“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
FAYETTEVILLE, Akr. (KNWA) — The Veterans Health Care System of the Ozarks announced that 7,482 cases have been reviewed for misdiagnosis in the wake of the public learning that an impaired VA doctor treated patients.
The organization made the announcement at a public town hall meeting at the VA hospital Monday afternoon.
Of the cases reviewed, 2,925 were reviewed by VA pathologists. The rest were reviewed by non-VA pathologists.
Some patients say that Dr. Robert Levy was the pathologist found to be impaired.
On March 1 of this year, a man named Robert Levy was arrested in Fayetteville for driving under the influence.
The report states Levy was stumbling and slurring his words.
Police say he was quote: “intoxicated with depressants.”
The VA hospital first found the pathologist to be impaired in March of 2016.
More than a year later the doctor was found impaired again in October of 2017; that’s when the hospital fired the employee.
The public was made aware of the issue on June 18, 2018, where letters were sent from the VA to any patient who may have been misdiagnosed.
Around one month later, the VA held its first town hall meeting.
I urge you all to please fight back! Please join the NATIONWIDE DON’T PUNISH PAIN RALLY ON SEPT. 18TH. EVERY STATE WILL BE HAVING A RALLY TO STAND UP FOR OUR RIGHT TO PAIN RELIEF!!
GO TO THE LINK AND IT WILL DIRECT YOU TO YOUR STATE PAGE WHERE ALL INFO IS LISTED. PLEASE SHARE EVERYWHERE! WE NEED THOUSANDS TO ATTEND IN EACH STATE! I BELIEVE THIS MAY BE OUR LAST CHANCE TO HOPEFULLY MAKE CHANGE, COME JANUARY THE DEA INTENDS TO CUT BACK ON PAIN MEDS ANOTHER 10%!!!
WOW! Great information Steve and thank you so much for putting it out there. We just didn’t know who or what to do until we read your article. My wife has AIP which is acute intermittent Porphyria. 15 years ago she was perscribed Oxycoton, which she had to be talked into. Long story short it works and she has a life BUT every month it is a fight to get her prescription filled. In fact I am the one who has to take it in because she has been treated like a common street drug addict.
We have had to cancel our vacations due to getting her meds filled on the 30th day.
They will not fill ONE day early. We know the bad stories of this medicine and everything and how addictive it is but the addiction is nothing compared to the the pain of Porphyria. I have had a pharmacist tell me I need to get my wife off this med as no decease is worth the addiction. I could go on and on but I won’t take up anymore of your time.
We are in our 60’s and we want to enjoy our retirement.
We want to thank you from the bottom of our hearts for giving us the information we have been looking for for so many years.
The sunny days of summer are not yet over, but flu season has already weaseled its way into drug and grocery stores, where pharmacies and clinics are administering vaccines to ward off influenza.
Stores such as Safeway and CVS Health started offering flu shots to customers this month after they received shipments of the vaccine.
“Because of the nice weather and all of that, it seems like ‘it’s already here?’ ” said Nikki Price, director of pharmacy operations at Safeway grocery stores. “The CDC recommends to get a flu shot whenever the vaccine is available.”
But with flu season still little more than a month away, some doctors say patients should wait until September to get their vaccines. There are factors to consider, and you should make a decision of when to take the vaccine. Perhaps taking it as soon as is available is not the best course of action. At www.anipots.com you can find more information on this topic so that you can make a well informed decision for yourself and your family.
“I don’t know if I would go and get it at this point in time,” said Dr. Greg Ambuske, an internal medicine physician at UCHealth Primary Care Clinic-Broomfield.
The flu is a contagious respiratory illness that can cause mild to severe illness, including death. Symptoms of flu include fever, cough, body aches, fatigue, sore throat and headaches, according to the Centers for Disease Control and Prevention.
The CDC recommends that everyone 6 months and older get a flu vaccine each year, especially those who are at risk for developing flu-related complications, such as children younger than 5 and people with heart disease.
The reason some doctors are saying to wait a few more weeks before getting a flu shot is that patients want to make sure they are protected during the season’s peak.
If a person gets a vaccine too early, their ability to fight the flu could wane during the peak period, said Dr. Mark Montano, medical director for CareNow Urgent Care, which is affiliated with HealthOne.
“It doesn’t mean I’m not protected,” he said.
But, Montano said, “I won’t have the same number of antibodies fighting the infection I’m exposed to.”
The timing and length of flu season varies each year, which can make the right time to get a flu shot a bit of a guessing game.
