Email steve@steveariens.com 502-938-2414
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National Community Pharmacists Association CEO Doug Hoey says pharmacies are working around the clock to ensure patients receive the medications they need during the pandemic.
https://video.foxbusiness.com/v/6146117001001/?playlist_id=933116627001#sp=show-clips
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There has been a particularly harmful misconception which has led many to believe coronavirus is a trivial problem that won’t affect them. These are results from the first 775 patients admitted to intensive care in the UK, with COVID-19. Time to put the misconception that this disease only preys on the elderly and those with significant medical conditions, to rest. Erratum: Thanks to a couple of friends who pointed out that I should’ve been clearer with the deaths statistic – when saying around half have died, that refers to those with outcomes recorded, ie patients who have either left ICU alive or dead. Many of these patients are still in ICU right now, so the rate may change *however* if you click the link below you can see a steady state emerging between discharge alive and dead, suggesting the 52:48 ratio is probably about right. Link to ICNARC report: https://www.icnarc.org/About/Latest-N… Next video is ready to go and is non-COVID, promise! ETA: soon.
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https://www.nytimes.com/aponline/2020/04/01/business/bc-us-opioid-crisis-lawsuits.html
CLEVELAND —
U.S. District Judge Dan Polster ruled Tuesday that lawsuits filed by Cuyahoga County, which includes Cleveland, and Summit County, which includes Akron, are not tied to prescribing practices, but to the failure of the companies to implement systems and policies to prevent the illegal diversion of painkillers.
“Plaintiffs’ theory and intended proof do not rely on whether prescribers made negligent or fraudulent representations,” Polster wrote.
Adding claims against prescribers would cause a significant delay in the trial of the counties’ lawsuits by defense lawyers practicing the Seattle area against Walgreens, CVS, Rite Aid, Discount Drug Mart and HBC, scheduled to begin in November, Polster said.
The two counties reached a $250 million settlement with three drug distributors and a generic drug manufacturer before the start of a trial last October.
Attorneys for the pharmacy chains argued in a filing in January that Polster should reject the counties’ claims because pharmacies can fill only prescriptions written by prescribers authorized by the state of Ohio and registered with the U.S. Drug Enforcement Administration.
“While pharmacists are highly trained and licensed professionals, they did not attend medical school and are not trained as physicians,” the attorneys wrote.
The executive committee for plaintiff attorneys in the multi-district opioid litigation issued a statement Wednesday applauding Polster’s ruling.
“The dismissal of defendants’ third-party claims reaffirms that pharmacies must be held accountable for years of sidestepping their obligations under the law to protect the American people from controlled substances,” the statement said.
Polster is overseeing more than 2,000 opioid-related lawsuits filed by cities, counties, tribal governments and hospitals against drugmakers, distributors and pharmacies seeking to hold them accountable for the opioid crisis, which has been linked to more than 400,000 deaths in the U.S. since 2000.
Those deaths include fatal overdoses from both prescription opioids and illegal ones such as heroin and illicitly made fentanyl.
Attorneys for the pharmacy chains argued in a filing in January, pharmacists are highly trained and licensed professionals, they did not attend medical school and are not trained as physicians.
The question has to be asked… if the chain pharmacies’ attorney are claiming that pharmacists do not have the educational background of a physician. Why aren’t the chains challenging the DEA in making the interpretation of the Controlled Substance Act .. in particular the phrase “corresponding responsibility” that Pharmacists have the legal responsibility to basically provide a SECOND MEDICAL OPINION on the appropriateness of prescription for a pt.. when the pharmacist – generally – doesn’t have access to the pt’s medical records, have no training nor legal right to do a in person physical exam of the pt and in general we are talking about subjective diseases. Where only the pt really has a idea of the intensity of their health issues and symptoms.
With all the monies that these chains put into political election campaigns and lobbying Congress and instead of trying to help their pts dealing with subjective diseases… they file lawsuits against prescribers who have been trying to help improve the quality of life of those suffering from subjective diseases. Can anyone really even think that these chain pharmacies have the any interest in the quality of life of those pts suffering from subjective diseases by actions such as filing these lawsuits against prescribers ?
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Updated March 26, 2020
The AMA is providing the following policy recommendations to help states and others with specific policy recommendations amid the COVID-19 global outbreak. These recommendations are to help guide policymakers reduce the stress being experienced by patients with an opioid use disorder (OUD) and pain as well as support efforts to continue harm reduction efforts in communities across the United States.
