CVS looks to expand health clinics with Aetna deal

http://www.theledger.com/news/20171201/cvs-looks-to-expand-health-clinics-with-aetna-deal

NEW YORK — CVS Health Corp is planning to significantly expand health services at its retail pharmacies if it completes a more than $66 billion deal for insurer Aetna Inc , a move that could save more than $1 billion annually, people familiar with the matter said.

A key rationale is to use many of the U.S. pharmacy chain’s 9,700 brick-and-mortar outlets to improve access to preventative care and cut back on some emergency room visits for Aetna’s roughly 23 million members with medical coverage, these people said.

The full benefits of the strategy will take several years to realize, requiring billions of dollars in investment to increase the number of CVS clinics and provide the staff and equipment for a wider variety of treatments, the people said.

Those funds would be diverted from planned investments in CVS retail facilities, and not amount to additional expenses, they said.

Deal talks between the companies are still underway, and an agreement could be announced as early as Sunday or Monday, sources familiar with the matter told Reuters. It is also possible that a deal is delayed or does not materialize, they said.

Health insurers have redoubled their efforts to cut costs in a time of steep prescription drug price rises and requirements to care for even the sickest patients under the Affordable Care Act.

Aetna last year tried to buy rival Humana Inc to gain more leverage over costs, but that transaction, as well as a proposed merger between Anthem Inc and Cigna Corp , was shot down by antitrust regulators.

Many insurers have already been encouraging patients to use urgent care centers, which can provide some of the same services as emergency rooms for as little as a tenth of the cost, said Laurel Stoimenoff, chief executive of the Urgent Care Association of America.

Minuteclinics

The industry has grown to about 8,000 urgent care centers nationwide, as more hospitals, insurers and private operators open such walk-in facilities, Stoimenoff said, with 400 to 500 centers added each year. They may be staffed by doctors and provide relatively advanced care including X-rays.

 CVS operates more than 1,000 MinuteClinics, which offer more basic services ranging from flu shots to physicals and are mainly staffed by nurse practitioners.

Combined with Aetna, the company would be able to seamlessly access medical records, offer certain preventive services to covered members for free and make drugs promptly available in adjacent CVS pharmacies, said Dan Mendelson, president of consultancy Avalere Health.

The in-store clinics could provide immunizations, check if a patient needs antibiotics, help manage chronic illnesses like diabetes or even administer medications by infusion, but are unlikely to offer acute treatment of serious injuries, healthcare experts said.

“It would probably be unsettling to people coming in to buy socks to have someone with a bleeding head come in for stitches,” said Greg Burke of the United Hospital Fund, a non-profit focused on improving healthcare in New York.

Expanding the clinics could eventually save the combined company more than $1 billion annually by substituting low-cost treatments in CVS stores for more expensive hospital visits, two people familiar with the matter said. The combined net income of Aetna and CVS is forecast to be about $9.25 billion in 2017, according to Thomson Reuters data.

Aetna competitor UnitedHealth Group Inc operates 230 MedExpress urgent care centers in 17 states in one of its fastest-growing divisions, with nearly 20 percent compounded revenue growth per year.

For CVS, which has seen non-pharmacy sales decline at its stores, the clinics could have the added benefit of bringing in new customers and providing alternatives for less productive retail space.

“It’s a tough retail environment. I think they’re going to devote less space to it and more to different healthcare services and clinics,” said Jeff Jonas, a portfolio manager at Gabelli Funds which owns shares in Aetna and CVS.

Filed under: General Problems | 1 Comment »

Filed under: General Problems | Leave a Comment »

How opioids started killing Americans at the corner pharmacy

http://www.sentinelsource.com/how-opioids-started-killing-americans-at-the-corner-pharmacy/article_4e393039-7b4d-5de4-b435-4c09930101dd.html

It’s been conventional wisdom for some time now that America’s opioid epidemic began at the pharmacy. Now there are numbers to put any doubt to rest.

More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died. Only 4 percent were ever diagnosed as having an abuse problem, said Mark Olfson, one of five researchers who conducted a massive study of the crisis and its causes for Columbia University Medical Center.

