CVS Health attempting to practice medicine WITHOUT A LICENSE ?

According to a recent press release  – see link above –  they are going to EMPOWER their employee pharmacist to make the final determination if a pt has a valid medical necessity for a particular medication.  Our country has a serious – and growing – pharmacist surplus… so any pharmacy that continues to employ pharmacist that seems to “enjoy” denying care to certain classes of pts…  then these corporate pharmacy employers are complicit in denying necessary care to pts…  The primary charge of the various state boards of Pharmacy is to PROTECT THE PUBLIC’S HEALTH AND SAFETY… and where are they ?

Here is a link http://www.ncpanet.org/home/find-your-local-pharmacy  to help pts locate a independent pharmacy where you are dealing with the Pharmacist/owner… whose primary function is to fill legit/on time/medically necessary for pts and doesn’t “play games” with pt’s healthcare needs.

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CVS to limit opioid drug prescriptions amid national epidemic

https://www.usatoday.com/story/money/2017/09/21/cvs-health-opioid-prescriptions/685201001/

Drug-store chain CVS Health plans to announce Thursday that it will limit opioid prescriptions in an effort to combat the epidemic that accounted for 64,000 overdose deaths last year alone.

Amid pressure on pharmacists, doctors, insurers and drug companies to take action, CVS also said it would boost funding for addiction programs, counseling and safe disposal of opioids.

The company’s prescription drug management division, CVS Caremark, which provides medications to nearly 90 million people, said it would use its sweeping influence to limit initial opioid prescriptions to seven-day supplies for new patients facing acute ailments.

It will instruct pharmacists to contact doctors when they encounter prescriptions that appear to offer more medication than would be deemed necessary for a patient’s recovery. The doctor would be asked to revise it. Pharmacists already reach out to physicians for other reasons, such as when they prescribe medications that aren’t covered by a patient’s insurance plan.

The plan also involves capping daily dosages and initially requiring patients to get versions of the medications that dispense pain relief for a short period instead of a longer duration.

CVS CEO Larry Merlo told USA TODAY that the company had often been asked to fill prescriptions of 30 to 60 of the powerful pills at a time for conditions that required a much more limited amount.

“We see that all too often in the marketplace and we believe it’s appropriate to limit those prescriptions to a much more moderate and appropriate supply,” he said. “We think this can help make an impact.”

He declined to wade into the debate over the role of drug companies, physicians and others in causing the crisis.

“From my perspective, it’s not a blame game at this point,” he said.  “I think as healthcare stakeholders we all play an important role in being part of the solution.”

Separately, CVS rival Walgreens announced plans for a new marketing campaign aimed at educating teenagers about the danger of opioids.

Taken together, the initiatives reflect an increasingly active role on behalf of two of the nation’s largest retailers in combating a deadly epidemic.

The White House has declared this week as Prescription Opioid and Heroin Epidemic Awareness Week.

President Trump recently announced plans to declare the opioid crisis as a national emergency, though the official declaration was still under a legal review as of last week. The move could free up certain federal resources to tackle the epidemic.

With more than 9,600 locations, CVS said it would also empower its pharmacists to proactively educate patients about the dangers of opioids and encourage shorter prescriptions to prevent addictions.

“The whole effort here is to try to reduce the number of people who are going to end up with some sort of opioid addiction problem,” CVS Chief Medical Officer Troyen Brennan said in an interview.

Pharmacists are the front lines of prescription drug distribution and so can play key roles in educating consumers about the dangers of opioids, said Mohamed Jalloh, spokesman for the American Pharmacists Association.

“Pharmacists are going to be stepping up their role to be able to spot questionable behavior,” he said.

One area where the nation’s largest drug-store chains are increasingly active is in providing safe ways to dispose of excess opioids.  CVS said it would add safe disposal kiosks to 750 of its stores.

Walgreens, which does not have a pharmacy benefits manager like CVS and thus cannot limit prescription dosages on its own, has already stationed disposal kiosks at about 600 pharmacies throughout the country, spokesman Phil Caruso said.

Walgreens also Wednesday launched a new marketing campaign dubbed “#ItEndsWithUs,” featuring “13 Reasons Why” actor Brandon Larracuente highlighting the risks of opioids and new online resources.

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I live in PA and have a 13 year old son with prescriptions for Vyvance and Strattera. I have been told on a number of occasions that I can’t fill his Vyvance prescription because “it’s too early”, but I can’t seem to get a straight answer about when I can fill it. I like to get it taken care of a business day or two ahead of time, in case the pharmacy doesn’t have the dosage, or there’s an insurance issue, both of which have happened on more than one occasion. The pharmacist made an exception when we were going away for a long weekend, but he got angry at me and I’m not sure I understand why. When my son went away to summer camp for a week and I needed to make sure he had 7 days worth of meds, I thought the pharmacist was going to have a stroke.