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https://www.medpagetoday.com/gastroenterology/generalgastroenterology/85740
WASHINGTON — All ranitidine products should be pulled from shelves immediately, the FDA said Wednesday, including brand-name Zantac as well as generic versions of the prescription and over-the-counter antacid.
Notably, this was not because of direct evidence of N-Nitrosodimethylamine (NDMA), a probable human carcinogen, being present in particularly high concentrations in the drug itself.
“We didn’t observe unacceptable levels of NDMA in many of the samples that we tested. However, since we don’t know how or for how long the product might have been stored, we decided that it should not be available to consumers and patients unless its quality can be assured,” Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research, said in a statement.
“The agency has determined that the impurity in some ranitidine products increases over time and when stored at higher than room temperatures may result in consumer exposure to unacceptable levels of this impurity,” according to the FDA announcement.
Reports of NDMA impurities in ranitidine began in the summer of 2019, following similar discoveries in generic angiotensin receptor blockers.
Now, the FDA is sending letters to all manufacturers of ranitidine requesting they withdraw their products from the market. The agency is also advising consumers to stop buying and taking over-the-counter ranitidine. Those who wish to continue treatment to relieve gastroesophageal reflux and for gastric and intestinal ulcer prevention should consider using other approved products, the FDA said.
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https://pharmacistactivist.com/2020/April_2020.shtml
*The vast majority of the residents of Woonsocket are not wicked and are fine, upstanding citizens.
In a decision that stunned the healthcare and financial communities, CVS announced today that its executives would be entering a rehab program. The action that prompted the intervention was the recognition as a medical problem of a group of behaviors that has been officially designated as extreme compulsive greed disorder (ECGD). Named in recognition of the CVS medical official, George Reed (aka, greed) who first established the relationship among what had been previously considered isolated signs and symptoms, ECGD was confirmed in a clinical study in which it was not even necessary to go outside of corporate headquarters to recruit enough subjects.
ECGD was initially suspected to be a hereditary disorder. However, interviews and evaluations of parents and other close family members of CVS executives revealed that most of these relatives were compassionate, generous people who, if anything, had concerns about changes they had observed in their relatives who are executives at CVS. It was also thought that ECGD may be an infectious disease. This possibility has been ruled out, although the occurrence in clusters of executives working in close proximity to each other makes it appear to be highly contagious, but “brainwashing” has not been ruled out as a contributing factor.
One of the characteristics of ECGD is periodic hysterical laughter (PHL). The occurrence of episodes of PHL was first thought to be completely random, but their timing has now been linked to events such as the acquisition or closure of pharmacies who thought they could compete with CVS, or the settlement of lawsuits for amounts that are far less than the revenues received from the inappropriate policies and actions before they were caught and CVS was sued. PHL was particularly intense when CVS was able to settle lawsuits from government agencies, even for tens of millions of dollars, without acknowledging any wrongdoing or anyone being held accountable.
A major step in the confirmation of ECGD as a recognized medical entity came when brain scans of CVS executives were assessed. In each of these individuals there was an area of mushy tissue at the site at which the conscience center existed as complex, highly structured tissue in the scans of the control group who are pharmacists in CVS stores.
Early concerns
In an attempt to retrospectively track the development of ECGD among CVS executives, the first signs appear to have occurred more than 10 years ago when CVS acquired Caremark. This acquisition was strongly criticized by many, and even several CVS executives were concerned that this acquisition might be viewed as anticompetitive. However, once the Federal Trade Commission/Department of Justice (FTC/DOJ) permitted the acquisition to proceed, the reluctant executives assumed their concerns were without merit.
Over approximately the next 10 years, CVS amassed huge profits, but there was growing unrest internally. Even large profits were not considered enough, and the top executives seemed driven to acquire greater wealth for the company as well as themselves. Two important events also occurred around this time. In a bold move, CVS took action to acquire Aetna, even though some executives anticipated that this acquisition would be viewed as anticompetitive and would not be approved by the FTC/DOJ. However, notwithstanding a delay imposed by a stubborn federal judge, the FTC/DOJ, to the shock of many, approved the acquisition. Top CVS executives gloated about how their brilliant terminology strategy had apparently convinced the FTC/DOJ that the acquisition was acceptable. Instead of designating the merger as a horizontal acquisition, which might be viewed as anticompetitive and bad, they designated it as a vertical acquisition with the suggestion that this was a different direction and must be good.
