What to Know

I’m gonna live forever, I’m gonna learn how to fly (high)….

People with higher IQs tend to live longer. A 68-year study proves* it — “Childhood intelligence was inversely associated with all major causes of death.” Science!

* Don’t be picky — let us have this moment

Naloxone-resistant fentanyl is in Georgia

Yay. Meet acrylfentanyl and tetrahydrofuran fentanyl, recently discovered by the good folks at the GBI. Acrylfentanyl is particularly nasty, and both can be absorbed through the skin.

Walgreens and Rite Aid call it quits, sort of

There’s no good marriage analogy: Instead of Walgreens buying all of Rite Aid’s stores, it’s only buying half — that’s 2,186 stores and three distribution centers for a mere $5.175 billion. Fred’s is out of the picture.

There’s a national shortage of bee and wasp venom

That’s bad news because the venom is used for venom immunotherapy by people allergic to stings. The two manufacturers both had contamination problems, so physicians have to ration their remaining supplies.

Bonus water-cooler fact: The venom is gathered by hand.

Place your bets now

What will be the bigger health issue this Fourth of July: fireworks injuries or food-borne illness poisoning?

A modest proposal

One Ohio legislator has a solution to the opioid crisis: Let overdosing addicts die. As in, if someone calls 911 for an ambulance, the dispatcher would say, “No.”

At a council meeting last week, [Middletown City Council Member Dan] Picard proposed a three-strikes-style policy for people who repeatedly overdose: Too many overdoses and authorities wouldn’t send an ambulance to resuscitate them.

The idea is to save the city money.

Get out the Purell

Today is National Handshake Day.

—Andrew Kantor • Jun. 29, 2017

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Flu vaccine in a patch, Georgia style

A team from the Georgia Institute of Technology and Emory University have developed a microneedle patch for delivering the flu vaccine.

The size of a band-aid, it’s applied to the skin painlessly, and the tiny needles dissolve when they’re done — just a few minutes. And it can be self-applied (assuming at least a moderate level of intelligence, of course).

If developed, the patch could allow vaccines to be distributed and administered more easily.

Bad news for Merck…

Merck was one of the companies around the world to be hit by the latest ransomware attack that began in Ukraine and spread around the world.

The attack is using software developed by the National Security Agency (“Eternal Blue”), and is similar to the “WannaCry” attack last month.

Are you safe? As long as you let your operating system update itself regularly, yes. Microsoft fixed the vulnerability in March… but apparently not everyone keeps their computers up to date.

…but good news, too

It tested its anacetrapib cholesterol-lowering drug and found that — unlike other companies’ products — it showed significant reduction in heart attacks, strokes, and other cardiovascular, er, events. This is a Very Big Deal, and you’ll certainly be hearing more about it… assuming the company can use its computers anytime soon.

Drugs: hard and soft

What’s a “hard” drug? What’s a “soft” one? Depends who you ask. So researchers looked at 132 scientific papers to get a consensus. They sort of got one, but there are some odd outliers.

Spoiler: Alcohol, marijuana, and nicotine are “soft”; everything else — from morphine to mescaline to opioids to meth — is “hard.”

Risks include…

Consumers have stopped paying attention to warnings in TV commercials for drugs. Solution: Relax the requirements on drug companies to share those warnings.

Obligatory note: Only the U.S. and New Zealand still allow direct-to-consumer drug ads.

—Andrew Kantor • Jun. 29, 2017

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Yes, you can dispense naloxone without a prescription

Georgia pharmacists! Remember: You can dispense naloxone without a prescription. For some reason — despite our e-mails, blog posts, news digests, smoke signals, and whatnot — there are pharmacists and technicians who don’t realize this.

So, once again: You can dispense naloxone without a prescription. There are rules and caveats, of course, so we have a short Web page explaining: GPhA.org/naloxone.

Ask your friends and co-workers to be sure they got the message, too. If not … let them know!

CBO gives report on Senate GOP’s healthcare bill

The bottom line: It would cause 22 million Americans — about one in 15 people — to lose their health insurance because they can’t afford it.

It would save the government $321 billion (over 10 years) “driven by deep cuts to Medicaid and skimpier aid for people purchasing private coverage,” as Politico explained.

