PROTEST EXPRESS SCRIPTS

When:  Friday May 17, 2024

Time: 09:00 AM – 01:00 PM

Where the Public sidewalk in front of Express Scripts HQ

Address: 1 Express Way, St Louis, MO

 

 

 

 

 

 

 

 

 

 

 

 

 

Please share with everyone you know

ON MAY 17, 2024, PATIENTS, CAREGIVERS, COMMUNITY MEMBERS, PHARMACISTS, PHYSICIANS, ASSOCIATIONS & ORGANIZATIONS WILL COME TOGETHER TO BOLDLY TAKE A STAND AGAINST ONE OF THE THREE LARGEST PHARMACY BENEFIT MANAGERS AND MAIL ORDER PHARMACIES IN THE NATION, EXPRESS SCRIPTS!

Many patients across the nation are forced or steered to Express Scripts against their will as it is the only option of coverage allowed by the pharmacy benefit manager (PBM) or insurance company. Express Scripts is a PBM and mail order pharmacy. Express Scripts often uses their own PBM to steer patients to their own pharmacy. Patients have faced life-threatening delays, interruptions in treatment, and some have been forced to receive medications such as room temperature medications not stored at the temperatures proven safe by drug manufacturers as the only option of coverage.

Express Scripts also uses their PBM portion of their business to restrict access to medications by restricting medications on the list of covered medications. Physicians are hiring additional staff to deal with long exhaustive obstacle courses to obtain the medications needed for their patients.

Express Scripts has a 1-star rating on the Better Business Bureau that highlights this Pattern of Complaints:

“Better Business Bureau is advising consumers to use caution when considering doing business with Express Scripts. BBB has received a pattern of consumer complaints alleging delays or failure to ship correct prescriptions or medications; failure to accept returns or medications which were shipped in error; failure to issue refunds; debiting credit or debit cards for prescriptions not shipped and poor customer service.”

When patients are so graciously allowed by their PBM to use their local pharmacies, PBMs like Express Scripts also oversee reimbursements to competitor pharmacies & often reimburse competitor pharmacies below their cost, causing closures of local pharmacies in the most underserved rural and urban areas across America.

Upon advocating for regulation, legislation, & protection from these pharmacies, advocates find themselves against one of the wealthiest lobbyist organizations in America, the Pharmaceutical Care Management Association (PCMA) that has in the last year doubled the amount they’re investing in lobbying by the millions. The Boards of Pharmacy also often have strong ties and even members sitting in regulatory positions making it almost impossible for protection & justice. It’s time to demand it! Patients deserve ethical treatment and safe access to their local pharmacies.

Often, many are “too sick to fight” & many pharmacists fear retaliation for speaking publicly about these issues.

This is why we need your voice. We look forward to meeting you there!

https://uniteforsafemedications.com/protest

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Imagine filling 7000 Rxs/month and losing money. Filling an Rx Every TWO MINUTES – from opening to closing and losing money!

Small Wyoming Pharmacies Pushed Out Of Business, Say Industry Is Like Mafia

https://cowboystatedaily.com/2024/04/14/small-wyoming-pharmacies-pushed-out-of-business-say-industry-is-like-mafia/

Eric Saul realized a dream of being his own boss in 2019 when he opened a little pharmacy in Casper.

His independently owned pharmacy grew faster than any of the other local ones at the time that were being supplied by pharmaceutical distributor Cardinal Health. By 2024, it was a thriving business, filling 7,000 prescriptions in a month.

“The killer of it was, we grew 20% from January last year to January this year,” Saul told Cowboy State Daily. But despite that growth, “we made 15% less from insurance companies.”

That’s when Saul decided to close his thriving pharmacy. Despite its popularity, he could see no way to become solvent in the current system, no light at the end of the tunnel.

“It’s just insane,” Saul said. “You’re busier from open to close, but making less than you did the last year, every year.”

Saul’s isn’t the only one facing these issues. He knows of at least five other independent pharmacies across the Cowboy State that have closed in the past year for similar reasons.