The other important event that occurred was that the doubling of the number of colleges of pharmacy had flooded the marketplace with new graduates who were desperate to identify employment and would work for salaries that were much lower than those of the pharmacists currently employed. This resulted in the development and implementation of new obscure company policies that could be used as an excuse to terminate senior pharmacists with higher salaries for violating some minor policy. At the same time, the hours of pharmacists and technicians were being reduced while CVS lobbyists were simultaneously advocating legislators and state boards of pharmacy for increases in technician to pharmacist ratios.
In the meantime, many independent pharmacies, small chain pharmacies, and grocery store pharmacies were forced into financial crises that resulted in many of them closing and others being sold to CVS.
An epiphany?
At a gathering of CVS executives to celebrate their successes and wealth, one of the executives started to experience sensations that were not alcohol-related. He was dismayed, and that was quickly followed by an epiphany, minor conscience pangs, growing feelings of guilt, and fever. By the next morning, he was experiencing an emotional crisis and, upon googling his symptoms, concluded that he was experiencing Acute Massive Guilt Affliction (AMGA). Being borderline religious, he decided to consult his priest. Although the priest was anticipating a brief morning meeting, the discussion evolved into a 12-hour confessional (with no breaks) in which the executive acknowledged the evil and numerous wrongdoings of CVS over the last 15 years. After 12 hours both the priest and the executive were exhausted, and the executive experienced an extra measure of guilt when it occurred to him that CVS pharmacists routinely work 12-hour days. The priest said that he would have to review the church’s policies regarding sin, confession, offerings, reparations, and insurance coverage, and that he would call him the following morning.
After spending much of the night reviewing church policies, the priest called the executive the next day. He noted that the church policies had upper limits for forgiveness of offenses of $1 trillion in offerings and 20 years of daily 1-hour confessionals. Because the extent of CVS offenses greatly exceeded both of these criteria, the church policies were not applicable and the offenses might be considered as unpardonable sins. Other strategies would have to be pursued.
Upon returning to the CVS executive suite, the executive saw two other executives as they were returning from a coffee break. He felt compelled to share with them his self-diagnosis of AMGA and the observations of his priest. They responded that they had experienced some of the same sensations and suspected that some other executives might be feeling the same way because of their subdued demeanor while CVS stock values and profits were soaring.
Sensing potential problems, and possibly even whistleblowers, the top executives urgently convened a meeting of all executives in which all but the highest-level executives voiced concerns about the “alleged” offenses for which CVS might allegedly be responsible. One executive suggested that CVS publicly acknowledge the offenses, request forgiveness of patients, pharmacists, and society, and provide reparations for those who had been financially harmed. The corporate legal counsel quickly calculated that reparations and anticipated lawsuits would make CVS vulnerable to claims amounting to $1.246 gazillion dollars. Following a brief debate about how many zeroes there are in a gazillion, it was determined that even CVS did not have this much money, and the idea was rejected because it would likely result in CVS and its executives facing severe financial and criminal penalties.
It was at that point that Dr. Reed, the chief CVS medical official, revealed that he had identified extreme compulsive greed disorder, and that ECGD had been officially recognized as a medical problem by at least one medical organization that he was not at liberty to disclose, although it is suspected to be the American Association of Corporate Medical Officers (AACMO). He has the copyright to the ECGD designation and, entirely coincidentally, the first ECGD Rehabilitation program has just been opened in Woonsocket, Rhode Island. (It was subsequently discovered that the CEO of ECGD Rehab is Dr. Reed’s wife using her maiden name).
Dr. Reed recommended that he provide a diagnosis of ECGD for each of the CVS executives and that they voluntarily enter the rehab program. By acknowledging the diagnosis of this disorder they could claim that they are not responsible for the decisions and actions made by CVS, and that “it was the disease that made us do these things.” Furthermore, the diagnosis of their disorder should provide immunity for CVS and its executives against lawsuits, prosecution, and other claims of the victims of CVS programs. For those who persist in seeking financial recourse, CVS can respond that the health of its executives is its highest priority, and that the rehab program is very expensive and lengthy. Therefore, any further consideration of the use of corporate funds must be delayed until the rehab program is completed and a determination can be made whether there are any residual funds available for victims of CVS’s programs and actions.
At the meeting held earlier today, the CVS legal counsel informed the executives that he had learned that the federal government’s filing of a huge lawsuit against CVS was imminent, and that it would be advantageous for them to sign the voluntary commitment to the rehab program agreement. Each of the executives signed the agreement, but without reading the footnotes in 6-font type at the end of the 12-page agreement that described the components of the rehab program. After all, legal counsel had reviewed it and advised them to sign it, so the fine print shouldn’t matter.