I am truly trying to follow the rules, but I can’t get anyone to tell me what the rules are. It seems to differ from pharmacist to pharmacist at the same pharmacy. I always go to the same Walgreens, so am a known customer. Is there a law that regulates the timing of the refilling of this medication? I don’t feel like I’m being treated like a criminal, as some do, but I feel like I’m being given the run-around, and no one seems to care about the importance of the patient having his medication.

Any advice you can offer would be appreciated!

I guess that many of these chain pharmacists must believe that everyone’s life is a “perfect circle” and that there is no “bumps in the road” of a pt’s life.. especially those suffering from subjective disease and in this particular case a 13 y/o kid.

Since this 13 y/o is probably in junior high and just imagine all the people around him (teachers, classmates and his family at home)  that are going to have to deal with his compromised “quality of life” if he goes without his medication(s) for a couple days.

What if he flunks a test because he couldn’t concentrate enough to study or can’t focus while taking the test.. because of his lack of medication ? There has been incidents of the cops called on kids who have become unruly in class or school and it is not outside of the possibility for a ADD/ADHD kid off their medications.

There can be consequences to pts who attempt to get their prescriptions filled at a store whose pharmacists are always “by the numbers”…  medication not in inventory, insurance problems, floater pharmacist who seem to “never be comfortable”.

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Number of drug overdose deaths continues to rise

http://www.swnewsmedia.com/prior_lake_american/news/public_safety/number-of-drug-overdose-deaths-continues-to-rise/article_8800101a-20cb-5587-9e96-1809e6c9f4c2.html

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More Long-Term Opioid Prescriptions Drive Increasing Use

https://www.uspharmacist.com/article/more-longterm-opioid-prescriptions-drive-increasing-use/

Baltimore, MD—Pharmacists are filling many more prescriptions for opioids now than at the end of the last century, and a disturbing percentage of them are for long-term use.

That’s according to a new study from the Johns Hopkins Bloomberg School of Public Health, which determined that opioid prescription use jumped significantly between 1999 and 2014. Much of the increase was related to prescriptions for 90 days or longer, notes the article, published online by the journal Pharmacoepidemiology and Drug Safety.

Results of the review were based on data from the National Health and Nutritional Examination Survey, which the National Center for Health Statistics has conducted every 2 years since 1999–2000. Prescription opioid use increased from 4.1% of U.S. adults in 1999–2000 to 6.8% in 2013–2014, a 60% increase. At the same time, long-term prescription opioid use, defined as 90 days or more, increased from 1.8% in 1999–2000 to 5.4% in 2013–2014.

Of all opioid users in 2013–2014, 79.4% were long-term users compared with 45.1% in 1999-2000, according to the researchers, who point out that long-term use was associated with poorer physical health, concurrent benzodiazepine use, and history of heroin use.

“What’s especially concerning is the jump in long-term prescription opioid use, since it’s linked to increased risks for all sorts of problems, including addiction and overdoses,” explained study author Ramin Mojtabai, MD, PhD, MPH, a professor in the Department of Mental Health at the Bloomberg School. “The study also found that long-term use was associated with heroin use as well as the concurrent use of benzodiazepines, a class of widely prescribed drugs that affect the central nervous system,” he says.

Combining opioids and benzodiazepines significantly increases the risk of overdose, even if the patient is taking a moderate dosage of opioid medication, Mojtabai points out.

For the report, Mojtabai examined eight consecutive biannual surveys, each of which included over 5,000 adults living throughout the U.S. Interviews were conducted via computer in participants’ homes. Participants, totaling more than 47,000 over the eight surveys, were asked to identify prescription medications they had taken in the past 30 days, and for what length of time. The response rate ranged from 71% to 84%.

Opioid-medication use overall and long-term use was more common among participants on Medicaid and Medicare versus private insurance, noted Mojtabai, who added that no randomized clinical trials support opioids’ extended use, because of the risks.

A survey of 5000 people, when there is a estimated 100 + million chronic pain pts… seems like a rather SMALL SAMPLING… and just how were these pts selected for this survey ?

A reported 60% increase in opiate prescriptions from 1999-2000 to 2013 – 2014… does that number compensate for the fact that our population grows about 3%/yr… so in the same time frame our population was abt 40% greater… so based on per million population.. the growth was really MAYBE – 20% ?

