Wednesday, June 24, 2009
Saturday, June 6, 2009
Brass Balls Award
This is strange.
A pharmacy chain actually doing something to make sure that they aren't losing money. It's weird to see a pharmacy chain taking a stand on the reimbursement front. Everybody else is seeing how many drugs they can have on the old el cheapo list and Walgreens goes and stops being a provider for Delaware Medicaid due to poor reimbursement.
For that, Walgreens earns the first Brass Balls Award from Pharmacy God. I couldn't find out how many pharmacies are in Delaware, but losing 66 pharmacy providers has to be significant.
Have you noticed that in the past, the chains that will actually take a stand on reimbursement issues are the ones who are pharmacies first? The mass merchandisers and grocery store operations will let pharmacy contracts slide because dropping an insurance will decrease the store's customer count, so pharmacy takes the hit in exchange for Mrs Jones hopefully buying a bag of chips and a few light bulbs. Pharmacy is the store's loss-leader, not the sale on Easy-Mac.
But Walgreens, Rite Aid, and CVS have been the ones to actually look at the contracts, run the numbers, and determine if the contract is worth the effort. I usually don't have a lot of good to say about these places, but maybe we could all learn from them when it comes time to sign the contracts next year.
Instead of looking over the terms and going oh crap, we're going to screwed, dropping an insurance or two may be what is needed to keep a pharmacy profitable.
The least you should do is read the entire contract to see how your reimbursements are calculated. I just left a position where the contracts were signed for us by a representative employed by our wholesaler.
What does the wholesaler care about the reimbursements? They're selling us the medications.
The best contract that I saw involved the following generic reimbursement rates, the lowest being what we were reimbursed...
A pharmacy chain actually doing something to make sure that they aren't losing money. It's weird to see a pharmacy chain taking a stand on the reimbursement front. Everybody else is seeing how many drugs they can have on the old el cheapo list and Walgreens goes and stops being a provider for Delaware Medicaid due to poor reimbursement.
For that, Walgreens earns the first Brass Balls Award from Pharmacy God. I couldn't find out how many pharmacies are in Delaware, but losing 66 pharmacy providers has to be significant.
Have you noticed that in the past, the chains that will actually take a stand on reimbursement issues are the ones who are pharmacies first? The mass merchandisers and grocery store operations will let pharmacy contracts slide because dropping an insurance will decrease the store's customer count, so pharmacy takes the hit in exchange for Mrs Jones hopefully buying a bag of chips and a few light bulbs. Pharmacy is the store's loss-leader, not the sale on Easy-Mac.
But Walgreens, Rite Aid, and CVS have been the ones to actually look at the contracts, run the numbers, and determine if the contract is worth the effort. I usually don't have a lot of good to say about these places, but maybe we could all learn from them when it comes time to sign the contracts next year.
Instead of looking over the terms and going oh crap, we're going to screwed, dropping an insurance or two may be what is needed to keep a pharmacy profitable.
The least you should do is read the entire contract to see how your reimbursements are calculated. I just left a position where the contracts were signed for us by a representative employed by our wholesaler.
What does the wholesaler care about the reimbursements? They're selling us the medications.
The best contract that I saw involved the following generic reimbursement rates, the lowest being what we were reimbursed...
- AWP minus some percent (I don't have the contract in front of me, but it wasn't good), plus 2.25
- GEAP
- Federal MAC
- Insurance company MAC
The insurance company MAC is what caught my eye. They could arbitrarily add a drug to their MAC list, set the price to whatever they wanted, and reimburse at that rate.
And we agreed to accept it without even asking to see what their MAC list was.
So again I would like to congratulate Walgreens for taking a stand. Maybe the other pharmacies in Delaware will take a look at the reimbursement rates and make the same decision.
Wednesday, May 13, 2009
Gun control?
The following was sent to me by a former co-worker. I liked it and thought that I would share it.
