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Chicago has moved a step closer to placing major restrictions on pharmacist workloads in a bid to improve consumer safety...The City Council Finance Committee on Tuesday approved a measure that would allow Chicago pharmacists to fill prescription orders for no more than 10 patients per hour, as well as guaranteeing meal and washroom breaks. It also would require pharmacies to post a list in plain sight showing which pharmacists and technicians have worked shifts longer than eight hours...The proposal's sponsor, Ald. Edward Burke, the committee's chairman, said he hoped to bring the plan up for a vote in the full City Council...The...alderman has argued that the proposal would reduce the "undue levels of stress" on pharmacists caused by pressure from retailers to fill hundreds of prescriptions a day. Pharmacists working constantly for as long as 12 hours a day have said they worry about losing focus during busy shifts and potentially putting their customers in jeopardy...Along with the 10-patient-per-hour limit, Burke's Chicago proposal would give pharmacists who work at least seven hours in a shift two 15-minute breaks and one 30-minute meal break. A pharmacy also would need to schedule at least 10 pharmacy technician hours per 100 prescriptions filled.

California governor Jerry Brown has just signed SB-17 – Drug Price Transparency into state law...This law is truly nutty. It won’t accomplish much of what it purports to do...Pharmacies and healthcare providers will become the primary beneficiaries of SB17’s requirement that pharmaceutical manufacturers provide advance notice of WAC price increases. Payers and patients will see limited gains. The state of California will see no appreciable benefit...This unexpected result will occur because the revenues and profits of pharmacies are linked directly to brand-name list prices. By providing advance notice of a price increases, pharmacies will have enormous incentives to purchase extra inventory and earn windfall profits. These profits do not have to be shared with third-party payers or patients...SB17 should encourage manufacturers to begin exploring direct inventory management relationships with key pharmacies to minimize speculation and the accompanying risks of drug shortages and diversion. It will be tough to negotiate these agreements, because pharmacies will see the lure of big profits...speculative purchasing will wreak havoc with pharmaceutical supply chains. What were California’s legislators thinking? Do they have any idea how little California will benefit from advance notice? What will happen to the excess inventory and higher pharmacy profits generated by California’s new law?...Don’t ask the people who wrote the bill. They seem completely oblivious to SB17’s actual impact...

Medical cannabis classes will no longer be held at the University of Maryland-Baltimore...The...School of Pharmacy has cancelled plans to start offering medical cannabis classes this fall...The online classes covered cultivation, manufacturing, dispensing, and laboratory standards of medical cannabis. However, after consulting with the Maryland attorney general’s office, the University directed the School of Pharmacy to not offer the classes...“The decision is due to legal concerns about United States law, and does not reflect any school concerns about the substantive content of the course materials,” Alex Likowski, Director of Media Relations, Communications, and Public Affairs, told Drug Topics..., the federal Controlled Substances Act remains in effect...“Under the CSA, cannabis is treated the same as any other controlled substance without regard to any medicinal use.

Stephen Paddock, who killed at least 58 people and wounded hundreds more in Las Vegas...with high-powered rifles, was prescribed an anti-anxiety drug in June that can lead to aggressive behavior...Records from the Nevada Prescription Monitoring Program...show Paddock was prescribed 50 10-milligram diazepam tablets by Henderson physician Dr. Steven Winkler on June 21...Diazepam...studies have shown can trigger aggressive behavior. Chronic use or abuse of sedatives...can also trigger psychotic experiences...“If somebody has an underlying aggression problem and you sedate them with that drug, they can become aggressive,” said Dr. Mel Pohl, chief medical officer of the Las Vegas Recovery Center. “It can disinhibit an underlying emotional state. … It is much like what happens when you give alcohol to some people … they become aggressive instead of going to sleep.”