This report time frame mostly encompasses what was declared the “decade of pain” when the Joint Commission that accredits all hospitals to be eligible for Medicare/Medicaid payments  declared pain the “Fifth Vital Sign” and made it a MAJOR STANDARD for hospitals to meet and the failure to meet that standard could mean that the hospital loss their accreditation…

Imagine that there is… “….no randomized clinical trials support opioids’ extended use, because of the risks …”

ALL CLINICAL TRIALS HAVE RISKS !!!

perhaps clinical trials of new/unproven medications have MORE RISKS than a clinical trial of a otherwise known safe medication.  Can you say… LAME EXCUSE ???

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Recovering addict says Walgreens pharmacist denied to fill Rx that helps her stay sober

http://fox45now.com/news/local/recovering-addict-says-walgreens-pharmacist-denied-to-fill-rx-that-helps-her-stay-sober

Here is a quote from the above Ohio rules link

“A pharmacist is not required to dispense a prescription of doubtful, questionable, or suspicious origin or if a prescription poses a risk to the health of the patient “

A pt normally gets their prescriptions filled in a pharmacy close to their home, their work or their doctor.

Not all doctors are authorized to prescribe SUBOXONE… so some pts who are trying to “stay sober” will probably have to travel some distance to find a prescriber that can provide Suboxone prescriptions.

According to the quote from the Walgreen’s Pharmacist that refused to fill this person’s prescription for Suboxone was …. 

“The pharmacist came over and she basically just said you don’t live in this area code-in this zip code, so it’s my personal policy to not fill these kinds of medications for people that live outside the zip code.”

So, it would appear that this Pharmacist’s personal policy is that any prescription for a person that lives outside of the pharmacy’s zip code AUTOMATICALLY falls under the Ohio law that it is …doubtful, questionable, or suspicious origin or if a prescription poses a risk to the health of the patient.

So according to the quote in the article from Walgreens….

“…Our pharmacists exercise professional judgement when dispensing prescriptions…”

That Walgreens condones their Pharmacists refusing to fill legit prescriptions based on “professional judgement” that is derived from the Pharmacist’s personal opinion, phobias, biases … which has nothing to do with them using their 5-6 year education to come to a conclusion based on FACTS…

The question begs to be asked… Is this particular pharmacist violating her “corresponding responsibility” by having a “just say no” based on the zip code that the pt lives in ?  If so, who believes that the Ohio BOP… would ask her to come before the BOP and explain how her actions and decision making process should not be considered UNPROFESSIONAL CONDUCT ?

In this country we have a serious – and growing – pharmacist surplus… so apparently Walgreens condones such actions of their pharmacists denying care for seemingly nebulous reasons are kept employed… when there are plenty of other pharmacists that are applying for jobs.

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Massachusetts Section 35: What it is and how it works

http://www.masslive.com/news/worcester/index.ssf/2014/04/massachusetts_section_35_how_i.html

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Attorneys general in Appalachia pressure, sue health insurers over opioids

http://www.cnhinews.com/cnhi/article_73975d9e-9d4f-11e7-b68b-f3d8febecaf0.html

HUNTINGTON, W. Va. — The nation’s advancing opioid epidemic has officials and lawmakers in the most impacted states taking on the entities they deem responsible for skyrocketing drug addiction and overdose numbers.

Kentucky Attorney General Andy Beshear and West Virginia Attorney General Patrick Morrisey announced at Marshall University Monday they will press the health insurance companies that have made billions off the sales of opioids to help curtail the nation’s largest drug problem to date.

They joined 37 other attorneys general in writing a letter to insurers requesting they adopt a “financial incentive structure” for the use of non-opioid pain management techniques when viable for chronic, non-cancer patients.

They argued insurance companies have the power to reduce opioid prescriptions and simplify patient access to other forms of pain management treatment.

“We’re not physicians, and we’re not going to be writing these policies,” Morrisey said. “What we’re doing today is asking these insurance companies to look closely at their coverage and payment policies so those unintentional payment incentives don’t exist.”

As opioid addiction and resulting fatalities have swept the country, both Kentucky and West Virginia have been especially hard hit by the epidemic. Last year, Kentucky had more than 1,400 opioid-related overdose deaths reported, according to a state report.

Last week, an additional Kentucky county joined nearly 20 others to file suit against the nation’s top 3 opioid producers in hopes of fighting to curb the rampant prescription drug problem in the Bluegrass State.

Beshear announced in June that his office intends to file multiple lawsuits against drug manufacturers, distributors and retailers where there is evidence that they contributed to the opioid epidemic by illegally marketing and selling opioids to Kentucky residents.

Beshear issued a request for proposal (RFP) for legal services to assist the Commonwealth in multiple lawsuits and to ensure that Kentucky tax dollars are not used for the costs of the litigation.