You're sound asleep when you hear a thump outside your bedroom door. Half-awake, and nearly paralyzed with fear, you hear muffled whispers. At least two people have broken into your house and are moving your way. With your heart pumping, you reach down beside your bed and pick up your shotgun. You rack a shell into the chamber, then inch toward the door and open it. In the darkness, you make out two shadows.
One holds something that looks like a crowbar. When the intruder brandishes it as if to strike, you raise the shotgun and fire. The blast knocks both thugs to the floor. One writhes and screams while the second man crawls to the front door and lurches outside.
As you pick up the telephone to call police, you know you're in trouble.
In your country, most guns were outlawed years before, and the few that are privately owned are so stringently regulated as to make them useless. Yours was never registered.
Police arrive and inform you that the second burglar has died.They arrest you for First Degree Murder and illegal Possession of a Firearm. When you talk to your attorney, he tells you not to worry: authorities will probably plea the case down to manslaughter.
"What kind of sentence will I get?" you ask.
"Only ten-to-twelve years," he replies, as if that's nothing. "Behave yourself, and you'll be out in seven."
The next day, the shooting is the lead story in the local newspaper. Somehow, you're portrayed as an eccentric vigilante while the two men you shot are represented as choirboys. Their friends and relatives can't find an unkind word to say about them. Buried deep down in the article, authorities acknowledge that both "victims" have been arrested numerous times.But the next day's headline says it all: "Lovable Rogue Son Didn't Deserve to Die."
The thieves have been transformed from career criminals into Robin Hood-type pranksters.As the days wear on, the story takes wings.The national media picks it up, then the international media.The surviving burglar has become a folk hero.
Your attorney says the thief is preparing to sue you, and he'll probably win.
The media publishes reports that your home has been burglarized several times in the past and that you've been critical of local police for their lack of effort in apprehending the suspects. After the last break-in, you told your neighbor that you would be prepared next time. The District Attorney uses this to allege that you were lying in wait for the burglars.
A few months later, you go to trial.
The charges haven't been reduced, as your lawyer had so confidently predicted. When you take the stand, your anger at the injustice of it all works against you.
Prosecutors paint a picture of you as a mean, vengeful man. It doesn't take long for the jury to convict you of all charges. The judge sentences you to life in prison.
This case happened.
On August 22, 1999, Tony Martin of Emneth, Norfolk , England , killed one burglar and wounded a second. In April, 2000, he was convicted and is now serving a life term.
How did it become a crime to defend one's own life in the once great British Empire ?It started with the Pistols Act of 1903. This seemingly reasonable law forbade selling pistols to minors or felons and established that handgun sales were to be made only to those who had a license.
The Firearms Act of 1920 expanded licensing to include not only handguns but all firearms except shotguns.Later laws passed in 1953 and 1967 outlawed the carrying of any weapon by private citizens and mandated the registration of all shotguns.
Momentum for total handgun confiscation began in earnest after the Hungerford mass shooting in 1987. Michael Ryan, a mentally disturbed man with a Kalashnikov rifle, walked down the streets shooting everyone he saw. When the smoke cleared, 17 people were dead.
The British public, already de-sensitized by eighty years of "gun control", demanded even tougher restrictions. (The seizure of all privately owned handguns was the objective even though Ryan used a rifle.)
Nine years later, at Dunblane , Scotland , Thomas Hamilton used a semi-automatic weapon to murder 16 children and a teacher at a public school.
For many years, the media had portrayed all gun owners as mentally unstable, or worse, criminals.Now the press had a real kook with which to beat up law-abiding gun owners. Day after day, week after week, the media gave up all pretense of objectivity and demanded a total ban on all handguns.
The Dunblane Inquiry, a few months later, sealed the fate of the few sidearm still owned by private citizens.During the years in which the British government incrementally took away most gun rights, the notion that a citizen had the right to armed self-defense came to be seen as vigilantism. Authorities refused to grant gun licenses to people who were threatened, claiming that self-defense was no longer considered a reason to own a gun. Citizens who shot burglars or robbers or rapists were charged while the real criminals were released.
