Opioid Limits, CVS Tackles Drug Prices, and More Pharmacy News

August 14, 2018

Small Doses is back, bringing you the pharmacy news you need in a way that works for you.

CVS Blames Manufacturers for High Drug Prices

CVS Health has implemented several programs to help control drug pricing, but manufacturers must lower their drug prices, the company said in a recent letter to HHS Secretary Alex M. Azar.

“Until drug manufacturers reduce the high price they set for these drugs, we know this problem is not going away,” the company states in the letter. “Despite our efforts to lower costs for consumers, we are working within a system where competition has been stalled, which hurts the consumer most.”

CVS Health offered the comments in response to a Request for Information on the Trump Administration’s Blueprint to Lower Drug Prices. “We support the Administration’s goal to lower drug prices and reduce out-of-pocket costs for consumers and we are using every innovative tool possible to bring down the cost of drugs ourselves,” the letter states.

Pfizer recently announced increases on more than 40 medications, but backed down and said it is freezing prices when confronted on the issue by President Trump. Novartis has also said it will not raise prices for the remainder of 2018. However, Bayer increased the list prices on two major cancer drugs: regorafenib (Stivarga) and sorafenib (Nexavar), which increased more than $1,000 per month. Now, Stivarga costs around $16,800 per month, while Nexavar costs about $18,500 per month, according to GoodRx.com. 

PCC Shortages Worry ER Pharmacists

Emergency department pharmacists have become increasingly concerned about shortages of prothrombin complex concentrate (PCC) (Kcentra, CSL Behring GmbH), ASHP says.

PCC is indicated before urgent surgery or during acute major bleeding to replace some of the blood coagulation factors in patients being treated with warfarin or other vitamin K antagonists.

“We have a very small number of vials left,” Krysta Baack, PharmD, BCPS, ED pharmacist at Nebraska Medicine–Nebraska Medical Center in Omaha, NE, tells ASHP in a press release.

CSL Behring issued an urgent recall of three lots of Kcentra in March after a manufacturing change resulted in an increased risk of vial breakage during transport and handling of the product. In addition, ASHP’s May 16 drug shortage bulletin stated that the manufacturer had “short-term delays in product releases” and insufficient stock for “usual ordering.”

Amie Quinones, ED pharmacist for Intermountain Medical Center in Murray, UT, tells ASHP, in a statement, that the PCC shortage forces clinicians to deviate from evidence-based practices that are the standard of care. “We have alternatives, but there’s no literature [support] for those alternatives,” Quinones says. 

Drug Errors Uncommon

A consumer advocacy group set out to collect information about drug dispensing errors, and so far has found relatively few. “We are now urging persons to call us anytime at 866-714-6466 if their local pharmacy provided them with someone else’s prescription or a prescription with the wrong drugs or incorrect dosage,” a recent statement from U.S. Drug Watchdog states. “For some people, the outcome of receiving the wrong prescription or a drug prescription with incorrect dosage could be fatal. We would like to help you get compensated.”

Since issuing the statement, Michael Thomas Martin, president of U.S. Drug Watchdog, says the organization has only received calls from two consumers who experienced minor drug errors. Both were cases of the wrong dosage for minor pain medication after dental procedures, and were not egregious or dangerous errors, Martin says.

“We expected to hear from customers of Walmart, Rite Aid, and other major chains about mistakes, but we didn’t get anything,” Martin says. “We are impressed. When you think of long pharmacy lines and drive up windows, people get cranky. We haven’t had any of those people call and say, ‘I’ve gotten the wrong prescription or the wrong dose.’”

U.S. Drug Watchdog decided to issue the call for patients to contact it about errors after an unnamed “credible pharmacy business insider” urged the group to look into the problem, which that person said was widespread-particularly at busy drug store chains with long lines of customers, says Martin. The unnamed insider said that a lot of errors were being made by compounding pharmacies as well. Drug Topics asked for the name of the business insider, but Martin would not provide it.

U.S. Drug Watchdog is a consumer advocacy group that sometimes works with attorneys in cases where drugs and devices have caused serious side effects. However, the group is not typically involved in class action lawsuits, because “we don’t necessarily believe consumers are well-served by these lawyers,” Martin says.

DEA May Issue Limits on Opioid Production

A new regulation from the DEA states that if the agency believes a particular opioid or a company’s prescription painkillers are being diverted for misuse, it can reduce the amount that is allowed to be produced in a given year.

“These common-sense actions directly respond to the national opioid epidemic by allowing DEA to use drug diversion as a basis to evaluate whether a drug’s production should be reduced,” says DEA acting administrator Uttam Dhillon. “This also opens the door for increased communication and better information sharing between DEA and individual states, as we work together to address the opioid problem plaguing our country.”