Among them is Gene Barbour, who owned the Medicap Pharmacy in Cheyenne. While Barbour said he was ready to retire, part of what drove that decision sooner rather than later was the very dynamic outlined by Saul.

“It’s the reimbursements,” he told Cowboy State Daily. “I can’t tell you how many thousands of scrips over the last few years that I’ve sold for less than the price of a bottle of aspirin over the counter.”

With reimbursements not even covering the price of the drug inside a pill bottle, that left Barbour subsidizing bottles, labels and his employees’ time to fill the prescriptions, not to mention the store’s overhead, like rent and utilities. It all just became increasingly unmanageable.

The entire pharmacy sector is broken, Saul and Barbour say, and small independent shops like theirs, which had hoped to provide an independent service in the marketplace, have no shot at all.

Their stories are just a window into how broken their industry is.

Saving Consumers Money, Or The Fox Guarding The Hen House?

The biggest issue both Saul and Barbour cited is vertical integration in the pharmaceutical industry.

Vertical integration refers to pulling disparate services under one umbrella so they’re no longer provided by separate companies.

It’s happened in a big way in the pharmaceuticals industry. The biggest players are now health insurer, pharmacy, and PBM, all in one.

PBM stands for pharmacy benefit manager. These are companies that started out as a way to make life easier for pharmacies. Without them, pharmacists confront a confusing maze of companies to send benefit claims through, one that would take an entire accounting department devoted only to that.

So PBMs took over that role for pharmacies. And they also played middleman, helping to negotiate lower costs for their customers.

Vertically integrated companies like Express Scripts and CVS contend that also being the PBM has helped them negotiate lower prices for members. It’s also helped them more readily control which drugs go on their lists of available medications, called formularies, to ensure everything on that list is proven safe and effective.

But questions have arisen about the role of PBMs in the marketplace, and that has sparked a Federal Trade Commission investigation into the six largest PBMs. That began in 2022 and is still ongoing.

The six under FTC scrutiny include CVS Caremark, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems.

The Walmarts Of The Pharmaceutical Industry

Pulling PBMs under the very same large umbrella is part of what Saul and Barbour believe has killed any chance of real competition in the sector for independent pharmacies.

“CVS was the major one that caused me to close,” Barbour told Cowboy State Daily. “They owned a large portion of our business, you know, of our customer base. And they have their own pharmacy, they have their own warehouses.”

And they have their own PBM.

“So (CVS) is the insurance company, the PBM and the pharmacy,” Saul told Cowboy State Daily.

With such a large customer base — 40% of the market — that’s made the CVS brand akin to Walmart in the retail sector. They’re big enough to tell independent competitors what reimbursements they must take to become part of serving their customers.

It’s the same dynamic that, for years, has allowed Walmart to tell its suppliers what prices they’ll take to be on the retailer’s shelves. As a result of that, independent retailers often find they can buy products for their stores off of Walmart’s shelves for less than they can buy them direct from a wholesaler.

That had Saul and Barbour losing money on thousands of prescriptions each month.

“I was losing $1.35 on every scrip I filled for (this one) co-op,” he said. “The pills inside the bottle were $1.35 more than the insurance paid. So, I wasn’t paid for that bottle, that label or that lid. Or my pesky staff who want paid, or the light bill, the heating bill, the cooling bill, the floor space. Just for the pills inside the bottle, I was paid less than they cost me sitting on the shelf.

“That’s disgusting.”

Code Of Silence

Talking about the situation publicly though, was dangerous, Saul and Barbour told Cowboy State Daily.

“If I talked negative about an insurance company, I’d get two audits in the next week,” Saul told Cowboy State Daily. “And these audits are $400,000 worth of drugs that takes me two days to print everything out.”

If the audit found even a minor mistake, such as a 28-day scrip where the patient got 30 pills instead of 28, Saul said the insurer could claw back the entire reimbursement, leaving him with no reimbursement at all for dispensing the medication.

And, with all the large insurers now having their own vertically integrated PBMs, independents like Saul and Barbour found they had little choice but to go along.

