New mothers who gave birth early in the pandemic filled far more opioid prescriptions than American women did previously, raising concerns about the potential for narcotic misuse.

About 38% of more than 460,000 women who gave birth from July 2018 through December 2020 were prescribed opioids for postpartum pain management, according to the University of Georgia study.

But there was a nearly 3 percentage point increase in the number of opioid prescriptions filled after March 2020 — when a national emergency was declared in the United States — than before the health crisis began.

The opioids these mothers were prescribed were also higher strength, the researchers noted.

"A lot of women receive opioids for treatment of pain during the postpartum period, but they are a particularly vulnerable group because many of them haven't used opioid medications before," said Emily Lawler, co-author of the study and an assistant professor in the School of Public and International Affairs.

"That makes them high risk for potential opioid abuse," Lawler said in a university news release.

The findings were especially concerning because opioid overdose deaths increased during the pandemic, surpassing 100,000 deaths annually, the study authors said.

Opioids are typically a last resort for pain management after pregnancy.

The American College of Obstetricians and Gynecologists (ACOG) recommends health care providers use an approach for postpartum pain that starts with a basic pain reliever like ibuprofen (such as Motrin or Advil) or acetaminophen (Tylenol). If that doesn't alleviate the pain, physicians are advised to then move to a low-strength opioid, such as codeine or tramadol.

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STOCKTON, Calif., November 5, 2018 — Therapeutic Research Center (TRC® Healthcare, or TRC), a leading provider of medication advisory and learning solutions and the author of Pharmacist’s Letter, and the Utah Pharmacy Association (UPhA), an organization committed to serving, advancing, and promoting the Pharmacy profession in Utah, announced today an agreement that enables UPhA to offer its individual members and Utah-based retail pharmacies employer-based training via subscription to Pharmacy Technicians University, a one-of-a-kind online training program for pharmacy technicians. In addition, UPhA can now offer subscriptions for its retail pharmacy store members to the Community Pharmacy Standard Bundle from TRC, which includes access to Pharmacist’s Letter, Pharmacy Technician’s Letter, the Learning Management Portal and CE Organizer for assigning and tracking continuing education, and Natural Medicines, the most comprehensive natural/alternative medicine and supplement database available.

“This is a great new, affordable option, especially for our independent pharmacy owners and their members, to access a top-quality technician training and education program. It gives our pharmacists and pharmacy technicians an opportunity to prepare for the National exam, as well as access certification and re-certification resources that were previously hard to find at a reasonable price.” said Shane Jensen, President of the Utah Pharmacy Association. “Utah has a number of independent and community pharmacies that often can’t get the services that larger organizations or chains are able to get at sustainable costs. This program, which many already find familiar, now accessible through the UPhA, makes it possible to continue to enrich the Pharmacy and Technicians education community in Utah and will help UPhA move its mission forward.”

“Skilled pharmacy technicians are increasingly important members of the modern pharmacy team and are providing efficiency and economic advantages to pharmacy teams,” said Wes Crews, Chief Executive Officer at TRC Healthcare. “However, training requirements for techs change often, are becoming more complex, and vary from state to state, creating a shortage of qualified pharmacy technicians. We are proud to partner with state associations such as UPhA to advance the pharmacy profession by delivering the online, competency-based curriculum in Pharmacy Technicians University. PTU helps simplify the educational experience, improve efficiencies, and reduce medication errors. With this agreement, UPhA can extend the PTU offering to Utah community pharmacy teams and to individual technicians in Utah, providing the tools and information they need to prepare for employment.”

TRC’s Pharmacy Technicians University (PTU) is committed to delivering the highest standard of excellence and value in its accredited remote learning program, including training programs that accommodate industry growth. Benefits include:

• Staying informed of and meeting new and existing state-mandated training and certification requirements
• Significant cost savings versus brick-and-mortar university courses, which offer less flexibility and limited course variety
  

The combination of PTU with Pharmacy Technician’s Letter delivers additional complementary benefits, including:

• Access to an intuitive CE organizer that allows users to easily track progress and effectively monitor and manage their training program and courses needs for licensure and compliance
• All-in-one-place tracking of due dates, renewal periods, and certificates of completion
  

Access to PTU for individuals and community pharmacies via this partnership is a strong compliment to the enterprise offerings for retail chains, larger community pharmacies and hospitals from TRC. This partnership helps technicians who want or need access to the highest quality evidence-based training and certifications programs have options.