Beshear, a Democrat, and Morrisey, a Republican, said the deadliest overdose epidemic in U.S. history is a bipartisan issue.

Suppliers of prescription opioids are partly to blame for the rise in heroin use in the Tri-State region, Beshear said.

“Nearly 80 percent of heroin users first become addicted through prescription pills,” Beshear said. “If we can reduce opioid prescriptions and use other forms of pain management treatment, we will slow or even reverse the rate of addiction.”

Beshear suggested insurers could cover costs for physical therapy treatments rather than simply provide pain pills, for instance. “Every one knows some patients will need prescription pills,” he said. “But a lot of people should have access to other forms of treatment.”

“There are steps that should be taken before subjecting a young mind to the power of these addictive pills,” Beshear said.

Morrisey said he’s optimistic every insurance company will “respond positively” to the letter from the attorneys general.

“I think 37 attorneys general provides a tremendous amount of pressure. We start how you’re supposed to start — asking nicely,” Beshear said. “But ultimately, when you don’t work with attorneys general and you end up working against them, you can ask the tobacco companies how that works out.”

Beshear told the Ashland, Kentucky Daily Independent the attorneys general don’t “want to go in with threats” but instead open a dialogue with the insurers, and it would be a “long way down the road” before any type of litigation is considered.

In addition to Kentucky and West Virginia, attorneys general from Illinois, Indiana, Missouri, Virginia joined in sending the letter to health insurers.

Our previous Surgeon General stated publicly that addiction is a mental health issue and not a moral failing http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c

Since it is highly unlikely that taking a opiate can cause a MENTAL HEALTH ISSUE.. who with “three brain cells hold hands” could come to the conclusion that addiction is nothing more than a symptom or manifestation of a person with undiagnosed/under/untreated mental health issues.

Keep in mind that our judicial system in 1917 declared that opiate addiction was NOT A DISEASE BUT A CRIME… and apparently out judicial system is still functioning under that century old edict.

Here is a picture of a Ford automobile from that era… how many of us would want to use such a vehicle as our primary mode of transportation TODAY ?

In 1917 women still did not have the right to vote, alcohol prohibition was still yet to come, it was just abt ONE DECADE after the Wright Brothers first took to flight.

There is a simple 24 questions – 5 minute – test http://nationalpaincentre.mcmaster.ca/documents/soapp_r_sample_watermark.pdf 

Imagine if it was a required test before the first refill of a opiate for anyone treated with a opiate for acute pain.

Imagine if PMP’s were indexed by digital finger or palm print, digital eye scan, or facial recognition.

Delta to roll out facial recognition technology at airport bag check   

Delta is using facial recognition to self-check baggage at airports and many software systems already use digit finger print recognition to login to pharmacy and point of sale equipment. Why the “push back” from implementing this for PMP and opiate prescribing and dispensing ?  If the bureaucrats are really interested in trying to deal with opiate addiction… shouldn’t they be interested in pulling out all the “digital stops”

Maybe the same bureaucrats that are failing to implement these “state of the art” tools are the same ones that are now attempting to extract untold millions of dollars from the same businesses that are part of the opiate manufacturing and distribution system ?

Remember the Tobacco settlement money will be running out in a few years… are they just looking for another “golden goose” that they can “milk” to replace that Tobacco money for another 10-20 yrs.

Maybe this fabricated OD crisis is more of a “smoke screen” for another agenda

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6 Stages of Fibromyalgia

https://www.life-enthusiast.com/articles/6-stages-of-fibromyalgia

Stage 1

You started experiencing pain and fatigue more than before, you’re not sure what is going on but you hurt and you are tired. You can hold a job, you can make it through your day, but you know something isn’t right… so it’s something you’re going to start researching.

Stage 2

You are in pain a lot, sometimes taking an anti-inflammatory drug or what have you. You do not get much relief, and you have accepted the fact this is something you are going to have for a while. you feel a lot of pain and you are exhausted almost every day, but for the most part you keep going and hold down a job, can still go to events, spend time with your friends and loved ones, and have some good time here and there.

Stage 3

You are in constant pain, you are constantly tired, you wonder whether you will be ever able to function normally again. You are considering not working, because you no longer have the energy you once had, you come home from work and all you can do is rest. You have to turn down invitations, you have no energy left and you have to rest up just to go back tomorrow. In this stage you start to feel more alone, and more and more people are beginning to think you whine too much. This stage can last a long time, perhaps years.

