Pro Pharma Talks

Compounding Pharmacies / FWA - Compound Requirements          - Must be for medications for specific patients, for a specific condition, for a specific       prescription          - Compounding in bulk for multiple patients before prescriptions are received is manufacturing! - Limits          - Patients will probably not know          - Prescriber will not know unless they have a commercial arrangement with the pharmacy          - Health Plans will only know when doing analysis of medication utilization          - PBMs will only know when doing analysis of medication utilization - What are compounds?          - Injectables with custom ingredients and dosing   &

Gender Bias in Medicine and Drug Research 1. Women 51% of population, but few women in clinical research 2. Sex is based on reproductive organs and functions assigned by chromosomes      - Gender is self-representation in response to socials institutions shaped by       environment and experience      - Action: Education, research, workforce development 3. Medical Biases against women      - Heart failure – Australia: women < men to receive recommended treatment for heart       failure      - Alzheimer’s Disease – women perform better than men in early stages      - Medical trials – women excluded           - 8 Rx in US withdrawn between 1997-2001 for less safe and effective           - Until early 1990’s women excluded from b

All About Vaccines with special guest Dr. Mark Walberg ______ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks YouTube: https://www.youtube.com/user/ProPharmaEducation

Vaping What is it? Is it vapor and flavor only? (From a child’s scientific understanding) Pharmacology principles Is this the same as smoking? Recidivism Initial impact of vaping Complications Respiratory illness Seizures Interventions Same as nicotine? OTC medications Education ______ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks YouTube: https://www.youtube.com/user/ProPharmaEducation

AI in Healthcare Disclaimer – PP develops, innovates and utilizes AI for our clients What is AI? “the theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages” Elements of AI Fundamental metrics Examples – hospital admissions, hospital length of stay, ER admits, drug utilization, drug  cost, total cost of care, etc. Manifests AS -- Increased productivity Improved efficiency Robotics Algorithms (Rules for analyzing data) Uses Current situation Predictions (trending based on current experience) Forecasts (estimates based on fundamental indicators) ______ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.proph

 1. Quality of prescription drugs     a. Health Canada responsible for efficacy and safety of drugs marketed in Canada     b. Health Canada operates under the Food and Drugs Act and regulatory mandate under the Food and Drug Regulations     c. Most drugs are not manufactured in Canada      d. There is no parity between drugs available without a prescription in US vs. Canada 2. Availability of prescription drugs     a. US Rx received in Canadian pharmacy must be approved by a Canadian physician prior to it being filled – cosigning     b. Canada Health Act – drugs administered in Canadian hospitals are approved at no cost to patients     c. Employers cover many Canadians and their families     d. Drug Shortages Canada –           i. Website for reporting drug shortages and discontinuations in Ca

1. Indigent / Homeless Population      a. No address      b. No phone      c. No income, or no money for health care      d. No transportation      e. No time management      f. Information varies dependent on associations      g. Information sharing is variable and frequently based on incorrect concerns, false conversations, etc. 2. Health Care Issues      a. Poor diet      b. Poor exercise program      c. Lack of follow up on relatively trivial problems that result in major complications      d. Poor historians      e. Frequently comorbid      f. Frequently have behavioral health problems      g. Inconsistent adherence – office visits, obtaining labs, picking up d

  Travel Health: 1. What are the most common health issues travelers may encounter?        a. Travelers diarrhea        b. In terms of “things that will kill you”, most travelers die from pre-existing medical conditions (MI) or accidents (specifically MVA) 2. Mentioned vaccines, are there other vaccines people will need to consider besides those for GI bugs?        a. Yellow fever… basically a mosquito-borne disease that destroys your liver and has a very high fatality rate. Found in South America (Amazon) and Sub-Saharan Africa. Mosquitoes bite during the day and can also carry dengue, chikungunya and zika… so still have to prevent mosquito bites.        b. Japanese encephalitis… similar to West Nile, it causes neurological symptoms. Found in Southeast Asia, mostly in rural parts. Need to have a travel health advisor assess whether or not you should get it. &nb

