What’s driving drug prices?

Drug prices overall keep going up, but one class is driving a lot of the cost: anti-inflammatories. At least, that’s according to Express Scripts.

The pharmacy benefit manager found that medications for inflammatory conditions such as psoriasis and rheumatoid arthritis drove 43.7% of spending, by far the highest among the different classes.

Down, though, are costs for pain/inflammation drugs and asthma treatments.

Up are specialty drugs. Down are generics. And so on. (Click that link above if you want the details.)

Next big diabetes webinar coming up!

The next session of GPhA’s “Healthy Patients = Healthy Business” diabetes webinars is coming up — these are courses that show you how to grow your practice while you help your patients.

You can attend (from the comfort of your living room) “Optimizing Diabetes Control: A Case Based Approach,” on Tuesday, March 24, from 7:00 – 8:00 p.m.

This one is all about the team — think workflow, best practices, and billing.

Taught by national diabetes expert and Georgia pharmacy owner Jonathan Marquess, “Healthy Patients = Healthy Business” will give you a deep dive into your role in keeping diabetes in check.

Sign up today!

Psoriasis: Blame the Twinkies

If you feed your mice a Western Diet (i.e., high in sugar and fats), they’re likely to develop inflammatory skin diseases even before they get obese.

In four weeks only, mice on Western diet had significantly increased ear swelling and visible dermatitis compared to mice fed a controlled diet.

But … why? Bile acids, dear readers, bile acids. Mess with lipid absorption and bile acids stop regulating those inflammatory compounds.

Today’s coronavirus tidbits

Infections in children is “remarkably low.”

Most people’s symptoms are mild, according to a huge Chinese study.

Mortality rates are low as well, except for seniors:

• Age 0 – 39: 0.2% mortality
• 40-49: 0.4%
• 50-59: 1.3%
• 60-69: 3.6%
• 70-79: 8.0%
• 80+: 14.8%

Cleaners, autism, and asthma (and folic acid)

Women who are exposed to phthalate while pregnant — a chemical common in household cleaners and some cosmetics — are more likely to have boys that show “autistic traits”.*

But wait! If once the kid is born you think you’re out of the woods … nope. “Exposure to cleaning products in first 3 months of life can increase risk of childhood asthma.”

* Good news: You don’t have to live in a hovel for nine months. Folic acid supplements seem to offset the effects.

Two things to know about antidepressants

They are “notoriously difficult to quit“ per the Journal of the American Osteopathic Association.

Patients who stop taking their medication often experience Antidepressant Discontinuation Syndrome (ADS), which includes flulike symptoms, insomnia, nausea, imbalance, sensory disturbances often described as electric shocks or “brain zaps”, and hyperarousal.

They increase the risk of type-2 diabetes, according to a Japanese study of more than 90,000 people. The good news: “Glucose tolerance improved when antidepressants were discontinued or the dose was reduced after diabetes onset.”

Wait a bit

Patients looking to have babies? Those shifty Danes have found that, for some reason, people living in Southern states are more likely to conceive in November — and further, that of all the regions they studied, the South has the biggest difference between seasons.

(And yes, if you’re wondering, the study did take into account sugar-sweetened beverage intake. Really.)

Why do cells age, anyway?

The mitochondria seem to be the culprit, sending signals to the nuclei to trigger cell senescence. And that leads to “formation of pro-inflammatory cytoplastic chromatin.”

Interestingly — if you’re thinking about living forever — HDAC inhibitors seem to interfere with this process.

Rural hospitals in danger

Georgia’s rural hospitals are in trouble — that’s according to a detailed analysis by the Chartis Center for Rural Health. It tracked closures that have happened and used that information to determine what makes a hospital likely to close in the near future.

• Since 2010, Georgia has had the 3rd highest number of closures — 7 in total (tied with Oklahoma and behind only Texas and Tennessee).
• Of the state’s 67 remaining rural hospitals, 18 of them (27%) are considered “most vulnerable” to closure — they are likely to shutter within a year.
• An additional 13 (19%) are “vulnerable” and are on course to close within three years.

The report is only eight pages long (plus the cover and team bios) and is worth a read.

Panic is the father of invention

The good news: Several drugmakers have said they’re now working on a CoviD-19 vaccine.

The bad news: “That’s because they believe the virus is so deadly that developing a vaccine is worth risking a lot of money.”

