how large healthcare organization(s) control costs in the long term

Posted on March 26, 2020 by Pharmaciststeve

A Woman With Lupus Said Her Health Care Provider Is Stopping Her Chloroquine Prescription And Thanked Her For The “Sacrifice”

https://www.buzzfeednews.com/article/tanyachen/kaiser-permanente-lupus-chloroquine

Dale said she’s been taking the medication for a decade, and she’s scared about possible consequences to her own health during the coronavirus pandemic if she’s forced to stop taking hydroxychloroquine.

“I am already immunocompromised, and not taking this medication with likely put me into a lupus flare, making serious complications from COVID more likely,” she said.

“The fact that they thanked me for my ‘sacrifice’ is disturbing,” she then added. “I never agreed to sacrifice my health and possibly my life and cannot believe that I am being forced to do so.”

In the message Kaiser sent to her about its decision to withhold the medication, it wrote, “Please do not contact your physician about an exception process to get a refill, as prescriptions will not be filled even if written by your physician. Hydroxychloroquine does build up a level in the system that stays in the body for an average of 40 days even after the last dose is taken. If you do run out of medication and feel your condition is significantly worsening, please contact your doctor to discuss alternative treatments.”

“Thank you for the sacrifice you will be making for the sake of those that are critically ill; your sacrifice may actually save lives,” the message said.

In a statement provided to BuzzFeed News, Kaiser Permanente confirmed that it was no longer filling routine prescriptions for chloroquine.

“As we face the real possibility of running out of the drug for everybody if we don’t take steps to mitigate the shortage, Kaiser Permanente, like other health care organizations across the country, has had to take steps to control the outflow of the medication to ensure access to severely sick patients, including both COVID-19 and those with acute lupus,” said Nancy Gin, regional medical director of Quality and Clinical Analysis at Kaiser Permanente, Southern California, which has 4.6 million members.

“Extensive experience and research show that hydroxychloroquine builds up in the body and continues to work for an average of 40 days even after the last dose is taken. By then, we expect the drug manufacturers to have ramped up production to meet the increased demand. Until then, we are no longer refilling routine prescriptions to ensure we have adequate supply to care for our sickest patients,” Gin said.

“Kaiser Permanente physicians and pharmacists are also working together on an evidence-based approach to identify alternative therapies for patients with lupus,” Gin added in a follow-up statement.

Dale said she immediately called her doctor and has been scheduled for a phone call next week.

Please do not misuse hydroxychloroquine. This med is critical for people who have SLE, like me. I was told today that my prescription cannot be filled because the suppliers are completely out. Now I do not have the meds I actually need for an incurable disease I actually have. 🤬 https://t.co/dlwuWCwVZk

Despite thin evidence for the drug’s effectiveness against coronavirus infections, shortages of chloroquine have erupted since Trump called it a “game changer” at a White House news conference late last week. The drug, a derivative of an antimalarial drug, has been added to the regimen for treating COVID-19 infections in China and South Korea and is being tested in clinical trials in the US.

However, experts on drug testing have been skeptical of the evidence for its benefits. A frequently cited French study of 20 patients saw several drop out of the trial to instead go into intensive care.

An Arizona man died on Monday after self-medicating with a related drug, chloroquine phosphate, where chloroquine was also touted at White House news conferences.

“For many people with lupus there are no alternatives to these medications,” the Lupus Foundation of America said in a statement on Monday, warning of shortages. “Hydroxychloroquine or chloroquine are the only methods of preventing inflammation and disease activity that can lead to pain, disability, organ damage, and other serious illness.”

Dale, who’s been calling multiple pharmacies in her local area, said, “I have learned that all area pharmacies are completely out of hydroxychloroquine.”

“In their mission statement, Kaiser says that they aim ‘to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve,'” Dale said. “How is denying medication for a chronically ill, immunocompromised patient during a pandemic improving my health?”

“I want Kaiser to follow their own mission statement and reverse the decision to withhold my medication.”

UPDATE

March 25, 2020, at 1:48 p.m.

This story has been updated to include a follow-up statement from Kaiser Permanente.

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abt 32 million Americans could be effected by this discriminatory policy

Posted on March 25, 2020 by Pharmaciststeve

https://www.costco.com/PharmacySearch?identifier=about-home-delivery&catalogId=10701&storeId=10301&langId=-1&krypto=8lckBDBM3NpZlgVGiH5MNDw5CoyNusIfXReqdxTIRAOfVk0L2bxk%2FgnIn1xMGogzz3x7xu0dcmlafVfN%2FUG1tA%3D%3D&ddkey=http%3APharmacySearch

Because state regulations vary, Costco Pharmacy is unable to fulfill prescription orders for Schedule II Controlled Drugs for patients without insurance.

I was looking at Costco’s mail order pharmacy web page and found the above blanket statement. We have about 10% of our population that does not have health insurance. Current USA population is 340 million.

Using some estimated averages there is probably some 3-6 million people that have a valid medical needs for being prescribed a C-II. Of course, this number doesn’t take into affect the number of people with health insurance whose health insurance will NOT PAY FOR C-II’s. This statement on Costco’s website is not clear if CASH for C-II is just a plain NO-NO… regardless if the pt has insurance that will not pay.

