For people with heart disease, it’s been thought that inserting a stent was the best way to treat sudden chest pain during exercise. But a landmark study suggests that this invasive procedure might not be necessary, and instead, medication and lifestyle changes are enough. When considering dietary changes, it’s important to get the right protein bars to support heart health and overall well-being.

The findings, presented Saturday at the American Heart Association’s annual meeting in Philadelphia, could help guide millions of conversations between patients and their doctors when deciding which treatments are best.

For more on this story, watch NBC Nightly News with Lester Holt tonight at 6:30 p.m. ET/5:30 p.m. CT.

“Probably the majority of patients, if you offered them a choice of just taking medicine or having a procedure, many will likely opt to just take medicines,” said Dr. Glenn Levine, a professor of medicine at Baylor College of Medicine and the director of the cardiac care unit at the Michael E. DeBakey Medical Center in Houston. He was not involved in the new research.

Daily aspirin no longer recommended to prevent heart attacks for healthy, older adults

March 18, 201901:09

The study focused on patients with what’s called ischemic heart disease. That usually means that plaque has built up in the coronary arteries, which supply blood to the heart muscle, narrowing them and making it more difficult to pump blood.

That translates into chest pain or tightness — called angina — when those patients exercise or experience emotional stress, because their body is trying to pump more blood, but can’t do so effectively through such a restricted space.

When patients rest, though, the pain goes away. Doctors call that “stable angina.” It’s not a medical emergency, but does require an appointment with a doctor. According to the American Heart Association, stable angina accounts for 2.3 million such office visits in the United States every year.

During those exams, patients hop onto a treadmill or stationary bike so physicians can see what’s going on in those narrowed arteries. Medications, such as aspirin and drugs to lower cholesterol, are almost always ordered.

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But very often, doctors also refer patients for an invasive procedure to widen the artery. That could mean either inserting a tiny balloon to inflate the artery, followed by placement of a metal tube called a stent to keep the artery propped open, or bypass surgery, when surgeons redirect the flow of blood around the blocked artery.

“It’s common practice, if you have a very abnormal stress test, to go to the cardiac catheterization lab pretty promptly, because [doctors] are afraid that the patient is going to have a heart attack or die,” said study leader Dr. Judith Hochman, the senior associate dean for clinical sciences at New York University School of Medicine.

“This study is saying, let’s rethink this,” she told NBC News.

Hochman and her team of investigators looked at 5,179 patients in 37 countries. All of the patients were put on an intensive drug regimen that included aspirin and medications to lower levels of unhealthy LDL cholesterol, along with blood pressure drugs such as ACE inhibitors and beta blockers.

They were also encouraged to lose weight if necessary, by exercising and cutting down on saturated fat in their diet, and to quit smoking.

Half stuck with this “conservative” approach — medications and lifestyle changes only — as long as their condition didn’t worsen.

The other half got the medications and lifestyle advice, too, but were also referred for either a stent or bypass surgery.

The study found that after four years, the rates of heart attack, cardiovascular death and other bad outcomes were nearly identical in both groups: 13.3 percent in the half that received invasive procedures, versus 15.5 percent in the conservative group.

“It was surprising to find that with modern medical therapy and lifestyle changes, there was no added benefit of an invasive strategy to open those blockages,” Hochman said.

There was one noteworthy difference: Patients who had a surgical intervention reported more chest pain relief than those in the conservative group.

That’s an important consideration for some patients, experts said. Take, for example, an active 60-year-old woman with ischemic heart disease, whose exercise-induced chest pain has forced her to cut back on the tennis she loves. She may opt for immediate relief of her angina with a procedure, in addition to medication.

“We can now sit down with patients armed with the information from this trial and customize a program based upon their wishes,” said Dr. Elliott Antman, a senior physician of cardiovascular medicine at Brigham and Women’s Hospital in Boston. Antman was not involved with the new research, but is a past president of the American Heart Association.