Learn point-of-care testing with GPhA and NACDS

Patients who use point-of-care “at home” tests need you. Don’t send them home without a helping hand. Learn how you can help them take control of their health with these tests … and how to best advise them when they show you the results.

Check out the 20-hours NACDS “Community Pharmacy-based Point-of-Care Testing Certificate Program” at GPhA.org/pointofcare.

Sunday, March 15
8:30 a.m. – 12:30 p.m.
GPhA Headquarters in Sandy Springs

$349 for GPhA member pharmacists, $149 for member technicians (techs can’t get the CE, though — sorry!)

The fluid still sloshes

On February 7, FDA commish Stephen Hahn said that there were no shortages of meds because of the Chinese coronavirus, but the situation was “fluid.”

Now the agency has stopped inspecting Chinese medication plants, and will instead “rely on facilities’ compliance history and other information to determine whether drugs are safe for import.”

And while Hahn said, “[T]here are no vaccines, gene therapies, or blood derivatives licensed by the FDA that are manufactured in China,” what he didn’t say is that 40% of U.S. generic drugs are made in India — which gets its ingredients from China. And that China provides us with a lot of other medications and medical supplies.

A call for compounder action

The FDA wants to regulate how compounding pharmacies make veterinary medications; it’s released a draft guidance document.

Our friends at the Alliance for Pharmacy Compounding* say that this rule — GFI #256 — would be bad for pharmacists and dangerous for animals.

The biggest issues:

• The rules would exceed the FDA’s authority. (The Drug Quality and Security Act is about human compounding.)
• It would require compounders to use finished products when possible, rather than bulk ingredients. Not only does that make those meds a lot more expensive, it’s also dangerous — measuring dosages with bulk ingredients is far more accurate than with finished products, which have significant variability in active ingredients.

And that’s not getting into the new record-keeping requirements….

So the APC would like pharmacists — especially compounders — to let their members of Congress know that GFI #256 is a Bad Idea. And it’s easy to do with this handy-dandy tool that will automatically send your message to your legislator.

* Née the International Academy of Compounding Pharmacists

Rx to OTC

What do GSK’s Voltaren Arthritis Pain gel and Alcon’s Pataday eye drops have in common? They’re both now approved as over-the-counter drugs. That is all.

Second wave of flu

“Flu season is getting weirder” is the headline. Why? Because as infections by the B strain are declining, infections by influenza A are on the rise.

In recent weeks, there has been a surge in activity of H1N1 in the U.S., according to data from the CDC. And that means even more people are going to the doctor for flu — the percentage of people visiting the doctor for flu-like illness increased from 6.6% of all visits last week to 6.8% of all visits this week, according to the CDC.

A rising tide floods all basements

The rising cost of healthcare affects taxpayers and the uninsured, but it’s also hitting employers pretty hard. The latest numbers, from 2018, show that…

• The average American with employer-sponsored insurance spent $907 out of pocket.
• The cost to the insurer was $4,985 per person.
• The cost per person rose 4.4% from 2017 to 2018, about double the country’s overall inflation rate.
• Over four years — 2014 to 2018 — total annual spending per person increased 18.4%.

Obviously those costs are being passed down to employers in the form of higher premiums.

“Research and development”

In case you’re curious, here are the 10 drugs with the biggest ad spending (TV, digital, radio, print) in 2019:

1. Humira ($577.3 million)
2. Xeljanz ($202.9 million)
3. Dupixent ($199.4 million)
4. Chantix ($197.4 million)
5. Emgality ($161 million)
6. Ozempic ($160.5 million)
7. Eliquis ($158.5 million)
8. Keytruda ($157.3 million)
9. Otezla ($155.9 million)
10. Trulicity ($148.3 million)

(And as we like to point out, only the U.S. and New Zealand allow direct-to-consumer pharmaceutical ads.)

One of those days

GPhA sent out an e-mail yesterday: The Board of Directors wants to hear from you about your workplace conditions.

Of course, that was the day that our e-mail system decided to have a little glitch, so anyone who sent a message in the morning found that it bounced. (By law, IT glitches only happen on important stuff and always in the dead of night.)

The GPhA BoD still wants to hear from you. Here’s a link (again) to President Chris Thurmond’s letter about the issue; send your comments to mritchie@gpha.org. Or, if you prefer, membership@gpha.org is working again.

Call for nominations!

GPhA is now accepting applications for its 2020–2021 Board of Directors. Help set the goals of the association — what services to offer, what policies to support, how best to use the association’s resources, and more.