Devices Used in Therapeutics 1. Types of devices used for TESTING / MONITORING and At-Home Test Kits discussed in this talk –      a. Blood Glucose monitors      b. Blood pressure monitors      c. Prothrombin Blood Coagulation monitors      d. Pregnancy test kits      e. and others 2. FDA Medical Device Classes      a. Class I = low to moderate risk to patient           i. 47% of devices           ii. 95% exempt           iii. Examples = Enema kits, elastic bandages, manual stethoscopes, and bedpans      b. Class II = moderate or high risk to patient           i. 43% of devices (most devices)         &

 Beliefs: 1. Cold temperatures bring on cold/flu 2. Going outside with wet hair gives you a cold 3. The flu shot causes the flu 4. Coffee Can Stunt Childhood Development 5. Cracking Knuckles Leads to Arthritis 6. Starve a Fever, Feed a Cold 7. Gluten is Bad 8. Sitting is the New Smoking 9. Eating chocolate gives you acne. 10. Walking around barefoot on a cold floor will give you varicose veins 11. Sugar causes hyperactivity in children.  ______ Make sure to subscribe to get the latest episode.  Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks YouTube: https://www.youtube.com/user/ProPharmaEducation

Remedies & Myths: 1. Krazy Glue can be used to seal small wounds      a. Contains cyanoacrylate      b. Con – irritate skin, kill cells, and aggravate infections, poison if swallowed 2. Treatment of burns      a. Put Butter on a Burn      b. Toothpaste on a burn      c. Honey on a burn      d. Aloe Vera on a burn      e. For Cuts and Scrapes, Apply Peroxide and Leave Open to the Air 3. Throw Your Head Back to Stop a Nosebleed      a. Throwing your head back causes blood down to the back of the throat and you may swallow it.  Swallowed blood irritates your stomach and causes vomiting      b. Tx – tip head forward, pinch your nostrils together while leaning slightly forward 4. Vicks for Foot Fungus, Headaches, Ear Aches      a. Vicks increases circulation &

 Rebates  • Spin – Rebates are a villain in producing higher drug costs • What are they?  --    o Discounts for favorable formulary placement   o Rebates are like discounts based on the volume of sales • Entities involved – PBM, rebate aggregator, Health Plan, drug manufacturer • What is rebated?  -- brand name drugs only • Contract between PBM or payer and drug manufacturer   o Terms of contracts are secret   o Manufacturers don’t want other manufacturers to know what they have guaranteed for discounts   o PBMs don’t want clients to know how much they keep   o PBMs negotiate discounts so the overall cost is lower, but they keep a percentage of the savings • Largest contractor for rebates is Medicare • Response   o CVS is giving patients a lower cost by giving rebates/discounts at point-of-sale   o Walgreens and others are doing the same • Industry question – Are rebates going away, or are they just being

 This Weeks Topic: 1. Opiate issue      a. Scale of problem      b. Who is to blame?  PhRMA, doctors, patients      c. Sites of Care – surgery, ER, dentists, primary care 2. Responses       a. Discontinuation of therapy – CDC response to taper       b. Opiate Stewardship      c. State Programs to intervene  ______ Make sure to subscribe to get the latest episode.  Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks YouTube: https://www.youtube.com/user/ProPhar

• Are all consumers the same? • Deloitte/ Four Consumer Classifications    • Trailblazers       o Younger, higher income, excellent health, more men, use report cards of doctors, hospitals, will change doctors if dissatisfied    • Prospectors       o 2nd youngest group, high income, men=women, open to wearable tech & virtual office visits, use quality ratings      • Homesteaders       o 2nd oldest, low income, women>men, not open to tech, avg. wellness, convenience > OOP, don’t change providers    • Bystanders       o Oldest, poorest, women > men, not open to tech, avg. wellness, don’t share info with doctor, least likely to follow healthy diet, choose doctor on OOP and convenience • Why are we talking about this?         o If consumer can pick their health care option, then who