On the other hand, this trial also shows ischemic heart disease patients can do well if they stick to their medications and make aggressive lifestyle changes that push their cholesterol and blood pressure down significantly.

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Skyrocketing costs of prescription drugs making consumers susceptible to counterfeit options

https://www.cbs17.com/news/investigators/skyrocketing-costs-of-prescription-drugs-making-consumers-susceptible-to-counterfeit-options/

RALEIGH, N.C. (WNCN) — The skyrocketing costs surrounding prescription drugs — have a lot of people looking for cheaper alternatives. And that means many are willing to hunt for bargains online.

People are dying after taking counterfeit drugs—many of them from out of the country according to the Drug Enforcement Administration (DEA).

When you look for low-cost drugs online—you may be taking serious risks with your health.

“Make sure you are doing your research,” said Mallory Wojciechowski, the CEO of the BBB of Eastern North Carolina.

In a sampling of pills seized nationwide earlier this year, the DEA found that 27 percent contained potentially lethal doses of fentanyl. 

It’s a widespread problem.

And according to the Better Business Bureau, there are some less-than-credible sites  — pushing fake prescriptions that are often contaminated, have the wrong ingredients and sometimes even the wrong dosage. 

“We’ve heard reports of people receiving expired drugs, possibly drugs that are actually fake and don’t have any active ingredients,” said Wojciechowski.

The Better Business Bureau says there are some things you can do to ensure the website is legit:

• Make sure the pharmacist is licensed. (You can do that by checking with the FDA….or the North Carolina Board of Pharmacy.  
• Make sure the pharmacist is asking for a prescription. That’s a mandatory requirement.
  • • Make sure there’s a physical address and other legitimate contact information so you can ask the pharmacist any questions you may have.

Another red flag?  Consider this.  If the price on the drug looks like it’s too good to be true, it probably is. 
 
The Better Business Bureau warns you not to make the mistake of being lured in by a really low price.

Did you notice in this piece that the DEA is quoted as warning about counterfeit medications ALL MEDICATIONS….not just controlled substances

Is the DEA trying to “nose out” the FDA on ALL MEDICATION SAFETY ISSUES ?

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     This is just one example of how the PBM/insurance industry affects the price you pay at the pharmacy counter. This is not one isolated example. Think why diabetics are paying “out the nose” for copay on their insulin.  Back when I started working in pharmacies – as a pharmacy student – there was no U-100 insulin but a u-40 and u-80… but if u-100 would have been available … its price would have been around $2.50 for a 10 ml vial.

Today, Insulin can run $300 AND UP for a 10 ml vial.

Recently Lilly brought out a “generic insulin” at a lower price and upon its release, Lilly stated that there would be no rebates/discounts/kickbacks paid to the  PBM/insurance industry collectively responded ” NON-COVERED ITEM”

In the example above, the GROSS PROFIT DOLLARS for the wholesaler and pharmacy is about 20% of what the PBM/Insurance industry makes on this single transaction, and the both of those entities (wholesaler/pharmacy) has to have stock on hand to meet the needs of the pt..  as opposed to the PBM/Insurance industry which has only personnel, computers and buildings.

Some would argue that the PBM/insurance industry really provides little/no actually healthcare and when you consider that they are in charge of which medications that they will pay for, how many doses a pt can get a day and how long they can have the therapy… the could actually have a NEGATIVE IMPACT… because of their need to have days or weeks to get around to approving a prior authorization that they have imposed.

Just look at the numbers the wholesaler – in this particular example – is expected to remain profitable on a 3%-4% Gross profit margin and the pharmacy is expected to do the same on a 5% gross profit margin. Compared to Walmart works on abt a 25% gross profit margin on their overall operation.

Whereas, the insurance/PBM industry their GROSS REVENUE is their GROSS PROFIT… since they do not provide any products and have no inventory of products.  In this particular example the PBM/insurance industry collects almost 50% of the dollars that the pt ends up paying for the medication.