PTU offers the most extensive and robust interactive courseware and training videos for medication learning available today and provides up to 600 hours of didactic, simulation, and experiential course content and the highest-quality technician training resources. PTU also offers a low-impact retail-pharmacy only program for those areas organizations that require less investment to meet standards in their state(s). PTU is one of the only online technician training programs that supports or exceeds the requirements for technician training in 50 states, including Washington D.C. And, PTU supports employer-designed training curriculums to allow organizations to “right-size” training in accordance with the state requirements where they operate.

TRC is committed to expanding and contextualizing its PTU course offerings to accommodate both retail and hospital pharmacy technician training needs for medication learning, including offering different levels of curriculum to align with various state board regulations and care- setting requirements.

To learn more about this new program, please contact UPhA at 801.438.2524 or visit www.UPhA.com.

About Utah Pharmacy Association (UPhA) The Utah Pharmacy Association is the organization that represents all aspects of pharmacy in Utah. UPhA is a non-profit trade association organized and committed to serving, advancing, and promoting the Pharmacy profession in Utah. UPhA represents pharmacists and technicians from all areas of the profession. UPhA’s strategic goals include providing new and quality education opportunities and resources to its members.

About Therapeutic Research Center (TRC) TRC is the leading provider of digital medication learning that updates, informs, and educates healthcare providers across the continuum of care. In addition to its highly regarded Pharmacist’s Letter, Prescriber’s Letter, Pharmacy Technician’s Letter, Nurse’s Letter and Natural Medicines online resources, TRC provides additional online solutions for hospital and community clinicians that expand on its trusted recommendations, such as drug comparison charts, patient education handouts, FAQs, and tutorials in its web-based products. In addition, TRC provides online continuing education programs for medication learning, competency, and compliance programs, and keeps clinicians and administrators informed via its continuing education (CE) dashboard and CE & Training Organizer. TRC provides the largest catalog of education and advisory services in the industry for pharmacy, delivering nearly 500 course options to help technicians and clinicians. TRC leads the way in the training of new pharmacy technicians with Pharmacy Technicians University (PTU), the first online accredited, interactive training program of its kind. Nearly 500,000 healthcare professionals rely on TRC’s advisory and education service to access concise, unbiased, timely information to improve medication use, prevent medication errors, and improve overall patient care, quality and outcomes.

Media Contact: Andrea Lashnits
Andrea.lashnits@trchealthcare.com
303-810-2995

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NCPA, ALEXANDRIA, Va. (Feb. 27, 2024) – As rumors swirl in Washington, D.C., that lawmakers may once again be punting on PBM reform, the National Community Pharmacists Association today released a survey showing many local pharmacies are running out of time.

“Nearly a third of independent pharmacy owners may close their stores this year under pressure from plunging prescription reimbursements by big insurance plans and their pharmacy benefit managers,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “This is an emergency. And if Congress fails to act again, thousands of local pharmacies could be closed within months and millions of patients could be stranded without a pharmacy.”

Community pharmacies have been battered for years by big insurance plans and their monopolistic pharmacy benefit managers. But the problems intensified this year under a new rule that is supposed to bring more transparency to the industry. On Jan. 1, provisions from a Centers for Medicare & Medicaid Services rule took effect requiring insurance plans and PBMs to apply all price concessions – called pharmacy direct and indirect remuneration fees – at the point of sale. Until this year, those concessions were applied well after the point of sale. The rule is intended to give pharmacies and patients more transparency on drug pricing. However, since it was approved in 2022, NCPA has been warning that the first quarter of this year would be perilous for community pharmacies because they would be hit simultaneously with a double-whammy: lower reimbursements on prescriptions at the point of sale resulting from a continued money grab from PBMs, and forced price concessions on prescriptions from last year.

With lower prescription reimbursements in one corner and higher back-end fees in the other, many community pharmacists are thinking about throwing in the towel. According to the new NCPA survey, 32 percent of all respondents say they are considering closing their doors in 2024 because of the cash crunch. Ninety-three percent say they may drop out of Medicare Part D in 2025 if this year’s experience continues, which would decimate patient access across the country, especially for senior citizens. More than half of all respondents say Medicare Part D prescriptions account for 40 percent or more of their business.

