Think

If you think back over decisions you really regret, often the common denominator is that you acted prematurely. That is, you did not allow sufficient time to think about your decision before acting.

Often a person feels that there is no time to think and acquire more facts because someone has set an arbitrary deadline to pressure you into a hasty decision. The pressure may come from an employer, a friend, a Board, law enforcement or a scam business “opportunity”. There is always sufficient time for good advice from a lawyer who knows the subject matter.

Do not start connecting dots before you have collected enough dots to acquire the true picture.

Know who your real “friends” are. Call me before you call HPRP or decide you can talk your way out of a situation without a lawyer. If you are under emotional and time pressure, you are extremely likely to make a decision you will always regret. Asking co-workers, colleagues or friends for legal advice is a mistake. One, they are not lawyers and there is no confidentiality; second, they may or may not, be well intentioned and they usually don’t know what they are talking about.

Every week I hear a new story about a health professional following that free advice to a catastrophic ending.

I have a dollar for every time someone has said to me “I wish I had talked to you first.”

Good Press

The New York Times has a good article on the expanded role and opportunity for pharmacists to take in patients' health care. Not only is this good press for the pharmacy profession, but it can serve to inspire you to start or expand new areas in your practice. For example,

The idea of using pharmacists in this way began to gain popularity in 2006 when someMedicare plans started covering medication therapy management programs, paying $1 to $2 a minute to pharmacists to review patients’ medicines with them; this year, about one in four people covered by Medicare Part D prescription drug plans will be eligible, according to agency estimates. For example, a Medicare Part D plan covered Ms. Gelinas’s medication management session at Barney’s pharmacy.

More employers and insurers also pay for pharmacists to advise patients, a role that the new health care law encourages with potential grants for such programs. In Wisconsin, for example, community pharmacists and some health plans have banded together to create a joint program, the Wisconsin Pharmacy Quality Collaborative, to standardize medication therapy management and ensure quality care.

Meanwhile Humana, which first paid for pharmacists to work with Medicare patients, expanded its coverage a few years ago. About a third of the 62,000 pharmacies in its network offer these services, and the insurer says it is studying whether a pharmacist seeing a patient in person has more impact than a phone call.

Genetic Information Nondiscrimination Act

I will be discussing this issue in my upcoming newsletter. If you are interested in reading the entire Genetic Information Nondiscrimination Act (GINA), I link to it here.

Prescription Drug Disposal

Here is an editorial from the Bangor Daily News out of Maine. It addresses the steps that Maine has taken to try to limit drugs from being flushed or thrown out.

In 2004, the Maine Legislature passed a bill creating an unused pharmaceuticals disposal program. In 2007, the University of Maine's Center on Aging received a $150,000 grant from the U.S. Environmental Protection Agency for a prescription drug mail-back pilot program. Prepaid mailers were made available to the public through pharmacies and medical clinics. Unused drugs were to be put into the mailers, which went to the Maine Drug Enforcement Agency where pharmacists tabulated what types of drugs are being discarded. The drugs were then sent to a hazardous waste incinerator.

Painkiller Abuse

In the last 5 years, emergency rooms have seen a 111% increase in visits because of painkiller abuse.

Visits to hospital emergency departments for abuse of pain drugs more than doubled from 2004 to 2008, jumping from 144,644 to 305,885 visits annually, according to a study released last month by the CDC and the Substance Abuse and Mental Health Services Administration.

Environmental Threats

The threats to our environment never end, do they? A settlement was reached between Michigan and Birds Eye Food Inc. related to groundwater contamination because of a plant discharging contaminated water.

Numerous residents in communities where Birds Eye has sprayed say it has caused their wells to produce water that is discolored and foul-smelling, and has elevated levels of potential toxins such as arsenic and iron.

Under the agreement with the state, Birds Eye agreed to install a new $3.8 million wastewater treatment system and spray only during the growing season, the department said. At other times, the wastewater will be discharged to Fennville's municipal treatment works.

Also, the company will complete an investigation of the groundwater contamination and do what is necessary to fix it.

Birds Eye will continue providing bottled water to people whose well water doesn't meet health standards until Fennville completes an extension of its water supply network.

Where is the punishment? How much profit has Birds Eye made from this plant in all these years versus the few dollars they will have to invest to build a treatment system?

Medicare Bust

Federal authorities cracked down on Medicare fraud nationwide today across 5 states. Eleven were arrested in Michigan and 94 were indicted nationwide.

The local health care companies were located in Detroit, Livonia, Southfield and Oak Park.

From the Detroit Free Press:

McQuade and Detroit FBI chief Andrew Arena said economically distressed areas like metro Detroit are hot spots for Medicare fraud, which prompted McQuade to assign more people to prosecute such cases.