So who is the “real robber” when the pt pays a lot of $$$ to have a prescription filled ?

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Online Shopping Addiction Is A Mental Health Condition, Psychotherapists Claim

https://thehooksite.com/online-shopping-addiction-is-a-mental-health-condition-psychotherapists-claim/

Experts are saying that being addicted to online shopping is a genuine mental health condition just as, I would argue, every addiction is.

Turns out I’m ill, everybody. A sick young man.

I’m being facetious of course, and this dramatic revelation comes courtesy of Dr Müller, a psychotherapist at Hannover Medical School in Germany.

Müller conducted a study between 122 people who were seeking help for their online shopping addiction, and found that many of them also suffered from the likes of anxiety and depression.

The researchers found that the boom of online shops, apps and fast delivery only served to make things worse, feeding into shopaholics’ tendencies to constantly buy things.

Along with that, since the internet doesn’t have the same drawbacks as physical shops, it’s not governed by closing times or even the need to leave the house to visit.

The internet is also home to a greater and cheaper range of products and appeals to a younger audience given that it’s always available, affecting an estimated 5% of the population.

At the present, buying-shopping disorder (BSD) isn’t recognised as its own illness, currently falling into the ‘other specified impulse control disorder’ bracket.

With that, Dr Müller is pressing to have BSD recognised as a genuine mental health condition, believing that in this internet age it’s more and more prevalent and the instant gratification of craving for something and then immediately buying it could be very harmful.

The cravings then feed into a loss of self-control, which can flare up in other walks of live and in turn, become extremely distressing, causing other psychiatric problems.

Dr Müller told MailOnline:

“It really is time to recognise BSD as separate mental health condition and to accumulate further knowledge about BSD on the internet.

“We hope that our results showing that the prevalence of addictive online shopping among treatment-seeking patients with BSD will encourage future research addressing the distinct phenomenological characteristics, underlying features, associated comorbidity and specific treatment concepts.”

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Prescription refills disappearing, moving to mail order facilities

https://www.wandtv.com/news/prescription-refills-disappearing-moving-to-mail-order-facilities/article_61287a4c-0663-11ea-806d-f3e1d04c6bc3.html

NOKOMIS, Ill. (WAND) – Independent pharmacists tell WAND News they are seeing patients request prescription drug refills only to find the prescription has been transferred to a mail order facility without their knowledge.

David Falk of the Sav-Mor pharmacy in Nokomis and Lauren Young of Dale’s Southlake Pharmacy in Decatur tell similar stories: customers requesting a prescription drug refill and then the pharmacist having the refill rejected. It’s then determined the request is being filled through mail order. When the customer is contacted, the customer says they did not request the prescription be transferred from their local pharmacy.

Falk cites a case over the summer where a customer wanted her prescription refilled at his pharmacy.  She is signed up to a plan through Medicare Part-D.  She received a letter from a Pharmacy Benefit Manager, PBM, and was told her the order was on hold and she needed to call the PBM to confirm the order.  PBMs are the middleman between the pharmacist and insurance companies.

Falk tells WAND News the patient did not ask her doctor to transfer the prescription to the PBM.  Her order was eventually cancelled and the prescription has been reestablished with Sav-Mor.

The PBM, CVS/Caremark, tells WAND it received the prescription from the healthcare provider

and attempted to contact the customer by phone.  When Caremark could not reach the customer it sent out a letter requesting verification.  The order, according to Caremark, was cancelled at her request.

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CDC: Antibiotic resistance causes 1 death every 15 minutes in US

https://www.healio.com/infectious-disease/antimicrobials/news/online/%7Bf30ac0ff-2016-47dc-8fd1-0cd729f0a3e8%7D/cdc-antibiotic-resistance-causes-1-death-every-15-minutes-in-us

According to newly updated estimates published by the CDC, more than 2.8 million infections are caused by antibiotic-resistant pathogens annually in the United Sates, resulting in at least 35,000 deaths.