The Senate Republican leadership is pushing for a vote this week, but some members are demanding more time to review the details of the bill (which were only released last week) and to meet with constituents.

The American Hospital Association and American Medical Association have already come out against the bill as it’s written, while insurance giant Anthem has said it’s in favor of the bill.

Read the details here or in your favorite news source.

Opioid epidemic/crisis news

Who’s getting opioids? More than half of people who get prescriptions have depression or another mood disorder.

In fact, “19 percent of the 38.6 million Americans with mood disorders use prescription opioids, compared to 5 percent of the general population.”

A Rhode Island physician is leading a group experimenting with emergency naloxone dispensers — think of those defibrillator boxes — starting with a rehab center.

Convention attendees: Tell us what you think

Did you attend the 2017 Georgia Pharmacy Convention? If so, would you please take a few minutes for our real-quick survey? It just asks about what you liked, what could be better, and of course gives you a chance to comment about anything.

We want to make every year’s convention better than the last, and your answers are a huge part of that.

Just click right here — it won’t take more than about six and a half minutes. And thank you!

More sunlight, fewer drugs

A University of Michigan study found that, when there are sunshine laws disclosing payments from drug manufacturers to physicians, those physicians prescribe fewer drugs. But there’s a slight catch:

They found that doctors prescribed significantly fewer name-brand drugs after the [sunshine] law was passed, and that doctors wrote fewer overall prescriptions. The implication is that while the decrease in name-brand prescriptions may have lowered costs, the decrease in generic prescriptions—while not as dramatic—suggests possible underprescribing.

Elsewhere

An Oklahoma doctor is charged with murder for prescribing excessive amounts of unnecessary opioids.

Indiana is seeing an increase in pharmacy robberies that coincides with the state’s crackdown on opioids. It has the highest rate of pharmacy theft in the nation.

Arizona and Maine join four other states (no, not Georgia) in allowing pharmacists to prescribe and provide tobacco cessation therapy.

—Andrew Kantor • Jun. 27, 2017

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Fair to middling

Last year’s flu vaccine was a bit less effective than usual for people under 65 (42 percent, the CDC figures), but for older folks it was virtually ineffective.

Iffy about research out of China?

You’re not alone, of course, but you might have less to worry about. The country is considering the death penalty for research fraud.

A tick bite could make you allergic to … meat?

Yep. Watch out for the Lone Star tick, notable for the spot on its back. Luckily, it’s a lot larger than the deer ticks that spread West Nile Virus.

The power of communication

You get a prescription for a patient that isn’t covered by his insurance. Have you considered texting him immediately? Here’s a story about why you might.

Extra virgin olive oil prevents Alzheimer’s!!!!!1!!!

Time to start chugging a bottle or two a day! (Reality: one study from one university found that “mice with EVOO-enriched diets had better memories and learning abilities compared to the rodents who didn’t eat the oil.”

WHATEVER! OLIVE OIL STOPS ALZHEIMER’S!!!!!!

(sigh)

—Andrew Kantor • Jun. 26, 2017

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“It’s a scam” vs ‘It’s a convenience’

It’s two, two, two meds in one! A little Aleve, a little Nexium, and for the low, low price of $3,252 a month!

In unrelated news, insurance companies are raising premiums.

Want to control type 2 diabetes better?

Make a team and include a pharmacist. Shocking, right?

How does Mylan avoid paying taxes?

It owns coal-processing plants — and gets tax credits for doing so. (Oh, and it also moved its headquarters to the Netherlands to avoid U.S. taxes.)

Long-acting Adderall gets FDA approval

Shire’s Mydadis should last 16 hours. That is all.

Trump’s first step to easing drug prices is out

The basics: Reduce regulations, cut back on the 340B program (which requires drug makers to give discounts to hospitals and clinics that serve low-income patients), and lengthen patent protection overseas.

That will save (or make) drug makers money, which the administration expects to be passed down to insurers and consumers.

The FDA wants to increase generic competition

It’s holding a hearing on July 18 to see how to get more generics to market and prevent “gaming” of the regulatory rules.

