What to Know

Yes, we can be embarrassed

Yesterday we pointed out that Georgia has the third-worst* level of medically uninsured people of the 50 states (plus DC). Today we have numbers courtesy of WalletHub, which looks at individual cities. Not a pretty picture.

Out of 547 metropolitan areas in the U.S., John’s Creek is the only Georgia city where fewer than 10 percent of adults are uninsured (8.3 percent); it ranks #215 on the list.

Columbus (#370) and Atlanta (#387) are the next highest-ranking.

Albany has the state’s highest uninsured rate, with more than one in five adults not having health coverage. Savannah isn’t much better off (19.6% of adults aren’t insured).

And then there’s Warner Robins, where almost 10 percent of kids aren’t covered.

*WalletHub says we’re fourth worst; we’re above Alaska

If you don’t like children…

…put them in your lap and go down a slide. You increase their risk of injury. The more you know.

Worried about a lack of Zika coverage?

Don’t be. Seems that hurricanes like Irma and Harvey make great conditions for Aedes aegypti mosquitoes.

Eat chocolate to lose weight

Study 1: “[T]he proportion of some bacteria in the gut may be responsible for how much weight we are able to lose.”

Study 2: “Several studies show that the consumption of cocoa increases the levels of so-called friendly bacteria in the gut.”

Ergo, eat chocolate to lose weight, right? Right?

Coffee Watch™

Caffeine — particularly from coffee — can apparently cut diabetic women’s risk of death in half. (If you’re only worried about death from cancer, tea is OK.) This comes from a new study presented at the European Association for the Study of Diabetes Annual Meeting.

The more the better, in fact.

This observational study found that the more caffeine women consumed the lower their risk of dying compared to those who never consumed caffeine. Importantly, the protective effect depended on the source of the caffeine: higher levels of caffeine consumption from coffee were associated with a reduced risk of death from any cause, particularly from cardiovascular disease; while women who consumed more caffeine from tea were less likely to die from cancer.

—Andrew Kantor • Sep. 18, 2017


Georgia’s uninsured rate is better, but still bad

Georgia’s uninsured rate dropped to only 12.9 percent — but we’ve still got the third-highest rate in the nation. (Only Texas and Oklahoma are worse.) And did you know that it’s illegal in Georgia for a state employee to advocate for Medicaid expansion? Click here for the full details from Census.gov.

Perhaps a spoonful of sugar?

Lack of medication adherence isn’t just bad for patients — even worse, it’s bad for drug companies, which lose billions of dollars when prescriptions aren’t refilled.

Getting people to take their meds isn’t easy. But that hasn’t stopped a lot of people from trying.

If you give a firm a loophole….

So remember how Allergan found a way (at least temporarily) around U.S. patent law by selling six patents to the Mohawk Tribe, which is out of federal jurisdiction? It seems SRC Labs has a similar deal. And pundits wonder: Could Pfizer be next? Or AbbVie?

*Fun fact: Repeated polls find that American Indians prefer being called by their tribe name (e.g., “Mohawks”) or “American Indians,” rather than “Native Americans.”

Next thing you know, they’ll invade Russia in the winter

Drug makers are busy, busy, busy fighting battles on a lot of fronts. They’re fighting a proposed pricing-transparency law in California, they’re spending millions fighting Medicaid drug-spending limits in Ohio, and they’re fighting a Japanese plan to lower drug costs by reviewing pharmaceutical payments every year instead of every two years.

Stupid is as stupid does

Martin Shkreli is in custody, bail revoked, after making an offer on Facebook: $5,000 for a strand of Hillary Clinton’s hair. That’s called “solicitation to assault.”

Zombie Watch™

Yet Another Obamacare Repeal Attempt.

—Andrew Kantor • Sep. 14, 2017


Georgia Medicaid change period ends soon

The Department of Community Health wants you to remind your patients on Medicaid that the Georgia Families Choice Change Period will end on September 30, 2017.

Members can change their current Care Management Organization (CMO) between until then. Members who do not choose their selection will remain in their CMO until the next open enrollment period.

The easiest ways to change a CMO selection during the Choice Change Period: Online at to www.georgia-families.com or by phone to (888) GA-ENROLL (423-6765) from 7:00 a.m. – 7:00 p.m. Monday through Friday.

Cancer: good news and bad

The latest report from the American Association for Cancer Research finds that the cancer death rate is declining, but new cancer cases are going to skyrocket — almost doubling by 2030. Why? Because people are living long enough to get cancer.

