GSPO Local Member, Alan Brown, Urges Substantive Remedial Action Regarding CVS Caremark

Alan R. Brown, RPh and Congressman Rodney P. Frelinghuysen (R) meet to discuss action regarding CVS Caremark

With the support of the Garden State Pharmacy Owners Organization (GSPO) and like-minded Congressional colleagues, including Congressman, Rodney Frelinghuysen (R), Alan Brown, RPh, owner of Liberty Drug in Chatham, has been requesting that the Federal Trade Commission review the CVS Caremark merger to ensure that, in this case, fair competition was not being stifled, as far back as 2 years ago. Since the merger, scores of complaints have been heard from consumers, senior citizens, pharmacies and others, that CVS has used its control of Caremark to harm competition.

Although the Commission has been conducting a wide-ranging competition and consumer protection investigation for the past 18 months, most recently, Mr. Brown and members of the GSPO have been stressing the need for full and complete relief of this case, including requiring that CVS divest Caremark.

Mr. Brown brings to attention, strong evidence that the CVS Caremark merger has harmed consumers. Some particularly anti-competitive practices of CVS/Caremark that attempt to drive consumers to CVS stores and, in the process, harm consumers and reduce competition include:

• The CVS/Caremark “Maintenance Choice” program that forces consumers to fill prescriptions at CVS store/mail-order or else, pay an increased co-pay to fill 90-day or maintenance prescriptions at non-CVS locations.
• The confusing “CVS Caremark” benefits card which makes customers (especially vulnerable, elderly patients) believe that they can only use their benefits card and fill prescriptions at CVS stores.
• Switching Medicare beneficiaries to CVS stores with an increased co-pay, thus, bringing these customers to the Part D “donut hole” prematurely.
• Using confidential patient information collected by Caremark to enable CVS pharmacists to solicit non-CVS customers by phone and mail in order to direct them to fill their prescriptions at CVS stores.
• Engaging in egregious auditing practices that threaten the viability of many pharmacies or are simply a way to increase profits and reduce patient choice.

By reducing choice, raising prices and violating patient privacy, the combination of CVS/Caremark poses profound problems for consumers. The need for comprehensive relief is clear – CVS is the largest pharmacy chain in the U.S. and Caremark is the largest PBM. Together they deal with over 40% of all consumers, and its activities have incredible potential for significant competitive and consumer harm.

The GSPO believes the remedy in this case is straightforward. None of these problems existed prior to the combination of CVS and Caremark. The simplest, most comprehensive remedy is to require CVS to divest Caremark. Only through divestiture can consumers be assured that CVS will be unable to use its control of Caremark to engage in deceptive and anti-competitive conduct. The fact that CVS and Caremark have engaged in deceptive practices in the past demonstrates the difficulty of crafting any remedy short of divestiture that will work.

If the staff seeks alternative relief, the Commission is being strongly urged, in the very least, to put in place a stringent firewall between CVS and Caremark to be monitored by an independent trustee. At the time of its merge, CVS committed to establishing a firewall between CVS and Caremark operations in order to prevent the improper and unlawful transfer of confidential information. This was consistent with past FTC PBM enforcement actions such as Lilly/PCS and Merck/Medci that required a firewall as a condition of permitting the merger. Since CVS made this pledge, it has become clear that this pledge has been utterly disregarded. The staff has received dozens of complaints documenting the sharing of Caremark data with CVS operations. The flagrant violation of this commitment made at the time of the merge demonstrates that, for a respondent whose goal is to use Caremark to drive pharmacy sales, civil penalties are unlikely to protect the privacy of consumers in the future.

Reduce Your Risk of Heart Disease

Heart disease is the leading cause of death in the United States. Its victims are women and men, and people of all backgrounds and ethnicities, in all regions of the country. Although heart disease is the nation's most costly and widespread health problem, it is among the most preventable.

The most common heart disease in the United States is Coronary Artery Disease (CAD). Coronary Artery Disease is the #1 killer in America, affecting more than 13 million Americans.

