CVS Will Stop Filling Controlled-Substance Prescriptions for Cerebral, Done (wsj.com) 99
CVS Health will stop filling prescriptions for controlled substances ordered by clinicians working for telehealth startups Cerebral and Done Health starting Thursday, a move that will impact thousands of patients. From a report: A CVS spokesman confirmed the change in a statement, citing concerns CVS has with the two companies following a review it conducted. Cerebral had earlier disclosed the change in a statement to The Wall Street Journal. Cerebral called CVS's decision unfortunate, adding that it was "doing everything possible to ensure these patients get access to medications that their healthcare providers have determined they need." Some pharmacies had already blocked or delayed certain prescriptions from Cerebral and Done prescribers over concerns that clinicians were writing too many stimulant prescriptions, The Journal reported in April. Cerebral had said prescription delays occurred because of confusion around telehealth policies. Done declined to comment at the time.
Cerebral and Done between them treat tens of thousands of patients for attention-deficit hyperactivity disorder, prescribing stimulants such as Adderall. Psychiatrists say stimulants can have significant benefits for people properly diagnosed with ADHD. But they are classified as schedule 2 controlled substances by the federal government due to their potential for abuse, the same category as OxyContin and Vicodin. Cerebral and Done grew very quickly from the onset of the Covid-19 pandemic, attracting patients with social-media ads that offered an ADHD diagnosis and prescriptions to treat the condition. Previously, clinicians were prohibited from prescribing stimulants without an in-person visit. The U.S. relaxed those rules in March 2020 for all schedule 2 substances due to the coronavirus public-health emergency.
Cerebral and Done between them treat tens of thousands of patients for attention-deficit hyperactivity disorder, prescribing stimulants such as Adderall. Psychiatrists say stimulants can have significant benefits for people properly diagnosed with ADHD. But they are classified as schedule 2 controlled substances by the federal government due to their potential for abuse, the same category as OxyContin and Vicodin. Cerebral and Done grew very quickly from the onset of the Covid-19 pandemic, attracting patients with social-media ads that offered an ADHD diagnosis and prescriptions to treat the condition. Previously, clinicians were prohibited from prescribing stimulants without an in-person visit. The U.S. relaxed those rules in March 2020 for all schedule 2 substances due to the coronavirus public-health emergency.
It's a digital pill mill (Score:5, Insightful)
Adderall is literally a racemic mixture of amphetamine and dextroamphetamine, who would've thought people would want to do shady things to get it? Did anyone see Breaking Bad?
Re:It's a digital pill mill (Score:5, Insightful)
FUD doesn't fill up the cemetery with headstones, but pharma opioid marketing has.
Re:It's a digital pill mill (Score:5, Insightful)
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So what?
if the patients are adults and want this stuff, isn't it better that they get legit FDA-approved pharmaceuticals of known potency and quaity, or that they be driven to the black market where they'll get who-knows-what adulterated with anything from fentanyl to rat poison. And supplied by smugglers and criminals who shoot up our streets?
I'd much prefer if they just go to CVS and pay Pfizer.
Re:It's a digital pill mill (Score:5, Interesting)
Eventually the tolerance builds and the prescriptions stop. Then you're in real trouble. You either decide you want rehab or change to street drugs.
Re:It's a digital pill mill (Score:5, Insightful)
That's why I don't think a prescription should be required. I'm generally in favor of making drugs legal with a few safeguards to ensure that non-users are minimally affected. There's an argument that it should be illegal to advertise them, but it's hard to craft a law that doesn't run afoul of the 1st amendment, which is more important. And there's a decent argument that kids shouldn't be allowed to buy them, but it's hard to pick any specific age as the boundary. Somewhere around 18 to 22 is probable appropriate. (Now how do you enforce that on-line? It may be a cure worse than the problem.)
Please note that my attitude still accepts a heavy death rate. But it's a rate among self-selected users. And I support taxing the addictive drugs to pay for recovery centers, etc. (Etc. includes subsidizing health care to pay for the excess costs required...and requiring them to care for the users. Again, this is a bit tricky to do properly.)