“Three PBMs now own 80% of the market,” he said. “So, when they come to you with a contract every year, you have no negotiating strength. It’s take it or leave it, and every year it gets worse and worse. Which is interesting, with (consumers) premiums going up and (our) payments going down.

“The only place I can figure it’s going are the pharmacy benefit managers.”

Membership Or Mafia Shakedown?

Saul has been told about strong-arm tactics that force drug manufacturers to pay huge rebates to get their products on the list of medications, or formularies, of the largest insurers.

In fact, that is one of the issues FTC is examining in its investigation, though the federal agency says it’s been difficult to understand that because of a lack of transparency in the whole process.

Saul told Cowboy State Daily he was informed by an employee of one large drug manufacturer that it was being strong-armed to pay $250 million to be on the formulary of one large health insurer.

The stakes for that drug manufacturer were extremely high, Saul added. Without being on the list, the drug manufacturer would get shut out of a huge swath of the marketplace.

While out-and-out kickbacks are not legal, negotiations to lower prices in the form of rebates are legal. But these negotiations have been kept confidential, hidden behind the PBM. Thus, it’s never clear if any of these “rebates” come back to consumers in the form of reduced costs.

From his observations, Saul believes it doesn’t. His own customers’ premiums never went down, he said, while his own reimbursements just kept getting lower and lower.

“They’re making billions of dollars just charging drug companies to be on their formularies,” Saul said. “And PBMs are coming out with record billions and billions of profit every year.”

State Change Stymied

What’s happening to squeeze small independent pharmacies out is happening nationwide, Saul said, and real solutions probably have to also come from that level. But he has been among Wyomingites pushing for changes at the state level that could help in the short-term.

That started a couple of years ago during a budget session. Saul said the Wyoming Legislature seemed to understand what needed to be done at the time, but simply ran out of time to get a bill over the finish line.

“The second year, it did make it past legislators, and then Gov. Gordon line-item vetoed everything out of it,” Saul said.

More recently, lawmakers approved a bill requiring insurers to provide reimbursements to pharmacists for drug prescriptions in a reasonable amount of time.

That bill, Saul said, is just too little too late.

“I mean, I haven’t had a problem with delayed payments,” he said. “So, I’m not sure why we were fighting that battle. I’m usually paid within a month of everything that I dispense except for maybe two insurance companies that probably totaled less than a hundredth of a percent of everything I did.”

Saul is particularly miffed with Gordon’s line-item veto.

“He literally signed a bill that was a title and definitions and of no help to pharmacies,” he said.

Meanwhile, Saul said, Wyoming has lost five independent pharmacies in the last 14 to 16 months.

“The last one was in Cheyenne,” he said. “There was one in Casper, two in Gillette, one in Pinedale. That’s pretty much proof that this is unsustainable.”

Gordon’s Take

A representative of the governor’s office referred Cowboy State Daily to the veto letter Gordon wrote to accompany his line-item vetoes on Senate File 151.

In the letter, Gordon agreed that the rising costs of health care, including prescription drug prices, are a matter of great concern for Wyoming, that is why he’s established the Governor’s Health Task Force to better understand the “cost drivers in Wyoming and to develop meaningful solutions to address the state’s high costs and limited access.”

Gordon said Wyoming’s low patient volumes are part of what’s driving increased costs and that proposed solutions often result in “cost-shifting (to consumers), instead of actually reducing expenses or making the system whole and more affordable.”

Cost-shifting onto consumers is what he feared would happen with SF 151, Gordon wrote, “despite the good work done by all involved to provide local relief.”

Gordon also highlighted a lack of agreement during testimony about the effects of the bill on the cost of health care for Wyoming consumers.

“During the interim, the Insurance commissioner mediated discussions with all parties in hopes of developing legislation that would have positive impacts,” Gordon said. “Unfortunately, after months of collaborative work, these efforts were unsuccessful, and we seem to have arrived back where we started.”

But, Gordon added, he has been concerned about the loss of small-town pharmacies for many years, and remains so.

