Sheepdogs Back on Duty

I was hoping that a Democratic President could change the culture of the executive agencies that had neglected their responsibilities to protect the public from predatory monopolistic corporations for more than eight years. I was beginning to lose hope. Then the following news was released.

CVS Caremark has come under criticism from various groups and lawmakers who have asked the FTC [Federal Trade Commission] to review the nearly $27 billion merger of a major drug-store chain and large pharmacy benefits manager that formed the company in March 2007.

In June, the FTC said it was referring to its Bureau of Competition a national independent pharmacists group's concerns that CVS Caremark's pharmacy-benefits-management operation, or PBM, had improperly shared patient information with the company's retail side to steer customers to CVS stores, to the detriment of competitors and customers.

The National Community Pharmacists Association called on the FTC to reopen the CVS Caremark merger, claiming the company engaged in anticompetitive behavior. State legislators and members of Congress this year also asked the FTC for a review.

In May, the National Legislative Association on Prescription Drug Prices, a nonprofit directed by state legislators, encouraged the FTC to open an investigation into CVS's acquisition of Caremark Rx "and the activities and conduct of the firm since the merger." The legislative group said CVS Caremark's conduct threatens to harm consumers by increasing prices and decreasing service and convenience.

While community pharmacists and lawmakers voice concerns that CVS Caremark has improperly wielded its power as a combined drug retailer and PBM, the company has had trouble keeping and winning PBM clients, a situation made clear Thursday as Chief Executive Tom Ryan said the company had some "big client losses" for 2010.

The client news sent CVS shares down nearly 21%, or $7.50, to $28.65, and left some Wall Street analysts questioning the company's retail-PBM business model.

Whether or not CVS Caremark is guilty of the allegations is to be determined. But I am greatly encouraged to see the FTC is back in the business of investigation violations of predatory corporate activities.

I has always struck me as inherently objectionable when a fox is allowed to guard a chicken, much less over the entire chicken coop. We citizens are essentially sheep at the mercy of large corporate wolves. It is a delight to see that sheepdogs are back.

HPRP Provider

I recently had lunch with Dr. Bruce Baker of West Brook Recovery Center in Grand Rapids—an HPRP provider. Dr. Baker is a fascinating person and genuinely cares about the best results for his patients and health professionals.

Dr. Baker told me about the increased usage of prescription drugs among high school students. Although illicit drug usage has fallen among high school students across the country, 15.4% of 12th graders have abused prescription drugs within the past year. The most popular drugs are Vicodin, amphetamines, tranquilizers and sedatives. The majority admit to obtaining the drugs from a friend or relative and only 20% admit to purchasing from a dealer or stranger.

Perhaps reminding patients to secure their prescription drugs at home as a routine part of your counseling may decrease availability of drugs to youth.

Lucrative Business Plan?

Veterinary drug filling could be a lucrative opportunity for pharmacies. If you wish to research this opportunity further, I would be happy to work with you.

Generic Tamiflu

An interesting scenario could unfold if the H1N1 outbreak worsens. NPR reports that the CDC is open to importing generic Tamiflu, named Antiflu, made in India. However, Tamiflu is under patent in the United States until 2016. Would the government override this patent if the outbreak worsens and Tamflu shortages persist?

Prescription Disposal

I know that the Wayne County Pharmacists Association has done some work to reach a solution to disposal of prescription drugs in Michigan. Here is an article about Iowa's new plans.

Pharmacy Liability Case

This blog post is from the Wall Street Journal. It addresses whether a pharmacy in Nevada is liable for the actions of a patient who abused pharmacy drugs. The pharmacies in the area were sent a letter warning them of this particular woman. Does this knowledge hold them liable?

A lawsuit filed by the victims and their families against Wal-Mart, who dispensed a painkiller prescription to Copening, asks whether drugstores must use information at their disposal to protect the public from potentially dangerous customers. In this case, state officials had sent letters to 14 pharmacies in the Las Vegas area warning that Copening could be abusing drugs.

Must Read from the Washington Post

As mentioned in my newsletter, this article is from the October 29, 2009 edition of the Washington Post. It is entitled, "DEA Crackdown Hurts Nursing Home Residents Who Need Pain Drugs".

Heightened efforts by the Drug Enforcement Administration to crack down on narcotics abuse are producing a troubling side effect by denying some hospice and elderly patients needed pain medication, according to two Senate Democrats and a coalition of pharmacists and geriatric experts.

Tougher enforcement of the Controlled Substances Act, which tightly restricts the distribution of pain medicines such as morphine and Percocet, is causing pharmacies to balk and is leading to delays in pain relief for those patients and seniors in long-term-care facilities, wrote Sens. Herb Kohl (D-Wis.) and Sheldon Whitehouse (D-R.I.).

The lawmakers wrote to Attorney General Eric H. Holder Jr. this month, urging that the Obama administration issue new directives to the DEA and support a possible legislative fix for the problem, which has bothered nursing home administrators and geriatric experts for years.

Alabama Supreme Court Case

In my upcoming newsletter, I address this Supreme Court case out of Alabama regarding the "learned intermediary" doctrine.

