Legislative update: Week 4

Don’t miss Greg Reybold’s latest update on what’s happening at the capitol. Our major anti-steering bill, which will prohibit PBMs from sending patients to PBM-owned pharmacies, is about to be introduced! Greg also reports on the students at the Gold Dome, plus a new bill prohibiting dextromethorphan from being sold to minors. See it and previous updates at GPhA.org/legislativeupdates.

Did a PBM pressure drug makers?

Bank of America Merrill Lynch analysts think so, looking at a letter from OptumRx that “demanded almost two years of advance notice from pharma companies before they lower the prices of their drugs.”

Said the analysts: “This would feed into the narrative that the middlemen in the supply chain are part of the problem for high drug costs.”

Tainted valsartan: not just China

Add Pfizer’s Japanese products — which actually come from India via Mylan Pharmaceuticals — to the list of recalled blood pressure meds.

Can you do a better track and trace?

The FDA is soliciting ideas for using modern tech to better track and trace drugs in the U.S. supply chain. By 2023 it wants a totally interoperable system connecting manufacturers, wholesalers, and distributors.

When hospitals collide, er, merge

The idea was that larger hospitals could use economies of scale to do better for patients. The reality … not so much. “[E]vidence from three decades of hospital mergers does not support the claim that consolidation improves quality.”

Vitamin C and diabetes

Patients with type 2 diabetes who took 1000 mg of vitamin C each day had a significant drop in blood glucose levels after meals — 36 percent. Caveat: It was a small study: 31 people.

Healthy and unhealthy cities

On the one side, Atlanta — ranked by WalletHub as the 19th healthiest city in the country — that’s based on 25 measures of the quality and availability of healthcare, 25 on food consumption, 25 on fitness, and 25 on green space and recreation.

On the other end of the spectrum, though, are Columbus (ranked #162 out of 174 metro areas) and Augusta (#168). Read the details and see the rankings here. Spoiler: #1 is San Francisco, and #174 is Brownsville, Tex.

Washington (state) hears the wake-up call

In the Washington county experiencing all those measles cases, “Former anti-vaxxers now seek out measles vaccine after outbreak.”

Get yourself an APhA MTM certificate

GPhA is offering APhA’s Delivering Medication Therapy Management Services this coming Sunday, February 17, in Sandy Springs. Having an official APhA MTM certificate is great for your patients, your practice, and your career.

What will you learn? Glad you asked. The class offers “a systematic approach for developing, implementing, delivering, and sustaining MTM services, from a marketplace overview to help implementing MTM services in your practice, and a review of the skills and knowledge you need.”

Check out the details at GPhA.org/mtm — heck, you can get a total of 21 CPE hours!

FDA sends out warnings

The FDA is very very not happy with 17 companies in and out of the U.S. for selling snake oil — er, we mean dietary supplements they claim will treat Alzheimer’s. (Pro tip: They don’t.)

Another universal flu vaccine in the works

This one from Oxford University and New York-based startup Blue Water Vaccines.

The vaccine, which covers all influenza A and B strains is, is approaching clinical studies and could feasibly enter Phase I trials by the end of 2019.

Apply now for the GPhA Board of Directors

GPhA is now accepting applications for the 2019–2020 board. We encourage applications from all pharmacy practice settings.

Applications are being accepted for the following seats:

• Representing the Academy of Independent Pharmacists (three-year term);
• At-large members elected by the GPhA membership (three-year terms).

The deadline for applications is 11:59 p.m. EST on March 11, 2019.

As the bylaws require, an online election will begin May 23, 2019 and will close midnight June 13, 2019 following the first general session of the 2019 Georgia Pharmacy Convention.

GPhA will announce election results on June 14, 2019, at the convention’s second general session. New directors will be installed at the 2019 General Membership Meeting on June 15, 2019.

For complete information on the roles and responsibilities of GPhA board members, as well as details on the application process that the GPhA bylaws require, go to GPhA.org/2019board. There you will also find a link to the actual application form.