Indeed, after the Martin shooting, a police spokesman was quoted as saying, "We cannot have people take the law into their own hands." All of Martin's neighbors had been robbed numerous times, and several elderly people were severely injured in beatings by young thugs who had no fear of the consequences. Martin himself, a collector of antiques, had seen most of his collection trashed or stolen by burglars.
When the Dunblane Inquiry ended, citizens who owned handguns were given three months to turn them over to local authorities.Being good British subjects, most people obeyed the law. The few who didn't were visited by police and threatened with ten-year prison sentences if they didn't comply. Police later bragged that they'd taken nearly 200,000 handguns from private citizens..
How did the authorities know who had handguns? The guns had been registered and licensed.
Kinda like cars.
Sound familiar?
WAKE UP AMERICA , THIS IS WHY OUR FOUNDING FATHERS PUT THE SECOND AMENDMENT IN OUR CONSTITUTION
"... it does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds."--Samuel Adams
You're sound asleep when you hear a thump outside your bedroom door. Half-awake, and nearly paralyzed with fear, you hear muffled whispers. At least two people have broken into your house and are moving your way. With your heart pumping, you reach down beside your bed and pick up your shotgun. You rack a shell into the chamber, then inch toward the door and open it. In the darkness, you make out two shadows.
One holds something that looks like a crowbar. When the intruder brandishes it as if to strike, you raise the shotgun and fire. The blast knocks both thugs to the floor. One writhes and screams while the second man crawls to the front door and lurches outside.
As you pick up the telephone to call police, you know you're in trouble.
In your country, most guns were outlawed years before, and the few that are privately owned are so stringently regulated as to make them useless. Yours was never registered.
Police arrive and inform you that the second burglar has died.They arrest you for First Degree Murder and illegal Possession of a Firearm. When you talk to your attorney, he tells you not to worry: authorities will probably plea the case down to manslaughter.
"What kind of sentence will I get?" you ask.
"Only ten-to-twelve years," he replies, as if that's nothing. "Behave yourself, and you'll be out in seven."
The next day, the shooting is the lead story in the local newspaper. Somehow, you're portrayed as an eccentric vigilante while the two men you shot are represented as choirboys. Their friends and relatives can't find an unkind word to say about them. Buried deep down in the article, authorities acknowledge that both "victims" have been arrested numerous times.But the next day's headline says it all: "Lovable Rogue Son Didn't Deserve to Die."
The thieves have been transformed from career criminals into Robin Hood-type pranksters.As the days wear on, the story takes wings.The national media picks it up, then the international media.The surviving burglar has become a folk hero.
Your attorney says the thief is preparing to sue you, and he'll probably win.
The media publishes reports that your home has been burglarized several times in the past and that you've been critical of local police for their lack of effort in apprehending the suspects. After the last break-in, you told your neighbor that you would be prepared next time. The District Attorney uses this to allege that you were lying in wait for the burglars.
A few months later, you go to trial.
The charges haven't been reduced, as your lawyer had so confidently predicted. When you take the stand, your anger at the injustice of it all works against you.
Prosecutors paint a picture of you as a mean, vengeful man. It doesn't take long for the jury to convict you of all charges. The judge sentences you to life in prison.
This case happened.
On August 22, 1999, Tony Martin of Emneth, Norfolk , England , killed one burglar and wounded a second. In April, 2000, he was convicted and is now serving a life term.
How did it become a crime to defend one's own life in the once great British Empire ?It started with the Pistols Act of 1903. This seemingly reasonable law forbade selling pistols to minors or felons and established that handgun sales were to be made only to those who had a license.
The Firearms Act of 1920 expanded licensing to include not only handguns but all firearms except shotguns.Later laws passed in 1953 and 1967 outlawed the carrying of any weapon by private citizens and mandated the registration of all shotguns.