Stage 4

You are in unrelenting pain all the time, good days are few and far between. You are calling into work sick more than you even make it in. You are in bed a good portion of your day. When you do have a good day you take advantage of it, and do as much as you can, all the things you have left in the past weeks you cram into your day, knowing well that tomorrow you will be paying for it. Your flares last for days. By this time your friends make plans without you, they already know your excuses and are nearly certain you will not be able to join in. Your family begins to think you are using fibromyalgia as an excuse to not do things, because stages 1-3 you were able to do much of what you just can’t do now. They think you are using your illness as an excuse, you feel alone, isolated, worried, emotional, sad. This stage can last years.

Stage 5

You have already been let go or have quit your job, you are asking questions about permanent disability and how long it takes to get it. You have heard horror stories about people being denied and the process taking years. You are struggling to make ends meet. Maybe have a person who takes care of you. You spend a lot of your day in bed, although you still take advantage of that one good day once in awhile. You are sore, very sore, you cry a lot, you feel like a prisoner in your own body. By this time you have already explained to your friends that it still feels good to be invited even if you don’t go. You have found that the only people that can relate to you are in a similar predicament. You wish your friends and family could understand.

Stage 6 (The Final Stage)

You may or may not still be waiting for disability pension. You cannot hold down a job. Fibromyalgia is now your lifestyle, most of your friends are living with fibromyalgia themselves, everything you do takes all your precious energy, simple daily tasks you took for granted in earlier stages, going to the bathroom, washing your hair, taking a shower, getting dressed, tying your shoes, take all you can give. You get irritated by your hair or clothes touching your skin, you have no energy or desire to put on “your face” before going out, no energy to keep a neat home. With all the medication you are on now or have tried, you are dealing with side effects and constant pain.

You are a human and still enjoy some things, like watching TV. You try to stay current on any news regarding fibromyalgia, in hopes they are closer to finding a cure. Most of your old friends are not around anymore, they have things to do. You need to rest a lot. It’s easy to feel overwhelmed in this stage, because things are piling up around you: bills, laundry, dishes. You do a little everyday, you push yourself so you don’t feel like your day was wasted in bed, you feel guilty that you no longer pull your own weight in the house. Your kids, spouse or family do things for you more than ever. They try to do it in a nice manner but you still feel like a burden, you can’t remember anything, cannot recall names or dates and you lose your train of thought mid-sentence. Also you know more about fibromyalgia in this stage then your own doctor and basically laugh when trying a new medication. You are without hope, same drill as before, same results, nothing helps much.

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States ask insurers to prioritize non-opioid pain treatment

http://abcnews.go.com/Health/wireStory/states-insurers-prioritize-opioid-pain-treatment-49937810

Attorneys general representing the majority of states asked health insurers Monday to encourage pain treatment through means other than prescriptions for opioid painkillers, which are responsible for tens of thousands of deaths a year in the U.S.

The top government lawyers in 35 states signed a letter to the trade group America’s Health Insurance Plans. The group, which also includes attorneys general for Puerto Rico and the District of Columbia, asked insurers to make coverage of non-opioid treatments such as physical therapy and massage a priority.

“The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable,” the attorneys general wrote.

The letter targets prescribing powerful drugs for chronic pain, a practice several studies have found is not effective.

The insurers group did not immediately respond to requests for comment.

Opioid-related overdoses have hit especially hard in the Appalachian states. On Monday, the attorney generals from two of them, Kentucky and West Virginia, held a joint news conference to highlight the pressure on the health insurance industry.

“If we can get the best practices changed with insurance companies and the payment incentives are just a bit different than what they are today, I think that’s going to continue to see the number of pills prescribed and dispensed drop dramatically,” said West Virginia Attorney General Patrick Morrisey, a Republican. “This is an important new front to open up.”

Kentucky’s Andy Beshear, a Democrat, said the number of overdoses might not fall quickly if companies follow the requests, but said it could help prevent more people from becoming addicted in the future.

The nation is in the thick of an opioid epidemic. In 2015, more than 52,000 people across the country died from drug overdoses — more than from car crashes or shootings.

Nearly two-thirds of those overdoses were from opioids, including prescription drugs such as OxyContin and Vicodin and illicit drugs including heroin and fentanyl. Often, abusers switch between prescription and illegal drugs.

A few years ago, governments were reacting mostly through measures such as creating databases of prescriptions to identify abusers or by increasing the availability of a drug that counteracts overdoses.

Lately, they’ve been getting more aggressive.

More than 60 local and state governments have filed, announced or publicly considered lawsuits against drug makers or distributors. In June, several attorneys general announced a multi-state investigation of the industry.

Since last year, states have been adopting laws limiting initial prescriptions to opioids in the hopes of cutting down on misuse.

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