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

Nearly every day for at least two decades pharmaceutical drugs have been brought by the carload to the Capitol — an arrangement so under the radar that even pharmacy lobbyists who regularly pitch Congress on their industry aren’t aware of it...The deliveries arrive at the secretive Office of the Attending Physician, an elaborate medical clinic where Navy doctors triage medical emergencies and provide basic health care for lawmakers who pay an annual fee of just over $600. Every one comes from Washington’s oldest community pharmacy, Grubb’s...Mike Kim...pharmacist-turned-owner of the pharmacy, said he has gotten used to knowing the most sensitive details about some of the most famous people in Washington...“At first it’s cool, and then you realize, I’m filling some drugs that are for some pretty serious health problems as well. And these are the people that are running the country,” Kim said, listing treatments for conditions like diabetes and Alzheimer’s...Kim’s tiny pharmacy — which, at its busiest, sends as many as 100 prescriptions to members in a day — is nestled among Capitol Hill’s stateliest row houses, less than four blocks from the Capitol building itself. Founded in 1867 and named for a previous owner, the pharmacy predates penicillin, the American health insurance system, and even the Lincoln Memorial.

Shares of drug retailers Walgreens Boots Alliance Inc, CVS Health Corp and Rite Aid Corp tumbled on Friday after reports that Amazon.com Inc was looking to make a move into selling drugs online...Amazon is reported to be in discussions with mid-market pharmacy benefit managers and has been hiring talent to assess the drug retailing market for its entry…We are convinced that AMZN will almost certainly enter the drug distribution value chain within 2 years, evolving into a more disruptive offering over time...Amazon’s entry into pharmaceuticals has been long rumored in the media...Shares of drug retailers Walgreens closed down 5.8 percent, Rite Aid 4.9 percent and CVS Health 4.9 percent.

CNN investigation exposes inappropriate use of drug in nursing homes...The maker of a little red pill intended to treat a rare condition is raking in hundreds of millions of dollars a year as it aggressively targets frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe...Nuedexta (dextromethorphan/quinidine), is approved to treat a disorder marked by sudden and uncontrollable laughing or crying -- known as pseudobulbar affect...This condition afflicts less than 1% of all Americans, based on a calculation using the drugmaker's own figures, and it is most commonly associated with people who have multiple sclerosis or ALS (amyotrophic lateral sclerosis)...The number of pills (from 2012) rose to roughly 14 million in 2016, a jump of nearly 400% in just four years...Nuedexta's financial success...is being propelled by a sales force focused on expanding the drug's use among elderly patients suffering from dementia and Alzheimer's disease, and high-volume prescribing and advocacy efforts by doctors receiving payments from the company...

Proponents argue that limits reduce the risk of addiction, but are they keeping pharmacists from caring for their patients?... As the opioid crisis worsens, pharmacies, pharmaceutical manufacturers, and legislators are scrambling to help solve the problem. Recently, those efforts have focused on limiting opioid supplies. But in the effort to prevent unnecessary medications, are pain patients getting left behind?...Express Scripts and CVS Caremark recently announced a seven-day supply limit, and PhRMA...supported a seven-day limit...one-size fits all approach and will supplant providers’ clinical decision-making and the needs of patients who have legitimate need for these medications...payer limits restrict patients with legitimate pain management needs from accessing opioids. Those limitations...will force patients not at risk of abuse or misuse to work with their prescriber and pharmacist—which will cost the health-care system and “significantly” impact patients with limited resources, physical restrictions, or transportation issues...

Last month, drugmaker Allergan announced that it has made a deal with a New York state American Indian tribe to help protect Restasis from competition, using the tribe’s sovereign immunity as a shield against patent challenges. The deal—the first such move by Allergan and, in the pharmaceutical industry, an unusual one at best—has unleashed a firestorm of criticism, including from lawmakers...Originally, patents on Restasis were set to expire in 2014. But Allergan filed more patents, covering the “specific formulation and the method of using” the product, that expire in 2024...Lawmakers and patient advocates, meanwhile, are concerned not only about the implications for Restasis but whether this will set a pharmaceutical industry precedent...The House Oversight committee wrote to Allergan Chief Executive Brent Saunders on Tuesday asking for documents and information regarding the deal...The agreement “may impair competition across the pharmaceutical industry and ultimately dissuade companies from pursuing less-costly generic alternatives to brand drugs,” according to the letter...Allergan said in a statement that it plans to comply with the information requests...patient advocates say they’re worried...Allergan’s sham patent transfer is an effort to circumvent the law to prevent a cheaper generic of Restasis to come to market,” said David Mitchell, the co-founder and president of the non-profit Patients for Affordable Drugs. “Patients will be hurt by this. Patients are being hurt by this. And it’s an outrage.”