Coronary arteries are blood vessels of the heart. Healthy coronary arteries are smooth and elastic, allowing blood to flow freely. As we get older, fat can start to deposit in the blood vessel walls and begin to build up, causing injury to the vessel. Over time, the process of injury and repair can cause plaque development in the interior calls of the arteries, compromising oxygen-rich blood to the heart muscle, which can lead to a number of conditions that affect your heart or increase your risk of death or disability.

Control What You Can:

Lifestyle changes are the best defense against heart disease.

Although there are a few factors that can't be controlled, including age, gender and family history, you can prevent and control many heart disease factors such as high blood pressure, high blood cholesterol and obesity with lifestyle changes and in some cases, medicine.

According to the National Institute of Health, the best way to reduce your chances of getting heart disease is by changing your key risk factors in your lifestyle. Medication obviously plays a key role in preventing and treating heart disease, but a wealth of research has shown the surprising success that simple lifestyle changes can make in helping along that effort. These include:

Following a Healthy Diet: This means more than just cutting back on fat. Studies have shown that a diet high in produce, whole grains, nuts, legumes and fish, reduced artery damaging inflammation better that the standard low-fat diet. Many people also find this type of diet more filling, palatable and attainable that just cutting back on fat.

Maintaining a Healthy Weight: Excess fat, especially around the belly, strains the heart, raises blood pressure, LDL and triglycerides, lowers HDL, causes insulin resistance, and produces substances in the blood that can inflame the arteries. By lowering your body weight by as little as 5 percent, you can lower your heart disease risk drastically.

Exercising Regularly: Regular aerobic exercise protects against every major cardiac risk factor. It improves both LDL and HDL cholesterol levels, reduces blood pressure, lowers the risk of type-2 diabetes, controls body weight, eases stress and depression, and may reduce arterial inflammation.

Managing Stress: Stress and negative emotions unleash hormones in your body that trigger heart-threatening changes. Anger and stress, for example, speed up the heart, raise blood pressure, narrow and inflame arteries, provoke abnormal heart rhythms and make blood prone to clotting. Regular aerobic exercise is an effective antidote for stress. Other methods include yoga, tai chi, meditation, and controlled breathing exercises.

Quitting Smoking: Cigarette smokers have more than double the heart disease risk of non-smokers. Fortunately, the risk starts to drop as soon as you quite.

To learn more about what you can do to lower your risk of heart disease, join us for a FREE educational seminar on Heart Disease Prevention Awareness, featuring Dr. Tobi Ippolito, MD, Board Certified Internist in Chatham, NJ on Wednesday, February 16th from 6PM to 7PM at Liberty Drug.

January is National Cervical Health Awareness Month

January is National Cervical Health Awareness Month. Nearly 4,000 women in America will die this year from cervical cancer. These cancers are largely preventable, and raising public awareness can save lives.

Cervical cancer is the only cancer known to be primarily caused by a common virus, the Human Papilloma Virus (HPV). In the United States, 11,000 new cases of cervical cancer will be diagnosed in 2010 from HPV caused tumors. HPVs are sexually transmitted via skin-to-skin contact. Recent research indicates the virus also cause some cases of cancers of the mouth and head and neck in men and women.

Cervical cancer is often stigmatized as a disease acquired as a result of promiscuous behavior. While risks of acquiring a high-risk HPV increase with the number of one's sexual partners, persons in longtime monogamous relationships can be infected from a lone sexual encounter that occurred years, even decades, earlier.

Although, most women and men acquire an HPV infection during their lifetimes, fortunately, most HPV infections are benign and disappear spontaneously. Some however, persist. Of more than 100 known HPVs, only about 15 are high-risk viruses. Cervical cancers caused by high-risk HPVs usually develop slowly and may grow, often asymptomatically, for years prior to medical detection.

Pap test screening is the first line of defense against cervical cancer. Pap tests are recommended for women every other year after the age of 21. Regular gynecological Pap tests detect most cell changes due to HPV long before they become cancer. Early detection of these precancers can be effectively treated before they become malignant. Unfortunately, four out of five women do not receive their regular Pap test. In 2010 more than half of the women diagnosed with cervical cancer either never had a Pap or were not screened in the last five years.

