Drug Topics Voices 12-10-2014

Follow the money

Re: “Generic drug price hikes cause hardships for pharmacies, patients” [Julia Talsma, November 21, www.drugtopics.com]:

In any other industry this would be considered PRICE-GOUGING, so why is the pharmaceutical industry allowed to continue with such unreasonable increases?

In most cases, I do not approve of government regulation, but it seems the industry refuses to regulate itself in this case.

The statement that “it is unclear what factors are driving the ... continued price increases” is not that difficult to answer. It is what drives most corporate decisions - greed.

Marilyn Coffman
Posted at www.drugtopics.com

Guess who (really) pays?

One of the biggest reasons for generic drug price increases is the kickbacks that generic drug manufacturers have to pay pharmacy benefit managers (PBMs), discount drug cards, chain drugstores, and the federal government. This also holds true for brand-name manufacturers having to pay kickbacks. These kickbacks increase the cost of prescription drugs to every man, woman and child in the world!

John Patton
Posted at www.drugtopics.com

And guess who gets?

Perhaps some of you have forgotten how our government works!

In this free economy, we do not have price controls.

In order for the healthcare bill to pass, it had to have the backing of the pharmaceutical manufacturers. The brand-name manufacturers, generic manufacturers, PBMs and insurance industries pour billions of dollars yearly into Washington. Why would you expect those receiving those dollars to cut them off by seeking to serve the taxpayers and voters of this country with price controls or regulations?

Congress has passed laws requiring the brand-name manufacturers to pay rebates on brand-name medications sold through Medicare, and now it is after the generic manufacturers to do the same. The manufacturers would not have supported Obamacare if price controls had been a part of the bill, and the bill could not have passed without their support. The manufacturers are only paying themselves off for their support of the bill.

If you have not been asleep, you should also know that the bill was passed without those passing it having read it.

The American population has just reelected back into office the majority of those who have been depleting your wallets for years. Evidently our population has not seen the need to elect a new crop of criminals and thieves, and enjoys being taken advantage of.

We do not have a budget.

If you in your business had employees who did not perform up to your expectations, would you keep them and hire more like them so you could lose money and your business too? The American public has done just this and has yet to realize that the money that the government spends is their money.

Most of us in the frontline of healthcare who actually take care of patients work hard and long, and do more and more for less and less.

We all need to do a better job of explaining to the general population who we are and what we do, and work toward change for a better society for our children and grandchildren, and those who will follow us as healthcare providers.

Ed Hackney
Atlanta, Ga.

It’s not just generics

Re: “Senate hearing will explore soaring prices of generic drugs” [Mark Lowery, November 14, www.drugtopics.com]:

Why limit it to generic manufacturers? Lantus, Levemir, and Humalog alone have gone up as much as 47% over the last 14 months.

Doug Bennett
Posted at www.drugtopics.com

You think?

Wonder if these price increases have anything to do with the ACA. Remember the drug companies made a deal with the government back in 2009?

Also, was it really because of unsafe practices that those manufacturers were shut down, or is Big Brother using the FDA the way it uses the IRS?

Why do we have to wait until 2016 to have the generic pricing problems fixed? They didn’t take that long to pass the ACA. Why are we quietly standing by and watching?

Randall Davis
Posted at www.drugtopics.com

Who needs a hearing?

Because “Greed is Good.” I don’t think Congress, especially the Senate, needs to hold a hearing on this. Anyway, it might detract from the time they need to count all their cash coming from Big Pharma PAC’s.

Anonymous
Posted at www.drugtopics.com

What would you call it?

Re: “Pharmacists on pharmacy: Drug Topics readers speak out” [November 19; www.drugtopics.com]:

In regard to gouging by compounding pharmacies, what do you call drug companies that charge almost $1,000 for a bottle of 30 tablets of a drug - cost-effective prescribing?

The insurance companies will hem and haw a bit, but will pay if the coding is right. It seems more like a bias. Or maybe Big Pharma, insurance companies, and the glorious FDA are in cahoots. I have seen a lot over 40+ years to make me doubt the big pharmaceutical companies and the FDA.

As for the insurance companies, they strain to swallow a gnat and swallow the camel with ease.

Anonymous
Posted at www.drugtopics.com

PBMs again

I am appalled at the way pharmacies are being underpaid by PBMs. When
reimbursements below cost (RBC) occur, there is very little a pharmacy can do to fix the problem. The PBMs make you fill out a form and they review it, and if they feel it does need an adjustment they will adjust it on the next fill - and will not go retroactive, so you lose on that fill.

Then there is a hidden DIR fee for preferred pharmacies done on the back end of claims that don’t appear on adjudicated claim fields. They show up later on the remittance advices. So you can never really figure out the true reimbursements.

I want everyone in the country to know that the PBMs are going to be the end of pharmacy if they can get away with RBCs.

Gary Einsidler, RPh
Boston, Mass.

It could happen to you

I recently read the articles on e-Rx issues published online in June 2014 [“Electronic prescriptions: Return to sender,” The Cynical Pharmacist, June 10; “E-Prescribing: The end of prescription errors? Hardly,” Tom Hanson, June 11] and thought I would share an issue that was not mentioned.

Surescripts and pharmacy management systems (EnterpriseRx) call it “looping.” It happened to me, and there was no simple resolution for the issue.

The doctor transmitted an e-Rx and my pharmacy received it. Somehow the exact same e-Rx kept showing up on my pharmacy system every 10 seconds, and it would not stop.

