Help stop Express Scripts from forcing Tricare patients away from community pharmacies

The short version: Go to Change.org right now, please, and sign GPhA’s petition to put the brakes on the Express Scripts/Tricare contact before anyone loses access to their medication.

Veterans and current servicemen and -women could be cut off from their neighborhood pharmacies when Tricare’s new contract with Express Scripts takes effect in just a few weeks. (It’s supposed to be January, but Express Scripts is telling patients to switch pharmacies by October 24.)

More than 15,000 independent pharmacies around the country will no longer accept Tricare.

Congress has the power to intervene, and Georgia’s Buddy Carter is already circulating a letter demanding an explanation.

And we need to spread the word. We need you to sign that petition — call attention to the dangers faced by pulling the pharmacy rug out from under Tricare patients and their families, and spread the word. More signatures means more clout.

Click here or go to GPhA.org/StopESI and sign it now! NOW!

What a short normal trip it’ll be

Psychedelics for depression: Not news. The trick is to keep the dose low enough (and the monitoring careful enough) to avoid seeing singing dandelions and kittens that smell like the number 6.

But in the age of molecular chemistry, why not separate the shroom’s anti-depressant effects from its psychedelic effects? And that’s what a coast-to-coast team of researchers did — created a compound that hits serotonin receptors, but doesn’t send Lucy into the sky, with or without diamonds.

In mice, anyway. They’re looking ahead, though, while using our favorite phrase:

“We don’t know if we’ll see the same effects in people. But we hope to find out. It would be a game changer to create a one-dose, long-acting therapy to help people with treatment-resistant depression and other conditions.”

Another reason to be sociable

The other day we told you that loneliness can make you age faster. Bad … but it gets worse. Norwegian researchers have now found that being lonely can double a person’s risk of getting type 2 diabetes.

The mechanism isn’t clear (yet) but they think it’s related to loneliness stress elevating the body’s cortisol levels, which increases insulin resistance.

And it seems to be loneliness specifically. The loneliness/diabetes relationship “was not altered by the presence of depression, sleep-onset insomnia or terminal insomnia.”

Shameless plug

Employee pharmacists: Fight loneliness on Saturday, October 22 at AEP’s shindig at Atlanta’s Monday Night Brewing! Just $10 gets you two drinks and all the socializing (or networking, if that’s your jam) you can handle. Check out GPhA.org/mondaynight for the details!

Avoid those Paxlovid errors

Enough pharmacists are already getting it wrong, according to Pharmacy Times. The issue is that 1) “Paxlovid” is actually two tablets — nirmatrelvir and ritonavir, and 2) there are two versions: one for patients with normal renal function, and one for patients with moderate renal impairment. (Those with severe impairment shouldn’t take it at all.)

Dispensing for that second group meant removing some of the nirmatrelvir tablets. Some pharmacists didn’t do that, or removed the ritonavir instead. So Pfizer made separate versions depending on renal function.

Problem solved! At least until patients got hold of it. They take the wrong pills or at the wrong time.

So…

• Be sure to find out if a patient has any form of renal impairment and choose the right drugs.
• Take the time to explain how to take it, even when the patient says, “Yeah yeah, sure sure.”
• Tell them not to transfer the tablets to a pill box. Use the blister packs.
• And “Avoid communicating the dose by tablet or blister color” because that’s apparently even more confusing.

It’s so I can breathe better

Viagra, it seems, might be able to help people with lung diseases. Opening blood vessels is opening blood vessels — no matter where those blood vessels are. Thus, found Canadian researchers…

The vasodilation caused by sildenafil can be beneficial in lung diseases such as pulmonary arterial hypertension (PAH) or idiopathic pulmonary fibrosis (IPF)

Consumers and drug pricing — surprises

Some interesting stats came out of a survey of independent-pharmacy patients by Prescryptive Health, a healthcare technology company without a spell-checker.

What’s interesting:

• 31% of consumers — including those with health insurance — said they primarily pay for prescriptions out of pocket.
• Of those who have insurance, 61% said they sometimes pay cash anyway.
  • Of those, 30% said their meds were less expensive paying cash (with a discount card) than their insurance co-pay.

Takeaway: Keep an eye on the cash price for the meds you dispense — you might be able to save your patients some money, and surprise them at the same time.

But also keep this in mind:

• It’s not all about price: 47% said “technology and modern communications” are their most important considerations for sticking with a pharmacy, “even more important than a pharmacy being lowest cost.”

Man flu is real

The headline reads “Man flu is not a thing.” And by “man flu,” Austrian researchers mean “hypersensitivity to acute rhinosinusitis,” i.e., that men are more senstive to the sniffles.

That’s the headline. But when you read the study, the conclusion is the opposite.

While women, they found, “showed a significantly higher symptom load at baseline,” they also improved significantly faster. And men and women had equal nasal, otological, and sleep symptoms.

But here’s the kicker they buried — the sentence that refutes that headline:

[A] significant time/gender effect was only found for emotional symptoms.

That’s right — men have significantly greater emotional symptoms. So unless you’re willing to say that feelings don’t matter, man flu is real. Science says so.

Bonus: the symptom reporting system is called the Sino-Nasal Outcome Test-22 — SNOT-22. Really.

The Long(ish) read: Brush Your Teeth edition

You don’t want gum disease for obvious reasons — bad breath and looking British, for starters. But periodontitis is being linked more and more to other health conditions: Alzheimer’s, cardiovascular disease, type 2 diabetes, and even cancer.

[Gum disease photo removed for potential violation of the Geneva Conventions.]

A literal pill drill

Some oral drugs have trouble being absorbed before they’re ruined by the digestive system. Insulin in particular can’t be taken by mouth because of that. (You already know this.)

Normal scientists: “Let’s see if we can find a way to neutralize the acids, or maybe use chemicals to weaken the stomach lining.”

MIT engineers: Forget that. Let’s build a pill-sized robot that drills through the stomach lining and then delivers the drugs.

Meet RoboCap. It is literally a capsule the size of a large vitamin, covered with a special coating, with a drill inside.

When the coating dissolves, the change in pH triggers a tiny motor inside the RoboCap capsule to start spinning. This motion helps the capsule to tunnel into the mucus and displace it. The capsule is also coated with small studs that brush mucus away, similar to the action of a toothbrush.

The spinning motion also helps to erode the compartment that carries the drug, which is gradually released into the digestive tract.