Flu season, which often gains traction in October, tends to peak between December and February, but it can last until May, according to Kristen Nordlund, a spokesperson with the CDC, in an email.
The CDC plans to release this year’s flu guidelines this week, and they will have more information on timing of vaccines, Nordlund said.
Montano said he thinks pharmacies and clinics are starting to offer flu shots in August so that they don’t “miss the opportunity to vaccinate somebody.”
“The CDC recommends that people get the flu vaccine as soon as it is available, and it is typically in pharmacies in August each year,” Amy Lanctot, a spokesperson for CVS, said in an email when asked about the effectiveness of getting flu shots in August.
“It takes two weeks for the body to build up immunity following vaccinations, so people are encouraged to get the vaccine as soon as they can, preferably by the end of October,” she said.
Walgreens Co., which is advertising flu shots at its stores in the Denver area, said it was unable to make someone available to comment for this story.
Health officials recommend getting a flu shot by the end of October. And they say that if a person misses the October time frame, it’s still beneficial to get a vaccine later in the season.
“Getting it too late is a greater risk than getting it too early, but vaccine anytime during the flu season is better than no vaccine at all,” Shannon Barbare, spokesperson for the disease control and environmental epidemiology division with the state’s Department of Public Health and Environment, said in an email.
Updated Aug. 20, 2018 at 11:25 a.m. Because of a reporting error, an earlier version of this story incorrectly quoted a phrase by Dr. Greg Ambuske. The story has been updated to reflect the true phrase.
Today as I walked toward a local chain grocery stores- with a pharmacy inside – they had a fairly larger banner about GETTING YOUR FLU SHOT… and I thought to myself… that like most chains – they are trying to get “everyone vaccinated”… this particular store was even offering a $25 gift card if you got you flu shot NOW… and in the “fine print” … details inside… which means anyone having Medicare, Medicaid or any federal insurance… IT DOES NOT APPLY.
The earlier you get your flu shot the more you risk that your blood titers will have fallen so that you may not have peak titers when the flu peaks. It takes 2 weeks for the shot to protect you and flu usually starts showing up in Oct and peaking late Dec and later…
We don’t get our flu shots between the last two weeks in Sept and the first two weeks in Oct and even that is no guarantee that you won’t catch the flu because the last few years the vaccine manufacturers and/or CDC have made “bad guesses” as to which one of the flu bugs will be prevalent this year
Our story brings to light a deadly suppression of facts & figures. Chronic Pain does not discriminate against age, sex, or race; suicides in all groups due to under managed pain are on the rise. We are, all of us, only one car accident or one surgery away – from a life of chronic pain.
About The Project
PAIN WARRIORS ~ sets out to examine the invisible crisis of Chronic Pain in North America, and its devastating toll on society. Without proper and timely education of the masses this growing concern can and will reach a tipping point, beyond which there is no return.
Society’s lack of public information regarding Chronic Pain, has sadly forced this disease and its sufferers underground. Not only are many denied adequate treatment , they are often looked upon by society as a whole as outcasts. We are , all of us, only one cancer or one car accident away from a life of chronic pain. As we age the numbers of chronic pain patients will only grow exponentially.
We intend to bring to light a deadly suppression of facts and figures. Without education and awareness, there can be no reform.
Compelling interviews showcase a broad cross section of pain patients, their loved ones and the doctors that treat them across North America. We share intimate, courageous and heart breaking 1st hand stories from pain patients in the trenches- the ongoing political and social issues they face and how they struggle to cope , just to get through another day.
In recent months, several American pain specialists have been targeted by the DEA and currently face loss of license and potential incarceration, for attempting to uphold their Hipprocratic Oath and serve the U.S. pain population. The lines between “pill mills” and legitimate doctors have become blurred and in many cases, unrecognizable to the general public and society at large.
In recent decades groups including breast cancer and aids patients have banded together formally with runs marches, rallies – telling their stories in the press.
Doing so has garnered more ambitious and imaginative solutions to treatment and health care reform. The best hope for pain patients, is to become more vocal and active in their own pain management.
The needed response to pain, it would appear, is to encourage patients to stand up and speak up.
PAIN WARRIORS plans to do just that – give voice to the voiceless. #givepainavoice #painwarriors
FREDERICKSBURG, Va. (AP) — When the former nonprofit director_a woman with a master’s degree in social work_moved from North Carolina to Spotsylvania County last fall, she brought detailed medical records about her chronic pain and the opioids she takes to treat them.