There are three seats open for the 2020-21 board: two at-large and one representing the Academy of Clinical and Health System Pharmacists. All are three-year terms.

GPhA encourages applications from all pharmacy practice settings. Visit GPhA.org/2020board for all the details and an application.

The deadline for applications is 11:59 p.m. EST on March 13, 2020.

Think like a vampire

Georgia ranks #4 for states for the highest risk of melanoma due to ultraviolet radiation, according to a new study — only Hawai’i, Utah, and Delaware have greater exposure. (California is #5, and Florida, the Sunshine State, is ranked #8.)

Walking for chocolate

Chocolate: You’re not just a delicious reason for living, you might also help people with peripheral artery disease. Really.

Patients with peripheral artery disease (PAD) who consumed a flavanol-rich cocoa beverage three times daily for six months saw significant improvements in their 6-minute walking distance compared to a placebo, in a small, phase II randomized study.

Pro tip: No, a Hershey’s bar won’t do the trick. It’s all about the epicatechin, a flavanol usually found in dark (85%+) chocolate.

Smaller payout

The National Opioids Settlement is still being worked out in Ohio. Certainly some major pharmaceutical companies will be paying billions for their role in the opioid epidemic, but the latest news is that the payout may be a lot less than originally expected. In fact, it may be less than half what Big Tobacco paid in 1998.

The money is meant to reimburse states, cities, and towns for “treatment and prevention programs, emergency services, law enforcement and other measures needed to fix the problems created by opioids.”

Whatever the final amount, it will certainly fall well short of what public health experts say is needed to heal the long-term effects of the opioid crisis.

Today’s research shocker

From the University of Pennsylvania: “People who rely on social media for information were more likely to be misinformed about vaccines than those who rely on traditional media.”

Lucy in the sky with dollars

If you’re still thinking about the whole medical-marijuana industry, welcome to 2020. Now it’s time to look at the companies planning to bring psychedelics to market.

[A] growing number of companies are conducting clinical trials of psychedelic treatments for everything from depression to post-traumatic stress disorder, and some have recently received the blessing of the U.S. Food and Drug Administration. This has created a legal way for these companies to conduct research on otherwise illegal drugs, opening the door to public listings.

Successful Parkinson’s drug trial

A phase II clinical trial of ambroxol — the respiratory drug — as a treatment for Parkinson’s brings good news. No, it’s not a cure, but it improved motor function, and looks like a candidate for the next step.

The results showed that ambroxol was safe and well tolerated with no reported adverse events during the study. The drug was also found to cross the blood brain barrier and it achieved […] a 35% increase overall in GCase protein levels found in participants’ cerebrospinal fluid.

Irony alert

Most N95 masks — the kind that might actually protect you from the coronavirus — are made in China. And the one U.S. manufacturer is a bit ticked that no one listened when he warned about this very scenario.

Double irony: Those masks are only useful if you’re walking around among infected people, like in a hospital. They won’t do your average Joe on the Street much good.

Final blow: Where is this panic over the flu, which has infected at least 22 million Americans and killed 12,000?

Fun fact: The U.S. government has a secret (well, formerly secret) stash of protective gear.

Drug safety prize

Tobias Gerhard, PhD, of Rutgers won the fourth annual Sternfels Prize for Drug Safety Discoveries for his proposal for finding a better way to know which drugs within a class will provide the best outcomes.

Currently, he said, “[M]ost treatment guidelines and insurance formularies consider drugs within medication classes as equally safe and effective, despite having limited evidence.”

The award is given annually “to the most novel, clinically relevant, and testable idea to reduce life-threatening drug-related adverse events.”

A medication for “social pain”

Been rejected? Ostracized? Lost a job? University of California researchers found an unexpected treatment: “Acetaminophen and forgiveness.”

When combined with a tendency to forgive, taking acetaminophen substantially reduced how much social pain people felt over time. More specifically, participants taking acetaminophen who were high in forgiveness exhibited an 18.5% reduction in social pain over the 20-day study period.

Enemy of my enemy

Here’s an unexpected way to treat brain tumors: with Ebola. Apparently glioblastomas have a weakness that happens to jibe with how Ebola avoids a body’s immune system.

“The irony is that one of the world’s deadliest viruses may be useful in treating one of the deadliest of brain cancers,” said Yale’s Anthony van den Pol, professor of neurosurgery.

Statins vs. prostate cancer?