“Corporate consolidation, vertical integration and increasing prices in the pharmaceutical market have all contributed to increase burdens placed rural pharmacies,” he wrote. “They are under greater stress than perhaps at any time before. As with many providers in the health care system, rural pharmacies are often left to manage operations with insufficient funds, subsidizing certain prescriptions and increasing compliance costs for accountability.”

Too Little Too Late

Gordon tried to take some of the sting out of his line-item vetoes by signing a governor’s directive to the Wyoming Department of Administration and Information to negotiate increased payments for independent pharmacists that participate in the group insurance program for Wyoming state employees and officials.

The increased amount was up to $10 per brand name label, or $12 per generic brand.

That also was too little and also too late, Saul told Cowboy State Daily.

“That was good, but it’s only 5% or 6% of your scrips,” Saul said. “It doesn’t make up for the negative ones that you have that aren’t, you know, Wyoming government insurance.”

Gordon also wrote in his letter that he hoped other health care group plan administrators and insurance providers would follow suit, and he encouraged lawmakers to continue working on the issues to craft a “thoughtful” compromise that would protect the sustainability of Wyoming’s independent rural pharmacies, while controlling costs to consumers.

The latter is something Saul said he is planning to pursue. Now that his business has closed, he has plenty of time to shake things up, and he no longer has to worry about retaliatory audits if he complains.

“In two weeks, there’s a fly-in in Washington, D.C., where the NCPA (National Community Pharmacists Association) has a meeting scheduled with legislators,” he said. “And my wife and I are literally thinking about flying out there. I mean, we’ve closed within the last month, and why have we closed? Well, let me just tell you.”

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It has been reported that the majority of those Americans OD/poisoned by illegal Fentanyl are of “military age”. That age bracket ( M&F ) contains about 60-65 million citizens.  Abt 100,000/yr die from the use/abuse of illegal fentanyl.  In a single year, that is more dying than all the years of war we were in the Vietnam War. That number is abt the same as our soldiers that died in each year of WW-2. Are we in an undeclared war with China?

US committee finds China is subsidizing American fentanyl crisis

https://www.msn.com/en-us/news/us/us-committee-finds-china-is-subsidizing-american-fentanyl-crisis/ar-BB1lJBm8

FILE PHOTO: A used needle sits on the ground in a park in Lawrence, Massachusetts, U.S., May 30, 2017, where individuals were arrested earlier in the day during raids to break up heroin and fentanyl drug rings in the region, according to law enforcement officials. REUTERS/Brian Snyder/File Photo

WASHINGTON (Reuters) -China is directly subsidizing the production of illicit fentanyl precursors for sale abroad and fueling the U.S. opioid crisis, a U.S. congressional committee said on Tuesday, releasing findings from an investigation it said unveiled Beijing’s incentives for the deadly chemicals.

China continues to provide subsidies in the form of value-added tax rebates to its companies that manufacture fentanyl analogues, precursors and other synthetic narcotics, so long as they sell them outside of China, the House of Representatives’ select committee on China said in a report.

“The PRC (People’s Republic of China) scheduled all fentanyl analogues as controlled substances in 2019, meaning that it currently subsidizes the export of drugs that are illegal under both U.S. and PRC law,” the report said, adding that some of the substances “have no known legal use worldwide.”

The report cited data from the Chinese government’s State Taxation Administration website, which listed certain chemicals for rebates up to 13%. It additionally currently subsidizes two fentanyl precursors used by drug cartels – NPP and ANPP, it said.

According to the Chinese government website, the subsidies remain in place as of April, the report said.

China’s embassy in Washington said China was sincere in drug control cooperation with U.S. authorities and had a special campaign underway to control fentanyl and precursor chemicals and crack down on illegal smuggling, manufacturing, and trafficking activities.

“It is very clear that there is no fentanyl problem in China, and the fentanyl crisis in the United States is not caused by the Chinese side, and blindly blaming China cannot solve the U.S.’ own problem,” embassy spokesperson Liu Pengyu said in an email.

The U.S. State Department did not respond to a request for comment.

Mike Gallagher, the Republican chair of the bipartisan select committee, told a hearing on the issue on Tuesday that China’s incentives suggest Beijing wants more fentanyl entering the U.S.