An now 16 hours of words from our sponsors

Americans watch an average of 16 hours of pharmaceutical ads a year, claimed Senator Claire McCaskill. (The U.S. and New Zealand are the only countries that allow such ads.)

But is that number accurate? Stat News crunched the numbers and … holy moly, it is. (And that’s assuming we watch only a few hours of TV a day, as people claim.)

Japanese students pay a visit

A group of student pharmacists from Hiroshima University stopped by the GPhA Headquarters as part of a week-long visit to learn more about pharmacy in Georgia and the U.S.

GPhA CEO Bob Coleman is on the left, next to Christine Klein, Mercer’s vice chair of experiential education. On the right is 2014 Mercer grad Stephanie White, PharmD. Click to enbiggenate.

This is a THING? What the heck?

Sulfur burps? (Note this useful information: “Treating sulfur burps typically involves treating the underlying cause.”)

—Andrew Kantor • Sep. 13, 2017


Rise up (at least twice an hour)

Getting up and moving around just every 30 minutes can probably counter the effects of sitting all day. (Not that this applies to you, but it’s worth mentioning to patients with desk jobs.)

What’s your CPE look like?

Let’s see… 30 hours every two years, so you should have about 10.4 hours of CPE completed by now.

Are you behind? You might want to check out our CPEasy webinars, or even our print-and-mail CPE lessons. It’s all on GPhA.org/education.

Or you could, you know, just panic next October when the licensure deadline looms. Your call.

So what does it really cost to bring a drug to market?

A new study that looked at 10 cancer medications found that the median development cost was only $757 million per drug — not the $2.7 billion that companies often cite when justifying soaring drug prices.

The drugmakers saw a total 700 percent return on investment.

But wait! say critics. That doesn’t take into account all the failures that happen before a working medication is created.

But wait! point out the authors. Yes, it does. The figures “include the companies’ total spending on research and development, not just what they spent on the drugs that succeeded.”

You don’t say

Advisory committee to FDA: Yeah, opioids in kids’ cough meds? Bad idea.

(Addiction isn’t the issue, “rather, that there’s little evidence the drugs work to treat cough in children, and there’s lots of evidence that they can have serious side effects.”)

How much naloxone should first responders carry?

Georgia’s PharmD on Demand crunched the numbers. The answers?

  • Law enforcement: 4 mg nasal spray per officer and 4 mg available for K-9 partner (usual dose 0.04-0.1mg/kg nasally)
  • EMS first responders: two 2-mg naloxone prefilled syringes per EMT
  • EMS drug boxes: four 2-mg naloxone prefilled syringes

—Andrew Kantor • Sep. 12, 2017


Quick Irma updates

Emergency refills. Remember: You can give emergency prescription refills to your patients and to evacuees (under certain circumstances). See GPhA.org/irma for details.

Healthcare Ready has activated the RxOpen map for Hurricane Irma. They will be actively tracking the storm and standing by ready to assist with requests for information or assistance at alerts@healthcareready.org or (866) 247-2694.

“Rx Open is an interactive map that helps patients and providers find nearby open pharmacies in areas impacted by disaster. The map will be updated daily throughout the federally-declared disaster.”

Refill Too Soon” Override. Use the Submission Clarification Code 13 — Payer-Recognized Emergency/Disaster Assistance Request.

Hat tip to Shawn

Shawn Hodges that is, GPhA member and owner of Innovation Compounding Pharmacy. He’s testifying on Capitol Hill this week on “Preserving Patient Access to Compounded Medications.”

(American) Indian giving

Got a patent you want to protect? Why not sell it to the Mohawk Tribe?

Under the deal, which involves the dry-eye drug Restasis, Allergan will pay the tribe $13.75 million. In exchange, the tribe will claim sovereign immunity as grounds to dismiss a patent challenge through a unit of the United States Patent and Trademark Office. The tribe will lease the patents back to Allergan, and will receive $15 million in annual royalties as long as the patents remain valid.

They don’t really know what they’re doing

When your patients walk away, medication in hand, more than half are likely to misuse them — not taking them, taking them with something they shouldn’t, or taking the wrong meds entirely.

Oh, and a different story reports that a third of people stop taking their prescriptions entirely, without telling a healthcare provider.


This story is getting so much airtime we had to include it. Yes, apparently sleeping with your dog in the room is a good thing — but not actually in the bed. (Here’s the full study from the Mayo Clinic.)

Gotta admire his dedication

Why so serious?