From the Detroit News:

"They prey on people desperate for drugs," said Barbara McQuade, U.S. Attorney for the Eastern District of Michigan. "Prescription drugs often are the benefit provided. They exchange stats that allow false billing."

A New Threat to Pharmacists

Britain will soon begin testing an automatic pill dispenser to be available in hospitals. However, the eventual goal is to have dispensing machines available for use by patients.

This is a dangerous and slippery slope for pharmacists. You cannot allow the profession to be seen as simply pill counters who can be replaced by machines. The video link used by the machine will connect patients with pharmacists overseas who will do your job for far less.

The machines would be able to dispense drugs at any time of the day or night. They come in two models, the paper reported, one holding 330 packs of medicine and the other 2,000.

Users insert their prescription into the machine and pick up a telephone to access a live video link to a registered pharmacist.

The pharmacist will check the prescription and ensure those who have to pay have done so before allowing the machine to dispense the drugs.

New CVS Controversy

Connecticut's Attorney General is investigating CVS' threat to drop a drug discount program because state law requires the lowest drug prices be for the state's Medicaid program.

[Attorney General Richard] Blumenthal, in cooperation with Department of Consumer Protection commissioner Jerry Farrell, Jr., has sent CVS Caremark a subpoena to explain why providing the discounts to the state Medicaid program would result in termination of its Health Savings Pass program in Connecticut and other information. The deadline for compliance is July 9.

In response to the matter, CVS Caremark said that it intends to "fully comply with all applicable legal requirements in this matter" and "will fully cooperate with the Attorney General's investigation."

Gone Fishing!

I will be out of the office until June 1. I am taking a long holiday weekend to enjoy some fly fishing at Sault Ste Marie.

As always, I can be reached in an emergency and Gina is at the office. Contact her if you have any questions.

Enjoy your holiday weekend.

CVS Caremark Editorial

Joseph Harmison, President of the National Community Pharmacists Association (NCPA), has an op-ed on The Hill website. In his piece, he praises the efforts of the Federal Trade Commission (FTC) and the many states investigating the unfair business practices of CVS Caremark.

In his piece, he names a group of bipartisan Senators and Representatives who have written letters on their constituents, both patients and pharmacists, behalf to the FTC. The Senators and Representatives include:

U.S. Senators Sherrod Brown (D-Ohio), Byron Dorgan (D-N.D.), Russ Feingold (D-Wis.), Amy Klobuchar (D-Minn.), Frank Lautenberg (D-N.J.), Mark Pryor (D-Ark.) and Roger Wicker (R-Miss.), and U.S. Representatives Michael Acuri (D-N.Y.), Robert Aderholt (R-Ala.), Marion Berry (D-Ark.), Jo Bonner (R-Ala.), John Boozman (R-Ark.), Judy Chu (D-Calif.), Lloyd Doggett (D-Texas), Jim Gerlach (R-Pa.), Walter Jones (R-N.C.), Larry Kissell (D-N.C.), Robert Latta (R-Ohio), Michael Rogers (R-Ala.), Linda Sanchez (D-Calif.), Jan Schakowsky (D-Ill.) and Anthony Weiner (D-N.Y.)

Note that this list of Senators and Representatives who have written to the FTC in support of their investigation does not include anyone from the State of Michigan. Contact your Senators and Representatives and remind them of how important it is to ensure fair business practices for everyone, not just the big corporations.

Tell them that you will watch how they act on this and take it into account when you are asked for campaign contributions or your vote.

In their letters, the Congressmen and women argued for,

“the FTC to reopen the CVS Caremark merger investigation and determine if the acquisition poses a threat of reducing competition or whether CVS is engaging in any unfair or deceptive business practices.”

Listed in Mr. Harmison's piece are these familiar problems,

This month, community pharmacists renewed the case against CVS Caremark and presented additional evidence to the enforcement agency. On one occasion, NCPA detailed CVS Caremark tactics that secretly boost the costs to health plans and profitability of its mail order pharmacy. Also brought to the FTC’s attention is how aggressive auditing is used to recoup funds from community pharmacies on minor technicalities.

Prescription Drug Use by Children

ABC News reports that prescription drug use by children has increased in the past year by 5 percent. Overall prescription drug use increased only 1.3 percent.

It is concerning that children are being treated with drugs normally used by adults, such as cholesterol fighters and Type 2 diabetes.

...they noted that more children are being treated with cholesterol fighters or powerful anti-psychotics normally used by adults.

DMC Story

Here is an article from NPR on the new DMC deal in Detroit.