“It wants the chaos and devastation that has resulted from this epidemic,” Gallagher said.

Fentanyl is a leading cause of drug overdoses in the United States. The U.S. has said that China is the primary source of the precursor chemicals synthesized into fentanyl by drug cartels in Mexico. Mexico’s government also has asked China to do more to control shipments of fentanyl.

China denies the allegation, and says the U.S. government must do more to reduce domestic demand.

The U.S. and China launched a joint counter-narcotics working group in January, following an agreement between U.S. President Joe Biden and Chinese leader Xi Jinping in November to work to curb fentanyl production and export.

U.S. officials have described the initial talks as substantive, but have said much more needs to be done to stem the flow of the chemicals.

The committee also said in its report that it found no evidence of new criminal enforcement actions by Beijing.

Ray Donovan, a former senior Drug Enforcement Administration official, told the hearing that the November agreement had not changed China’s support for the illicit chemical industry’s supply to the Western hemisphere.

“We need to apply more pressure,” Donovan said.

 

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And what is the FDA’s recommendation?:

Buy more of these medications from CHINA!

US drug shortages hit all-time high, pharmacists warn

Data shows that there are 323 active drug shortages

https://www.foxbusiness.com/lifestyle/us-drug-shortages-hit-all-time-pharmacists-warn

Drug shortages in the U.S. are at an all-time high, and some of the medications in short supply are life-saving chemotherapy drugs and emergency medications stored in hospitals, pharmacists warn. 

The American Society of Health-System Pharmacists (ASHP) and Utah Drug Information Service reported that there were 323 active drug shortages in the first quarter of the year, marking the most shortages since they have been tracking the data since 2001.

It surpassed the previous record of 320 shortages in 2014, according to the data. 

While ASHP CEO Paul Abramowitz warned that all drug classes are vulnerable to drug shortages, he said that “some of the most worrying shortages involve generic sterile injectable medications, including cancer chemotherapy drugs and emergency medications stored in hospital crash carts and procedural areas.” 

This includes drugs like oxytocin, Rho(D) immune globulin, standard of care chemotherapy, pain and sedation medications, and ADHD medications. 

The “ongoing national shortages of therapies for attention-deficit/hyperactivity disorder also remain a serious challenge for clinicians and patients,” Abramowitz added. 

Short-term shortages are caused by demand outstripping supply, but “the most severe and persistent shortages are driven by economic factors that undermine investment in manufacturing capacity, manufacturing quality, and supply chain reliability,” according to a separate report from the ASHP. 

“These economic challenges are driven by extreme price competition among generic manufacturers,” the ASHP added. 

Abramowitz continued to stress that more work needs to be done at the federal level to fix the root cause of the issue. 

“ASHP will continue to engage with policymakers regularly as we guide efforts to draft and pass new legislation to address drug shortages and continue to strongly advocate on behalf of our members for solutions that work,” he said.

The Department of Health and Human Services (HHS) published a white paper last week recommending ways Congress can assist with the issue.

“With today’s white paper, HHS offers solutions and stands ready to work with Congress to ensure no patient faces the devastating consequences of drug shortages or goes without needed medicines,” it said in a press release.

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How scammers have sunk to a new low with an AI obituary scam targeting the grieving

Don’t fall for this heartless trick by crooks trying to take advantage of your time of sadness

https://cyberguy.com/scams/how-scammers-have-sunk-to-new-low-with-ai-obituary-scam-targeting-the-grieving/

As if scammers couldn’t sink any lower, there’s a new online scam taking advantage of grieving people. It’s a strange pirate scam that uses AI to scrape data to build fake obituary websites, exploiting the information of somebody who is deceased in an attempt to scam vulnerable victims.

We can only hope that this unfortunate situation doesn’t affect you or anyone you care about. If, unfortunately, you have passed away, there’s little you can do to prevent someone from exploiting your obituary for their own gain. However, these scammers specifically target kind-hearted individuals who are still alive and willing to assist grieving families. It’s essential to remain vigilant and protect yourself and your loved ones from such deceptive practices.