NCPA supported the CMS rule because it allows pharmacists to see their lowest possible prescription reimbursements up front, instead of being surprised months later with a huge bill for back-door DIR fees. But the organization anticipated that the insurance plans and their PBMs, which fought the rule, would make the transition as painful as possible. NCPA urged CMS in letters and meetings to require the insurance plans and PBMs to be helpful during the transition, and the agency issued guidance last year warning them against anything that would jeopardize patient access. NCPA also reached out to PBMs directly asking them to be flexible. As the survey results suggest, those entreaties were ignored.

“If a third of all community pharmacies close, and if more than 90 percent stop accepting Medicare Part D, it will be a catastrophe for seniors, a hardship for most other patients, and a devastating blow to the overall health care system,” said Hoey. “This demands immediate action by Congress and the administration.”

NCPA sent a letter to CMS today, outlining the problem in black and white: “In 2023, there were over 300 independent pharmacy net closures — almost one less pharmacy open for patients a day — and there are approximately 2,200 fewer retail pharmacies than there were four years ago. Increased vertical and horizontal consolidation of PBMs and health plans has caused severe inequities to pharmacies and Medicare Part D beneficiaries alike. These are startling developments. Action is needed to ensure independent pharmacies can continue to serve their patients."

According to the survey, 99 percent of respondents say their prescription reimbursements have gone down since the rule took effect on Jan. 1. More than half say that insurance plans and their PBMs are reimbursing pharmacies less than the cost to purchase the drug for at least 3 of every 10 prescriptions they fill. Over half of pharmacy owners say they are losing money on over 60 percent of the Part D prescriptions they fill when the other costs of running a pharmacy, like rent, taxes, utilities and payroll, are added in.

Pharmacy owners are doing everything they can to avoid closing their doors. Forty-two percent got a line of credit to get them through the transition. Nearly 60 percent have had to use it. Many are cutting hours, reducing staff, and eliminating services. Nearly 70 percent, according to the survey, have had to dip into their personal savings.

When asked which PBM is causing the most financial stress in the Medicare Part D program, almost half identified Express Scripts, with CVS/Caremark coming in at 35 percent. Perhaps not so coincidentally, most respondents said they received letters from Walgreens, which is closely aligned with Cigna-Express Scripts, and CVS, a vertically aligned health care conglomerate that includes Aetna and Caremark, proposing to buy their pharmacies. 

“There are bipartisan majorities in both chambers of Congress who support the reforms we’ve been pushing. Additionally, the CBO shows that one of those reforms will save taxpayers $1 billion. If policymakers are serious about drug prices, patient access and the federal budget, then there’s absolutely no good reason to delay these reforms for even one more minute,” said Hoey.

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What they're saying: "This is our Colonial pipeline moment," said John Riggi, national adviser for cybersecurity and risk for the American Hospital Association, referring to the 2021 cyberattack that led to a six-day shutdown resulting in gas shortages along the East Coast.

Growing cyberattacks on health facilities have disrupted care at individual hospitals and even across multiple health systems, but none has had such a wide-reaching impact across the sector, experts said.

This attack on Change Healthcare, which is part of United's health services unit Optum, may have rippled even further than needed.

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Kroger (KR) and Albertsons, which both employ mostly unionized workforces, said they wanted to merge to be more competitive against non-union giants such as Walmart, Amazon and Costco. The grocers are also facing increased pressure from Aldi, the fast-growing German discount supermarket chain.

The merger would accelerate “our position as a more compelling alternative to larger and non-union competitors,” Kroger CEO Rodney McMullen said when the deal was announced.

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Sen. Chuck Grassley (R-IA) is calling on Majority Leader Chuck Schumer (D-NY) to immediately hold floor votes on pharmacy benefit manager reform bills passed by key committees throughout 2023, noting a lackluster update he just received from the Federal Trade Commission on its investigation into common PBM business practices and their effect on patient and payer drug costs. Grassley’s request comes as PBM reforms appear increasingly unlikely to be part of a potential scaled-back health care package in March. In January, Grassley along with Senate Commerce Committee Chair Maria Cantwell (D-WA) and 12 other lawmakers requested an update on the status of FTC’s section 6(b) study, which began in the summer of 2022. But FTC’s Feb. 13 response to the lawmakers reveals that after nearly two years, the commission has yet to collect all the information it requested from any of the six major PBMs initially tapped for the study-- CVS Caremark, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems.