For men with a high risk of prostate cancer, statins* might be a way for them to live longer. Why? Researchers aren’t sure, but there seems to be a connection.

The study couldn’t prove cause and effect, but it found that statins, taken alone or with metformin, did seem associated with an increase in survival.

Next step: Finding proof of cause-and-effect, and narrowing down the best drug combo.

* Atorvastatin, pravastatin or rosuvastatin, but not lovastatin.

Craig-market insulin

Knowing what we know about the price of insulin in the U.S., it’s not surprising that a study found “Unregulated sales of insulin [are] common on Craigslist.”

During a two-week period, researchers turned up 327 ads from private parties selling insulin at a fraction of the retail price, according to a report in JAMA Internal Medicine.

Smart medicine

• Want to know if a baby is developing normally, at least neurologically? Finnish researchers have a “smart jumpsuit” that “accurately measures the spontaneous and voluntary movement of infants.”
• Know someone with a chronic wound, maybe a result of diabetes? Bioengineers have developed a “smart bandage” that can “precisely deliver different medications to the wound with independent dosing.”
• Got a baby that doesn’t fuss when it’s got a wet diaper? Avoid diaper rash with an inexpensive “smart diaper” that, when it detects dampness, “sends a signal to a nearby receiver, which in turn can send a notification to a smartphone or computer.”

Older than you’d think

60 million years ago, dinosaurs were apparently suffering from Langerhans cell histiocytosis, which afflicts humans today.

Granted it’s a rare condition in 2020, but you have to admit that evidence of a modern disease in a 60-million-year-old hadrosaur is worth a “Hmm, that’s cool.” And, write the study’s authors, “The hadrosaur pathology findings were indistinguishable from those of humans with LCH.”

Media worth checking out

Coronavirus answers, podcast-style

If you’re a podcast listener, you might want to check out a recent episode of the daily science ‘cast “Short Wave” that answers some of the basic questions* about CoviD-19, including “Why is there so much media coverage of a virus that’s not nearly as deadly as some others?”

* It does not, however, answer why some people write “CoviD” in all caps — it’s not an acronym. It stands for Coronavirus Disease 2019.

The pharmacist who tracked down his son’s killer — and a local pill mill

You might want to check out “The Pharmacist” — now on Netflix, it tells the story of Dan Schneider, the Louisiana pharmacist whose son was killed as a result of the opioid epidemic, and who went on to catch his son’s killer and hit back at a major pharmaceutical company.

Stop selling Belviq

The FDA asked Belviq’s maker, Eisai, to voluntarily recall the weight-loss drug because a clinical trial shows an increase in cancer rates. And when the feds ask you to “voluntarily” do something, you should probably do it. (Eisai did.)

Carter’s bill would ban PBM spread pricing

Georgia’s own Buddy Carter, along with Democrat Tony Cárdenas of California, have introduced the Drug Price Transparency in Medicaid Act (H.R. 5281). It would ban PBMs from using spread pricing in managed care.

Instead, it would require “pass-through pricing,” where PBMs must pay pharmacies the actual cost of the drugs they dispense, plus a dispensing fee, and are only allowed to charge the managed care company “a reasonable administrative fee that covers the reasonable cost of providing such services.”

CoviD-19 update

 Nothing to see here

There was a big spike in cases last week. Why? Simple: Chinese authorities made it quicker to diagnose.

 Battle over the name

Coronavirus Study Group: We have named the virus responsible for CoviD-19. It is “SARS-CoV-2.”

World Health Organization: Ugh. No way. That’s too easy to confuse with “SARS-CoV,” the virus that causes SARS.

Coronavirus Study Group: So what should we call the virus responsible for CoviD-19?

World Health Organization: “The virus responsible for CoviD-19.”

Kidney disease? Watch those dosages

Got patients with chronic kidney disease? There are a lot of meds that may need to be adjusted for them, from antibiotics to hypoglycemics and then some. Check out the deets from the American Academy of Family Physicians.

Let them build their own prisons

Mice with antibiotic-resistant bacteria might be in luck: A totally new type of antibiotic.

Typical antibiotics kill infections by preventing them from building their cell walls. But these new chemicals are nastier: They let the bacteria build the walls, but they don’t let them tear them down so they can divide. We imagine biochemist Beth Culp with an evil gleam in her eye as she said this:

“In order for a cell to grow, it has to divide and expand. If you completely block the breakdown of the wall, it is like it is trapped in a prison, and can’t expand or grow.”