I called Surescripts and they told me the looping occurred from the doctor’s computer and they could not stop it. I called EnterpriseRx and they claimed they didn’t have control and could not shut my system down to disconnect and stop receiving any eRx. I called all over, even to the doctor’s private lines, and couldn’t reach her.

Surescripts finally got hold of the doctor and got the looping to stop. But before that happened, it went on for hours, and I couldn’t get any valid new e-Rx for my pharmacy.

I also had to pay for every single looping e-Rx that came to my pharmacy. I was out a couple hundred dollars. Surescripts and EnterpriseRx refused to pick up the tab.

This could happen again to me or any other pharmacy. Hopefully someone from Surescripts or EnterpriseRx has found a solution for this by now.

It is so unfair for us to get charges for the e-Rxs - and assuming that the doctors are not compensated for transmitting them.

Kevin Dang, PharmD
San Jose, Calif.

And now, for something completely different

Re: “Washington pharmacists fighting Plan B mandate” [Mark Lowery, Dec. 2, www.drugtopics.com];

Maybe the state of Washington should mandate that CVS pharmacies sell tobacco.

Bill Sarraf
Posted at www.drugtopics.com

Beg to differ

Posted November 30 re: “E-cigs: Healthy tobacco alternative? Definitely not” [Madeleine Bile, Student Corner, September]:

I really wish this author had spent a little more time researching this topic. Her article pretty much looks like what you’d find if you googled “E-cigs bad.”

She also refers to what is exhaled as “second-hand smoke.” The exhalant of e-cigs is water vapor.

As a pharmacist and former 20-year smoker, I have not touched a regular “analog” cigarette in two-and-a-half years since I started using electronic cigarettes. I also have no problem recommending them to current smokers.

The accidental poisoning of young children with the nicotine liquid is no different from a parent leaving gummy vitamins out where a child can get them and overdose. If we used this excuse to say that e-cigs are dangerous and should not be used, than I need to walk out and pull all the yummy childrens vitamins off the shelf.

I do agree that more research needs to be done, but there is no reason to paint such a broad picture and say that they are not beneficial in helping people quit smoking. I am proof that they do work.

Anonymous
Posted at www.drugtopics.com

Supplemental info

Re: “Can dietary supplements help manage type 2 diabetes?” [Mark Lowery, Diabetes Supplement, November]:

I don’t have a lot of time for a blow-by-blow extirpation of all the assumptions, misdirections, and generalities expressed in this article, but I have to say something to help balance this one-sided attack on all that is non-Pharma.

First of all, some people (maybe a lot of people) are chromium-deficient. So exploring this with a lab test might reveal those patients who would benefit from 500 to 1,000 mcg of chromium with each meal. Try it. It works. There IS evidence for this.

Second: Berberine has been shown in studies to be equal to metformin for reducing blood sugar. It has an added benefit of controlling yeast overgrowth in the gut, which is a primary driver of carbohydrate cravings. This is the gut-brain connection that you may have heard about. Try 500 mg PO BID and get back to me.

Third: Magnesium’s role in glucose metabolism is well known. It is also well established that somewhere between 60% and 75% of the population is magnesium-deficient. Ask for an RBC Magnesium Level on a lab slip to deterimine the extent of the nutritional deficiency.

The overuse of diuretics (hey! they don’t work for hypertension - stop using them!), the (over?)-consumption of caffeine, and the low mineral content of our processed-food diet contribute to this deficiency.

The problem is that most pharmacists don’t understand that the salt form of the magnesium makes all the difference in bowel tolerance. In fact, so many doctors are misinformed that they have scared my patients about taking magnesium. I tell them that all they have heard is wrong.

If a knowledgeable pharmacist or doctor were to recommend an amino acid chelate (like Mg glycinate or Mg threonate or Mg maleate) and give half a dose in the morning and two-thirds of a dose in the afternoon, there wouldn’t be any issues with loose stools and the patients would sleep better, have stronger bones, less anxiety, and better blood sugars. Most people have a 1,200-mg elemental magnesium deficit.

How about Vanadium? See chromium above.

What about advanced glycation end products (HbA1c and fructosamine levels)? These are the major contributors to erectile dysfunction, hypertension, Alzheimer’s disease, coronary heart failure, stroke, macular degeneration, renal failure, cataracts, atherosclerosis, etc., etc. And peripheral neuropathy.

(Also see “Advanced lipoxidation end-products,” http://www.ncbi.nlm.nih.gov/pubmed/23767955.)

Are there any pharmaceutical agents addressing this problem? Are pharmacy school students taught about this pathology? Are there any supplements that address advanced glycoxidation and lipoxidation end products (AGEs and ALEs)?

Turns out there are! L-carnosine, alpha lipoic acid, berberine, benfotiamine, pyridoxine-5-phosphate, methyl-B12, biotin, d-chiro inositol (this one is really good for Polycystic Ovarian Syndrome), cinnamon(!), Yerba mate tea, etc., all reduce the formation of AGEs, RAGEs, and ALEs.

Lastly: Antioxidants. Do they have a role? Or have they, too, been relegated to the used car lot? Read the literature on PubMed (mounds of it) that supports the use of antioxidants in the treatment and mitigation of diabetes and its sequelae.

Pharmacists shouldn’t ignore the evidence about supplements in the treatment and mitigation and reversal of diabetes so as to accommodate their patients’ misguided attempts to self-treat their diabetes.

They should use that evidence to support and promote the health of these better-informed patients who realize that a lifetime of metformin, insulin, and bad dietary advice will just put them in their graves faster.

Diabetes is a curable disease, but drugs won’t cure it.

Mark Burger
Posted at www.drugtopics.com