also Schedule II.
The HALT Fentanyl Act exempts those drugs, but not future discoveries.
Lawmakers haven’t yet accepted that they cannot repeal the iron law of prohibition any more than the universal law of gravitation. For some time, we have been getting troubling reports of the veterinary tranquilizer xylazine—drug users call it “tranq”—becoming an additive to fentanyl and other illicit narcotics. This tranquilizer greatly potentiates opioids’ effects, producing more powerful “highs.”
Likewise, in 2019, health departments in Europe, Canada, the United Kingdom, and the United States began seeing another class of synthetic opioids called nitazenes appearing in overdose toxicology screens. Last fall, the Tennessee Department of Health reported that nitazene-related overdose deaths increased fourfold between 2019 and 2021.
Because most health departments have not been testing for nitazenes, public health officials don’t know how prevalent nitazenes are becoming among black market drugs. But don’t be surprised if, before long, Congress holds hearings about the “nitazene crisis.”
Lawmakers are right to want to do something that stops the alarming rise in overdose deaths. But adding one category of opioids to the list of Schedule 1 drugs is an exercise in futility. If lawmakers were serious, they would remove government obstacles that make it difficult or even illegal for harm reduction organizations to save lives in their communities.
This includes repealing or amending the federal “crack house statute” (21 U.S.C. Sec. 856), which blocks organizations from opening overdose prevention centers. There are 147 government-sanctioned OPCs in 91 locations in 16 countries. Some have been operating since the mid-1980s. The federal ban makes the U.S. an outlier among developed countries.
States should repeal drug paraphernalia laws that outlaw the equipment which drug users can use to test the drugs they bought on the black market for fentanyl and other contaminants. It also means removing government barriers to methadone treatment by allowing clinicians to treat patients in their offices—like everyone else with a health problem—thus expanding access to this proven addiction treatment.
If policymakers double down on the same prohibitionist policies they have employed for over 50 years, deaths from illicit drug overdoses will continue to rise. Doing the same thing repeatedly, with even more vigor this time, will only result in the appearance of more potent and dangerous drugs.
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Cigna owns the PBM Express Scripts – according to this article https://www.drugchannels.net/2022/04/the-top-pharmacy-benefit-managers-of.html Express Script is the SECOND LARGEST PBM, HOWEVER, recent announced merger between Humana & United Health, suggests that merger will push Express Script down to THIRD PLACE.
One of the basics of the practice of medicine is starting, changing, stopping a pt’s therapy. While Cigna is just denial payment for a particular therapy, not technically stopping the pt’s therapy, but few people can afford to pay “rack rate” for some fairly expensive tests and/or procedures. Some would argue that denying payment for a expensive test or procedure is basically stopping a pt’s therapy because the pt has a health insurance policy – which is technically a contract – and generally a contract between two parties and party is paying money for payment for necessary medical services and the other party ends up playing games and finding excuses to not fulfill the terms of the contract. Some would consider that FRAUD.
According to this lawsuit, this is not just a few examples, but involves denial of care to hundreds of thousands of pts and the denials are being done on a wholesale level.
Cigna, the healthcare and insurance giant, was hit with a lawsuit on Monday that alleges the company systematically rejects claims in a matter of seconds, thanks to an algorithmic system put in place to help automate the process—further raising questions about how technology could harm patients as more healthcare organizations look to embrace AI and other new tools.
The suit, which was filed in California and is seeking class action status, was brought forth by a pair of plaintiffs who were denied coverage by Cigna. One plaintiff, Suzanne Kisting-Leung, was referred for an ultrasound because of a suspected risk of ovarian cancer. Another, Ayesha Smiley, had been tested for a vitamin D deficiency at the order of her doctor.
The health insurer’s digital claims system, called PXDX, is an “improper scheme designed to systematically, wrongfully, and automatically deny its insureds medical payments owed to them under Cigna’s insurance policies,” the complaint alleges.
After the lawsuit was filed Monday, Cigna defended the software system. “PXDX is a simple tool to accelerate physician payments that has been grossly mischaracterized in the press,” spokesperson Justine Sessions said in a statement. “The facts speak for themselves, and we will continue to set the record straight.”
The suit follows a Propublica investigation in March that detailed Cigna’s software system for approving and denying claims in batches. The algorithm works by flagging discrepancies between a diagnosis and what Cigna considers “acceptable tests and procedures for those ailments,” according to the lawsuit.
Over two months last year, the company denied more than 300,000 claims, spending an average of 1.2 seconds on each claim, Propublica reported. While medical doctors signed off on the denials, the system didn’t require them to open patient medical records for the review. The complaint says that this violates a California competition law for unfair and fraudulent business acts. The suit also alleges the system violates the state’s insurance code for failing to adopt a “reasonable standard” for processing claims.
The complaint comes as a boom in artificial intelligence and other advanced technology has raised questions about the future of work, potentially upending every industry from advertising to insurance. Healthcare is one sector where a high-tech makeover could both be beneficial—aiding doctors in filling out burdensome paperwork or helping narrow down diagnoses—but also fraught, due to issues of patient privacy, access to care and the high cost of medical bills.
Cigna isn’t alone in adopting new tech to remake its processes. In April, Google’s cloud division unveiled new tools for healthcare claims processing that uses AI to organize data and streamline decision-making. Blue Shield of California and Bupa are among the companies using the tool.
The firm representing the plaintiffs, Malibu, California-based Clarkson Law, has previously taken on tech giants when it comes to AI. Earlier this month, the firm filed lawsuits against OpenAI, the company behind ChatGPT, and Google, which has its own generative chatbot called Bard, for allegedly stealing the data of millions of people—including artists and writers who copyrighted their works—to train and build their AI products.
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