Elsewhere: “Insulin in Connecticut” edition

Connecticut is considering a bill that would cap the cost of insulin at $50 per month, and “limit the price of insulin-related supplies, such as syringes, pumps and blood sugar meters, to $100 a month.”

Colorado and Illinois are considering measures that would set a $100 cap, but the sponsor of Connecticut’s bill pointed out, “Capping the cost at $100 is great, but $100 is still a lot of money to people.”

Fun weekend science read:

“Scientists ♥ Their Emojis, But It’s Complicated“

Yikes — we missed Cassie!

There should have been four big shouts outs in yesterday’s Buzz. There were actually four GPhAers who made this year’s Bulldog 100 — we missed Cassie Riley, owner of Jennings Mill Drug Company in Watkinsville!

We’re sorry, Cassie!

Test failure

Good: The CDC had sent CoviD-19 test kits to state labs to speed up identification of the infected.

Bad: Some of those kits may not work. It’s not that they give inaccurate results, it’s that state health officials may not be able to get them to function properly and have to send samples to CDC instead.

And the understatement of the day:

“Obviously, a state wouldn’t want to be doing this test and using it to make clinical decisions if it isn’t working as well, as perfectly, at the state as it is at C.D.C.”

An answer from Emory

Emory researchers think they have an effective treatment for the virus. It’s called EIDD-2801, and it seems pretty potent according to the university:

EIDD-2801 is an oral ribonucleoside analog that inhibits the replication of multiple RNA viruses, including respiratory syncytial virus, influenza, chikungunya, Ebola, Venezuelan equine encephalitis virus, and Eastern equine encephalitis viruses.

EIDD-2801 was about to be tested on humans (for flu treatment), but now the researchers want to test it against the CoviD-19 virus as well. Click here for the lay version of the story.

SB313 in the news

A Georgia Senate subcommittee held a hearing on SB313 — an important bill that will help rein in PBMs and curb some of their worst abuses.

“What we’re seeing is self-dealing on the grandest of scales in health care by the pharmacy benefits managers,” said Greg Reybold, vice president of public policy for the Georgia Pharmacy Association.

Greg will have more about that hearing and what it means in his next Legislative Update. In the meantime, read about the hearing and the bill…

…in the AJC
…in The Center Square
…in the Augusta Chronicle
…in Northwest Georgia News

What’s gonna happen with the drug supply?

It’s not entirely clear how CoviD-19 will eventually affect the U.S. drug supply, but Moody’s has its predictions.

For branded drug makers, manufacturing plants in China chiefly serve the Chinese and Asian markets, where demand is plummeting as people are avoiding going out, even for medication. So the companies’ biggest issue will be to their bottom lines.

For generic drug makers, it might be a bit dicier, because some of those companies rely on Chinese ingredients. Many, though, will have “safety stock and alternate supply arrangements” in place.

Bottom line: There’s potential for disruption, but it doesn’t seem like it will be a huge issue.

Medical cannabis card count

In case you were curious, the current count is 14,511 Georgians with cards allowing them to possess — but not buy or transport — “low THC oil,” according to the Department of Public Health. That’s a jump of more than 70 percent in a year.

Crazy math

Utah is saving money by paying for state workers to travel to Mexico to see physicians and pharmacists there, where their medications are a lot less expensive.

The cost difference is so large that the state’s insurance program for public employees can pay for each patient’s flight, give them a $500-per-trip bonus and still save tens of thousands of dollars.

28 diseases later

The Chinese government says that cases of CoviD-19 seem to have plateaued, the mortality rate remains low, and it looks like a vaccine will be available in the not-too-distant future.

So maybe you’re looking for something else to worry about. Don’t fret; Live Science has you covered with “28 Devastating Infectious Diseases.” Including pictures!

Locks need to be locked

The CDC did a study and wants to remind people: “Child-resistant packaging keeps kids safe – but only when pills are inside.” Apparently…

Each year there are about 400,000 poison center calls and 50,000 ER visits as a result of young children ingesting medications when adults weren’t paying attention.

The biggest culprit: Pill organizers that aren’t child-resistant — especially grandparents’.

Elsewhere: “When the wind comes right behind the rain” edition

The Oklahoma Pharmacy Board is investigating staffing levels at chain pharmacies for “creating a stressful work environment for pharmacists.”

Fun fact: The Oklahoma state motto is “Work conquers all.”