The findings of the new study, published Tuesday in the American Journal of Psychiatry, split the epidemic into two groups: those who were diagnosed with chronic pain and those who weren’t. In the year before they died, about two-thirds of those studied were diagnosed with chronic pain and prescribed an opioid. (Many would also get a prescription for anti-anxiety drugs called benzodiazepines, which can make for a deadly combination.) The other third among those who died had no diagnosed chronic pain but became addicted to opioids in another way.

“Those are different populations,” Olfson said in a telephone interview. “Understanding those things puts us in a better position to combat the epidemic.”

According to the National Institute on Drug Abuse, more than 33,000 Americans died from opioid overdoses in 2015. Most of those deaths were linked to prescription pain pills, though the use of heroin was already growing rapidly, accounting for almost 13,000 fatalities that year. The scourge has continued to inundate America’s health care infrastructure. An analysis published this week by OM1 Inc., a company that uses artificial intelligence to improve health outcomes,

found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related.

And while opioid prescriptions have become harder to come by, the drugs are still too easy to obtain, U.S. health officials have said. The amount of opioid painkillers prescribed in the U.S. peaked in 2010 and declined each year through 2015, according to the Centers for Disease Control. Nevertheless, the drugs are prescribed about three times as much as they were in 1999, the CDC said in July.

Olfson said he hoped the study would alert lawmakers and health care providers to those at highest risk, as well as the dangers of prescribing opioids and benzodiazepines simultaneously.

Each piece of data, he said, helps give people a sense of the “crisis we’re in the midst of.”

“found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related”

The article was about OPIATE OD’s… ED visits that could include “opiate related”.. would be someone in pain- or addicted – seeking a prescriptions for a opiate...

10 Most Common Reasons for an ER Visit

Most of the TOP TEN REASONS for a person to go to an emergency room is for direct/indirect issues that would involved PAIN..

The “crisis” that we are in.. seems to be more build out of FABRICATED DATA !… it is more like a “magic act” than reality..

Filed under: General Problems | 1 Comment »

Boston Doctor Criticizes New Opioid Awareness Campaign

www.boston.cbslocal.com/2017/11/30/boston-doctor-criticizes-new-opioid-awareness-campaign/

A new public awareness campaign on trains and buses statewide is the latest effort to prevent the opioid crisis.

It’s called “Resist The Risk” and it in features powerful images like a baby in the hospital with the words “the first weeks of my life were spent in detox.”

“The point of these images was to grab people’s attention to get them thinking about this,” said Acting US Attorney William Weinreb.

“Resist The Risk” opioid awareness ad (WBZ-TV)

The US Attorney District of Massachusetts and DEA New England Field Division are sponsoring the campaign, which kicked off this week. It includes four different ads that will be on MBTA buses along with Red and Orange line trains.

The campaign is already drawing criticism from a local doctor.

“Showing a consequence that’s scary that might happen to somebody years down the line is not effective for youth,” said Boston Medical Center Doctor Richard Saitz.

Boston Medical Center addiction specialist Dr. Richard Saitz says the ads may be counterproductive and drive addicts away from treatment.

“Resist The Risk” opioid awareness ad (WBZ-TV)

“If they could simply stop drug use and resist the risk they would. They can’t, they need help to do so, they need treatment,” said Dr. Saitz.

Acting US Attorney William Weinreb is defending the program saying the ads are geared toward informing young people about the dangers of opioids.

“Our message is directed at a different population, people who are not already addicted, but people who are thinking about using pain pills recreationally,” said Weinreb.

The Acting US Attorney admits the ads are stirring up controversy, but points out it’s getting the conversation going on the topic.

Filed under: General Problems | 2 Comments »

Three days ago I had an appointment with my pain doctor. He prescribed me hydrocodone. He has periodically prescribed this when my pain levels have increased. Normally I take tramadol but sometimes it requires a stronger hydrocodone. The last time I had been prescribed one was eight weeks earlier.  I’ve never had a problem with him prescribing both. I have been advised by both the doctor and my previous pharmacist to never take the two together which I am well aware . normally I take the tramadol but if my pain levels increase I switch and I take the hydrocodone in place of the tramadol until I feel like I can go back to the tramadol . I do this deliberately because I do not want to stay on hydrocodone every day but I need something so I prefer the lesser. 