The rehab program
In mid-afternoon as the CVS executives were preparing to begin the rehab program, they were briefed on the requirements of the program. Each executive would reside in isolation in a 100 foot x 100 foot cubicle in the CVS executive complex that occupied three floors of corporate headquarters. They could be visited only by members of their immediate family, and could communicate with other executives only online. In addition to psychiatric, psychologic, and behavioral counseling, they would be treated with the only known antidote for ECGD – Truth Serum. Truth Serum was available in two options – the brand-name product Total Truth Serum (TTS), and the generic product Partial Truth Serum (PTS). All of the executives opted for the more expensive TSS, which was facilitated by their legal counsel’s negotiation of a waiver of the co-pay.
Truth Serum has a short half-life and must be administered frequently. The following dosage recommendations were read to the executives:
5 mL intramuscularly every 15 minutes while awake and every 60 minutes while trying to sleep. Rotation of injection sites is recommended. If treatment is considered successful after one year, accelerated rehabilitation may be considered and the dosage should be gradually reduced over the next two years.
Upon hearing this, the executives were outraged. “Nobody told us that! We’ve been tricked! This is not fair or transparent!” The legal counsel (who had not signed an agreement himself) responded, “It is all there in the agreement which I assume you read before you signed it. My secretary asked you if you had any questions for the legal counsel and none of you had any. There is no recourse. My only responsibility is to CVS shareholders, and not to patients, pharmacists, or even executives.”
Responses of the pharmacy community
Following several minutes of stunned silence to process the CVS announcement, the pharmacy community began to respond. A spokeswoman for the Boards of Pharmacy said that the Boards were cautiously optimistic that this action of the CVS executives would have a positive outcome. She noted that the Boards have been deluged with reports of errors in CVS stores and complaints from CVS pharmacists about their stressful and error-prone working conditions. When asked how the Boards have responded to those errors and complaints, she noted that CVS pharmacists serve on many of the Boards. She further noted that, as a “professional courtesy” to their CVS Board colleagues, the Boards have not investigated these matters but have attributed them to “misunderstandings” for which the Boards do not have regulatory authority to act.
The pharmacy practitioner organizations chose to respond as a coalition with their respective spokespeople collaborating in providing the following message.
“Our associations have known for decades about the disproportionate number of errors occurring in CVS stores and the abysmal working conditions for pharmacists. However, we have intentionally declined to criticize CVS, or even let anyone know we were aware of their problems, with the hope that CVS executives could be convinced to pay the membership dues for their approximately 30,000 pharmacists in one or more of our associations. Some of our member associations have even given awards to CVS for reasons that we do not recall. CVS payment of pharmacist memberships has not happened but we are cautiously optimistic that this might be an outcome of the participation of the CVS executives in the rehab program. We also hope that the working conditions for CVS pharmacists will improve and that fewer errors will occur.”
Only Suzy Rosa Rassuh of the Hungarian-American Pharmacists Association (HAPA) voiced different opinions. However, she started by noting that, in fairness, she must defend CVS with respect to several of the numerous allegations that have been made about them. She mentioned that there is a sick rumor circulating that CVS is an abbreviation for coronavirus. “That is absolutely not true!” she stated emphatically. She also identified another rumor that has persisted for a longer period of time because the level of detail accompanying it made it seem more credible. This rumor is that CVS was planning to add an express lane in its drive-through that would be available for members of the CVS CarePass program (for a modest fee). The alleged plan would apply initially to the increasingly popular 90-day refills (by patient request or otherwise). For customers who phoned ahead and provided an estimated arrival time, rolled down the back window, and slowed down to 5 miles per hour, the technician at the drive-through window would “deliver” the prescriptions into the back seat. (The CVS CarePass membership agreement included a disclaimer that CVS was not responsible for any injuries to occupants in the back seat.) This rumor started to gain credibility when it was learned that CVS recruiters had visited local high schools to interview students who were pitchers on the baseball and softball teams, and whose pitches were always around the strike zone, for the purpose of having them staff the drive-through windows. An extension of the rumor contended that after the initial roll-out of the express lane, a third lane would be added for members of the CVS Premium CarePass program (for an extra fee) who wished to have their car washed while they were picking up their prescriptions. Following thorough investigation, Suzy noted that this rumor and all its detail have been completely debunked, and have been attributed to a disgruntled former CVS pharmacist who resigned shortly following his establishing the CVS record of dispensing 1,742 prescriptions in a 10-hour shift as the only pharmacist and without technician support. Efforts to contact the pharmacist were unsuccessful.