Bulldog 100: Three big shout-outs!

ADD’s Personal Care Pharmacy, Forest Heights Pharmacy, and PharmD On Demand were all named to the 2020 Bulldog 100 — the 100 fastest-growing businesses owned or operated by UGA alumni.

Congrats to all three!

Urgent: Another Medtronic recall

This time it’s for the MiniMed 600 Series Insulin Pumps — it might deliver an incorrect dose. It’s already injured at least 2,175 people and caused one death.

Shocker: PBMs are profiting from skyrocketing DIR fees

A new analysis from XIL Consulting* “shows that payers and Pharmacy Benefit Managers (PBMs) are profiting from [DIR] fees at a rate in excess of 500% per prescription as compared to the average PBM administration fee.”

DIR pharmacy fees overall have skyrocketed by 1,600% in the last five years, totaling $8.5B since 2013. These fees are collected by PBMs and health plans and shared with Medicare.

However, a loophole in the program allows health plans and PBMs to pocket an excessive amount of pharmacy DIR fees rather than offset prescription costs for seniors.

* The CEO is a former high-level exec at Express Scripts

Happy 25th anniversary, Georgia Health Policy Center!

Check out the 25 events going on throughout 2020, from speakers to films, service days to bike rides.

Now it has a name

The disease caused by the Wuhan coronavirus has been officially dubbed “CoviD-19*” which stands for Coronavirus Disease 2019. The virus itself is “SARS-CoV-2.”

Why does it matter? Time explains.

* Or you can refer to it by the name of the U.S. Army Medical Corps doctor who first identified it: Captain Tripps.

Maybe it has a vaccine

San Diego-based Inovio Pharmaceuticals is beginning pre-clinical trials on a vaccine for CoviD-19. “The vaccine has been tested on mice and guinea pigs. It will next be tried on a group of human patients.”

Meanwhile, the head of the National Institutes of Health finds it “very frustrating” that none of the major pharmaceutical companies has stepped forward to create a vaccine — there just isn’t enough profit in it. (Johnson & Johnson did say it was interested, however.)

Could all viruses have an Achilles heel?

Maybe so — at least, that’s what Massachusetts General Hospital researchers think they’ve found. It’s a protein called Argonaute 4 or AGO4.

AGO4 has wide antiviral properties:

[O]nly cells that were deficient in AGO4 were “hyper-susceptible” to viral infection. In other words, low levels of AGO4 make mammalian cells more likely to become infected.

In other words, increase the levels of AGO4 and you might protect against every virus. Here, want some more science?

[Agronautes] are RNA interference (RNAi) and microRNA effector proteins and RNAi is the major antiviral defense strategy in plants and invertebrates. Studies of influenza infected mice have shown that AGO4-deficient animals have significantly higher levels of the virus.

The smoking, er, vaping gun

Juul: We’ve never intended our products for kids.

Massachusetts: So what about these ads on “Nickelodeon, the Cartoon Network, Seventeen magazine, and educational sites for middle school and high school students?

The Long Read: Did you know?

“No person who was born blind has ever been diagnosed with schizophrenia.”

Marietta sues Mallinckrodt

The city of Marietta is suing the maker of Acthar, because the company jacked up the price of the drug from $40 to over $39,000 for a single vial. Mallinckrodt’s defense is the usual: ‘It cost a lot to develop the drug.’

In a statement, the company said […] it has invested more than $600 million in clinical trials and other development programs for Acthar and offers significant discounts to many customers and a “range of free drug and commercial copay assistance options.”

Acthar was first released in 1952.

The U.S. Department of Justice is also suing Mallinckrodt over illegal kickbacks.

Techs: Get your worm!

Early-bird registration for TechU — the day of meeting, greeting, CE, and Topgolf — ends on Valentine’s Day (that’s this Friday, February 14).

Don’t miss out on the big event this May for Georgia’s pharmacy techs! Check out GPhA.org/techu for the details and sign up now!

If you miss out on early bird registration, don’t sweat it. It’s only $5 difference, and you know what they say: “The second mouse gets the cheese.”

Starting the thousand-mile journey

One way to encourage people to quit smoking: Give them a “goody bag” containing a two-week starter kit of nicotine replacement therapy along with educational material and contact info for Quitline.

The study was done by a dentist, and he suggested that primary care providers could be the ones to give away the bags, but it seems like there’s another healthcare provider that patients probably see a bit more often….