A few weeks ago, officials with the Detroit Medical Center, the city's largest health system, made an announcement that was as startling as it was welcome: that they intended to sell the nonprofit to an investor-owned company. As part of the deal, Nashville-based Vanguard Health Systems promised to spend $850 million on much-needed capital improvements. If the deal goes through, hospital officials say it will be the largest single investment in Detroit ever.

CVS Caremark Lobbying Numbers

Businessweek has the numbers for CVS Caremark's lobbying.

$1.98 million in only the first quarter.

Its lobbying interests included changes to Medicare and Medicaid programs that were made as part of the health care overhaul. Those included the elimination of the "donut hole" coverage gap in the Medicare Part D drug benefit. CVS also discussed reimbursement rates for generic drugs, changes in coverage, and regulation on generic biologic drugs.

The company lobbied on antitrust legislation, along with disclosure requirements, employment, and training, and the Federal Employees Health Benefits Program.

Lansing Sues Retail Pharmacies

The City of Lansing is suing several retail pharmacies. It accuses the stores of violating a state law that covers the sale of generic drugs and overcharged city workers.

...city attorney Brig Smith alleged that Walgreens, CVS and Rite Aid violated a law that exists in three states, including Michigan, and restricts the amount of profits that retail pharmacies can collect from generic drugs.

CVS Investigation

CVS continues to run into problems. The company revealed that it is under investigation in 24 states because of its business practices. A primary focus of the investigation is whether CVS gave incentives for customers to transfer their prescriptions to CVS.

CVS Caremark Corp., the largest U.S. provider of prescription drugs, said its business practices are under investigation by 24 states.

The probe is similar to one that was started by the U.S. Federal Trade Commission last year, CVS said in a filing today. The District of Columbia and county of Los Angeles are also participating in the investigation, according to the filing. CVS said it’s cooperating with the investigations.

A multistate task force is reviewing the relationship and practices of CVS and Caremark following their 2007 merger, Connecticut Attorney General Richard Blumenthal said in March. The offices of the attorneys general of Illinois and Florida also confirmed in March that they were taking part in the investigation.

CVS also said it received a subpoena from the Office of Inspector General within the U.S. Department of Health and Human Services for information on incentives for customers to transfer their prescriptions to CVS’s pharmacies. Offers included gift cards, cash, non-prescription goods and coupons, according to the filing with the Securities and Exchange Commission.

Prescirption Drug Thefts are Increasing

The Associate Press reports that thefts of large lots of prescription drugs is increasing.

Pharmaceutical heists in the U.S. have quadrupled since 2006, a coalition of industry and law enforcement estimates. And experts say the reasons include spotty security and high drug prices that can make such thefts extremely lucrative.

Vitamin D Supplements for Infants

New research is indicating the need for Vitamin D supplements for infants.

Personally, I take Vitamin D supplements and strongly encourage others to do it.

Prescription Disposal

Cape Cod is another community reconsidering how prescription drugs are disposed. The community depends upon a single water source. Contamination of the water supply is carefully monitored.

We must reach a better solution for disposal of prescription drugs across the nation. Disturbing reports of their effects on amphibians and fish should be enough to convince stakeholders of the necessity of action.

Wisconsin Prescription Drug Law

Wisconsin lawmakers are attempting to rid a 1939 law requiring a minimum mark-up on wholesale prescription drug prices. If passed, this will allow large companies like Wal-Mart and Target to sell prescriptions at a steep discount.

Community pharmacists are fighting this law hard.

The American Workers, State, and Business Relief Act of 2010

The Senate passed the American Workers, State and Business Relief Act of 2010. If signed into law, this bill will extend Medicare reimbursement rates at their current level and extend for 6 months a temporary increase in the federal medical assistance percentage.

This bill will probably have effects on DME accreditation as well. I will link to information on that shortly.

Newsletter Reminder

Reminder: Email me your address if you want to receive my newsletter but currently are not on the mailing list.

The newsletter is a great resource for health professionals.

Fish Oil Supplement Problems

ABC News reports that fish oil supplements have PCB contaminants.

According to California law, people should not be exposed to more than 90 nanograms of this carcinogen a day. But the results of the activists' tests showed three of the 10 -- Nature Made Cod Liver Oil, and Now Foods' Salmon Oil and Double Strength Cod Liver Oil -- contained much more than that.

Nice Article

Here is a nice article from the New York Times on the struggles that independent pharmacies have against chain pharmacies.

It highlights the extra mile that these pharmacists will go to ensure their patients' health and happiness.

Prescription Disposal Assistance During Earth Week

The National Community Pharmacists Association (NCPA) is working to promote proper prescription drug disposal this Earth Week.