 Topic: The Flu Vaccine Influenza: 1. Why do we need a flu shot every year?      a. Virus and vaccine           i. Virus is constantly mutating/changing           ii. Vaccine only works against one portion of a protein on the surface           iii. WHO/CDC basically makes an educated guess as to which virus will be the most likely      b. Even in a “bad” year when the vaccine doesn’t match well, the effectiveness is still about as good as most medications at preventing/treating their corresponding diseases. 2. Why should people get the flu shot?      a. Because it decreases your chance of getting flu, getting a severe case of the flu, being hospitalized for the flu and even dying from the flu      b. The “but I am a healthy adult” excuse…    &n

 Topic: Generic Vs. Brand Vs. Biosimilars Top 10 Generic Pharmaceutical Companies – many are branded companies, e.g., 1, 2, 3, 9, 10      1. Pfizer Established Pharma      2. Teva Generics (including Allergan Gx)      3. Sandoz / Novartis      4. Sun Pharma – Indian multinational pharmaceutical company      5. CR Pharmaceuticals – second largest distributor in Chinese pharmaceutical market      6. Yangtze River Pharma – Chinese multinational pharmaceutical corporation      7. Mylan – Morgantown      8. EMS – largest pharmaceutical company in Brazil      9. Abbott Established Pharma      10. Hengrui Therapeutics in Princeton, NJ = Jiangsu Hengrui Medicine Co. Ltd. Is largest ethical pharmaceutical company in China Effectiveness / Risk / Safety   &nb

Episode Outline: Topic: Amazon, Berkshire Hathaway, and JP Morgan Chase Tackle Healthcare Goals       •Save money      •Ensure Quality      •Satisfy patients Employers buy health care      •Cost           •Single Plan = $5,700 / employee           •Family Plan = $14,900 / family      •Employee pays = 28% of premium cost Problems      •Employer sponsored health care      •Volume over Value      •Patient not involved Remember, Potential Solutions?      •Patients get a seat at the table      •Fixed fees for clinicians      •Integrated care      •Health coach ______ Make sure to subscribe to get the latest ep

Episode Outline: Topic: How other countries handle Universal Health Care?         • APPROACHES TO UNIVERSAL HEALTH CARE                o Public Insurance -- United Kingdom                o Private Insurance – Netherlands                o Mixed Public-Private Insurance – France         • PUBLIC INSURANCE                o Single payer                o Government finances with taxes                o Direct contracting with providers           

 Episode Outline: FENTANYL – USE VS. ABUSE Bottomline – When used appropriately (surgery, cancer) it is very beneficial!  Approach:  How to balance benefits vs. risks? What it is?        • Synthetic narcotic painkiller and anesthetic – created 1960        • Pharmacology – binds to opiate receptors in brain – fast and in small doses 50-100x > morphine, 50x > heroin        • Dosage forms – injection, patch, sublingual, tablet, film, lozenges, lollipops        • Rx pain after surgery, severe cancer pain               o Rx requires enrollment in program to decrease risk of medication                o NMT 4x/day        • Drug Interactions –       &nb

Episode Outline: Insulin Prices & What To Do About It Sky rocking cost of insulin        -  ADA and Health Care Cost Institute – prices 2x between 2012 and 2016, 3x in decade before 2012        -  100 year history – R&D is over – price changes are PhRMA increases        -  Sanofi        -  Novo Nordisk        -  Eli Lilly Insulins        -  Old – Humulin, Novolin        -  New Analog insulins – Lantus, Levemir, Novolog, Humalog – less hypoglycemia Harvard Study        -  Type 2 diabetes        -  JAMA recent study        -  Anthem patients witched from new to old insulins       &