 

 

How the fake obituary or “bereavement scam” works

Have you ever been on your social media account and seen someone post an obituary page of someone they have lost? Perhaps you’ve clicked on the links to learn about the person, their impact, how they’ve passed, or to read the information regarding the funeral.

Monitoring search trends

Scammers do this by first monitoring Google search trends to determine when people are searching for obituaries after a death.

Creating bogus obituaries

Then, once the scammers find out who has died, they create bogus obituaries with the help of AI that are hosted on legitimate funeral/memorial websites.

SEO optimization

Next, the scammers optimize these pages using SEO tactics so that the scammer’s page ranks first when someone searches for a specific person’s obituary page.

The trap is set

Then, when the prospective victim goes to click on it, though, they’ll be redirected to an e-dating or adult entertainment site, or they’ll be given a CAPTCHA prompt that, unbeknownst to them, will install web push notifications or pop-up ads when clicked.

These may give fake virus warnings but link to legitimate landing pages for subscription-based antivirus software programs. Worrying that you might accidentally download a virus, innocent victims instead walk right into a scam.

The scammers profit in two ways

After this, two things can happen:

• Scammers monetize this via affiliate reward programs from software downloads people are tricked into thinking they need.
• Scammers get revenue from adverts on the page that pay per impression.

So, while they may not explicitly target you in the same fashion as other scams, they’re still quite creative. Although Secureworks Counter Threat Unit emphasizes that this scam is not currently infecting devices with malware, it is possible that this scam could evolve in that direction in the near future.

MORE:HOW TO ENSURE YOUR PASSWORDS DON’T DIE WITH YOU  

How to protect yourself from falling for an obituary scam

To protect yourself from one of these scams, there are a few questions to ask yourself if you see an obituary page:

Do you have a connection to the person who has passed away? If you’re not connected in any way to the person you see the obituary page for, don’t click on it. And, if you do know the person, make sure you click on the original link that was shared on social media from the contact you know well; don’t search it in Google, as the first option that comes up could be a fake one.

Know the fake websites. Some fake obituary websites include Nextdoorfuneralhomes.com, Memorialinfoblog.com, Obituaryway.com, and Funeralinfotime.com. But keep in mind that some scammers are using common sites, too.

Check if the person has actually passed away. This may seem obvious, but some of these scammers are writing obituaries for people who have not actually passed away!

Look out for suspicious pages. Key signs of a fake obituary include overly descriptive language and an impersonal tone. Many scammers rely on AI to write these obituaries as quickly as they can and don’t usually take the time to review them to make them sound more human. After all, they are in a rush to snag you shortly after the person has died.

 

MORE: SCAMMERS ARE USING FAKE NEWS AND MALICIOUS LINKS TO TARGET YOU IN AN EMOTIONAL FACEBOOK PHISHING TRAP

Kurt’s key takeaways

Many scammers prey on emotionally vulnerable people to get their way. Though this obituary scam is next level, it’s not much different than someone taking advantage of someone during a phone scam, where the victim is rushed to send over money or provide information. So, always keep your wits about you if you’re ever not sure. Before clicking on a link, opening a file, or answering that phone call, take a minute.

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HHS OIG Toolkits for Calculating Opioid Levels and Identifying Patients At Risk of Misuse or Overdose

https://oig.hhs.gov/reports-and-publications/all-reports-and-publications/hhs-oig-toolkits-for-calculating-opioid-levels-and-identifying-patients-at-risk-of-misuse-or-overdose-2/

Filed under: General Problems | 5 Comments »

Filed under: General Problems | 2 Comments »

