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The relentless rise in prescription drug prices is prompting pharmacists to become more proactive in helping patients save money. Community pharmacists have had a front row seat for the tsunami of prescription price hikes that has been building for decades...What has really caused it to bubble up above the surface are the high deductible plans, and also the changes in insurance plan designs [that] are shifting more of the cost burden to consumers…

• Customer Relations Take a Hit
  Naturally, pharmacies are bearing the brunt of patient frustrations...J.D. Power 2017 U.S. Pharmacy Study reports “notable declines” in overall customer satisfaction that are driven by cost...
• One National Chain Reacts
  CVS Pharmacy Rx Savings Finder to help patients save money...tools to patients, prescribers, and pharmacists so they can evaluate prescription drug coverage in real-time and identify lower-cost alternatives...the right drug at the lowest possible cost for patients to ensure they are able to access and stay on the medications they need...
• Business Implications
  ...escalating prescription prices are also causing revenue problems for pharmacies...Zero reimbursements for many generics is common...retroactive DIR fees undermine patients’ access to prescriptions and hinder their own ability to manage their businesses.
• Revenue Boosting Options
  exploring alternative revenue streams—including chronic care management—and efficiency improvements...
• Alternative Revenue Streams
  expanding over-the-counter medications and products...offering immunizations, diabetes and cardiovascular education, smoking cessation, and nutrition classes...

Health Canada this week said it intends to restrict the marketing and advertising of opioid drugs...Evidence suggests that the marketing and advertising of opioids has contributed to increased prescription sales and availability of opioids...From presentations sponsored by opioid manufacturers at conferences to advertisements published in medical journals, these practices “can take many forms of direct and indirect activities and incentives.”...Manufacturers of opioids with a presence in the Canadian market are “strictly prohibited” from advertising to the public, but not to healthcare professionals...Health Canada...set forth additional authority for the Minister of Health to require implemented risk management plans from opioid manufacturers. These plans must include the preclearance of all materials related to opioids and provided to healthcare professionals to safeguard the compliance of their marketing clearances.

Laura Joszt, Managing Editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

If you need to get rid of old or expired medication, there are now 11 local Walgreens where you can get the chore done...The company opened its 1,000th medication disposal kiosk in the nation...4905 W. Tropicana Ave. in Las Vegas. The steel-box kiosks in Walgreens pharmacies are open during store hours for people to drop off unused pills for free, ensuring that the active ingredients don’t get into Nevada’s landfills or sewage systems...Gov. Brian Sandoval, who was on hand for the kiosk unveiling, said the disposal boxes also will help curb Nevada’s opioid crisis by keeping the drug out of the wrong hands...There are 12 kiosks located in Nevada: one in Henderson, nine in Las Vegas, one in North Las Vegas and one in Reno...Richard Ashworth, Walgreens president of operations, said the kiosks across the U.S. have already collected more than 270 tons of medications since the program began in 2016. The company plans to open 500 more kiosks...

A woman in Arizona made the brave choice this week, to make a very private loss — a miscarriage — into a public discussion, in the hopes that her story can save other women from what she went through at her local Walgreens. The pharmacist there refused to fill the prescription required to help her end her pregnancy, citing moral objections, even though her fetus no longer had a heartbeat...Pharmacists have been known to refuse to give women this medication, as well as prescriptions for over-the-counter emergency contraception pills, because of their anti-abortion beliefs...

Online black-market sales of opioid painkillers more than doubled in the United States during the two years after these drugs were “rescheduled,” putting tighter restrictions on legal prescriptions and sales, according to a recent study...In October 2014, hydrocodone combination products...were reclassified from...schedule III to schedule II, imposing stricter controls on prescriptions written by doctors and on patients’ ability to refill them...Almost immediately, the proportion of all drugs illicitly purchased in the U.S. from sellers on the “dark net” that were in the opioid category began rising, reaching 13.7 percent in 2016. Stronger, more dangerous opioids also gained in popularity in these so-called cryptomarkets...cutting off supply leads to people sourcing their drugs from illegal and uncontrolled sources, and they buy products of higher strength - with all the dangers that this type of supply carries...A better approach would be harm reduction, therapeutic intervention, reliable treatment options, dealing with over-prescription early on, and providing information on the danger of opioid use to reduce stigmas...policy measures like up-scheduling, an introduction of abuse-deterrent formulations, prescribing limits, and prosecuting health care providers created a powerful push that precipitated the changes in the overdose dynamics we are contending with today...

Ned Milenkovich, PharmD, JD, PTNN. , Pharmacy Week in Review, this weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

A more difficult question is raised if a pharmacist refuses to fill based upon his or her religious beliefs...a University of Wisconsin student requested a refill on her birth control prescription at her local pharmacy. The pharmacist on duty, Neil Noesen, RPh, refused to fill it, citing his religious beliefs. He also would not transfer the prescription or tell her where she could get it filled...The student filed a complaint with the Wisconsin Board of Pharmacy.The board’s administrative law judge restricted Noesen’s license, finding that a pharmacist with a conscientious objection to dispensing a prescription must ensure there is an alternative mechanism for the patient to receive the medication, including informing the patient of their options to obtain their prescription.”...The Court on appeal ruled, “Noesen had a right to refuse to provide birth control pills but not to refuse to transfer a valid prescription to another pharmacy.”...The Trump administration is making it easier for medical providers to object to procedures on religious grounds...an HHS proposed rule...would allow HHS to enforce protections for religious medical providers...Pharmacists must be familiar with their state regulations and new federal guidelines...

When terminally ill Americans receive experimental medicines through so-called “compassionate use” programs, they typically only get these drugs after extensive tests for safety and effectiveness, a recent study suggests...This means that sufficient evidence of safety and effectiveness has been generated, ensuring that terminally ill patients are not being exposed to therapies that are unlikely to be beneficial or unsafe...this...suggests that companies and the FDA are providing expanded access to experimental therapies in a responsible way that protects patients and the public health...This system may change under The Right to Try Act of 2017, which would let companies decide whether to give patients experimental therapies without any input from the FDA...The chances of a drug not helping a patient or causing serious harm are higher when medicines are earlier in development, Paul Beninger, MD, MBA, of Tufts University School of Medicine...This is much more likely with Right to Try than with the current compassionate use system…

The 340B Drug Pricing Program took center stage at the Senate's HELP panel for the third time in several months...this time turning the focus to audits of hospitals and drug manufacturers conducted by the Health Resources and Services Administration...HRSA Director Krista Pedley said that, in the past five years, 12 of 600 program manufacturers faced audits compared to 981 of 12,700 of hospitals...No findings of wrongdoing were discovered in any of the 12 audits of manufacturers, she noted, whereas 60% of the audits of covered entities resulted in repayment to manufacturers...