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.