FTC says it expects to have all the requested materials very soon as its staff continues to push the PBMs, as well three related group purchasing organizations who were also tapped for investigation in the summer of 2023, to finalize the production of required documents and data for the study as quickly as possible.

Should any of the companies fail to comply fully with these requirements, FTC told Grassley it will engage in legal action to compel their compliance.

But Grassley says the commission’s response is deficient and reveals that not only are PBMs failing to fully cooperate with FTC’s demands for the investigation, but FTC itself is incapable of providing lawmakers with the status report they’ve been waiting on.

"FTC's deficient response amplifies the urgent need for transparency and accountability across the board. The agency ought to provide Congress a concrete status update, and PBMs must start playing ball and coughing up the information FTC requested on day one of its investigation,” Grassley said in a statement.

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It is increasingly likely that only a handful of programs facing imminent deadlines could be included in legislation needed to fund the government by March 8, such as community health center funding, a reversal of Medicaid cuts to hospitals serving low-income and uninsured patients, and at least a partial rollback of Medicare physician payment cuts. 

A reauthorization of a federal pandemic preparedness program and a sweeping bill to address opioid and substance use disorder are among the policies likely to be left on the cutting room floor, sources said. The authorizations for those bills expired at the end of September.

Potential reforms to the business practices of pharmacy benefit managers (PBMs) also seem unlikely to make it into the funding package, though sources stressed no final decisions have been made. 

PBM reform has been a bipartisan priority for both chambers, including legislation that advanced through the Senate Finance Committee and Senate Health Committee. But competing priorities in the House and Senate have led to complications, and the two sides have been unable to hammer out any agreement. 

A partial government shutdown is looming as congressional negotiators failed to come to an agreement this past weekend on the first four appropriations bills set to expire on March 1, including legislation to fund the Food and Drug Administration.  

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Attorneys for Lipitor purchasers including Rochester Drug Co-Operative Inc and Puerto Rico's Drogueria Betances LLC disclosed the agreement in a filing on Wednesday in U.S. court in Trenton, New Jersey.

The distributors' case will continue against Ranbaxy, the attorneys filing said.

The proposed settlement, which requires a judge's approval, comes after more than a decade of litigation. Pfizer did not admit liability.

Pfizer in a statement called the allegations "factually and legally without merit." It said the settlement was "fair, reasonable and the best way to resolve this litigation."

A representative for Sun Pharma (SUN.NS), opens new tab, which acquired Ranbaxy in 2014, did not immediately respond to a request for comment.

Pfizer introduced Lipitor in 1997, and the drug drove more than $130 billion in sales during its first 14 years on the market.

The pharma distributors claimed Pfizer fraudulently sought to extend its patent rights over Lipitor. They accused the company of paying Ranbaxy to delay introducing a generic version of Lipitor and engaging in sham litigation with Ranbaxy over the drug.

Lawyers for the plaintiffs said the settlement provides "immediate economic relief" to class members and avoids the risk of continued litigation, potential appeals and no recovery. They said they will seek up to about $31 million in legal fees from the settlement fund.

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The Federal Trade Commission and HHS have launched an investigation into whether the business practices of pharmaceutical chain middlemen like group purchasing organizations (GPOs) and wholesalers are contributing to drug shortages. The agencies are seeking stakeholder input on the issue as the Biden administration grapples with how to avert chronic generic drug shortages.

The joint request for information (RFI) comes as the generic drug lobby and consumer advocacy groups raise concerns that three wholesalers are controlling 90% of the purchasing of generic drugs for most hospitals, which they say makes it harder for generic drug makers to secure sustainable prices and ultimately contributes to the drug shortage crisis. FTC announced Wednesday (Feb. 14) it is exploring whether the wholesalers and GPOs have exploited their market power to push down prices of generic drugs to a point where these drug makers can’t make a profit and they must stop manufacturing, thereby causing shortages.