Georgia is the 30th happiest state in the nation. (Minnesota is the happiest, in case you were wondering. Hawai’i, oddly, is number 3. Unhappiest? West Virginia.)

Could this be “Lee”?

—Andrew Kantor • Sep. 12, 2017


Hurricane Irma and pharmacy

There is an official state of emergency for 30 counties in Georgia* (see list below).

In those 30 counties, Emergency Refill Dispensing rules are in effect for the duration of the emergency.

Per the Board of Pharmacy:

“[A] pharmacist may dispense a 72 hour refill supply of a prescription drug repeatedly to a patient, but in total not more than a thirty (30) day supply, without practitioner authorization if:

  1. The refill is not for a controlled substance;
  2. In the pharmacist’s professional judgment, the prescription drug is essential to the maintenance of the patient’s life or to the continuation of therapy;
  3. The pharmacist makes a good faith effort to reduce the information to a form that may be maintained for the time required by law or rule, indicates it is an “emergency refill prescription,” and maintains the record as required by state and federal law and as required by state and federal disaster agencies for consideration for possible reimbursement programs implemented to ensure continued provision of care during a disaster or emergency;
  4. The pharmacist informs the patient or the patient’s agent at the time of dispensing that the prescription drug is being provided without the practitioner’s authorization and that authorization of the practitioner is required for future refills; and
  5. When emergency conditions permit, the pharmacist notifies the practitioner that the refill occurred.”

We’ll keep updated info on GPhA.org/irma — check that out.

* Appling, Atkinson, Bacon, Brantley, Bryan, Bulloch, Burke, Camden, Candler, Charlton, Chatham, Clinch, Coffee, Echols, Effingham, Emanuel, Evans, Glynn, Jenkins, Jeff Davis, Liberty, Long, McIntosh, Pierce, Screven, Tattnall, Toombs, Treutlen, Wayne, and Ware.

Corporate responsibility

In the face of the opioid crisis, here’s a great story on how one drug distributor is faced with the ‘bottom line vs. good of society’ conundrum. It gets even stickier when shareholders begin demanding changes to business practice.

Establishing rigorous systems to prevent drug diversion and illicit sales is expensive. It requires employees, investment in technology, and a willingness to rat out customers—some of the most lucrative ones. Selling lots of pills adds to the bottom line.

What’s in it for me?

Consumers, says Nielsen, want to know what’s in their products. And that’s not just food — it includes supplements and beauty products. (They’re more interested in what’s not in a product, in fact: artificial this or that, high-fructose corn syrup, spider eggs … you get the picture.)

39% of consumers in the United States say they would switch from their current brand to one that provides clearer, more accurate product information, and 68% are willing to pay more for foods and beverages that don’t have ingredients they perceive as bad for them. For 53% of consumers, the exclusion of undesirable ingredients is more important than including beneficial ingredients.

Pharmacy owners (and owners-to-be) should keep this kind of insight in mind. If the label doesn’t have the info, you should. (Click here for the full report as a PDF.)

Pro tip for opioid makers

If you’re going to trick an insurer into approving your medication for a patient, you really need to be sure that 1) you aren’t recorded lying to get the approval, 2) your company hasn’t already been warned about committing just that type of fraud, and 3) the patient doesn’t die from taking your pills.

[The employee] can be heard lying to an insurer about the prescription for Fuller, who did not suffer from breakthrough cancer pain and, in fact, had a history of addiction to other opioids. Nonetheless, the Insys representative lied to a call center working on behalf of the insurer in order to win authorization.

Zika may be part of a pattern

A combination of global commerce and global warming means that invasive species of mosquitoes are gaining footholds in places they haven’t been before.

See Jane read. Read, Jane, read.

While ‘presidential speeches, novels, and news articles’ are using simpler and simpler language, the opposite is true for scientific papers — they’re getting harder to read, and thus harder for the public, lawmakers, and even journalists to understand. And that ain’t good.

(Why? “[A]n increase in general scientific jargon over years” and possibly “the cumulative growth of scientific knowledge makes an increasingly complex language necessary.”)

An anti-depressant for Parkinson’s

The anti-depressant nortriptyline (aka Pamelor) might slow or even stop the onset of Parkinson’s by preventing the creation of the proteins that lead to the disease. Or, as the paper put it, “Nortriptyline inhibits aggregation and neurotoxicity of alpha-synuclein by enhancing reconfiguration of the monomeric form.”