If you have questions before you apply, feel free to contact Governance Manager Merrily Bennett at mbennett@gpha.org.

The long read: Atlanta and the fight against HIV

From Georgia Health News: “In new offensive against HIV, metro Atlanta is a battleground.”

Oooooh, you’re in troublllllllle

The FDA is “taking action” against Walgreens for selling tobacco to minors just a bit too often. Which technically means “ever” but in this case means “22 percent of its inspected stores having illegally sold tobacco products to minors.”

Just because we can doesn’t mean we will

Yes, the FDA has approved a heck of a lot of new drugs in the past couple of years — more than 1,600, in fact. But what you don’t hear is that 43 percent of them have never been sold to patients, and that means prices aren’t coming down.

“It’s a real problem because we’re not getting all the expected competition,” FDA Commissioner Scott Gottlieb said.

Last year’s flu vaccine did a lot more good than you realize

From a study in Clinical Infectious Diseases, which found that, although the 2017-2018 vaccine was only 38 percent effective, it still saved a lot of people:

We estimated that influenza vaccination prevented 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths.

Swallow that robot

A group of researchers from M.I.T., Harvard, and Novo Nordisk have developed a set of tiny robots that can be swallowed, and which then inject medication:

The device works by attaching itself to the inside of the stomach then injecting a payload through the gastric wall. […] a tiny, spring-loaded needle is released once the sugar glass that surrounds it is dissolved by acid in the stomach.

Thinking about owning your own pharmacy?

Our friends at NCPA have a workshop coming up. (It’s in Charlotte, N.C., which isn’t too far.)

It’s an intensive three-day event for pharmacists considering pharmacy ownership or current owners looking to polish their management skills. It’s a soup-to-nuts crash course on pharmacy ownership, whether you’re starting from the ground up, purchasing an existing store, or expanding to become a multi-store owner.

J&J goes transparent

Johnson & Johnson will be the first major pharmaceutical company to start adding drug prices — list and out-of-pocket — to its television ads.

“We’re starting with our most widely prescribed medicine so we can assess how the price and cost information is received by a broad range of people. We will take into account patient and consumer feedback in guiding roll-out to additional medicines we advertise on TV.

TIL*: Insulin edition

You can buy human insulin at Walmart for about $25 a vial without a prescription. (Note: this is human insulin, which is a little different than the insulin analog that most diabetics take.)

* “Today I learned” Honestly, it’s embarrassing to have to explain this to you kids

Just keep paying, just keep paying….

“Consistent payments from drug companies influence physician prescribing practices”

Holy moly! We snagged Lucinda Maine!

That’s right —Lucinda Maine, PhD, RPh, and EVP & CEO of the American Association of Colleges of Pharmacy is the second big keynote signed for the 2019 Georgia Pharmacy Convention!

She’ll be talking about the nationwide push — the Pharmacist for Healthier Lives Campaign — to have the public recognize pharmacists as the critical (and accessible) healthcare providers we know they are.

Yet another great reason to be ready to register on March 1!

The fate of Georgia’s tobacco money

Georgia receives $150 million a year as part of its share of the $206 billion 1998 Tobacco Master Settlement Agreement (when tobacco companies agreed to pay toward the health costs of smokers).

So, wondered Georgia Health News, with the state having just received an “F” for smoking prevention, where is all that money going? The answer: Less than 10 percent went to cancer treatment. Most of the rest goes to the general Medicaid fund. Read on, MacDuff.

Good news for our furry friends

A new study finds that “Combo of diabetes, leukemia drugs may fight breast cancer” — at least in mice. Metformin plus venetoclax destroyed their cancerous tumors. Human trials could be in the future.

And other researchers have developed an immunotherapy-style bone cancer vaccine for dogs that seems to increase remission time for Man’s Best Friend™.