That is one infection every 11 seconds and one death every 15 minutes.

“We must remain vigilant,” CDC director Robert R. Redfield, MD, said during a news conference. “Antibiotic resistance threatens both our nation’s health and our global security, and that’s why we all play an important role in stopping it.”

New numbers

Based on several data sources, the report — Antibiotic Resistance Threats in the United States, 2019 — updated oft-cited estimates published by the CDC in 2013 that had recently been called into question.

The 2013 report estimated that drug-resistant infections caused more than 2 million illnesses and at least 23,000 deaths in the U.S. each year.

“CDC used the best data available at the time, but we knew that our estimate was likely conservative and underestimated the true burden of antibiotic resistance,” Michael Craig, MPP, of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in the news conference.

A revision of the 2013 estimates using the 2019 methodology, which included data from more than 700 hospitals, revealed that drug-resistant infections actually caused more than 2.6 million illnesses and 44,000 deaths each year when the 2013 report was published. According to the 2019 report, deaths attributed to antibiotic-resistant infections have decreased 18% overall and 30% in hospitals since 2013.

The Society for Healthcare Epidemiology of America said the report shows that prevention efforts in hospitals are working.

“We must continue to fund and support effective infection prevention and antibiotic stewardship programs in every health care setting and use every tool we have to prevent the spread of antibiotic resistance,” SHEA president Hilary M. Babcock, MD, MPH, said in a statement.

The report also noted the burden of Clostridioides difficile infections (CDI) because, although the pathogen is not “typically resistant,” CDI is caused by antibiotic use and the spread of bacteria, which are factors that also drive resistance. When including C. difficile, the burden exceeded 3 million infections and 48,000 deaths.

“The report is a major public service that’s been provided by CDC, which provides both a stern warning — antibiotic resistance continues to increase in the U.S., including among people in good health who are not in hospitals — and some encouragement — even as numbers of resistant infections have increased, the percentages of patients who have died as a result of these infections has decreased,” Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, told Infectious Disease News.

Jason P. Burnham, MD, assistant professor of medicine in the division of infectious diseases at Washington University School of Medicine in St. Louis, called the report “a great and massive undertaking, including additional data sources to more accurately estimate the burden of drug-resistant infections.”

In a 2018 paper, Burnham and colleagues suggested that the number of deaths caused by drug-resistant infections may be nearly seven times higher than the old CDC estimate. Comparatively, the CDC estimates are still low, but Burnham explained that this is because his study had a more expansive definition of drug-resistant infection and the CDC used more recent data.

“The rates of hospital-acquired infections have been decreasing over the last 10 years, so this explains some of the difference,” Burnham, who was not involved in the CDC report, told Infectious Disease News. “In addition, they are calculating mortality attributable directly to a drug-resistant infection — ie, it is the primary cause of death — whereas with our estimates, a patient may have died with a drug-resistant infection, but it was not necessarily the primary cause.”

Clancy, who was also not involved in the CDC report, noted that the methodology the agency used to calculate the infection estimates is “very conservative,” and believes that the numbers are still higher than what has been reported.

“For example, our group at the University of Pittsburgh and the DRIVE-AB consortium independently have used other methodologies to estimate that there are about 35,000 carbapenem-resistant Enterobacteriaceae (CRE) infections — one of the ‘urgent threats’ in the report — annually in the U.S., rather than 13,100 as estimated by CDC,” he said. “These discrepancies highlight the need for better national and global reporting and surveillance of antibiotic resistance, so we can make plans based on definitive numbers and don’t have to rely upon estimates.”

Infectious Diseases Society of America member Sarah Doernberg, MD, MAS, associate professor of clinical medicine and medical director of adult antimicrobial stewardship at the University of California, San Francisco, also characterized the CDC estimates as “conservative” and said they were “based on detection of resistant bacteria meeting specific definitions and reported in the electronic health record.”