Methionine — it was you all along

It seems as if high levels of methionine (the amino acid common in meats and eggs) can ‘over-fuel’ T-cells, which is bad news for people with inflammatory and autoimmune disorders. Reducing methionine, researchers found, “altered the reprogramming of T cells, limiting their ability to cause inflammation in the brain and spinal cord.”

Of course, this was only in mice, but — as always — it’s an interesting step in an important direction.

One dose is all it takes

Of the HPV vaccine, that is. It seems (further tests to come) that a single dose may be as effective as multiple doses for preventing cervical cancer.

Which anti-depressant is most likely to work?

It may seem like a crapshoot, trying to figure out which drugs will work for whom. But there may be an answer in the brain’s “neural signature” — that is, which regions are active, based on electroencephalography scans.

So… give patients anti-depressants, let an artificial intelligence monitor their brain patterns, and eventually (say the researchers), the computer will be able to develop a model and accurately predict what’s likely to work for each patient.

Med supply worries

The virtual shutting down of China hasn’t yet impacted the supply of medication to the U.S. … at least that’s the official word for the moment. Of course, there are still plenty of drugs in pipeline, even if the supply has been temporarily stopped. The bigger issue will likely crop up in a few months.

As FDA commish Stephen Hahn put it, “The situation is fluid.”

Welcome to the Future: “Skin in the Game” edition

The article’s lede says it all:

A team of researchers in Canada have successfully trialled a new handheld 3D skin printer, which treats severe burns by ‘printing’ new skins cells directly onto a wound.

So forget about skin grafts — just print it using “a bioink based on fibrin – a protein involved in the clotting of blood – infused with mesenchymal stromal cells.”

Just … wow.

The Long Read: “No Profit, No Product” edition

“Coronavirus: The Latest Problem Big Pharma Won’t Solve”

[N]one of the four top vaccine companies has shown significant interest. It has been the Coalition for Epidemic Preparedness Innovations, a government- and charity-funded initiative to accelerate the development of vaccines to respond to outbreaks, that has been leading the effort to find a vaccine for 2019-nCoV.

Oh, Augusta

Augusta was ranked one of the 10 least healthy states in the country by the latest WalletHub analysis — ranked #167 out of 174 U.S. cities.

Atlanta is the highest rated in the state (#22), and Columbus came in at #158.

The ratings are based on 10 measures, from cost of medical visits and premature death rate, to physical activity and even availability of healthy foods. (And in case you’re intersted, San Francisco was rated most healthy; Brownsville, Texas, was at the bottom.)

Preventative measures

The good news: The federal government says it will spend $66 million to prevent the spread of the Wuhan coronavirus in the U.S.: $30 million to evacuate and quarantine Americans in China, and $36 million to send CDC staff to states where the virus has shown up.

The bad news: That’s more than half the entire U.S. fund for dealing with sudden disease outbreaks. But hey, what are the chances of another outbreak happening?

Who goes there?

Scientists in Brazil have discovered an entirely new virus. Like, really new.

“…an enigmatic virus whose genome seems to be almost entirely new to science, populated by unfamiliar genes that have never before been documented in viral research.” Meet Yaravirus.

Learn point-of-care testing with GPhA and NACDS

Patients who use point-of-care “at home” tests need you. Don’t send them home without a helping hand. Learn how you can help them take control of their health with these tests … and how to best advise them when they show you the results.

Check out the 20-hours NACDS “Community Pharmacy-based Point-of-Care Testing Certificate Program” at GPhA.org/pointofcare.

Sunday, March 15
8:30 a.m. – 12:30 p.m.
GPhA Headquarters in Sandy Springs

$349 for GPhA member pharmacists, $149 for member technicians (techs can’t get the CE, though — sorry!)

Flu update

The type A variant is now “on the rise.”

22 million Americans infected; three million in the last week. At least 12,000 deaths nationwide, and more than 210,000 hospitalizations.

If lives weren’t being ruined, this might actually be comical

Pharma company Cephalon ran trials of its opioid, Fentora. In publishing the outcome, the company reported “no unexpected” adverse events, and that it was “typical.” The FDA approved Fentora for restricted use.

In fact, newly released documents show…

In one trial, 11 patients overdosed. One patient’s husband overdosed on the trial drugs. And 35 people reported their opioids were stolen, and dozens dropped out of the study without returning the tablets they had […]

Among the patients was a man who tried skating through an unscheduled drug test by submitting his wife’s urine. Another woman replaced her pills with empty blister cavities “to make it appear that she was returning study med(icine).”