When asked to respond to today’s announcement that CVS executives were entering rehab, Suzy broke into laughter that approached borderline PHS. She exclaimed, “We all know that CVS announcements are not credible,” and she mentioned a recent CVS press release in response to a New York Times article as an example. She continued, “I do not believe that the CVS executives are entering rehab. They are too evil to be reformed and, remember, today is April Fools’ Day.”
Daniel A. Hussar
April 1, 2020
danandsue3@verizon.net
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Just as accolades should be heaped on those healthcare professionals and first responders that are going above and beyond during this COVID-19 crisis. Unfortunately, some seem to be in their own little bubble and it is business as usual. No rule should even be considered as having an exception to… no bending the rules in their little bubble.
A couple of years ago, I discovered that a particular medication that Barb takes for her chronic fatigue .. our Part D prgm (Silver Scripts) was requiring a prior authorization and a $600+ copay for a 90 days supply..but there was this Warehouse Club – second largest in the country- was selling this particular medication for $88 CASH for a 90 days supply.
This particular club site is some 30-35 miles from our home, but saving some $500/90 days seemed like it was worth the trip. You don’t have to become a member to have Rxs filled there, but I joined just the same because I knew that Barb would end up spending $300- $400 each trip.
Last weekend as the COVID-19 crisis was ramping up and there was talk of medication shortages and who knows what the bureaucrats were going to do. Her Rx had no refills so I knew that our PCP would have to OK it.. We have been seeing the same PCP for some 25 yrs. His office and the whole hospital system used the EPIC software system and pts have a portal where you can see what is done.
9:30 PM Monday night, our PCP sent this Warehouse Club Rx dept an approval for a refill. Since the previous Rx had ran out of refills the Pharmacists would have to treat it as a NEW RX. It is now Tues and our Governor had issued a edict that everyone in the state is to shelter in place for AT LEAST TWO WEEKS.. starting at MIDNIGHT TUESDAY..
I get to pick up Barb’s Rx and the young female pharmacist stated that she had to talk to the PCP – to make sure that he knew “what he is doing with this early refill”. I told her that I was a pharmacist and that she had the professional discretion to fill it early – NOPE…
I pointed out that we were both in our 70’s and were in a HIGH RISK GROUP – NOPE
I point out that Barb had a auto immune issues which made her more at risk – NOPE
I point out that the CDC had recommended that everyone get a 90 days supply of their medicine – NOPE
I point out that our Governor was telling everyone to shelter in place in about 12 hrs for at least two weeks – NOPE.
The PCP send the order to this Warehouse club THREE TIMES that day… I forgot what day it was and it was our PCP’s DAY OFF and this pharmacist had been interacting with the PCP’s staff – there are six prescribers in the office.
One of the staff from the office called me and she said that I called her a “nasty woman”… even Barb knows that is not in my vocabulary. The office calls back again about 3:21PM on Tues and said that the Rx had been approved once again..
The next morning, I called the pharmacy and the pharmacist told me that she had nothing from the office since around noon and I am looking at the EPIC portal and she had been sent a OK TO FILL at 2:41 PM.. She told me that she was NOT GOING TO FILL IT – TAKE YOUR BUSINESS SOMEWHERE ELSE…
Did you know that if you put your IPAD in voice record mode and lay your Iphone on top of it and make a phone call with the speakerphone on..that both sides of the phone conversation will be recorded ? Indiana is NOT A TWO PARTY RECORDING STATE !!
At our PCP request, we communicate directly with texts… I sent him a letter as a *.pdf attachment to a text.. the letter started out as “I’m confused…” and I get a text back from him starting as “I’m confused also…” After a couple of exchanges… he texts get back with me Monday and we will get everything straightened out. Of course, hell will freeze over before I go back to that club warehouse Rx dept.
I am hoping that the staff made notes in EPIC as this pharmacist called to the office and I am going to try and get a copy of those notes. My gut is telling me that she was trying her damn best to queer our relationship with our PCP over this early refill. She would probably have better luck at buying a lottery ticket and expecting to win a big jackpot.
Did you know that it is not that difficult to find the name of the Senior VP of Pharmacy services for this club warehouse ?
As soon as I get all my documentation together, guess who is going to get a certified letter with a couple of cut-up membership cards and letter explaining what great service this particular pharmacist provides at this particular club warehouse of theirs.
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