This press release explains some of the details.

Proper prescription drug disposal is a benefit to the environment and community.

Lawyers USA Blog Post

One of my cases was cited and I was interviewed for a Lawyers USA article regarding the Nevada pharmacy liability case. I cannot link to the blog entry because it is a subscribers' only site.

It it nice to be recognized in the field as an expert with an important case history in health care law.

Newsletter

I am currently working on a new newsletter that we hope to have sent out in the beginning of March.

As always, if you have any comments regarding the newsletter of wish suggest topics, please contact me. My email address is cpencak@pharmacylawpro.com

California Pharmacy Labeling Law Rejection

The Los Angeles Times reports on a rejection of a pharmacy labeling rule in California. The pharmacy board was set to vote for new labeling rules for prescriptions until Governor Schwarzenegger appointed a CVS executive to the board the day before the vote but left three other spots vacant. The rule was defeated in a 5-4 vote.

Not only did CVS oppose the vote but so did one of Governor Schwarzenegger's largest campaign contributors- the California Retailers Association. The Association has contributed over $400,000 to his political committees.

What are your thoughts on this?

Early Education Changes

As changes to education standards are considered, I have a couple suggestions.

First, children should be taught how to think from an early age. If children know how to think, they can learn anything easier. Theories of logic, deductive reasoning and inductive reasoning are applicable across all subjects.

Second, in addition to practical finances, students need to learn practical probability and statistics. This will make them smarter with their finances, better citizens and lead to smarter medical decisions. Casino patrons will have a better idea that their chance of winning is slim. Voters will better understand political polls and concepts such as loaded questions leading to desired answers. Even medical decisions, such as new drug choices, will be affected because patients will understand studies regarding the effectiveness of new drugs.

Time for Change for Performance Enhancing Drugs?

Is it time for a new look at performance enhancing drugs? Should we make the drugs legal through prescription?

Look at any bodybuilding forum online and it is clear that their availability is widespread. If an athlete wants to use the drugs, he/she can. Their level of knowledge is quite impressive. Users combine multiple drugs to achieve the benefits while counteracting the side effects. Yet the manufacturing of the drugs can be suspect and their safety should be questioned.

But this knowledge comes from others’ trial and error and locker room talk. It would be safer for knowledgeable physicians to prescribe performance enhancing drugs. Physicians and pharmacists can monitor the long-term effects and ensure a safer supply of drugs.

I see performance enhancing drugs being especially important for motivating people to exercise. Why should we prescribe drugs like Lipitor to lower cholesterol but not prescribe drugs that will help and encourage people to exercise? The drugs can help people achieve and see results faster and encourage them to continue exercising.

Atypical Antipsychotics MOA

Do any of the physicians or pharmacists out there know the mechanism of action that causes weight gain in patients taking atypical antipsychotics?

Please let me know.

I would be interested in looking at the MOA and what suggestions this might hold for weight gain. Conversely, can we learn anything more about weight loss from the MOA?

Technology in Health Care

The Nashville Business Journal reports on a talk that Steve Ballmer gave at the Nashville Health Care Council. The main point of his speech was the distance that health care has to go to catch-up to technology. Yet, it is an area which can benefit extensively from improvements in health care.

“I’m optimistic. The money is coming. The national debate has been engaged. And now is the time where our industry may be able to step up with some enabling factors and make an even bigger difference,” Ballmer said.

It is amazing that health care technology seems to lag so far behind other sectors, yet technology offers so much that can improve our profession to improve patient safety and health. It can even allow us more time to interact with patients. After all, that is what we went into practice for.

Ohio Prescription Database Fight

According to the Cleveland Plain Dealer, the Buckeye State Sheriffs' Association is working with the Ohio State Board of Pharmacy to write a law requiring doctors, nurses, dentists and others who write prescriptions for narcotic pain killers to consult a database. This is meant to prevent patient drug abuse.

According to the paper, Ohio would be the second state after Nevada to have this requirement.

However, doctor groups are expected to oppose this law because it adds another requirement.

Jeff Smith, director of government relations at the Ohio State Medical Association, said the group would likely oppose any mandate on doctors forcing them to check a database for prescriptions.

"We're not ready to agree to that kind of administrative burden on the Ohio physicians," Smith said, adding that it would hit doctors at a time when they are seeing more patients and implementing their own electronic medical records.

Doctors receive training on what to look for and how to evaluate potential patients who are doctor shopping for dangerous pain medications, Smith said.

However, he said, the statewide doctor's association is willing to work with the pharmacy board to understand why physicians aren't already voluntarily participating.