So I go to the doctor and things have changed and he needs to now do a facet Rhizotomy of my L5 right side due the spinal stenosis. He prescribed me some hydrocodone and my appointment is December 19 . I take it to the Walgreens pharmacy where I always gone and a new pharmacist says that she doesn’t feel comfortable filling it.

First she said that about the mix of the two and I told her I have been advised by the previous pharmacist as well as my doctor never to take together… then she stated that she felt because I had tram on hand that I should just take that and not the hydrocodone and I told her I have a need for the hydrocodone and then she just flat out said she wasn’t comfortable with it.

I am not Dr shopping, I am not pharmacy shopping. I deliberately make sure my pain doctor fills both prescriptions and I go to the same pharmacy and I have been for a year and a half for both prescription . I do not fill these regularly ,sometimes I have anywhere from 7 to 12 weeks in between prescriptions. And I don’t want to try to go to a different pharmacy because I don’t want to be accused of pharmacy shopping.

I’ve had four surgeries in the last three years and I do have chronic pain however sometimes I don’t need hydrocodone. But when I do need it I don’t understand why her personal feelings have a right to tell me I can’t when my physician feels that it’s necessary.

I also am on permanent disability as a result of my condition.

I see that I can file a complaint but I don’t know whether what she did falls under the category. I know that she can refuse for specific reasons but she did say verbatim “I just don’t feel comfortable with it” she said this at least three times.

This morning I’m going in again which will be my fourth morning in a row and I’m sure she’s going to refuse it again. And I’m just wondering what I can tell her in response regarding the Legality of the of this refusal.

One of the recommendation for pts is to always use the SAME PHARMACY… many pts believe that if they go to the same “physical pharmacy” each month that they are going to the SAME PHARMACY..

However, especially in chain stores… one or more of the pharmacists that are in charge of the Rx dept may have changed in the interim month…  and along with that change can come a new pharmacist with a change in experience level, opinions, biases, phobias.. basically “there is a new sheriff in town”

But there are some 22,000 independent pharmacies out there.. where you will be dealing with the Pharmacist/owner… and generally they don’t change “sheriffs” randomly… and unlike their chain counterparts.. they only get paid when they fill legit/on time/medically necessary prescriptions…  and tend to not “play games” with the pt’s necessary medications.

Here is a link that can help anyone find a independent pharmacy by zip code.

http://www.ncpanet.org/home/find-your-local-pharmacy 

More and more pts are discovering that trying to “buck the system” typically does not get them very far. We have a serious – and growing – pharmacist SURPLUS.. and if the chain pharmacies were not happy with their pharmacists turning down controlled prescriptions and denying care to pt with legit/on time/medically necessary prescriptions… they would BE REPLACING THEM… since they are not … it would appear that they could care less about those pts that are thrown into cold turkey withdrawal or denied timely access to their medically necessary medication.

Filed under: General Problems | 1 Comment »

The real history of the DEA and opioids

https://www.washingtonpost.com/opinions/the-real-history-of-the-dea-and-opioids/2017/12/01/6ab9d194-d5f7-11e7-9ad9-ca0619edfa05_story.html

The Nov. 29 news article “Ex-DEA officials want anti-opioid tool restored” continued the false narrative that a law passed by Congress and signed by President Barack Obama hinders the Drug Enforcement Administration’s efforts to combat the opioid epidemic.

As a former associate chief counsel for the DEA, I was responsible for supervising all administrative litigation and enforcement actions against DEA registrants. During my tenure, my team initiated a record number of enforcement actions, including immediate suspension orders. After my departure, the volume of administrative actions significantly decreased. That was in 2013, a full three years before the enactment of the Ensuring Patient Access and Effective Drug Enforcement Act.

Former DEA employees who say the decrease is because of the legislation would prefer to rewrite history.

During Joseph T. Rannazzisi’s tenure as the head of the Office of Diversion Control, oxycodone and hydrocodone limits increased by more than 300 percent. The idea that the DEA was simply responding to the demand in prescribing is fundamentally false. In the 1970s, the DEA significantly reduced the amphetamine quota to successfully combat rising abuse of speed pills. In the 1980s, the methaqualone quota was reduced to combat the illicit use of quaaludes. It is perplexing why the DEA did not address the opioid epidemic in the same manner.

Larry Cote, Washington

The writer leads Quarles & Brady’s
DEA compliance and litigation practice group.