In the RFI, FTC and HHS want public input on the market concentration of GPOs and wholesalers and insights into their contracting methods.

The RFI requests comments, documents, and data regarding compliance with legal obligations by manufacturers, GPOs, and drug wholesalers under the Clayton Act and the Robinson-Patman Act.

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“Americans deserve and expect protection from inflated prescription drug costs, from forced pharmacy closures, and from barriers to their pharmacy of choice that result from PBM tactics”

WASHINGTON, DC – Pharmacies and pharmacists serving communities throughout the nation in independent and chain pharmacies, in specialty pharmacies, in grocery stores and other retail locations, and in other practice settings are urging the U.S. Congress to capitalize on the bipartisan work for pharmacy benefit manager (PBM) reform in the 118th Congress, and to enact without delay crucial protections in Medicare and Medicaid for patients and for pharmacies. 

In a letter to the Congressional leadership and to all members of Congress, the National Association of Chain Drug Stores, the National Community Pharmacists Association, FMI – The Food Industry Association, the National Grocers Association, the American Pharmacists Association, and the National Association of Specialty Pharmacy state:

“For pharmacists and pharmacies serving patients and communities throughout the nation, we urge Congress to enact necessary pharmacy benefit manager (PBM) reforms without delay to reduce Americans’ prescription drug costs and to sustain health care access.

“Methodically, and with bipartisan and overwhelming support, PBM reforms to protect Americans in Medicare and Medicaid have advanced in the U.S. Senate and U.S. House of Representatives. 

“Among the essential reforms advanced in the 118th Congress are: 

Medicaid managed care pharmacy payment reform and a ban on spread pricing; 
defining and enforcing reasonable and relevant Medicare Part D pharmacy contract terms; and
establishing relevant, standardized and transparent pharmacy quality measurements in Medicare Part D.
“On December 14, 2023, the Centers for Medicare & Medicaid Services wrote to PBMs and plans: ‘We are hearing an increasing number of concerns about certain practices by some plans and [PBMs] that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers.’

“Be aware, as of January 2024 the harmful and aggressive tactics of some PBMs affecting Americans and their pharmacists and pharmacies seem to have gotten even worse. Many of our members report that some PBMs now are reimbursing pharmacies even further below the pharmacies’ cost for the prescriptions that they fill – especially in Medicare. 

“Americans deserve and expect protection from inflated prescription drug costs, from forced pharmacy closures, and from barriers to their pharmacy of choice that result from PBM tactics. Please act now: Congress must not delay these crucial reforms in Medicare and Medicaid.”  

MTM AND STAYING UP-TO-DATE
Participating in topic discussions is a great way for pharmacists to stay up-to-date on MTM clinical studies. If pharmacists serve as preceptors for pharmacy students on their advanced pharmacy practice experiences (APPEs), they can include topic discussions as teaching opportunities. This can also include journal clubs that involve selecting a recently published clinical study to share in APPEs. Pharmacists and students can perform a literature search to identify clinical studies published within the past year that are related to a specific disease state. Facilitating discussions with multiple pharmacists or other health care professionals can also serve as MTM professional development.

One study utilized a preintervention and postintervention survey to evaluate a multipreceptor approach for topic discussions on ambulatory care APPEs, with topics including diabetes, hypertension, dyslipidemia, heart failure, anticoagulation, devices and physical assessment, and asthma.3 The study found that students’ knowledge assessment scores increased significantly from baseline (P < .001).

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Pharmacy Times: Can you give an overview of the Meds-to-Beds program and how it is implemented?

Jennifer Winters: So, Meds-to-Beds is a transitions of care (TOC) program where a patient who's discharging from the hospital to home can receive their medications prior to leaving the hospital. At its core, Meds-to-Beds is really a medication adherence program, so the practice of professional pharmacy has been very involved with an adherence for, I would say the last 20 years. Many, many articles have touted the importance of med adherence and there have been statistics stating that, up to 33% of medication-related hospital admissions are because of patient nonadherence. There's also a dollar value assigned to patients being nonadherent to their medications, so in answer to some of that data that was coming out in the early 2000s, health systems across the nation really started to look at how can we help our patients become more compliant when they're prescribed the medication, that's often when they're impatient, or getting ready to be discharged.

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