Cutting through the headlines

Headline: “Smoking Marijuana Linked to Better Sperm Counts.” Reality: Yes, men who smoked pot did seem to have a higher sperm count, but the researchers don’t know which way the cause-effect works. Co-author Dr. Jorge Chavarro of Harvard explains:

A far more likely explanation, he says, is that men with higher testosterone levels — who tend to have higher sperm counts and concentrations than men with lower levels of testosterone — are also more likely to use marijuana.

Vitamin C fights gestational diabetes?

It could be that a diet high in vitamin C can help pregnant women from developing gestational diabetes. File this under “Keep an eye on it ’cause it’s just one study.”

If you haven’t read it before, it’s new to you

Another article on why the U.S. pays more for drugs than any other country.

[T]he overall complexity of the U.S. health care system and the lack of transparency in the drug supply chain system create conditions favorable to limited competition and price maximization.

Antidepressant overprescribing in the elderly

It happens with more than a quarter of older people according to a study published in Pharmacology Research and Perspectives. The main culprits: living in a nursing home, multiple medical conditions, multiple prescribers, and “receiving the prescription via telephone, e‐mail, or patient portal.” (Scroll down to “Discussion” if you want to avoid all the boring detail.)

Elsewhere: Could be worse; could be Britain

The country looks more likely than ever to leave the EU in a month without a deal. And that’s going to play havoc with its healthcare system.

Stockpiling of medicines in the event of a no-deal is already underway. Two-thirds of medicines imported to the UK come from the EU, but there has been a shortage of some medical supplies for some time. […] Even products made in the UK could be affected if they rely on ingredients imported from the EU.

The long read: Income and drug purchasing

https://www.nytimes.com/2019/02/07/upshot/income-strong-predictor-drug-purchases-serious-diseases.html

Legislative update: Week 3

Don’t miss Greg Reybold’s more-exciting-than-the-Super-Bowl update on what happened at the capitol this past week — see it and previous updates at GPhA.org/legislativeupdates. And look for a special message from CEO Bob Coleman in your inbox, too.

Students at the Gold Dome

Student pharmacists from UGA and PCOM headed to the Gold Dome on Tuesday to meet with legislators and let them know they’re invested in their future careers.

Check out the pic — and imagine those hundreds of fresh-faced white-coat wearing students as they made their way through the halls of the capitol. That’s how you make a statement!

Remote hypertension control

Smart devices and new technology are making it easier for patients to stay at home. For example, one study just showed how patients with hypertension don’t need to go to the doctor or pharmacist for a blood pressure check when they’ve got a whole Internet at their disposal.

Unintended consequences

After Purdue’s switched to ‘abuse-deterrent’ OxyContin, users switched to heroin — and that spiked hepatitis C infections.

Coming back for more

A survey found that older patients with diabetes are visiting the ER … a lot.

What is this, 1953?

More measles cases are popping up around the country, and Georgia is one of the states reporting them. And then there’s Newton County, which is seeing cases of whooping cough among kids.

Elsewhere: Great White North edition

Canada is looking to change how much it’s willing to pay for drugs (it will no longer use the U.S. for comparisons, for example). Drugmakers panicked and “offered to give up C$8.6 billion ($6.6 billion) in revenue over 10 years, freeze prices or reduce the cost of treating rare diseases.”

The Canadian government declined the offer.

The long read from the Washington Post: “CVS bought your local drugstore, mail-order pharmacy and health insurer. What’s next, your hospital?” (https://www.washingtonpost.com/business/cvs-bought-your-local-drugstore-mail-order-pharmacy-and-health-insurer-whats-next-your-hospital/2019/01/31/4946dcda-1f2c-11e9-9145-3f74070bbdb9_story.html)

Gweneth Paltrow’s fake-science “health” site, Goop, is coming to Netflix in video form. Now you can watch how to “detox” your body after a health crisis. Bonus: Delta Airlines is sponsoring the podcast version. (https://www.usatoday.com/story/life/people/2019/02/05/gwyneth-paltrows-goop-gets-netflix-docu-series/2775500002/)

Why do most people who take medical cannabis take it? Chronic pain. (https://www.upi.com/Health_News/2019/02/05/Chronic-pain-drives-most-medical-cannabis-use-study-says/4291549385294/?sl=5)

Botox on the cheap

If you’re the kind of person to treat your laugh or frown lines* with botulism toxin, good news: The FDA has approved a cheaper alternative to Botox.