Filed under: General Problems | Leave a Comment »

From Dr. Forest Tennant
To Advocates and Concerned Parties
RE: Key Points in DEA Search and Seizure Warrant of Nov. 13, 2017
This lengthy search warrant shows some issues which are serious and, if implemented, will hurt pain patients and physicians throughout the Country. Even physicians and patients without pain issues will be affected.
There are 2 major issues that must concern all parties. 1. Claims of fraud and “kick-backs” for prescribing Subsys® (fentanyl sublingual spray) off-label to 2 Medicare patients, and then receiving “kick-backs” or “bribes” by receiving speaker fees and/or under-the-table money from Insys Pharmaceutical and/or United Pharmacy which is the distribution pharmacy for Subsys® in Los Angeles. The labeled indication for “Subsys®” in the PDR and REM agreement is cancer breakthrough pain.
One of the 2 patients in question actually was post-surgical, ovarian cancer and was in pain treatment for abdominal adhesions/neuropathies and possible cancer recurrence. My last speech for Insys was in 2015 and I prescribed Subsys® before and after my short speaking endeavor with Insys. At no time has Insys, United Pharmacy, or other party offered a “Quid Pro Quo”, directed prescribing, or offered money to prescribe.
Serious questions:
1. Are we now saying that prescribing off-label or accepting speaking fees is a crime?
2.
The search warrant claims that every patient who is receiving a high opioid dosage and/or a benzodiazepine and/or carisoprodol (Soma®) cannot be completely taking the drugs, are diverting them to the streets, and somehow kicking back money to me. Their basis is a review of pharmacy records by a Kaiser General Practitioner who can’t believe that some rare, very ill pain patients might need a dosage over 100 mg MED. Not stated, but implied, is that these patients are endangered. Our clinic, since 1975, has only taken intractable pain patients (some recent exceptions) who have failed standard treatments. All patients must have family involvement, physician referral, sign multiple consents describing risks, and undergo genetic, hormone, and other testing. Be clearly informed that my clinic in the past 10 years has not had an overdose death, suicide, automobile accident, or report of diversion. We know that some intractable pain patients only respond to a risky regimen that may include benzodiazepines, opioids, and carisoprodol.
SERIOUS QUESTION: Are physicians, patients, and families now going to be accused of crimes simply based on pharmacy records without even interviewing patients, family, and physician to determine the pathologic state of patients?
Sincerely, Forest Tennant M.D., Dr. P.H.

Filed under: General Problems | Leave a Comment »