What are your thoughts on this? It often is the pharmacist who is required to verify that patients are not doctor shopping and abusing prescriptions. This bill attacks the problem from another angle. Is it more effective this way or through pharmacies?

Medical Cost Database

A state representative in Colorado is pushing a bill to create a state medical cost database. Basically, this would allow for transparancy into medical costs at various locations across the state.

The database systems combine information from all patients, whether they paid through private health insurance, Medicaid or out of their pockets.

Kefalas said he'd like to see Colorado's system track the cost of various episodes of care and compare them to similar situations in other parts of the state.

This is a good idea to help illuminate some of our medical care costs and perhaps a step in the right direction to lower them.

Healthcare Reform Benefit

One of the greatest benefits that a true healthcare reform act can have is to prevent "job lock". This happens when employees fear leaving their employer to begin their own businesses because the employee fears losing health care.

But the opportunity cost of sticking around a larger company for the coverage can be steep. Job lock costs U.S. workers an estimated $3.7 billion every year in foregone wages, according to a 2009 report from the White House Council of Economic Advisers.

Imagine if we had true universal healthcare. The entrepreneurs in our society would have the freedom to pursue their dreams and reinvigorate business with new companies and ideas because they would not have to fear losing their healthcare.

FTC Ban on 'Pay to Delay'?

According to the USA Today, the FTC wants to ban drug companies from paying to delay generic alternatives.

Agency officials estimate the deals cost American consumers $3.5 billion per year in unnecessarily high drug prices.

The FTC advocates making this ban in the healthcare reform bills being negotiated.

Disturbing Quote

From the Seattle Post Intelligencer, this is a disturbing quote from a pharmacy robber:

A 14-time felon has been charged with robbing the Maple Leaf Pharmacy and the Ballard Walgreens with an illegally possessed handgun, and is suspected of robbing the Reckless Video in Maple Leaf last month.

Jacob Harley Shook, 29, was released from the Monroe prison about six weeks ago, and told a friend he met there "robbing pharmacies for OxyContin is the only way to go," according to court documents.

More Outsourcing

Walgreens and Genpact have reached agreement to have Genpact provide accounting service. Genpact is a business outsourcing company. Note where there company has centers. According to their website, "We strive to be the first mover in a location to corner talent and set industry standards. We eagerly adopt Tier-2 cities to expand the talent pool, while maintaining price advantage for our clients." In other words, they look to be "the first mover" to take advantage of cheap workers.

This is another sellout of jobs overseas when our economy needs it least.

South Dakota Database

South Dakota is taking steps to implement a database to prevent doctor shopping. With the economic problems, questions remain whether the project could receive long-term funding. Additionally, it remains to be seen which government agency would supervise the database. The Attorney General is a supporter-

Attorney General Marty Jackley doesn't see money as a problem. Federal grants are available for start-up, and a pool of money from legal settlements can pay the bills for as long as 10 years before the state would need to look for more federal money or increase fees or taxes to maintain the database.

What are your thoughts on these systems? Have you as a pharmacist been subjected to increased burdens and problems?

Asian Carp Invasion

I hope people have been following the ominous progress of Asian Carp towards the Great Lakes. We must do more to prevent invasive species from invading the Great Lakes. Not only do they ruin local ecosystems, but they cause BILLIONS of dollars in damages.

Zebra mussels and other invasive species have already taken hold, but we can still prevent the Asian Carp from ruining our precious resources.

FDA Scam

Multiple sources are reporting on a scam being run by individuals calling people posing as the FDA. The scammer tells individuals that they are violating law by purchasing their medicine from outside the country. If the individual doesn't pay, they will be punished. This leads to individuals paying thousands of dollars to the scammer out of fear.

Helping to prevent innocent people from being scammed is another reason for strong community pharmacists. A strong pharmacist-patient relationship is more valuable than a few dollars saved from buying questionable drugs from online.

Extortionists posing as federal agents have taken as much as $31,000 from frightened people who thought they would be prosecuted for purchasing their medications from outside the country, federal regulators say.

Nevada Supreme Court Case

I've discussed this case previously on the blog, but the Nevada Supreme Court rendered a decision in Walmart v. Sanchez. This decision has a positive outcome for pharmacists.

The Nevada Supreme Court has ruled that pharmacies are not liable for the actions of their customers when those medicated patients cause harm to third parties. The much-anticipated ruling comes in a case filed against Wal-Mart and other local pharmacies involving a Las Vegas woman who killed one person and injured another while driving under the influence of prescription drugs.

Happy Holidays and Happy New Years

I hope everyone enjoyed the holidays and had a wonderful New Year. Look for more activity on the blog now that the holidays are over.