In recognition of Cervical Health Awareness Month this January, Liberty Drug will be hosting a free educational seminar on HPV and Cervical Cancer featuring Dr. Russell Hoffman, MD, Chief of Obstetrics and Gynecology at Overlook Hospital, Summit, NJ on Wednesday, January 19th from 6PM to 7PM.

For more information about Cervical Health Awareness Month, visit the National Cervical Cancer Coalition.

April is National Autism Awareness Month

In order to highlight the growing need for concern and awareness about autism, the United States recognizes April as National Autism Awareness Month. This gives us a perfect opportunity to promote education to the public about autism and the issues within the autism community. For more information, visit the Autism Society of America.

What is Autism?
Autism is a spectrum disorder, meaning that its symptoms range from mild to severe and vary by individual, often referred to as an Autism Spectrum Disorder (ASD). It is characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements and sensory dysfunction. An autistic child might appear to be largely oblivious to his surroundings, violently overwhelmed by physical sensations, or seem outwardly to be simply socially awkward. As of 2007, the Centers for Disease Control (CDC) estimates one in 150 children are diagnosed with autism.

Behavioral Treatment
The general goal with behavioral treatment for individuals with ASD is to teach appropriate behavior while decreasing inappropriate behaviors. This type of assessment and teaching is formally known as Applied Behavioral Analysis (ABA). The field of ABA includes structured and naturalistic methodologies for assessment and interventions, including but not limited to discrete trial training, incidental teaching, pivotal response training, natural environmental training, verbal behavior, fluency-based instruction, task analysis, descriptive assessment, functional analysis and positive behavioral support.

Biomedical Treatment
Although ASD is diagnosed on the basis of behavioral parameters, there are many underlying biomedical factors which can contribute to these symptoms. The biomedical approach is a science-based, molecular-biological approach to treatment. The aim is to address the underlying health problems. Affected children often have an exaggerated response to toxins, foods and airborne allergens. It is well documented that they are often deficient in various nutrients, enzymes, antioxidants and essential fatty acids, and they require methylation support. The guiding principle is to remove what is causing harm and add what is missing. This integrative approach addresses the physical AND behavioral symptoms of autism. The Autism Research Institute asked parents to rate the effectiveness of numerous biomedical treatments. As of 2008, over 26,000 parents of autistic children had evaluated more than 80 interventions. Detoxification was considered helpful by 74% of parents. Other highly rated therapies, considered to be helpful included: gluten/casein-free diet, 66%; food allergy treatment, 64%; methylcobalamin, 56% and essential fatty acid therapy, 56%.

Regardless of the type of treatment, age at intervention has a direct impact on outcome – typically, the earlier a child is treated, the better the prognosis will be. Thanks to advances in all treatments, today it is recommended to use a combination of approaches (e.g. biomedical and ABA). ABA alone cannot heal the child’s medical conditions and a medical approach cannot make up for deficits with the child’s peers. Many parents today feel that an all around approach covers all bases.

Thyroid Imbalance

Approximately 200 million people worldwide have thyroid disorders. The risk increases with age and is more common in women. Symptoms of hypothyroidism (low thyroid) may include fatigue, depression, anxiety, slowed metabolism and heart rate, dry skin, cold and heat intolerance, high cholesterol, fluid retention, constipation, memory and concentration impairment, headaches and migraines, swollen neck, low body temperature, irritability, decreased libido, low blood sugar, and weight gain. Patients may have some or all of these symptoms, but may not be diagnosed for years.

Thyroid Hormone exists in two major forms:

• Thyroxine (T4), is an inactive form that is produced exclusively by the thyroid gland and is converted to the active form in the body.

• Triiodothyronine (T3) is the active form of thyroid hormone, About 20% of T3 is produced by the thyroid gland, with the remainder produced through conversion of T4 in various tissues of the body when more T3 is needed.