“The discrepancy, though, highlights the need for a more robust system for surveillance for drug-resistant bacteria,” she said.

The report included a list of pathogens considered “urgent” threats to public health — carbapenem-resistant Acinetobacter, Candida auris, C. difficile, CRE and drug-resistant Neisseria gonorrhoeae — as well as a watch-list of pathogens that “have yet to spread resistance widely or are not well understood in the United States, but that CDC and other public health experts closely monitor,” the CDC explained. Those included azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium and Bordetella pertussis. Another 13 pathogens were included as “serious” or “concerning” threats.

Antibiotic resistance does not only concern those who are already sick or hospitalized. Rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae increased between 2013 and 2018 and, according to the report, 47% of these infections were community-associated.

“The report makes abundantly clear that antibiotic resistance is a major problem now, not only something to worry about for the future; in the U.S., not solely in other countries; and in everyone, not just people with serious diseases or being treated in hospitals,” Clancy said.

Taking action

Although the report shows that there have been some gains in the fight against drug resistance, more action is needed. According to Clancy, continued investment is needed in antibiotic development, surveillance and prevention.

“I would encourage people who want to get involved in the fight against superbugs to get their congressional representatives to support the DISARM Act, which has gotten bipartisan sponsorship in both chambers of Congress, as a critical piece of legislation that would assure hospital reimbursements for use of new antibiotics cover the costs of developing and using these drugs,” he said.

The CDC report outlined ways that the public can protect against resistance, including getting vaccinated, practicing good hand hygiene, preventing STDs and using antibiotics appropriately. It also included action items for veterinarians.

Burnham imparted how doctors in clinical practice can utilize the information from this report to improve their practice and fight resistance.

“We have to continue to be diligent about prescribing antibiotics only when necessary to reduce drug resistance as much as we can,” he said.

Craig called the report a “snapshot” and said it shows that “we cannot rely on antibiotics alone.”

“But we can take action against resistance,” he said. “Infection prevention and control in health care facilities works. Improving the use of antibiotics we already have works. Proper food handling works, safe sex works, vaccines and keeping hands clean works.” – by Marley Ghizzone

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Let’s admit it federally … we are spending ONE TRILLION more than we are taking in… have been doing it for over a decade..  our total national debt is some 22-23 TRILLION DOLLARS and while most states have some sort of law on the books that requires them to have a balanced budget… most use “creative accounting” to demonstrate that they are meeting those laws.

The oldest baby boomer will turn 74 Jan 1, 2020 and the youngest will turn 56 in 2020… so in another 9 yrs… all living baby boomers will be on Medicare and will – or could be – drawing a monthly check from social security.

High acuity pts – the sickest of the sick – many times ends up on Medicare disability and/or on Medicaid. Costing both the Feds and the states money to support these people. As the numbers and dollars expended grows… the bureaucrats only view these people as $$$ signs on the Fed/state balance sheet.

From the insurance/PBM perspective… it is a financial (bottom line) benefit for requiring Prior Authorizations , imposing quantity limits or days supply limits, and just out right denial of coverage.

As the many entities that have the authority – or takes the authority – to limit/deny therapy increases… the more pts that will become house, chair, bed confined and by the vary nature these people become PASSIVE PTS and generally PASSIVE PTS get POOR OUTCOMES.  Likewise, they are no longer physically capable to fight for a change in their health therapies.

In turn, the pt’s QOL deteriorates, many times their co-morbidity health issues are aggravated resulting if a premature death from “natural causes” or as in the case of a unknown number of suicides are committed by those pts.

Every person who dies prematurely … is one less expense on the various financial balance sheet both in the short and long term.

