Small Doses News for Pharmacists May 2018

CVS Sued

CVS Health is denying allegations that its PBM, CVS Caremark, charged Medicare for higher prices than it was paying pharmacies. “We believe this complaint is without merit and we intend to vigorously defend ourselves against these allegations,” Mike DeAngelis, senior director of corporate communications for CVS Health, tells Drug Topics. 

Aetna filed the lawsuit in U.S. District Court in 2014, but it was unsealed after the government declined to intervene in the case in early April. In addition to the Medicare charges, Aetna claims that CVS Caremark “carefully managed the [maximum allowable cost] prices so as to hit the minimum aggregate discount it had guaranteed Aetna, but not to allow Aetna to get the benefit of any lower prices.”

Metformin and Nicotine

A study published in the Proceedings of the National Academy of Sciences found metformin reduced nicotine withdrawal symptoms in mice.

Metformin is an activator of AMP-activated protein kinase (AMPK), a master regulator of energy homeostasis activated in response to cellular stressors, writes senior author Julie Blendy, PhD, professor of systems pharmacology and translational therapeutics at the University of Pennsylvania in Philadelphia.

“We discovered that the AMPK pathway is activated following chronic nicotine use, but is repressed following nicotine withdrawal. We reasoned that increasing [phosphorylated AMPK] levels pharmacologically might reduce symptoms of nicotine withdrawal,” she writes.

Government Targets Fentanyl, Heroin Ring

A recent government crackdown on illegal drugs removed thousands of pounds of fentanyl and heroin from the streets.

Operation Saigon Sunset, a joint effort between the DOJ and federal and state authorities, targeted 100 defendants for arrest who are part of a major multistate heroin and fentanyl distribution network, called the Peterson Drug Trafficking Organization .

The initiative “removed from our streets enough fentanyl to kill more than 250,000 people and massive amounts of other drugs that would have wreaked havoc and misery on our good citizens,” says U.S. Attorney Mike Stuart. “Best yet, today’s actions have resulted in the destruction of a supply network, the supplier of suppliers of illicit drugs.”

Smoking Cessation Drugs and Cardio Risk

While concerns have been raised about the risk of serious cardiovascular events associated with smoking cessation drugs, a recent study of varenicline (Chantix) and bupropion hydrochloride (Zyban, Wellbutrin) found no evidence. In trials, over 8,000 smokers received either varenicline, bupropion hydrochloride, or nicotine replacement therapy.

The incidence of cardiovascular events during treatment and follow-up was less than 0.5% for a major event. “No significant treatment differences were observed in time to cardiovascular events, blood pressure, or heart rate. There was no significant difference in time to onset of [a major adverse cardiac event]” compared to a placebo, the researchers say.

Psychiatric Pharmacy Needs to Show Value

An American Journal of Health-System Pharmacy editorial, written by two psychiatric pharmacists and accompanied by a state hospital pharmacy benchmarking report, notes that staff:bed ratios in state hospital psychiatric pharmacy departments remain “strikingly lower” than in non-psychiatric hospitals.

Out of 116 hospitals surveyed, over 30% of hospitals use no indicators to monitor pharmacy productivity. “The time has come to redefine pharmacy productivity metrics and align them with organizational goals and priorities to ensure sustainability and success … Psychiatric pharmacy presents the opportunity to increase access to evidence-based care, which should help ensure optimal outcomes for patients,” write the authors.