The theory behind the use of T4 alone (levothyroxine), is that the thyroid gland converts T4 into T3. However, as the thyroid gland of a hypothyroid person is already malfunctioning, its ability to convert T4 to T3 may be hampered as well. T3 (liothyronine) is commercially available only as an immediate acting preparation, which often causes undesirable side effects including palpitations. Many patients have tried using thyroid hormones such as evothyroxine (T4) and liothyroinine (T3), and have found that Armour Thyroid^® (Desiccated Natural Thyroid), which contains a specific ratio of T4 and T3, works best for them.

Just this year, Armour Thyroid^® was reformulated by is manufacturer to improve dissolution, and during that time, availability problems forced patients to switch to the similar natural thyroid drugs, Nature-Throid^TM and Westhroid^TM. When the reformulated Armour Thyroid^® came back on the market, many patients complained that the reformulated product was not working as well as before, and some patients switched to Nature-Throid^TM and Westhroid^TM again. Currently, there is a nationwide shortage of Armour Thyroid^®, and the manufacturer has not indicated any date as to when the product will be back on the market. Nature-Throid^TM and Westhroid^TM are also unavailable.

As of this month, Desiccated Natural Thyroid - Thyroid USP (porcine) - is available only through compounding pharmacies. Thyroid USP has been shown by analysis to meet the same potency standards as that which is used to manufacture commercial products that are currently on back-order. The pure chemical forms of T4 and T3 can also be used to create a custom blend to meet the specific needs of each patient. Please visit www.LibertyDrug.com for more information about thyroid imbalance and compounded thyroid.

Air Pollution Linked to Diminished IQ in Children

In the August 2009 publication of Pediatrics, the findings of research funded by the National Institute of Environmental Health Sciences, the EPA and several private foundations, conducted at Columbia University, unveiled that there is possible correlation between increased air pollution and decreased IQ scores in children.

The study researched the effects of environmental pollutants known as polycyclic aromatic hydrocarbons (PAHs), which include chemicals released into the air from the burning of coal, diesel, oil and gas, or other organic substances such as tobacco. Hundreds of children born to mothers of varying races were followed from the time they were in utero to 5 years old, at which time they were given the Wechsler Preschool and Primary Scale of Intelligence test which provides full scale IQ scores. It was found that children that had high exposure to these pollutants had an average of 4.5 points lower that those that had less exposure, evidence that high levels of PAHs effects children's IQ scores adversely. Read more about this study.

What You Don't Know About Prostate Cancer

According to the American Cancer Society, one in every six men will develop prostate cancer in their lifetime. While prostate cancer is slow-growing and curable if found early, there are few if any early warning signs. Some of these symptoms that may indicate prostate cancer include pain, weight loss and urinary disruption. In April, the American Urological amended the testing schedule for the prostate-specific antigen (PSA) from beginning at age 50 to age 40 for men with average risk. Make sure you have talked to your doctor about your risk and regular screenings.

Currently there is no sufficient data to prove that prostate cancer is preventable however maintaining a healthy diet and lifestyle are universally important for men’s health. Recently studies have shown that drinking 8 oz of pomegranate juice daily may slow the progression of localized prostate cancer and lycopene, a compound found in cooked tomato products, may also provide protective benefits.

If you happen to be diagnosed with prostate cancer, there are several treatment options available:

• Prostatectomy has the highest cure rate and is one of the more aggressive options and involves the surgical removal of the prostate. Talk to your doctor about the risks involved with any surgical procedure.

• Radiation therapy can be both external or through radioactive pellets (seeds) implanted directly in the prostate. This is used on older men who tend not to tolerate surgery and can require special technology.

• Hormone therapy is another option that requires shots or pills to decrease testosterone levels which slows the growth of prostate cancer, as the cancer cells need testosterone in order to grow.

• Cryotherapy creates an iceball within the prostate to freeze the growth of cancer cells. This is not the most common method of treating prostate cancer but you should talk to your doctor about the best treatment for you.