Pharmacy Update: June 22

The Ohio Attorney General has filed a lawsuit against pharmacy benefit manager (PBM), OptumRx, alleging the PBM overcharged that state for the cost of prescription drugs. Investigators found nearly $16 million worth of overcharges to the Ohio Bureau of Workers’ Compensation.

The WV Public Employees Insurance Agency (PEIA) has awarded its Third Party Administration (TPA) contact to UMR, effective July 1, 2019. UMR, a UnitedHealthcare company, will replace HealthSmart, the current TPA. Healthcare providers in West Virginia DO NOT need to be part of UHC’s network to see PEIA patients. PEIA’s in-state provider network will not change as a result of the TPA transition.

In its latest move to rein in what it views as anticompetitive tactics in the healthcare industry, the Federal Trade Commission filed a lawsuit against health information company Surescripts charging the company with illegally monopolizing the e-prescribing market. The FTC alleges that the company employed “illegal vertical and horizontal restraints in order to maintain its monopolies over two e-prescribing markets: routing and eligibility.”

According to researchers, a fast-acting form of “nicotine replacement therapy” (NRT), such as gum or lozenge, work best in combination with nicotine patch. Patients were 15% to 36% more likely to successfully stop smoking with a nicotine patch and other type of NRT than if they used only one time of NRT alone. A dosage of 4 mg versus 2 mg of nicotine gum appeared to increase a patient’s chance of successfully stopping smoking.

On June 25, 2018, the West Virginia Board of Pharmacy voted to prohibit the sale of non-FDA approved cannaidiol (“CBD”) products in the pharmacy setting. After further consideration of both state and federal regulations regarding those products, the Board withdrew that prohibition, effective immediately. While the Board no longer specifically prohibits these sales of CBD products in its licensed pharmacies, it offers no opinion on the legality of such sales under federal law.

It is estimated that drug abuse and misuse may occur in up to 50% of chronic non-cancer pain patients receiving opioids. All prescribers need to understand that risks of opioid abuse and should utilize methods to screen patients for their possible risks, according to the Therapeutic Research Center. Validated tools are available to identify and stratify patient risk. In addition, patients taking opioids chronically are at an increased risk of suicide and should be screened for depression and suicidal ideation.

When chronic opioids are prescribed, it is important to make sure patients have realistic expectations about their treatment. Pharmacists and providers should explain that reducing pain intensity by at least 30% is considered a treatment success, according to the Therapeutic Research Center. Also, goals should be set with the patient for functional improvement. These goals should be documented for future monitoring purposes and used to determine efficacy of treatment.