Georgia gets some cash to fight opioids

The CDC is giving states, including Georgia, $28.6 million to track — and prevent — opioid abuse. The money is part of three programs: Prescription Drug Overdose: Prevention for States, the Data-Driven Prevention Initiative (DDPI), and Enhanced State Opioid Overdose Surveillance.

The latter two include money for Georgia. The DDPI will pay to “scale up prevention activities that include increasing the use of prescription drug monitoring programs and improving clinical feedback from these systems,” and the ESOOS funds will be used by medical examiners and coroners to “for enhancing their surveillance activities.”

Wait, what?

A high-fat diet may be good for you.

Too much meat may lead to diabetes.

Zika injections (!) might fight brain cancer.

—Andrew Kantor • Sep. 08, 2017


Adams becomes Surgeon General

Jerome Adams was sworn in as the nation’s newest Surgeon General. He’s the former health commissioner of Vice President Mike Pence’s home state of Indiana.

Fun fact: “The Surgeon General is a commissioned officer in the U.S. Public Health Service Commissioned Corps, one of the seven* uniformed services of the United States, and by law holds the rank of vice admiral.”

*Army, Navy, Air Force, Marines, Coast Guard, NOAA, and Public Health Service

So why does the U.S. have employer-sponsored healthcare?

Other countries don’t do it that way — what’s the deal? The deal is it’s a result of WWII-era wage freezes, and businesses’ need to attract workers … and then an IRS decision to make those benefits tax-exempt. Read the story.

Piling on

Manchester, N.H., joins the list of municipalities* suing drug makers over the opioid crisis. The small city had at least 71 people overdose in August alone.

*I really hate that word

Affording cancer

About one in 10 cancer survivors doesn’t take necessary meds because they can’t afford them. But that number is down from 2010, when about 1 in 7 had to skip their drugs.

Isn’t that special

There are 15 specialty pharmacies on Inc’s list of the 5,000 fastest-growing companies in the country, as Drug Channels reports. Topping the list: Solera, Infusion Express, and PantheRx.

—Andrew Kantor • Sep. 06, 2017


In case Zika isn’t enough …

… you can always worry about West Nile virus, which is already posting bigger-than-average numbers in Georgia this year. Keep that repellent flowing.

Cost of drugs too high? Blame the pharmacy, of course

At least that’s the takeaway from J.D. Power (you know, the company that rates satisfaction).

According to the J.D. Power 2017 U.S. Pharmacy Study, decreases in satisfaction with both brick-and-mortar and mail order pharmacies are driven primarily by declines in satisfaction with cost.

Irony watch

Nevada will start using fentanyl to execute prisoners.

And of course

Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma

(and José)

—Andrew Kantor • Sep. 05, 2017


In case Zika isn’t enough …

… you can always worry about West Nile virus, which is already posting bigger-than-average numbers in Georgia this year. Keep that repellent flowing.

Cost of drugs too high? Blame the pharmacy, of course

At least that’s the takeaway from J.D. Power (you know, the company that rates satisfaction).

According to the J.D. Power 2017 U.S. Pharmacy Study, decreases in satisfaction with both brick-and-mortar and mail order pharmacies are driven primarily by declines in satisfaction with cost.

Irony watch

Nevada will start using fentanyl to execute prisoners.

And of course

Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma Irma.

(and José)

—Andrew Kantor • Sep. 05, 2017


FDA asked to remove ultra-high-dose opioids

A petition has asked the agency to remove pills and sprays that give the equivalent of more than 90 mg per day.

One in three Americans is obese

Look left, look right. If you don’t see an overweight person, guess what?

Follow the dashed line

A new CDC report shows the striking effect of fentanyl and other synthetic opioids on the overdose death rate since 2013.

Click to enlarge:

“Volunteer.” I do not think that word means what you think it means

A federal judge has ruled that penalizing employees for not joining “voluntary” wellness programs makes those programs non-voluntary.

That means they could violate the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act by requiring employees to disclose sensitive information.

Your Zika update

Fewer cases, but that doesn’t mean it’s not lurking out there.

Tomorrow, eye of newt (take 2)

We covered anti-virals from frog mucus. And antibiotics from dragon’s blood. Today: a heart-disease treatment from tick spit.

Speaking of ticks

“The Georgia Department of Public Health has confirmed nearly 20 human cases of West Nile virus so far this year, including at least three deaths. In 2016, there were seven human cases of WNV and no confirmed deaths related to WNV.”

—Andrew Kantor • Sep. 01, 2017