As she searched for a pain management doctor in the Fredericksburg area, she called at least eight different offices. Before she could even describe her situation, the receptionist would cut her off, saying: “We don’t prescribe opiates.”
The woman, whose first name is Becky, was shocked, then scared. She eventually found a doctor to treat her, and she signed a contract spelling out her expected behavior. It specified monthly urine tests, even though her insurance requires only four a year, and regular pill counts to be sure she didn’t exceed daily dosage. She could use only one pharmacy, even if that facility was temporarily out of stock, and she agreed to pay fines — or be dismissed as a patient — if she violated any terms. You will get more info here about the boston probation-violation attorney.
“I think we (chronic) pain patients get it; we understand why this is happening and all of us are willing to do whatever we need to do to show that we’re working with the program,” she said. “But at the same time, we’re being treated like criminals before we even have done the first thing.” If you want experienced attorney for criminal defense case then get redirected here.
Doctors are looking at opioid prescriptions through a microscopic lens because since 2013, more people in Virginia have died from drug overdoses than vehicle accidents or guns, according to the Virginia Department of Health.
Drugs caused 10,379 fatalities in the commonwealth between 2007 and 2017 — and more than 72,000 deaths in the United States in 2017 alone, according to estimates from the Centers for Disease Control and Prevention.
As a result, the health care industry has reduced the number of opioid prescriptions, hoping to curtail “drug seekers” who may start with pain pills, which become a gateway drug to more illicit substances.
But the cutback also is affecting those with legitimate pain problems.
“People who use drugs responsibly, just like a diabetic uses insulin, face greater scrutiny simply because they are managing their pain to lead as functional lives as possible,” said Sally Balsamo, co-founder of the Alliance for the Treatment of Intractable Pain. “This is yet another byproduct of the other side of the opioid epidemic.”
Becky, the Spotsylvania patient who moved from North Carolina, didn’t want to use her last name for fear someone would look up her address and rob her medicine cabinet. She agreed to be photographed because she said few people in the area know her.
The 44-year-old doesn’t get out much because of chronic bladder problems and severe nerve pain in the pelvic region. For the last two decades, she’s tried other measures, from lesser drugs to repeated nerve blocks to reduce the pain.
She was coping — and working full-time — despite pain caused by the pudendal nerve, which is in the tailbone and affects bladder and anal continence and sexual function. A 2014 procedure meant to block the pain hit the nerve instead and “kind of took me back a decade in terms of progress,” she said.
“At that point, an opioid was pretty much necessary,” said Becky, who had to quit her job. “I was miserably in pain.”
A recent report from the Virginia Department of Health says prescription opioids have been the leading category of drugs causing or contributing to deaths since 2007. The report also points out that those who die from drug overdoses tend to mix prescribed painkillers with illicit drugs such as cocaine, heroin or fentanyl, a synthetic drug up to 100 times more potent than morphine.
Deaths from all drugs more than doubled in Virginia from 721 in 2007 to 1,538 in 2017, according to the VDH.
But deaths from prescription opioids alone remained constant in the same period, according to the report. In 2007, 401 people died from overdoses of prescription drugs. The number of deaths stayed in the 400-range for the next seven years — even dropping to 398 in 2015 — before hitting 507 in 2017.
That leads patient advocates such as Balsamo to conclude that the opioid epidemic doesn’t extend to those who take only the medicine prescribed to them.
Less than 1 percent of patients with chronic pain problems actually abuse opioids, but they’re all being treated like “drug addicts or junkies,” she added.
Distinguishing those who are in legitimate pain can be tricky.
“It’s not like a broken bone or a kidney stone, which I can objectively diagnose. Basically, I’m just taking the patient’s word for it,” said Dr. Robert Fines, an emergency physician with Mary Washington Healthcare who quickly added he doesn’t typically prescribe opioids for pain that he can’t measure.
Patients checking into emergency rooms know they’ll be asked their level of pain, from zero to 10, the worst imaginable. Many list a 10 because they know a high rating means they’ll be seen sooner, said Dr. Jayson Tappan, medical director of the emergency department at Spotsylvania Regional Medical Center.
When Patrick Neustatter practiced family medicine in Stafford County, he saw patients who deserved an Academy Award for their depiction of agony. He also met people with lower back problems or fibromyalgia, a condition that can cause widespread muscle pain, who had trouble functioning.
“You’re always trying to decide if they’re taking you for a ride or if they have legitimate issues,” Neustatter said. “Doctors don’t like the idea of someone pulling one over on them.”