—Andrew Kantor • Jun. 21, 2017

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Millen hospital will stay open

GA Medical Holdings has purchased Optim Medical Center-Jenkins less than a week before the rural hospital was set to close. The hospital will remain open, and its new owner is likely to expand its medical testing business.

The federal government is good at talking about lowering drug prices

You know all that talk in Congress about lowering drug prices and putting pressure on drug makers? Yeah, lots of talk.

At least so far, the powerful pharmaceutical industry has managed to keep the package that is speeding toward Trump’s desk free of any controversial policy changes that could threaten the industry’s business model — as well as any partisan add-ons that could jeopardize its smooth, overwhelmingly bipartisan trip through the policymaking process.

Fun fact: The Pharmaceutical Research and Manufacturers of America spent $7.9 million to lobby Congress in just the first three months of 2017.

What about the executive branch? you ask.

Unfortunately, what little we know about proposals coming from the White House — and the task force led by Joe Grogan (a lobbyist for Gilead Sciences until March) — is that they really won’t do much:

  1. Increase patent protection overseas, which will raise costs in other countries but probably won’t affect prices here
  2. Vague goals to “moderniz[e] our regulatory and reimbursement systems” and limit “barrier to entry, including the cost of research and development”
  3. Push for value-based pricing, so drug makers would give refunds if their products don’t work… but it’s not clear how to measure that and who would get the refunds. PBMs?
  4. Issuing Treasury bonds to pay for expensive meds (like Gilead’s Harvoni)

Amusingly:

Some of the text in the document is cribbed directly from policy papers published by the pharmaceutical industry’s powerful lobby — Pharmaceutical Research and Manufacturers Association (PhRMA).

Teens aren’t getting opioid treatment

Even with good health insurance, a study in JAMA Pediatrics found that only about 27 percent of teens are getting the recommended treatment (buprenorphine or naltrexone).

(That link was to the study. Prefer a news story? Click here instead.)

No, you can’t always sue in California

The Supreme Court has ruled (8-1) that out-of-state residents can’t sue a company in California unless there’s a strong tie between the company and the state (e.g., the headquarters).

575 people not from California (and 86 who were) tried to sue Bristol-Myers-Squib in the Golden State, even though the company is headquartered in New Jersey. SCOTUS but the kibosh on that.

And that means….

A mistrial in the Johnson & Johnson baby powder lawsuit.

Novartis is less interested in hiring here

US to Novartis: You should hire more people here.

Novartis CEO to US: No thank you — we don’t like your visa restrictions. “This makes [the US] a less attractive location for investment,” he said. “By contrast, Switzerland and Europe will become more attractive.”

Shed a small tear

Martin Shkreli is broke.

—Andrew Kantor • Jun. 21, 2017

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Some big wins in the cancer war

Check out this roundup of drugs that are winning big against breast, lung, and prostate cancers.

Drugs are easy to get on the dark web

Forget shady, late-night street-corner meetings. With fentanyl so potent, a lot of doses can fit in a small envelope. Buyers and sellers are using the dark web — the unsearchable parts of the Internet that are only accessible with special browsers — to make their deals.

As of Friday, the leading dark net market, AlphaBay, had more than 21,000 listings for opioids and more than 4,100 for fentanyl and similar drugs, from dozens of dealers large and small. Many of those individual listings are like items in a catalog, representing an endless back-room supply of pills, powders and nasal sprays.

Keeping you informed

We say that ‘getting the latest pharmacy news’ is a benefit of GPhA membership. That may not sound like a big deal, but check this out:

When naloxone was made available without a prescription in Georgia in December, we sent out notices, posted to Facebook and Twitter, had explanations on GPha.org, even gave you the paperwork you need to keep on file.

But not everyone is a GPhA member, so we get headlines like “Pharmacies not aware Narcan can be sold without prescription.”

“[P]ersonnel at two pharmacies contacted in Newnan on Thursday were not aware of the change, and were adamant that anyone trying to buy naloxone would need a prescription.

Just because it may not work doesn’t mean you shouldn’t use it

Vivitrol may not even work, but its maker, Alkermes, is pushing the opioid addiction treatment hard — as an alternative to buprenorphine and methadone, which actually do work. The company’s tactic: Use political connections to sell Vivitrol. And health officials are not happy.