* Or depression, or sweating, or incontinence, or migraines…

No punches pulled with that letter

Sanders to Catalyst Pharmaceuticals: “How many patients will suffer or die due to Catalyst’s decision” to raise the price of Firdapse from zero to $375,000? (Click here for the full text of the letter as a PDF.)

Aw, nuts

If you think you’re seeing more adult patients with food allergies, you’re not alone.

[A]necdotally, doctors say they are seeing more adult patients with food allergies and it is important to know the scope of the problem to better understand and manage it.

Laugh while you can

Because you have to be awake for brain surgery, neuroscientists at Emory University say electrically-stimulated laughter might be the best way to keep you calm.

Emory neurosurgeons see the technique as a “potentially transformative” way to calm some patients during awake brain surgery, even for people who are not especially anxious.

ICYMI: Aloha edition

Hawai’i is considering raising the legal age to buy cigarettes … to 100 years old.

All natural facepalm

Gweneth Paltrow’s fake-science “health” site, Goop, is coming to Netflix in video form. Now you can watch how to “detox” your body after a health crisis. Bonus: Delta Airlines is sponsoring the podcast version.

Elsewhere: Mile high* edition

The city of Denver is considering decriminalizing magic mushrooms. (Small amounts only, and it means you’d get a ticket for possession, not jail time.)

*We used the headline “Rocky Mountain high” once before, in case you’re wondering

The long read: One CVS to rule them all?

“CVS bought your local drugstore, mail-order pharmacy and health insurer. What’s next, your hospital?”

Georgia finally considering Medicaid expansion

The state — one of only about a dozen that hasn’t expanded coverage to more low-income people — is spending $1 million to investigate the possibility of a Medicaid “waiver” that would allow it to limit who would be covered. A wide majority of Georgians — 71 percent — support Medicaid expansion.

The end of PBM rebates?

That’s what the administration says it’s considering, at least for Medicare and Medicaid.

HHS’ proposal would eliminate a legal provision that allows drug companies and pharmacy benefit managers to negotiate rebates in exchange for making it easier for patients to get access to certain drugs.

Rebates would still be OK as long as they’re passed on to consumers.

PBMs say that doing so would bring about the End of the World As We Know It, and is also beyond the power of HHS. Drug manufacturers support the proposal.

Don’t do this:

The CDC says kids are using too much toothpaste when they brush. A pea size is enough; too much can mean ingesting extra fluoride.

Some fentanyl off the street

DEA agents (based on a hunch!) seized more than 250 pounds of fentanyl from a hidden compartment in a tractor-trailer. (Oh, and almost 400 pounds of meth.) Almost all illegal drugs come into the U.S. via legal border crossings, with 85 percent coming through San Diego — but now Arizona’s crossings are becoming more of a hotspot.

Well why not?

What do you do when a competitor’s generic drug is recalled? If you’re Alembic, maker of a non-recalled version of valsartan, you raise the price — up to 469 percent.

Speaking of generic-drug price hikes, remember that lawsuit against the “cartel” of 20 generics manufacturers? It’s expanded to 45 states (Georgia isn’t one), D.C., and the Department of Justice — and now may include wholesalers.

Elsewhere: Rocky Mountain edition

Colorado is looking at a wholesale approach to allowing drug imports from Canada. Rather than allowing patients to buy inexpensive Canadian drugs, the state is considering a bill that would allow it to “import prescription drugs from licensed Canadian suppliers and distribute them to Colorado pharmacies and hospitals.”