Abt 15 yrs ago, I was working only as a “temp/locum” Pharmacist as an independent contractor. I had signed up with several Pharmacist temp services and I was working in all kinds of community pharmacies from independent pharmacies to Big Box stores. The technician brought to me a refill for a Suboxone, which was a couple of days early, had refills, but the pt’s insurance was not going to approve paying for it a couple of days early.  The technician offered the pt the cash price for the 2-3 tablets that he needed and the cost was too much for him to afford. I walked out front to talk to him, and he was obviously very upset. He was concerned that not having those 2-3 doses, his attempt to get sober may be compromised.  I always try to be a problem solver. In talking to this young man, I mentioned that insurance companies will often pay for early refills for someone going on vacation. “Did I hear you say that you were going on vacation and that was the reason for this early refill?”.  It took the young man a couple of minutes to catch on what I was asking. I asked him if he would like to use the pharmacy’s phone to call his insurance company to see if they would provide an “early vacation refill authorization”?  He made the phone call to his insurance and they approved the early refill, we filled his Rx for the 30-day supply that he could afford and he went happily on his way. Was he able to successfully get sober and stay sober? I don’t know because I was at this Big Box pharmacy that one day and knew that my “just saying no” to his refill, may have caused him to break his path to sobriety.

Why Aren’t Pharmacies Filling My Patient’s Life-Saving Medication?

https://www.doximity.com/articles/116b245b-74d8-4068-8eb8-ebea2a24805a

I sat on the phone yesterday consoling a single mother going through heroin withdrawal. In between bouts of vomiting and dry heaving, she pleaded, “When will I be able to pick up the medication you ordered that stops all of this?” This mother had already overcome significant barriers Americans face when seeking addiction treatment, including stigma associated with treatment, affordability of treatment, and finding high quality, highly trained addiction specialists. I had prescribed an FDA-approved addiction treatment medication that reduced her chance of death from addiction by more than 50%. Seemed like it should be a happy ending. Instead, she found her local pharmacy refusing to fill the prescription.

That pharmacy’s response is just one example of a troubling, growing trend. Pharmacies across the country are refusing to fill the life-saving addiction treatment medication buprenorphine/naloxone. As a multi-state licensed addiction psychiatrist, I find myself in daily debates across the country with major retail pharmacy chains who refuse to fill this medication. The DEA and the federal Substance Abuse and Mental Health Services Administration (SAHMSA) have both issued recent policy statements urging health care practitioners and pharmacies alike to increase access to this medication with fully telehealth treatment of substance use disorders.

Why are so many pharmacies refusing to fill valid, legal, physician-issued prescriptions for the single most important and effective medication used to treat addiction? The answer, ironically, lies in recent well-meaning landmark court proceedings designed to decrease the opioid epidemic.

In late 2022, CVS, Walgreens, and Walmart were forced to pay an eye-popping $10.7 billion to settle allegations that the pharmacy chains failed to adequately oversee opioid painkiller prescriptions, thus contributing to America’s opioid addiction crisis. CVS alone agreed to pay nearly $5 billion in fines over 10 years, while Walgreens would pay $5.7 billion over 15 years. With this decision, the pharmacy chains also agreed to implement robust “controlled substance compliance programs” that required additional layers of opioid prescription reviews, mandatory state prescription pharmacy database checks, and new employee training programs on prescription monitoring oversight.

This well-meaning legislation was designed to rightfully reduce access to dangerous and addictive prescription opioid drugs like Oxycontin, Percocet, and Vicodin, among others — drugs which are gateways to opioid addiction and are often involved in opioid overdose deaths. Buprenorphine is also a controlled substance, although it contains a very low, weakened amount of a “partial” opioid to treat withdrawal and ultimately has a very different, safer chemical make up than traditional opioids. The chemical makeup is designed to prevent people from getting high on it. It also contains the opioid overdose agent Naloxone or “Narcan,” which further reduces abuse potential. These important differences make it a safe, effective, FDA-approved medication designed to treat addiction, not cause or worsen it. Despite all of these important differences, some pharmacies continue to lump it in with other opioid medications. Ironically, the very measures designed to curb addiction are now resulting in less access to our most important medications used to fight addiction.

I spend a significant portion of my days trying to convince pharmacists to fill these prescriptions. Pharmacists’ objections to refilling the meds include: “The patient lives too far away from your treatment facility,” “You did not see the patient in person,” or “There is no previous prescription for buprenorphine on file for this patient.” Pharmacists concerned with no previous prescription is puzzling. Luckily, due to increased addiction treatment access, many patients are starting to treat their opioid use disorder for the first time — and this is a good thing! It means we are broadening treatment access to more folks who need it most and saving more lives.