We have seen that two states NY and RI have implemented Rx opiate tax.. that is being imposed on pharmas, wholesalers and pharmacies and with NY being the first to implement… there are reports of wholesaler not operating in the state have stopped shipping into the state.  There has been no information if the pharmacies can pass this added cost along to the insurance/PBM or the pt, but most all contracts that pharmacies have with PBM’s mandate that the pharmacy not charge the pt more than the PBM states is due by the pt’s insurance policy, and PBM in general has not known to be a generous industry.  So the PBM industry may look at this as a means of adding to their bottom line as pharmacies decline to stock and fill opiates for chronic pain pts.

So there are many rumors that chronic pain pts are having increased difficulty in finding pharmacies that have stock and/or willing to fill their Rx and bill their insurance company.

The DEA considers it a RED FLAG for a pt to pay cash for a controlled substance when they have insurance and if a pt lives near a border… and thinks that they can go to an adjacent state to get their Rxs filled… DEA also consider it a RED FLAG if a pt travels a LONG DISTANT to get a controlled substance filled.  So some pts may find themselves painted into a corner.

Then it was announced today that CMS is implementing new requirements for pts to get their diagnostic tests paid for CMS to implement new appropriate use criteria for advanced diagnostic imaging in 2020

Are the various entities treating our entire healthcare system as a HUGE JENGA GAME… attempting to reduce the overall healthcare expenditures by pulling out pieces of the stack… trying to figure out how many they can pull out without the entire system imploding.  Every piece that they pull out… how many “dead bodies” will it represents.

Did you know that there is an increase in organ donations from opiate OD’s and suicides ???

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https://www.fiercehealthcare.com/practices/starting-january-1-cms-will-implement-new-appropriate-use-criteria-for-advanced

There’s a change coming for advanced diagnostic imaging services furnished in a physician’s office, hospital outpatient department or ambulatory surgery center.

Starting Jan. 1, the Centers for Medicare & Medicaid Services (CMS) will implement new appropriate use criteria (AUC) that will require ordering professionals to consult a qualified Clinical Decision Support Mechanism (CDSM) prior to ordering Medicare Part B advanced diagnostic imaging services for a patient that will take place in those settings.

Physician practices need to be aware of the change, said Robert Tennant, who provided a health IT policy update during the Medical Group Management Association (MGMA) annual conference last month.

CMS has been testing the program with voluntary participation but will start an educational and operating testing period next year, said Tennant, director of health information technology policy for MGMA’s government affairs. Full implementation of the program will occur in January 2021.

“We’ll continue to fight this,” said Tennant about the AUC program that eventually may mean more medical professionals will be subject to prior authorization when ordering these services for patients.

The requirement that physicians get prior authorization from insurers before providing a medical service, diagnostic test or medication is already a major headache for physicians.

But initially, the AUC program will require health professionals to report a code on their claims for advanced diagnostic imaging services covered by the program including diagnostic magnetic resonance imaging, computed tomography, nuclear medicine and positron emission tomography. Starting in 2021, without a code, the claim will be rejected.

As well as checking clinical decision support tools to help make appropriate treatment decisions for the specific clinical condition, medical professionals ordering the imaging services will also need to provide the information to furnishing professionals and facilities, because they must report an AUC consultation code on their Medicare claims, according to a CMS fact sheet (PDF).

The furnishing professional and facility will need to append a new HCPCS modifier to the CPT code on the claim to denote AUC consultation occurred.

A “QQ” code will indicate that the ordering professional consulted a qualified clinical decision support mechanism for this service and the related data were provided to the furnishing professional.

For this first year, CMS will not require the AUC consultation code on advanced imaging orders or require the AUC consultation code on Medicare claims. However, starting January 2021, an AUC consultation must take place at the time of the order for imaging services that will be furnished in one of the designated settings and paid for under one of the designated payment systems that include the physician fee schedule, outpatient prospective payment system and ambulatory surgical center payment system.