Not a single study has been completed comparing Vivitrol with its less expensive competitors. Some studies have shown high dropout rates, or found that many participants returned to opioid use while taking Vivitrol or after going off it.

EpiPen rebates benefitted PBMs, not consumers, according to lawsuit

Several consumers have filed a class-action lawsuit against PBMs CVS, Express Scripts, and Prime Therapeutics over the price of EpiPens, saying:

“[I]nstead of negotiating for lower or stable prices for all plan members, Defendants negotiated for increasingly large rebates from Mylan for themselves and their clients, driving up the price of EpiPen. Rather than passing these rebates on to Class members in the form of lower or stable prices, Defendants kept significant amounts, resulting in massive revenue increases for themselves and massive price increases for members of the Class.”

According to the suit, the PBMs violated the Employee Retirement Income Security Act.

—Andrew Kantor • Jun. 13, 2017

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Pharmacist salaries: a mix of news

Adam Fein at Drug Channels has done his annual analysis of pharmacist salaries — thorough (really thorough) as always.

Some takeaways:

  • Pharmacist salaries are up from last year — about 0.6%, which is slower than other healthcare professions.
  • The highest salaries were at mass merchants, but those salaries have been going down.
  • What else is going down? Employment at mail-order facilities. (Fein points out that this could be because there are so few employed there anyway — about 3,800 nationwide — so a small change in number would look like a large change in percentage.)
  • Going up: employment at hospitals and healthcare facilities.

Read all about it.

Looking to develop a collaborative practice agreement?

The CDC — working with APhA, the National Alliance of State Pharmacy Associations, the American Medical Association, and others — has released a “resource and implementation guide … intended to assist pharmacists in developing and executing a collaborative practice agreement (CPA), and in turn, advance team-based care.”

Remember: CDC resource aside, pharmacists need to be sure they are in compliance with state-specific laws as well, so consult an attorney before you enter into any kind of agreement!

Dog flu is in the news

Lots of dogs in Georgia are getting it.

AMA to demand pricing in ads

The American Medical Association is going to vote whether to demand that drug companies include the cost of medications in their consumer advertising.

The demand won’t have power, but it will be a clear statement. The AMA has already called for a ban on direct-to-consumer ads from drug companies; currently only the U.S. and New Zealand permit such ads.

Putting that old argument to the test

Pharma companies charge more for their drugs in the U.S. than anywhere else — a lot more. (We pay an average of 240 percent more than other developed countries).

They’ve always argued that they have to, because other countries cap their prices and they need the money to pay for research and development.

That turns out not to be the case.

Researchers looked at the prices of drugs, the companies’ spending on R&D, and the excess cost in the U.S.Conclusion: The higher prices we pay compared to the rest of the world “generates substantially more than the companies spend globally on their research and development.”

“This finding counters the claim that the higher prices paid by US patients and taxpayers are necessary to fund research and development. Rather, there are billions of dollars left over even after worldwide research budgets are covered.”

FDA wants Opana off the market

It asked the drug’s maker, Endo, to voluntarily remove it. And by “voluntarily,” it means, ‘or we’re gonna do it for you.’ (Sorry, it will “take steps to formally require its removal by withdrawing approval.”)

Also on Capitol Hill

While everyone was watching the Comey testimony yesterday to see if anyone’s pants caught fire, HHS secretary Tom Price was defending Trump’s proposed cuts to Medicaid, the CDC, the FDA*, the NIH, and other agencies.

*Not really cuts, because the plan is to have the industry pay more and the government pay less

Not one drink

Even a little alcohol during pregnancy can change a baby’s facial features. The changes are slight, but they hint that there might be other changes going on.

…unless it’s coffee or tea

New research seems to show they can help prevent cirrhosis.

Some antibiotics might work better than we think

The standard petri-dish test for antibiotics might not be the best. “Physicians may be relying on the wrong test for identifying antibiotics to treat infections.”

Elsewhere

Thanks in part to work by the New Mexico Pharmacists Association, pharmacists there will be able to prescribe contraceptives starting today.

Nevada is one step away from quietly implementing Medicaid for all.

Also in Nevada, a tweaked bill calling for drug-pricing transparency is likely to be signed by the governor. (He vetoed the first version.)