I’m successful in convincing the pharmacist to ultimately dispense the drug about half of the time. After an hour on the phone with the pharmacist, I addressed all of her questions and she dispensed the prescription to the single mother waiting outside in the grocery store parking lot. Many other times, my patients are forced to pharmacy hop until we find an understanding and well-informed pharmacist. It is tiring and exhausting.

What is the solution? We desperately need advocacy help from our high-profile medical stakeholders, as well as more pharmacist education and training on buprenorphine. It would be helpful if the DEA, the American Medical Society, and SAMHSA released specific policy statements encouraging all pharmacies to fill these prescriptions without geographic, mileage, or in-person requirements. If you are a pharmacist reading this article right now, please share it with as many of your colleagues as possible to spread the word: we need your help!

The best way to quickly curb the opioid epidemic is increased access to effective treatment. This is one of very few life-saving addiction treatments in our medicine arsenal. Its effects on mortality rates mean that your loved one suffering from opioid use disorder is more than twice as likely to survive with this medication. We need help reducing well-meaning but misinformed pharmacy red tape to its access. We owe this to the American public. We owe this to our friends, family members, and loved ones whose lives are jeopardized by addiction. We owe this to our children. We owe this to the more than 500,000 people we’ve lost in the U.S. in the past two decades due to overdose. Martin Luther King Jr. famously said, “The ultimate tragedy is not the oppression and cruelty by bad people but the silence over that by the good people.” Now more than ever, we need loud, passionate advocacy from you: our good people.

Dr. Lauren Grawert is a double board certified addiction psychiatrist. She received her medical degree from Medical University of South Carolina College of Medicine and has been in practice 15 years. She speaks multiple languages, including Spanish. She was Chief of Psychiatry at Kaiser Permanente of the Mid-Atlantic from 2018-2022. She is currently the Chief Medical Officer at Aware Recovery Care. She enjoys working with the media in her spare time to reduce stigma around mental illness and addiction. She has been interviewed by SAMHSA on Co-Occurring Disorders and most recently published articles in Capital Psychiatry and Northern Virginia Magazine.

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Has anyone ever reached out to ACLU about denial of care at the Emergency Dept concerning your pain? I got this from ACLU this AM.  Apparently, according to this ACLU email, only pregnant females who are denied care at a ED with long-standing protections to access necessary emergency care at hospitals are being discriminated against.

 

 

Steve, the Supreme Court is considering a second case that could devastate abortion access nationwide and make pregnant people second-class citizens in the emergency room. Anti-abortion politicians are now trying to take away people’s power to get emergency care if they are facing severe complications during pregnancy. Their claim is that pregnant people are somehow excluded from long-standing protections to access necessary emergency care at hospitals – threatening doctors with prison time for providing abortion care in a medical emergency. We don’t need to tell you how disastrous this would be. Everyone has a right to the emergency treatment they need without political interference. That’s why we’re urging Congress to act to end state bans and protect all forms of reproductive health care – including emergency care, IVF, and medication abortion. We need you with us to send a clear message: Congress must defend our reproductive freedom. Steve, federal law protects patients in emergency situations – patients experiencing medical crises should never be turned away from the emergency room. Period. But if anti-abortion activists win, doctors could face jail time for doing their medical duty – and pregnant patients could be left to suffer. It’s yet another prong of the coordinated campaign to push abortion out of reach entirely, proving that extreme politicians and the groups supporting them do not care about the well-being of pregnant people, do not care that abortion is supported by a vast majority of Americans, and does not care who they will hurt with their extreme agenda. Denying emergency care is not an accident – it’s an intentional part of their cruel vision for the world. Steve, it’s completely unacceptable – which is why we’re using every tool at our disposal to fight back. We can’t do this alone, we need you with us. Join the growing number of your fellow ACLU activists calling on Congress to protect our reproductive health care and restore our rights. Thank you for all that you do, Alexa Kolbi-Molinas Pronouns: She, her, hers Deputy Director, Reproductive Freedom Project

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