The revised limits will “encourage vigilance on the part of opioid manufacturers, help DEA respond to the changing drug threat environment, and protect the American people from potentially addictive drugs while ensuring that the country has enough opioids for genuine medical, scientific, research and industrial needs,” DEA says in a statement. 

Blood Pressure Drug Could Help Diabetics

For the first time, an inexpensive blood pressure drug has been shown to ease the symptoms of Type 1 diabetes.

Verapamil (Calan, Verelan) was associated with a lower increase in insulin requirements, on-target glycemic control, fewer hypoglycemic events, and an improved mixed-meal-stimulated C-peptide area under the curve, a measure of endogenous beta cell function, researchers say in the study published in Nature Medicine.

“Addition of once-daily oral verapamil may be a safe and effective novel approach to promote endogenous beta cell function and reduce insulin requirements and hypoglycemic episodes in adult individuals with recent-onset T1D,” the University of Alabama researchers write.

Verapamil, an antihypertensive calcium-channel blocker, may work because it protects some of the pancreatic cells that are damaged, allowing them to continue producing a little insulin, according to the researchers.

“This will have to be proven in a larger population and also in other age groups. We also would like to extend it to children,” Anath Shalev, MD, director of the diabetes center at the University of Alabama, tells NBC News.

The researchers also previously found that verapamil promotes the survival of insulin-producing beta cells and reverses diabetes in mouse models.  

CDC Issues Fentanyl Alert

Overdose deaths from fentanyl and fentanyl analogs are on the rise, CDC’s Health Alert Network says.

“The dramatic rise in the supply of illicitly manufactured fentanyl and fentanyl analogs has been mirrored by an equally dramatic rise in deaths involving synthetic opioids other than methadone, a category which includes fentanyl and fentanyl analogs,” says the alert.

Synthetic opioid overdose deaths in the U.S. rose from 3.1 to 6.2 deaths per 100,000 between 2015 and 2016, marking the first year that synthetic opioids became the most common type of opioid involved in all opioid overdose deaths. Preliminary data from the National Center for Health Statistics finds that more than 55% of opioid overdose deaths occurring nationally in the 12-months ending November 2017 involved synthetic opioids, accounting for more than 27,000 overdose deaths.

“This 12-month sum of synthetic opioid overdose deaths exceeds the total number of all opioid overdose deaths in 2013, when deaths involving synthetic opioids first began to climb,” the CDC says.

From January through June 2017, the National Forensic Laboratory Information System received an increased number of drug submission reports from state and local forensic laboratories of fentanyl analogs and other synthetic illicit opioids. For instance, carfentanil, 100 times more potent than fentanyl, rapidly increased from an estimated 1,251 submissions in 2016 to 2,268 during the first six months of 2017, the system reports.  Prescription Kiosks Grow in Popularity

Hospitals and the Department of Defense have endorsed kiosks as a convenient way for patients to pick up prescriptions. Retail pharmacies are starting to recognize their value too.

Interest from major retail chains has picked up in the past two months or so, says Linda Pinney, founder and CEO of Asteres, which has delivered more than two million prescriptions via its ScriptCenter kiosks.

“Stores are looking at all these various ways to improve their traffic - such as curbside pickup - because foot traffic is dropping at the front of the store. The advent of home delivery services like Amazon, PeaPod, and DoorDash is hurting foot traffic at all types of stores, including supermarkets and drug store chains,” Pinney tells Drug Topics.

Asteres, which has hundreds of kiosks in healthcare systems, military bases, and Veterans Administration facilities, is now in talks with several major retail chains, according to Pinney.

ScriptCenter kiosks differ from Express Scripts and MedAvail’s new MedCenter prescription kiosks because they are operated by the pharmacies themselves and are not considered a dispensary. They simply serve as a pickup point for prescription-and a convenient service that could draw in new pharmacy customers. “We are not replacing the pharmacy; we are an extension of the pharmacist. The pharmacy fills it as usual and ScriptCenter is a pickup place,” Pinney says.

MedCenter kiosks, meanwhile, can safely and securely dispense chronic, acute, and OTC medications under the supervision of licensed pharmacists, and are compatible with both handwritten and electronic prescriptions, according to Express Scripts.

ScriptCenter and MedCenter kiosks have pharmacists available via video or phone calls. Patients at the kiosk can press a button and conduct a video chat with a pharmacist.

Asteres has grown three-fold or four-fold in the last three years. “We have taken our time to go after branded hospitals, such as Cleveland Clinic and Johns Hopkins. Now that the concept is being proven and it has a good value, it is starting to take off,” Pinney says.

Also, more state boards of pharmacy are allowing the kiosks because they realize that “you need alternate access points,” Pinney says. “Thirty percent of discharge scripts are not picked up due to not having access. Convenience equals compliance.”

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