I was a Pharmacy Technician for years and have a Pharmacist in the family. I regret that I held judgment in the past before I had to get controlled substances myself, maturing, and facing judgment from a nurse. When I was a Pharmacy Technician if anyone was paying cash for a controlled substance I was told to tell them that we were out of stock, if they had a home addresses more than ten miles from our store I was told to tell them the same thing. I thought I was doing what was right, but at the same time it is how I was trained. This one white guy came in once with a younger man of color and handed me a script from a dentist for Vicodin. I asked if he had his insurance card, and was told that he did not have insurance. The training given to me was that this was a huge red flag because people pay cash to avoid billing their insurance to get multiple scripts filled. I felt bad about the whole situation, but I went and talked to my boss who told me to tell him we were out of stock. Just then the older white guy opened his wallet and showed me his Ohio state Board of Pharmacy License verifying that he was a licensed Pharmacist, and said to me “you wanna check your shelf again”. My boss who was a licensed Pharmacist and said, “Oh we have it after all”. Yet 99% of the time we were instructed to turn down the uninsured. The reason being that the insurance company would send us back a response to soon, so if you were getting multiple scripts you could get away with it. This was before the Prescription Monitoring Programs. Also if you dressed in a Polo with Dockers and had no tattoos you were generally safe. I developed RSD after a tumor was removed from my left sciatic nerve, and called the nurse at the surgeon’s office to tell her that the Tylenol 3 I was taking every four hours was not working. She said, “whatever you must just be an addict trying to get more pain medication”. Meanwhile my left foot blew up like a balloon, turned beat red, and felt like someone was light my foot with a couple of large lighters, and shocking it with a tazer. I had my 40 cal out after I talked to the nurse. I was going to end my life to stop the pain. Decided to lock up my 40 cal in my lock box and give the keys to my mom. She said this doesn’t make sense since you never had any surgery on your foot. I laid in her room all night till the next morning when she called the doctors office and the surgeon said to come right in. I did and he said your brain thinks that your foot is injured because we had to take your sciatic nerve apart, and the nerve block must have wore out. He said I am paging the first available pain management specialist to see you asap. Also he was not happy about the Nazi Nurse. I do not know what happened with her. Now when you call the after hours number in your discharge instructions you would think that if you were taking medication as prescribed and having severe pain, or swelling that the nurse might want to rule out an infection, or that maybe something worse. In not so many more words she said other things reflecting her opinion that I was a junky. Recently I had Walgreens give me shit on a transfer of sleep medication. It was filled by my old Pharmacy on the sixth of one month, but picked it up on the seventh of that month supposedly. I moved closer to Walgreens, and transferred it there. I went to pick it up on the seventh and they said that my old Pharmacy said that my wife or I did not pick it up until several days later. I was like I do not think that is the case, but the said it is exactly 30 days from the date you last picked up your medication. This means if they do this it will make it so nobody will take extra tablets. And if you live in a rural area and have a 45 minute drive to the Pharmacy from your Family Farm you will just have to make those extra trips. For instance if you are out of blood pressure medication and need it the day before you will have to make to trips. CVS and Walgreens are the to biggest fighters of pick up date and fill date. All of them plus Rite Aid kept partially filling a friend’s scrfor Ultram because it was for 140 tablets a month. They kelp saying that they by law could not fill the whole thing at once, but could fill half of it then get the rest after 15 days. We’ll when he would go back for his partial they kept saying that insurance would not cover another month when he had a month. “SIMON SAYS”. Then they told him some shit about the DEA personally checking into him. He went back in their and showed him his stump where he lost his leg from an infection. Then started yelling that maybe he go up the street in their ghetto neighborhood and find a compassionate herion dealer to treat his pain. Having a fresh amputation just made them dumbfounded. They still just started to repeat their lines. I drove him to a small local chain, and they filled the who script that was a monthly script with no problem, or rhetoric

Filed under: General Problems | 2 Comments »

http://www.commercialappeal.com/story/news/2017/11/29/neglect-tennessee-nursing-home-led-patients-harm-including-death-inspectors-find/905613001/

A Memphis nursing home has been hit with record fines after inspectors found widespread neglect resulting in actual harm to multiple patients including one who died after transfer to a hospital showed widespread wounds with maggots that apparently had gone untreated.

The fines totaling $50,000 were imposed on the 211-bed Ashton Place Health and Rehabilitation Center, 3030 Walnut Grove Road, the highest such penalty ever imposed. In addition to the fines Tennessee Health Commissioner John Dreyzehner ordered a freeze of any new admissions to the facility and appointed a monitor to oversee its operations.

The 98-page inspection report, which prompted Dreyzehner’s action, cites multiple cases of patients suffering actual physical harm due to failure to follow a physician’s orders, failure to administer prescribed drugs and failure to inform physicians’ of their patients deteriorating condition.

A male patient who was admitted to the home on July 26 of this year with no visible wounds ended up being transferred to a hospital multiple times for ulcers and ultimately died on Oct. 11 where hospital staffers found maggots in wounds that appeared to be untreated.

The state surveyors noted that the records of wounds on the patient recorded at the nursing home when he was placed in an ambulance omitted at least five wounds that were found by hospital staffers minutes later.

The report states that nursing home records indicated the patient also was not given the pain medications his doctor had prescribed.

“He was not assessed regularly nor did he receive his pain medication regularly,” the report states.

Neglect and poor care was also detailed for other patients, including a female patient suffering from ovarian cancer whose worsening condition was not reported to her doctor. She died on Oct. 24.

In that patient’s case, the report states she was apparently given a medication that wasn’t prescribed. 

The report was highly critical of managers at the facility and noted that top officials contended they were unaware of the problems reported by direct care staffers.

Home managers “failed to ensure that care was provided as called for in care plans for five of 16 residents,” the report states.

According to the report, the home’s medical director stated, “I have support, no direction. I have talked (to them) about the staff they have here. I don’t have much confidence in them.”