Momentum for total handgun confiscation began in earnest after the Hungerford mass shooting in 1987. Michael Ryan, a mentally disturbed man with a Kalashnikov rifle, walked down the streets shooting everyone he saw. When the smoke cleared, 17 people were dead.
The British public, already de-sensitized by eighty years of "gun control", demanded even tougher restrictions. (The seizure of all privately owned handguns was the objective even though Ryan used a rifle.)
Nine years later, at Dunblane , Scotland , Thomas Hamilton used a semi-automatic weapon to murder 16 children and a teacher at a public school.
For many years, the media had portrayed all gun owners as mentally unstable, or worse, criminals.Now the press had a real kook with which to beat up law-abiding gun owners. Day after day, week after week, the media gave up all pretense of objectivity and demanded a total ban on all handguns.
The Dunblane Inquiry, a few months later, sealed the fate of the few sidearm still owned by private citizens.During the years in which the British government incrementally took away most gun rights, the notion that a citizen had the right to armed self-defense came to be seen as vigilantism. Authorities refused to grant gun licenses to people who were threatened, claiming that self-defense was no longer considered a reason to own a gun. Citizens who shot burglars or robbers or rapists were charged while the real criminals were released.
Indeed, after the Martin shooting, a police spokesman was quoted as saying, "We cannot have people take the law into their own hands." All of Martin's neighbors had been robbed numerous times, and several elderly people were severely injured in beatings by young thugs who had no fear of the consequences. Martin himself, a collector of antiques, had seen most of his collection trashed or stolen by burglars.
When the Dunblane Inquiry ended, citizens who owned handguns were given three months to turn them over to local authorities.Being good British subjects, most people obeyed the law. The few who didn't were visited by police and threatened with ten-year prison sentences if they didn't comply. Police later bragged that they'd taken nearly 200,000 handguns from private citizens..
How did the authorities know who had handguns? The guns had been registered and licensed.
Kinda like cars.
Sound familiar?
WAKE UP AMERICA , THIS IS WHY OUR FOUNDING FATHERS PUT THE SECOND AMENDMENT IN OUR CONSTITUTION
"... it does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds."--Samuel Adams
Monday, May 11, 2009
I hope this isn't cutting edge medical research
Every day I get my email updates from Medscape. Usually the material contained in them is about two weeks ahead of the media reporting. That's good because I have time examine the latest medical "news" before Sanjay Gupta or others in the media have a chance to freak out the public.
Not too long ago, an article appeared from the 2009 American Urological Association's annual scientific meeting. The title... Generics Not Equal to Brand-Name Drugs for Overactive Bladder.
The title caught my eye because, the last that I checked, there was only one generic in that class... oxybutynin. But I continued reading the article.
Back in the Stone Ages when I was in pharmacy school, we didn't do a whole lot of literature searches. But the there are a few things that I remember:
Based on the previously mentioned title, I was expecting to see a comparison of Ditropan XL with some of the generic oxybutynin extended-release products. After all, the first line of the article states, "A comparison of brand-name oxybutynin with generic substitutes for overactive bladder shows that bioequivalence in generic formulations can vary from 80% to 125% of the branded drug..."
Let us continue, remembering that this particular article is a summary of what was presented to the AUA. I don't have the actual study from which the data was produced.
The study design made sense to me... the patients kept a journal of how things were going both before and after the switch from brand-name product to generic.
Now here's the problem with the study... the patients weren't switched from Ditropan XL to a generic. They were switched from Detrol LA, Vesicare, Enablex, and Sanctura XR to generic oxybutynin. Not even the same chemical entity.
Gee golly.... I wonder if we take people off of the latest greatest medications and switch them to something that's been around since the dawn of time if they might not get the same results as before?
Know what happened? The people had a worsening of symptoms. The patients had to pee more often, get up in the middle of the night more, and had more urinary urgency.
It wasn't because they were given a generic.