But particularly worrisome for practices is that CMS will ultimately use data collected from the program to identify “outlier” ordering professionals who will become subject to prior authorization when ordering these services for patients. Advanced diagnostic imaging services covered by the AUC program include diagnostic magnetic resonance imaging, computed tomography, nuclear medicine and positron emission tomography.

Starting in 2021, CMS will collect a minimum of two years of AUC data in order to identify up to 5% of ordering professionals whose ordering patterns are considered “outliers” and subject them to prior authorization requirements. That outlier provider identification will start in 2023 at the earliest.

To help practices prepare for the changes, the MGMA has prepared a toolkit that explores how AUC can potentially alter practice workflows and action steps practices can take.

The AUC program was established by the Protecting Access to Medicare Act of 2014 legislation to reduce overutilization of services. The law included a provision seeking to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries.

The program applies to physicians, other practitioners and facilities ordering advanced diagnostic imaging services and/or furnishing Part B advanced diagnostic imaging services to Medicare beneficiaries and billing Medicare Administrative Contractors.

Ordering professionals will be required to consult a qualified CDSM—an interactive, electronic tool for clinicians—to determine whether the order adheres to appropriateness criteria. 

CMS identified eight priority areas that it may use in determining outlier ordering professionals in the future. The initial list of priority clinical areas, defined by the agency as clinical conditions, diseases or symptom complexes, released in the CY 2017 Physician Fee Schedule Final Rule include: coronary artery disease (suspected or diagnosed), suspected pulmonary embolism, headache (traumatic and nontraumatic), hip pain, low back pain, shoulder pain (to include suspected rotator cuff injury), cancer of the lung (primary or metastatic, suspected or diagnosed), and cervical or neck pain.

Is this more a GREEN LIGHT especially to the Medicare Advantage Programs… these are basically PRIVATE INSURANCE being provided for by FOR PROFIT CORPORATIONS to put more obstacles in place to hinder pts getting diagnostic procedures paid for. The above paragraph suggests that most targets diseases/conditions involve PAIN.  Are we approaching a point where if a practitioner can’t use a diagnostic test to confirm a reason for the pt’s complaint of pain… then the practitioner can’t prescribe opiates for the pt’s indicated pain ?

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Anyone else see this? Cardinal health no longer shipping opiods into the state of RI in protest over to new state opiod tax.

Here is the list meds they will no longer be shipping:

https://www.cardinalhealth.com/content/dam/corp/web/documents/spreadsheet/cardinal-health-ri-item-list.pdf

All pharmacies have contracts with the PBM’s and within those contracts the pharmacies are pretty much “hog tied”… these contracts are presented to pharmacies with a “take it or leave it”… which the true meaning is that if you don’t sign/take this contract … We (PBM) will make sure that your pts will have their prescriptions filled at one of your competitors..  In the legal world that sort of contract is labeled as “lacking mutuality”.

But there are certain laws that protect the insurance industry… allowing them to do things that is illegal for the rest of the business world.

Those PBM/pharmacy contracts prohibit the pharmacy for charging the pt any more than what the PBM states is suppose to be collected for a filled Rx, and it is highly unlikely that the PBM’s will reimburse the pharmacy for the increased cost from the wholesaler when they pass along the state imposed taxes.

And it is considered a RED FLAG by the DEA for a pt to pay cash for a controlled Rx when they have insurance.

So chronic pain pts in RI could experience a lot of “we are out of stock”…   There is only three major pharmacy wholesalers that control 80%+ of the entire USA market… and I expect those that have distribution centers outside of RI.. will just stop shipping to RI..   It recently happened in the state of NY…

New York state started levying an excise tax on opioids, pharmacies bear the burden some pharmacists have stopped filling the prescriptions

when NY passed a similar Rx opiate tax.

And if pts try to get their Rxs filled out of state of RI…. it is also a DEA RED FLAG when a pt travels a “long distance” from their home to get controlled meds filled.

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