One resident, the report states, was left sitting in her own stools for five hours. Another was found choking after she pulled out her oxygen tube.

Records showed another patient apparently did not get 37 of 106 prescribed doses of Lyrica and 29 of 106 prescribed doses of morphine.

Filed under: General Problems | 1 Comment »

The Health 202: Jeff Sessions wants to put more cops on the opioid beat. Experts say that won’t solve the problem.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/11/30/the-health-202-jeff-sessions-wants-to-put-more-cops-on-the-opioid-beat-experts-say-that-won-t-solve-the-problem/5a1ef05130fb0469e883f90b/

If the opioid epidemic was simply a problem of supply – people being able to access drugs too easily – than a targeted new effort in Appalachia announced by Attorney General Jeff Sessions yesterday would be a huge stride toward combating the crisis.

The problem with this approach, however, is that experts agree the opioid epidemic is all about demand. Far too many Americans rely on opioid painkillers, creating a huge customer base for illicitly gained prescription drugs and more serious street drugs, such as heroin and fentanyl.

Sessions’s new plan involves sending more Drug Enforcement Agency agents to the areas where opioid abuse is most rampant. But those fighting the epidemic on the ground say the law enforcement strategy must be coupled with medical help for those suffering from addiction, or the Trump administration won’t get very far in its efforts.

“This is a demand-driven problem and we are trying to apply supply-restricting solutions,” Michael Brumage, executive director of the Kanawha-Charleston Health Department in Charleston, W.Va., told me (West Virginia is the state hit hardest by the crisis). “That’s what we tried on the war on drugs, and that failed.”

Sessions is creating an entirely new DEA division overseeing the Appalachian region to help local law enforcement combat drug abuse, especially of prescription opioids, The Washington Post’s Sari Horwitz and Matt Zapotosky report. He also announced $12 million in new grants and the designation of an opioid coordinator to work with prosecutors to better manage prosecutions.

“Today, we are facing the deadliest drug crisis in American history,” Sessions said at a news conference yesterday. “Based on preliminary data, at least 64,000 Americans lost their lives to drug overdoses last year. That would be the highest drug overdose death toll and the fastest increase in that death toll in American history.”

The new Louisville Field Division will unify drug trafficking investigations in Kentucky, Tennessee and West Virginia, with a focus on the Appalachian Mountains, officials said. It will include about 90 special agents and 130 task force officers.

Washington Examiner’s Kelly Cohen:

At least in terms of geography, Sessions is spot on. A few weeks ago, I wrote about the prevalence of opioid abuse in the Appalachian region – and how it gets worse and worse the closer in you get to West Virginia (which is basically the epicenter of the crisis).

If you look at what researchers call “diseases of despair” (drug and alcohol overdose, suicide and alcoholic liver disease), they have a stronger foothold in the center of Appalachia than on the fringes. In central Appalachia, those maladies led to 94.4 deaths per 100,000 people, but the rate is 52.3 deaths per 100,000 in southern Appalachia.

But law enforcement officers will tell you that keeping an area free of drug dealers for any length of time is a steep task. Brumage called the new DEA forces a “step in the right direction,” but his enthusiasm is tempered.

“Once you bust everybody in a particular area, you have a temporary lull but it lasts only a few days,” Brumage said. “There are always people and supply willing to fill the void.”

Activists who watched the uphill and international “war on drugs” of the past several decades also fear the Trump administration will halt its efforts with beefing up law enforcement, instead of also pouring more resources into helping Americans break free of their drug addictions.

“The emphasis continues to be punishment, so I think it’s very concerning,” said Gabrielle de la Gueronniere, director of policy for the Legal Action Center, a nonprofit organization that fights discrimination against people with a history of addiction. “We’re not really treating this as an illness. There’s a huge treatment gap.”

Sessions also announced that White House counselor Kellyanne Conway will continue to help lead the opioid effort:

Several reporters clarified that the Trump administration isn’t creating a new “drug czar,” as some reports suggested. Politico’s Brianna Ehley:

Politico’s Sarah Karlin-Smith:

On a related topic, Sessions said he’s “dubious” of a law restricting DEA’s enforcement powers, which The Post detailed in a recent investigation. Per The Post’s Sari Horwitz:

Filed under: General Problems | 1 Comment »