H1N1 Outbreak Tracking

Rhode Island is the first state to use electronic prescriptions to track outbreaks of the H1N1 virus.

"Surescripts is using information supplied by pharmacies to document how much Tamiflu and other antivirals are being dispensed to patients. The company is giving the data — categorized by zip codes of the pharmacies where the medicine is dispensed and the age group of the patient receiving it — to epidemiologists at the state health department."

American Pharmacy Educator Week

It is the inaugural American Pharmacy Educator Week. Celebrate the people that helped get you to where you are today.

DME

Here is a news story out of Montana regarding the official signing of the DME accreditation delay. I addressed this bill in a couple previous postings as well as my upcoming newsletter.

"Tester argued that the accreditation process can be expensive and time consuming for community pharmacies that are often the only option for seniors in rural communities. He also argued that accreditation is redundant, as pharmacies are already subject to oversight and regulation as medical professionals and as state-licensed businesses."

CVS GreenBag Tag

CVS is starting a program to reward users for turning down bags or using reusable bags. More information can be found here.

You know I'm in favor of moves that will protect trout habitats.

Prescriptions for OTC Decongestants?

As the meth problem continues, some communities are responding by requiring prescriptions for all medicines containing pseudophedrine. Oregon has a state-wide law and now a town in Missouri has passed a law locally requiring a prescription.

"The new law's critics include the Missouri Medical Association, Missouri Retailers Association and the Missouri Pharmacy Association. Many in the pharmacy industry say such laws will make it more difficult and expensive for those who are sick to get relief."

Donating Cancer Drugs

This is a helpful development for those who cannot afford cancer drugs.

Here is a link to Michigan's guidelines for its Cancer Drug Repository.

Continued Fight against Meth

The news lately is filled with communities and states trying to fight meth through tracking pseudophedrine purchases. It seems like it won't be long until a stricter federal law is enacted.

In August, Democratic Sen. Ron Wyden of Oregon drafted federal legislation calling for a nationwide prescription mandate for pseudoephedrine; he said he planned to introduce it this year. The White House Office of National Drug Control Policy, which establishes policies and priorities for drug-control programs, is examining Oregon's law, though it hasn't taken a position on it.

A Bill Threatening Wisconsin's Pharmacists

Here is another example of "big box pharmacies" driving independent pharmacists out of business. Obviously the "big box pharmacies" receive more income from other sales and can afford to sell prescriptions for lower prices.

Newsletter Announcement

I know it has been delayed, but the Fall 2009 newsletter is almost finished. It is in the final editing stages and will be going to the printer later this week.

We will also be posting an electronic PDF on my website soon so you can read it there too.

I hope you enjoy it as much as I've enjoyed writing it.

Georgia Pharmacy Audit Bill of Rights

Here are a couple links to the Georgia Pharmacy Audit Bill of Rights. I discuss the importance of this bill as an initial step in my latest newsletter.

Here is a link to a website with the text of the bill.

Here is a link to a savable or printable version of the bill.

A Fine Editorial

From the Hartford Courant, comes this editorial by Pharmacist Robert Bradley.

"Anyone who values having the option of going to a local independent pharmacy and dealing with a pharmacist who knows you personally and has the time to discuss your prescription needs should contact their state legislators and the governor's office and ask them to support small pharmacies by reconsidering this new state law on self-insurance."

And First off the Line is...Iowa

Iowa is making great strides in converting to electronic prescriptions.

"Iowa's largest integrated health care system and the nation's largest provider of electronic prescribing software today announced the launch of an initiative to convert a majority of the state's physicians from paper prescriptions- known to be the cause of costly medical errors- to electronic prescribing."

Liberty is not a Popularity Contest

This is a frightening precedent for civil liberties.

I have to agree with dissenting Judge Karen Nelson Moore, who wrote,

"I cannot think of any other circumstances where we have endorsed an invasion of a person's privacy with so few facts from which to draw an inference that the intrusion would likely uncover evidence of a crime."

U.S. District Judge Janet Neff wrote,

"There is no such things as a fair-weather Constitution, one which offers the harbor of its protections against reasonable search and seizure only in palatable contexts and only to worthy defendants."

Constitution liberties are not subject to popularity contests. Law enforcement has an innate tendency to expand its jurisdiction like a wildfire in the wind. Judges must be a firebreak to prevent harm and humans being consumed by that fire.

Judges must steel themselves against all-too-human, inner emotions and exercise mental discipline.

It is precisely where a defendant is unpopular or reviled that calm and levelheaded thinking in a judge is most required.

While this case involves the repugnance of child pornography, the law of this case will soon be applied to other searches for any alleged crimes. This holding is not limited to child pornography cases. Anything you ever searched is on a computer today.

Generic Replacements

The Alabama Attorney General has stepped in to prevent district attorney suits against CVS, Walgreen, Wal-Mart and Rite Aid. The attorneys allege that these pharmacies filled prescriptions with generic drugs, even when doctors did not specify the use of generics.

The district attorneys claim the Alabama AG is protecting big business and vow that voters will remember this in the next election.

"If that's the position he wants to take, good luck in the next election," said District Attorney Arthur Green of Jefferson County's Bessemer Division.