Does this suggest that “corporate healthcare” is really not “healthcare for all ” ?

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FDA warns of EpiPen device malfunctions

Posted on March 25, 2020 by Pharmaciststeve

FDA warns of EpiPen device malfunctions

https://www.modernhealthcare.com/safety-quality/fda-warns-epipen-device-malfunctions

The brand name and generic versions of Mylan’s EpiPen devices are vulnerable to malfunctions that can cause them to work improperly or not at all, according to a federal safety alert issued Tuesday.

The EpiPen and EpiPen Jr. devices, which are commonly used to treat emergency allergic reactions, may have delayed injections or fail to inject properly due to design issues or improper administration by users, the U.S. Food and Drug Administration alert said. The agency was made aware of the issues through a letter Mylan recently sent to healthcare workers warning of the problems. Mylan was recently acquired by drug maker Pfizer but continues to use its name.

In a statement, a Pfizer spokeswoman said the company routinely studies and evaluates data regarding administration of its EpiPen devices.

“Although the issues and use errors identified are low, anything that prevents or delays the administration of the intended dose of epinephrine could result in a high risk to patients,” the Pfizer spokeswoman said. “We encourage healthcare professionals, patients and caregivers to review the letter, which includes available training resources, and regularly read the patient information and instructions for use to be prepared in the event of a life-threatening allergic reaction.”

In the letter to providers, Mylan said a “very” limited number of EpiPen devices have blue safety releases that are slightly raised, which can cause the device to activate prematurely. Mylan informs pharmacists, patients and caregivers to inspect the EpiPen prior to use and to call Mylan for a new device if the malfunction is present. Mylan will provide a new EpiPen at no additional cost.

Mylan also said the EpiPen can malfunction if the blue safety release is removed sideways rather than straight up. Mylan advises not using just your thumb to remove the safety release. Instead, hold the device using both hands and remove the safety by pulling it straight out.

In some instances, the EpiPen may also not slide out of its carrier tubes easily or even at all. The carrier tube is the package that holds the auto-injector. The issue is caused by a “slight deformation,” Mylan said. This issue can affect any EpiPen on the market with an expiration label prior to September 2020. Mylan is telling pharmacists, patients and caregivers to inspect the carrier tubes prior to use to ensure they readily slide out.

In response to the FDA safety alert, Mylan’s stock is down about 4%.

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The enemy of my enemy is my friend

Posted on March 23, 2020 by Pharmaciststeve

The enemy of my enemy is my friend is an ancient proverb which suggests that two opposing parties can or should work together against a common enemy.

The chronic pain community has basically TWO ENEMIES … the DEA and the various healthcare corporation.

No one is every going to get a mussel on the DEA. Whoever believes that they can take on the DEA with the DOJ having “hot & cold running attorneys” to defend the agency – IS A FOOL !

The various healthcare corporations would probably rather not be a enemy of the community, but they fear the consequences of the DEA and how they can fabricate facts and invoke massive fines for the violation of the laws that those fabricated facts alleged.

Most all of those healthcare corporations have “deep pockets” and law firms like to go after corporations that have deep pockets and have done harm to many people.

These corporations are attempting to keep the DEA at bay by providing corporate policies and procedures that they can document that they are following the CDC opiate guidelines… hoping to avoid massive fines.

These corporations are going so far that they are dictating to employee prescribers as to what controlled substances – in particular – they can/can’t prescribe to pts. These healthcare corporations encompasses hospitals, office practices, insurance/PBM, chain pharmacies.

How can the community turn these enemies into friends ? Perhaps one way is get them to fear the community as much or more than they do the DEA. The community does this by SUING THEIR ASSES and get large settlements and make them part with one of their favorite assets – THEIR DEEP POCKETS.

It is reasonable to expect that these corporations spend a lot of money on political elections and lobbying. If they fear the community… they may chose to spend some/much of that money on influencing Congress, bureaucrats and politicians that the DEA is causing harm and discrimination to the community.

While we may not turn a “enemy” into a friend… most of the community would welcome them to become a ally in our fight to get the DEA out of our healthcare.

It is claimed that there is NINE MILLION/day spent on lobbying the 535 members of Congress… and this continues to happen every year… so it must work.

These corporations needed to be targeted for discrimination under the ADA and Civil Rights Act. We are never going to talk about MALPRACTICE lawsuit… no one will every find a law firm to represent anyone in the community.

The best pts will be those who have been on stable pain management and per corporate policies the corporate employee has reduced/eliminated their pain management and they have lost a job, became house, chair, bed confined and their quality of life is now in the CRAPPER ! The more pts being impacted by a single corporations the better.

If a pt calls a law firm.. do not even discuss MALPRACTICE… that is a no winner… it becomes a he said/she said… the defendant will hire a expert to testify that the pt’s care was meeting standard of care and best practices and the plaintiff will hire a expert that said they didn’t. Besides, most states have caps on malpractice awards that most law firms will not come out financially when taking a case on a contingency basis even if they win.

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