List of drugs dropped by CVS’s PBM

Pharmacy benefit managers, or PBMs, which administer drug benefits for employers and health plans and also run large mail-order pharmacies, have been challenging the rising cost of new medications. When drugs are knocked off their formularies, patients may have to pay full price for them. PBMs often keep or dump a product depending on whether they can obtain favorable pricing…

Here is the full list of drugs dropped by CVS, according to CNN:
Abilify (antipsychotic)
Amitiza (irritable bowel disease)
Avonex (multiple sclerosis)
Bydureon (diabetes)
Carac (dermatology)
Cardizem (high blood pressure)
Clobetasol spray (dermatology)
Clobex spray (dermatology)
Cymbalta (depression)
Diovan (high blood pressure)
Exforge, including Exforge HCT (high blood pressure)
Extavia (multiple sclerosis)
Fluorouracil cream 0.5% (dermatology)
Fortesta (testosterone replacement)
Fosrenol (kidney disease)
Incruse Ellipta (Chronic obstructive pulmonary disease)
Intuniv (ADHD)
Invokameet (diabetes)
Invokana (diabetes)
Matzim LA (high blood pressure)
Monovisc (monovisc)
Noritate (dermatology)
Plegridy (multiple sclerosis)
Qsymia (anti-obesity)
Relistor (gastrointestinal)
Valcyte (anti-infective)
Viagra (erectile dysfunction)
Zubsolv (opioid dependence)

Pharmacist dismisses patients by order of DEA

The accident happened 10 years ago when Chris Young was 35. He owned a salvage yard in Maui, Hawaii, and his employee had hoisted a junker on a machine called an excavator when the hydraulics gave out. The car fell on him from above his head, smashing his spine…  To control the pain, Young, who has since moved to Florida, needs high doses of narcotic painkillers, but he can’t always fill his doctor’s prescription…

Young’s pharmacist is Bill Napier, who owns the small, independent Panama Pharmacy in Jacksonville. Napier says he can’t serve customers who legitimately need painkillers because the wholesalers who supply his store will no longer distribute the amount of medications he needs. “I turn away sometimes 20 people a day,” says Napier.

Last year Napier says federal Drug Enforcement Administration agents visited him to discuss the narcotics he dispensed. “They showed me a number, and they said that if I wasn’t closer to the state average, they would come back. So I got pretty close to the state average,” Napier says. He says he made the adjustment “based on no science, but knowing where the number needed to be. We had to dismiss some patients in order to get to that number.”

According to Napier, DEA agents took all of his opioid prescriptions and held on to them for seven months. Napier hired a lawyer and paid for criminal background checks on his patients taking narcotics to help him decide which ones to drop…

“What we’ve seen is dramatic reductions in our ability to provide appropriate care for our patients in pain,” says Dr. R. Sean Morrison, director of the palliative care program at Mount Sinai Hospital in New York. Morrison’s patient Ora Chaikin has been taking high levels of narcotics for years to control her pain. She has had multiple surgeries because her bones and ligaments disintegrate, a problem caused by rheumatoid arthritis and other autoimmune diseases. But Chaikin, who lives in Riverdale, N.Y., says her mail order pharmacy, CVS/caremark, has been denying her medications.

“Every month there’s a reason they won’t give me my medication,” says Chaikin. “Sometimes it’s ‘Well, why are you taking this dose?’ ‘My doctor prescribed it.’ ‘Well, why did your doctor prescribe so much?’ ‘Ask my doctor,’” she recounts. “That’s the dose that works for me and you’re made to feel like a drug addict.” …

In a statement, CVS/caremark said that the dosage of pain medication prescribed to Chaikin “exceeded the recommended manufacturer dosing.” It also said that she “continued to receive her controlled substance prescriptions from CVS/caremark without interruption.” …

Ora Chaikin’s wife, Roseanne Leipzig, who is a geriatrician and palliative care physician, says when it comes to narcotics, there is nothing in medical literature that says a dose is too high. “There is no maximum dose for narcotics,” she says. “It’s the dose you need to take care of the pain.”

The Florida Board of Pharmacy, which is responsible for licensing pharmacists and educating them on safe practice, has heard enough complaints from pain patients that it is addressing the issue in public meetings. In June, Lesley Young testified before the board on behalf of her husband. She said she has driven more than 100 miles trying to find a pharmacy that would fill her husband’s prescriptions for painkillers.

“I’ve had to do the pharmacy crawl like many of us here,” Lesley told the board. “I’ve been the one who had to go in and beg, crying, with stacks of his medical records, with stacks of imaging, only to get turned away, often rudely, saying ‘We don’t deal with those kinds of patients.’

The next Florida Board of Pharmacy hearing is set for Monday. A representative of the DEA has been invited to attend.

Because Florida is pretty much the only state where the media is reporting on the war against pain patients, you might think that it’s not happening in other states. Of course that’s not true. And the media is focusing on the pharmacy crawl, which is only one problem among many. I know that doctors are abandoning patients, or just refusing to treat pain patients, but the media isn’t looking at that problem.

Under comments:

lservies, on August 5, 2015 at 6:45 pm said:
In the State of Tennessee, the DEA has forced all state licensed pain clinics to reduce ALL patients meds to under 200 milliequivalents of morphine per day. For us long-time chronic pain patients who are opiod tolerant, that is next to nothing. The State law actually reads that all patients who require more than 200 milliequivalents of morphine doses per day are required to go to a state licensed pain clinic. And now, they won’t let the clinics dispense over that amount.

His and her pain circuitry in the spinal cord

“Research has demonstrated that men and women have different sensitivity to pain and that more women suffer from chronic pain than men, but the assumption has always been that the wiring of how pain is processed is the same in both sexes,” said co-senior author Jeffrey Mogil, Ph.D., E.P. Taylor Professor of Pain Studies at McGill University and Director of the Alan Edwards Centre for Research on Pain…

The research was conducted by teams from McGill University, The Hospital for Sick Children (SickKids), and Duke University, and looked at the longstanding theory that pain is transmitted from the site of injury or inflammation through the nervous system using an immune system cell called microglia. This new research shows that this is only true in male mice. Interfering with the function of microglia in a variety of different ways effectively blocked pain in male mice, but had no effect in female mice…

According to the researchers, a completely different type of immune cell, called T cells, appears to be responsible for sounding the pain alarm in female mice. However, exactly how this happens remains unknown…

The discovery comes as there is increased attention to the inclusion of female animals and cells in preclinical research. The U.S. National Institutes of Health recently unveiled a new policy, similar to one already in force in Canada, to require the use of female animals and cell lines in preclinical research.

“For the past 15 years scientists have thought that microglia controlled the volume knob on pain, but this conclusion was based on research using almost exclusively male mice,” said Mogil. “This finding is a perfect example of why this policy, and very carefully designed research, is essential if the benefits of basic science are to serve everyone.” …