Getting pain under control has become such a high priority that government agencies who regulate the health care industry — and oversee its funding — have made it a fifth vital sign. It’s as important a measurement as temperature, pulse rate, breathing rate and blood pressure, Tappan said.
The government also decided to equate a hospital’s reimbursement with patients’ satisfaction ratings of how they were treated, including how their pain was managed.
“Over time, that led things to get a little out of control and those well intentions probably created the opioid epidemic that we have,” Tappan said.
At the same time, pharmaceutical companies offered stronger, safer opioids that promised less dependency. Trusting these statements initially led doctors to prescribing more opioids, said Dr. Jason Sneed, who practices osteopathic medicine, a “whole person” approach rather than treating specific symptoms.
…
“Unfortunately, what a patient wants and what is best for them are often not the same thing,” Sneed said.
Fines has seen that as well. Perhaps medical advances have led some to believe they should never be in pain, no matter the situation.
“I have noticed a kind of general trend in society where people feel it’s their human right not to feel discomfort,” Fines said.
He’s not referring to people with cancer or broken bones or victims of horrible vehicle accidents. He’s talking about patients with sprained ankles and toothaches who demand narcotics.
…
Mark Snyder has a medical record “as fat as a phone book,” but said he hasn’t been able to find a clinic to manage his chronic pain since he moved from New York to the Northern Neck in May.
Snyder has more than 20 health issues, including heart problems and degenerative discs, kidney cancer, arthritis and diverticulitis. He’s been on pain medicine since 1986 for nerve damage after a severe car accident in which he was hospitalized for nine months and almost lost his arm and leg.
…
Since moving to Virginia, he’s found doctors to address all his other health problems and has had all his prescriptions filled except for the opioids. As a result, he’s faced withdrawal symptoms that he says compound the pain by 10 times.
“I’m 68, I’m not a 20-year-old looking to get high,” he said. “A cancer patient can’t even get medicine? There’s something wrong with the system.”
Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help manage her blood pressure.
Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.
The copay for a 90-day supply was $285, which seemed high to Ma.
“I couldn’t understand it — it’s a generic,” said Ma. “But it was a serious situation, so I just got it.”
A month later, Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication. Because 90 days hadn’t yet passed, Anthem wouldn’t cover it. So during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.
The pharmacist told him it would cost about $40.
“I was very shocked,” said Ma. “I had no idea if I asked to pay cash, they’d give me a different price.”
Ma’s experience of finding a copay higher than the cost of the drug wasn’t that unusual. Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics.
USC researchers analyzed 9.5 million prescriptions filled during the first half of 2013. They compared the copay amount to what the pharmacy was reimbursed for the medication and found in the cases where the copay was higher, the overpayments averaged $7.69, totaling $135 million that year.
USC economist Karen Van Nuys, a lead author of the study, had her own story of overpayment. She discovered she could buy a one-year supply of her generic heart medication for $35 out of pocket instead of $120 using her health insurance.
Van Nuys said her experience, and media reports she had read about the practice, spurred her and her colleagues to conduct the study. She had also heard industry lobbyists refer to the practice as “outlier.”
“I wouldn’t call one in four an ‘outlier practice,’” Van Nuys said.
“You have insurance because your belief is, you’re paying premiums, so when you need care, a large fraction of that cost is going to be borne by your insurance company,” said Geoffrey Joyce, a USC economist who co-authored the study with Van Nuys. “The whole notion that you are paying more for the drug with insurance is just mind boggling, to think that they’re doing this and getting away with it.”
Graphic by Lisa Overton
Joyce told PBS NewsHour Weekend the inflated copays could be explained by the role in the pharmaceutical supply chain played by pharmacy benefit managers, or PBMs. He explained that insurers outsource the management of prescription drug benefits to pharmacy benefit managers, which determine what drugs will be covered by a health insurance plan, and what the copay will be. “PBMs run the show,” said Joyce.
In the case of Express Scripts, the company manages pharmacy benefits for insurers and also provides a prescription mail-delivery service.
Express Scripts spokesperson Brian Henry confirmed to PBS NewsHour Weekend the $285 copay that Ma paid in 2016 for his wife’s telmisartan was correct, but didn’t provide an explanation as to why it was so much higher than the $40 Costco price. Henry said that big retailers like Costco sometimes offer deep discounts on drugs through low-cost generics programs.
