Bad PillPack! No cookie!

Of all the things to overbill the government for, apparently (by its own admission!) PillPack chose insulin — and it got caught. The Amazon subsidiary will have to pay out $5.6 million from Jeff Bezos’s spare change jar.

From April 2014 through Nov. 2019, PillPack’s general practice was to dispense insulin pens to patients using full cartons. PillPack would dispense and bill for the full carton and falsely underreport the days of supply to make it appear that the dispensing did not violate the program’s days-of-supply limit.

So much CE in one gorgeous place

Sure, you might come to the Georgia Pharmacy Convention for the great resort and tax-deductible* vacation, but there’s a ton of CE to be had, too.

Prefer courses with detailed titles? We’ve got “Novel Trends with biologicals for the treatment of inflammatory disorders.”

Prefer something with a name that’s more fun? How about “ Oh My Aching Head—Tension, Sinus, or Migraine?”

From accounting principles to vancomycin, the Georgia Pharmacy Convention has the best, most up-to-date education you’ll find — hours and hours of CE available for pharmacists and technicians.

Register today at GPhAConvention.com and we’ll see you at the beach (and in the classroom).

Antioxidants do it again

If you want to avoid dementia, you’ll want to up the levels of antioxidants in your blood — specifically lutein, zeaxanthin, and beta-cryptoxanthin. NIH researchers followed 7,283 people for an average of 16 years (!) and found a pretty direct correlation between levels of those antioxidants and dementia risk.

Every standard deviation increase in lutein and zeaxanthin levels, approximately 15.4 micromols/liter, was associated with a 7% decrease in risk of dementia. For beta-cryptoxanthin, every standard deviation increase in levels, approximately 8.6 micromols/liter, was associated with a 14% reduced risk of dementia.

Caveat: It’s possible that the causation is more complex, e.g., people with higher levels of those chemicals are also people who live healthier lifestyles in other ways.

(Interesting side note: Readers with amazing memories might remember a story from January where we reported that higher levels of lutein and zeaxanthin also helped reduce macular degeneration. So this seems to be good stuff.)

Our thoughts and prayers are with the PBMs

“PBMs in the Senate hot seat as bipartisan transparency measures may take root.”

Echoing recent and similar questions from the FTC, front and center at the Senate hearing were the anti-competitive practices of PBMs, like artificially inflating the list prices of certain drugs while collecting a growing portion of rebates, and increasing out-of-pocket costs for consumers along the way.

Ibuprofen, BP drugs, and kidneys

According to the computer at the University of Waterloo, patients who take diuretics and RSA inhibitors for hypertension should probably not take ibuprofen: “[I]n people with certain medical profiles, the combination can cause acute kidney injury, which in some cases can be permanent.”

This isn’t based on human testing — it comes from “computer-simulated drug trials.” And it makes sense, with dehydration from the diuretic being a danger in itself to kidneys “and then the RAS inhibitor and ibuprofen hit the kidney with this triple whammy.”

“It’s not that everyone who happens to take this combination of drugs is going to have problems […] If you happen to be on these hypertension drugs and need a painkiller, consider acetaminophen instead.”

Cool medical science

Passing the acid test

If you want to get a drug to the small intestine, you need to get it past the stomach. That’s a problem, what with all that acid. What’s an engineer to do? How about “create a new class of material”?

[It] is able to both withstand the harsh acidic conditions of the stomach and then dissolve predictably in the comparatively gentle environment of the small intestine.

And they wouldn’t be real engineers if they didn’t give it a wonky name — in this case, “polyzwitterionic complex” or pZC. The UMass Amherst folks hope “that pZCs could help transform the delivery of medicines, from familiar oral antibiotics to new classes of delicate protein therapeutics.”

Better than dialysis

On the horizon, potentially replacing dialysis and transplants, is an artificial kidney — no easy feat, but one that’s already in process. At the moment it’s a backpack-sized device, but the University of Washington nephrologist leading the charge considers it “the first phase of a progression that will he hopes will lead to something small and implantable.”

How soon? “[T]he first preclinical trials for an artificial kidney could happen as soon as 18 months from now,” he says.

There’s more to drug-drug interactions

When you’re worrying about drug-drug interactions, you obviously worry about how they interact directly — how they affect each other. But Korean researchers realized there’s more: You also need to worry about how they affect gene expression. That is, even if the drug’s chemistries don’t interact, they could cause genes to express themselves in complementary or conflicting ways.

Thus they developed a computer model to predict those kind of interactions — hopefully (once its out of the lab) helping figure out why certain combinations cause unexpected side effects.

Telehealth speedbumps

With the pandemic came the rise of virtual doctor visits. But now some pharmacies are cutting off telehealth patients from ADHD meds because they’re afraid of stimulant abuse.

It doesn’t help when an online mental health company like Cerebral runs ads talking about ‘easy ADHD treatment,’ then writes a lot of stimulant prescriptions. And while “the risk of inappropriate prescriptions was likely minimal,” larger pharmacies are becoming wary — especially of newer telehealth providers — as they try to balance patient need with the risk of abuse.

The Long Read: A Drug for Farsightedness edition

An optometrist explains how Abbvie’s Vuity drops treat presbyopia (aka “age-related blurry near vision”).

(Spoiler: “Since presbyopia limits the ability of the lens to change shape, these eye drops compensate by causing the pupil to get smaller.”)