And now Virginia — and possibly other states — is suing Cephalon, accusing it of violating the Virginia Consumer Protection Act.

CBD news

Nielsen reports that 3 to 5 percent of the U.S. CBD-product market will be for … pets.

• 74% of consumers who purchase CBD products own pets
• 24% of pet owners use hemp or CBD for themselves, their pet or both.
• Among dog owners, about 26% are using CBD products; half are already administering it to their dogs.

Elsewhere: CBD (legal) can show up on sensitive blood tests as THC (illegal), so Tennessee is looking to tweak its law to keep people from being arrested after a false positive.

Elsewhere: Paying for effectiveness

Last week we told you about Zolgensma, the drug for infants that Novartis has priced at $2.1 million.

While people around the world are hoping to win the company’s lottery to get the life-saving med, Massachusetts came up with an interesting twist. It’s Medicaid program, MassHealth, will only pay for the drug if it works. (MassHealth has a history of negotiation better drug prices with manufacturers.)

The Long(ish) Read: An idea so crazy it just … might … work

Instead of arresting drug addicts, police help get them treatment.

Georgia’s Medicaid proposal goes to Washington

Georgia wants to change how it operates the state’s Affordable Care Act insurance marketplace, where about 450,000 Georgians get their health insurance. The federal government is considering the plan; here’s the story.

Emory brings in the pharmacists

Emory Healthcare learned a great way to both improve medication adherence and save money in its hospitals: It brought its specialty pharmacy in-house, and it integrated pharmacists tightly into patient care.

It had its bumps, but in the end it worked: Adherence jumped more than 25%, treatment time declined, and waste was reduced.

Pharmacists were asked to perform a wider set of duties to which they were not accustomed, and providers and pharmacists had to give up a measure of independence.

But the pharmacists possessed up-to-date knowledge of clinical advances and drug indications and availability—specifically, cost consciousness—and they had frequent interaction with patients throughout the care timeline. They were ideally positioned to work closely with providers and patients to ensure protocols were followed and patients were appropriately monitored and informed.

Ragnarök Watch: “Facts is facts” edition

Did you know that eating garlic can prevent the coronavirus? It can’t. But that doesn’t stop the rumors from spreading with all sorts of false information. So the World Health Organization finds itself fighting a different kind of pandemic: an ‘Infodemic’.

— and —

The ophthalmologist who sounded the alarm about the coronavirus — and who was officially reprimanded by Chinese police for ‘spreading illegal and false information’ — has died of the virus. He was 34.

Latest flu numbers

Per the The Georgia DPH, 42 Georgians have died from the flu so far this season; more than half were 65 and older. At least 1,375 people have been hospitalized in the state.

Latest flu tool

The CDC has a nifty new tool called “Mia” — it’s a portable kit that can sequence a virus in half the time it normally takes (only about 14-1/2 hours).

It may not be quite up to “Star Trek” standards for instant science, but the “Mobile Influenza Analysis” can mean being better prepared when the flu strikes … humans or pigs.

A lottery for life

Babies with a disease called spinal muscular atrophy (SMA) will likely die, but there’s a treatment called Zolgensma, made by Novartis. The company has set the price for Zolgensma at $2.1 million in the U.S., making it the most expensive drug on Earth. (It is currently only approved in the U.S.)

Families who can’t afford the treatment are trying to raise the money, but obviously many can’t. So Novartis came up with a solution: It will give away 50 treatments in the first half of the year via a lottery, and another 50 in the second half.

Those babies will live. The others will have to take regular doses of a drug called Spinraza, which is widely available (and thus affordable outside the U.S.), but doesn’t work as well.

Gigantic cancer-genome project concludes

A massive, worldwide effort* to sequence and understand the cancer genome has ended with the simultaneous publication of 22 (!) papers and dozens of new discoveries — the mutations, the causes, the timelines, and much much more.

Here’s the news story, and here are all the papers, courtesy of Nature.

* More than 1,300 researchers, 38 types of cancer, and 2,800 patients.

Optimizing vaccines

On one end of the spectrum is the idea of a universal vaccine — for the flu, for example. One shot to rule them all, so to speak.

But the other side is also important: Designing vaccines for a disease that are tailored for patients’ age, location, and even what strains of a disease are circulating. Modern computer modeling can design a vaccination program that’s much more effective than ‘everyone gets the same shot.’