USC’s Geoffrey Joyce said it is possible that Costco negotiated a better deal on telmisartan from the drug’s maker than Express Scripts did, and thus could sell it for cheaper. But, he said, the price difference, $285 versus $40, was too large for this to be the likely explanation.
Joyce said it is possible another set of behind-the-scenes negotiations between the pharmacy benefit managers and drug makers played a role. He explained that drug manufacturers will make payments to pharmacy benefit managers called “rebates.”
Rebates help determine where a drug will be placed on a health plan’s formulary. Formularies often have “tiers” that determine what the copay will be, with a “tier one” drug often being the cheapest, and the higher tiers more expensive.
Pharmacy benefit managers usually take a cut of the rebate and then pass them on to the insurer. Insurers say they use use the money to lower costs for patients.
Joy said a big rebate to a pharmacy benefit manager can mean placement on a low tier with a low copayment, which helps drives more patients to take that drug.
In the case of Ma’s telmisartan, Express Scripts confirmed to PBS NewsHour Weekend that the generic drug was designated a “nonpreferred brand,” which put it on the plan’s highest tier with the highest copay.
Joyce said sometimes pharmacy benefit managers try to push customers to take another medication for which it had negotiated a bigger rebate. “It’s financially in their benefit that you take the other drug,” said Joyce. “But that’s of little consolation to the person who just goes to the pharmacy with a prescription that their physician gave them.”
But Joyce said the pharmacy benefit managers also profit when collecting copays that are higher than the cost of the drug.
In recent years, the industry has taken a lot of heat from the media and elected officials over a controversial practice called “clawbacks.” This happens when a pharmacist collects a copay at the cash register that’s higher than the cost of the drug, and the pharmacy benefit manager takes most of the difference.
The three largest pharmacy benefit managers – Express Scripts, CVS Caremark, and OptumRx – all told PBS NewsHour Weekend they do not engage in clawbacks.
But Howard Jacobson, a pharmacist at Rockville Centre Pharmacy in Long Island, NY, showed PBS NewsHour Weekend several recent examples of clawbacks. In one instance, Howardson acquired a dose of the generic diabetes Metformin for $1.61. He said if a patient paid out-of-pocket, he likely would sell if for $4. But in a recent transaction, the pharmacy benefit manager told Jacobson to collect a $10.84 copay from the patient, and it took back $8.91.
In the case of Z. Ming Ma and his wife Gretchen Liu, there was no pharmacist involved, because they purchased the medication directly from Express Scripts.
Express Scripts’ Brian Henry reiterated to PBS NewsHour Weekend that the company does not engage in clawbacks and opposes the practice. And he also blamed the health insurer, Anthem, for Ma’s high copay. “Anthem has its own Pharmacy and Therapeutics committee that evaluates placement of drugs on the formulary based on their own clinical and cost review – thus setting their own formulary and pricing,” Henry said in an email.
But Lori McLaughlin, a spokesperson for Anthem, pointed the finger back at Express Scripts. “Anthem currently contracts with Express Scripts for pharmacy benefit manager services and under that agreement Express Scripts provides the drug pricing,” she said in a statement. “Anthem is committed to ensuring consumers have expanded access to high-quality, affordable health care which includes access to prescription drugs at a reasonable price.”
McLaughlin also pointed to a lawsuit filed in March 2016 by Anthem against Express Scripts, for, she said, “breach of its obligation to provide competitive pharmacy pricing.”
As for Express Scripts’ contention that it doesn’t engage in clawbacks, USC’s Karen Van Nuys said it’s a matter of semantics. “Whenever the copay is higher than the cash price, and the difference isn’t reimbursed to the patient, someone else must be pocketing the difference,” Van Nuys said. “Maybe it isn’t technically called a clawback, but the principle is the same.”
So what’s a patient to do? Websites like GoodRx and WellRx can help consumers find the best prices at local pharmacies. They provide coupons and savings cards for certain drugs as well as out-of-pocket price information, which could be less than a copay.
It’s not always better to pay out-of-pocket, even if it’s cheaper. Patients need to look at the terms of their insurance plans and do the math.If a patient has a high deductible, it might make more sense in the long-run to pay the higher price and use up the deductible so insurance kicks in sooner.
Z. Ming Ma said he does find the Express Scripts home delivery service convenient. But he wasn’t happy about the price of his wife’s medication, and is glad he found another way to buy it.
“You have no choice, you can’t bargain,” he said. “I knew I wasn’t going to win.”
This story has been updated to reflect that Gretchen Liu is 78 years old.