Tennessee is going to begin reimbursing pharmacists for some MTM services.

—Andrew Kantor • Jun. 09, 2017

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Fake Percocet kills at least two in Georgia

In what’s being described as a “wave” of overdoses across central Georgia — Albany, Centerville, Macon, Perry, and Warner Robins — at least two people have died (some reports say four) and dozens have been hospitalized after taking counterfeit Percocet pills they bought on the street.

The drugs look legit at first glance, but authorities say a telltale sign is that the word “Percocet” is imprinted at an angle.

It’s not over — reports of overdoses apparently continue to come in. And the GBI hasn’t yet identified what the drug contains (although the Atlanta-Journal Constitution is speculating that it’s fentanyl).

“The substance has not yet been identified but it is extremely potent and has required massive doses of naloxone (Narcan) to counteract its effects,” the [Georgia DPH] said. “Testing is being done to identify the pills and the ingredients.”

Read the AJC story.

Or the one from WMAZ.

Or from NBC News.

WHO updates essential meds list

The World Health Organization has updated its list to 433 of “drugs deemed essential for addressing the most important public health needs.” In other words, these are the drugs WHO believes everyone should have access to. (Countries that provide universal healthcare to their citizens use this list as a guide to determine what to make available.)

WHO has added 10 antibiotics to the list for adults and 12 to the list for children. It also added new cancer medication, hepatitis C cures, HIV treatments, and more.

Click here for the full list for adults or here for the children’s list. (PDF).

When patient advocates are paid by industry

Nevada’s legislature passed a bill that would add transparency to insulin pricing. Diabetics pressed hard for the bill, but patient advocates, like the American Diabetes Association, kept quiet. Why? The answer probably won’t surprise you:

Many of the dozens of U.S. diabetes advocacy organizations, large and small, garner significant portions of their funding from insulin manufacturers.

—Andrew Kantor • Jun. 07, 2017

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One letter, today’s epidemic

In 1980, a letter to the New England Journal of Medicine — a letter, not a study, mind you — said that very few people given opioids became addicted. Since then, that letter has been widely cited as “evidence” that opioids weren’t addictive.

Now a study has looked at the effect of that one-paragraph letter. The authors conclude…

We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy.

Any day now

Here’s the latest talk of a universal flu vaccine: This one is based on a white blood cell found in nasal tissue.

EpiPen pricing: All talk, no walk

All the outrage, hearings, and investigations of Mylan’s EpiPen price gouging have resulted in huge decreases in prices. Just kidding — they’ve had no effect whatsoever.

Mylan, [company executives] said, is an example of a firm that has thrived by learning to absorb, and then ignore, opprobrium. The company has an effective monopoly on a lifesaving product, which has allowed its leaders to see public outrage as a tax they must pay, and then move on.

But read the article if only to see whom exactly, got the middle finger from Mylan’s chairman.

Up, up, and away

In case you were wondering how the talk of drug pricing has affected other companies, Pfizer has raised the prices of 91 of its drugs by an average of 20 percent in 2017. The current U.S. inflation rate is about 2.7 percent.

Elsewhere

Nevada’s governor vetoed a bill requiring drug makers to be more transparent in reporting the costs, prices, and price hikes of diabetes drugs (especially price hikes higher than inflation) — as well as the rebates they paid to PBMs. He cited “insufficient evidence” it would make a difference. The bill was opposed by a number of ‘patient groups’ that were backed by the pharmaceutical industry.

A ballot issue in Ohio would peg the price the state government pays for drugs to the price paid by the Department of Veterans Affairs. (This would not include Medicaid.) But the pharmaceutical industry (part of a coalition against the bill, which includes the Ohio Pharmacists Association) argues that if it lowered prices for the state, it would raise them for everyone else to make up the difference: “[I]f the drug companies were forced to sell to the state,like any other business they make that up by raising prices for those of us who aren’t covered,” said a spokesman.

Texas, which has been working for years to close women’s health clinics across the state, is now trying to figure out how to address its “skyrocketing rate of pregnancy-related deaths,” the highest in the developed world.

—Andrew Kantor • Jun. 05, 2017

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