It was because they were given a DIFFERENT FRIGGIN' DRUG!
The article then goes on to discuss the changes in PSA levels in men when switched from Avodart to the generic formulation. This is off-topic from the article's title, but we'll address it as well. Anybody want to bet five bucks that the generic formulation was finasteride? I can see PSA levels changing because, again, it's a DIFFERENT FRIGGIN' DRUG!
In the commentary that follows the findings of the study, Dr Steven A. Kaplan (the presenter of the study) said, "I always sign my prescriptions dispense as written" because "... the science supports it." Umm, Dr. Kaplan, the science that supports your justification for driving up health care costs by unnecessarily placing a DAW on your medication orders is faulty.
Let's see if the presentation meets the criteria that I remember from college.
I hope that the attendees of this conference actually look at Kaplan's study rather than taking his conclusions at face value.
I can see already see Kaplan's presentation for next year's conference... Brand Name Medications More Effective than Generics for Treating Prostatitis.
He'll be comparing Levaquin to ampicillin, tetracycline, and oral vancomycin.
Not too long ago, an article appeared from the 2009 American Urological Association's annual scientific meeting. The title... Generics Not Equal to Brand-Name Drugs for Overactive Bladder.
The title caught my eye because, the last that I checked, there was only one generic in that class... oxybutynin. But I continued reading the article.
Back in the Stone Ages when I was in pharmacy school, we didn't do a whole lot of literature searches. But the there are a few things that I remember:
- check sample sizes of research populations
- check the author's references to see if the author if relying too much on one researcher's work
- make sure that the conclusions that are presented match up to the objectives of the study
Based on the previously mentioned title, I was expecting to see a comparison of Ditropan XL with some of the generic oxybutynin extended-release products. After all, the first line of the article states, "A comparison of brand-name oxybutynin with generic substitutes for overactive bladder shows that bioequivalence in generic formulations can vary from 80% to 125% of the branded drug..."
Let us continue, remembering that this particular article is a summary of what was presented to the AUA. I don't have the actual study from which the data was produced.
The study design made sense to me... the patients kept a journal of how things were going both before and after the switch from brand-name product to generic.
Now here's the problem with the study... the patients weren't switched from Ditropan XL to a generic. They were switched from Detrol LA, Vesicare, Enablex, and Sanctura XR to generic oxybutynin. Not even the same chemical entity.
Gee golly.... I wonder if we take people off of the latest greatest medications and switch them to something that's been around since the dawn of time if they might not get the same results as before?
Know what happened? The people had a worsening of symptoms. The patients had to pee more often, get up in the middle of the night more, and had more urinary urgency.
It wasn't because they were given a generic.
It was because they were given a DIFFERENT FRIGGIN' DRUG!
The article then goes on to discuss the changes in PSA levels in men when switched from Avodart to the generic formulation. This is off-topic from the article's title, but we'll address it as well. Anybody want to bet five bucks that the generic formulation was finasteride? I can see PSA levels changing because, again, it's a DIFFERENT FRIGGIN' DRUG!
In the commentary that follows the findings of the study, Dr Steven A. Kaplan (the presenter of the study) said, "I always sign my prescriptions dispense as written" because "... the science supports it." Umm, Dr. Kaplan, the science that supports your justification for driving up health care costs by unnecessarily placing a DAW on your medication orders is faulty.
Let's see if the presentation meets the criteria that I remember from college.
- Sample size..... Kaplan's sample size was only 156 patients.
- References..... I didn't look to see if there we any since the study was on patients at his practice site.
- Conclusions..... Sorry, no.
I hope that the attendees of this conference actually look at Kaplan's study rather than taking his conclusions at face value.
I can see already see Kaplan's presentation for next year's conference... Brand Name Medications More Effective than Generics for Treating Prostatitis.
He'll be comparing Levaquin to ampicillin, tetracycline, and oral vancomycin.
Tuesday, May 5, 2009
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