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That's far to reasonable to ever happen here, unfortunately.
Only place I differ with you is I'm fine with barring corporations from advertising this stuff. They aren't people, so fuck 'em: they have no 1a rights. If shareholders or execs want to individually take out ads to encourage people to use their employer's product, they are free to do so - they can also assume the liability.
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What about the people who are affected by such a policy of "let people self police"?
The kids who have to live with junky parents until they either die of neglect, outgrow their parents and leave, or are noticed and taken into care? None of those outcomes are particularly brilliant...
Drug and alcohol addiction often has a splash zone, which can be quite large - addiction is rarely something which is contained to the addict.
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Eventually the tolerance builds and the prescriptions stop. Then you're in real trouble. You either decide you want rehab or change to street drugs.
Interesting, so you’re saying it’s a medical treatment issue and not a criminal one. Sounds like we need to fund more treatment and get rid of the criminal laws.
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THAT is exactly what happen in Portugal in 2010.
They have had absolutely amazing results.
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It seems like we go to the doctor for medical advice. Anything from my arm hurts, what's wrong, to "I heard about this cool drug Adderall".
If I ask them about cool drug, they should tell me what it is, what dosage I should take, what the side effects are, and how likely it is to address any specific complaint I have. Then it's my choice to take the drug or not take the drug. The pharmacist should stand on the other side, supplying a quality product of the desired dosage, and also give a last warning about s
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If I ask them about cool drug, they should tell me what it is, what dosage I should take, what the side effects are, and how likely it is to address any specific complaint I have. Then it's my choice to take the drug or not take the drug.
So you want your doctor to prescribe you a drug just because you asked about it and then decided you want it?
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Of course. They did their research. They know more than the doctor.
It's like the anti-vaxxers who complained about the vaccines, but never complained about those "Big Pharma" drugs being pumped into their bodies every day to keep them alive after they contracted covid.
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So you want your doctor to prescribe you a drug just because you asked about it and then decided you want it?
As opposed to the ones that the pharmaceutical industry literally pays doctors to over-prescribe?
If I am going to take something I really don't need I'd rather choose it myself.
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So you want your doctor to prescribe you a drug just because you asked about it and then decided you want it?
I don't want them to prescribe anything. I want them to give me advice, which I can take or leave. Their advice might be "let's have that arm set and cast, and you should take these pills at this dosage and frequency for this duration. This is a medical emergency and time is of the essence, let's do it right now."
It can also be "You really should not take that cool new drug, you do not have the con
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...adulterated with anything from fentanyl to rat poison...
Fentanyl, itself an FDA-approved pharmaceutical...
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Your point?
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Agreed. It's amazing how much people think they deserve to control everyone else's life.
Live your life. I'll do the same with mine.
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When medical marijuana was the norm in California, I worked next to an office that did nothing but medical MJ prescription
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Where do you think these doctors have gone now that demand for MMJ prescriptions has declined with legalization?
Moved on to the next drug that needs to be legalized just like MJ.
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Psychiatrist don't need to hide in the shadows to put half the country on psychotropics, they do it quite in the open.
Obviously they are going to be a bit upset when their margins get undercut though.
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You would make a good click bait journalist.
Re: It's a digital pill mill (Score:2)
If people want to abuse Adderall, they will procure it, either from a "pill mill" or on the street. It's not hard to do so. Wouldn't you rather them get it from a safe source like CVS than on the street?
Re: It's a digital pill mill (Score:2)
Re: It's a digital pill mill (Score:2)
You seem to be arguing with me not against me.
What I am saying is there should be no controlled substances. Attempts to control them cause more harm than good. It causes legitimate harm to people who actually need them (like my wife who frequently is unable to get the prescription medicine she needs and her doctor advises since it is a "controlled substance"), and people who actually want to abuse it will buy it trivially anyway on the street - fueling criminal gangs. These attempts at controlled do not hel
Re: It's a digital pill mill (Score:2)
Is that legal? (Score:3)
Regardless of the problems with Cerebral et. al., aren't the prescriptions already issued still considered valid? Or are all prescriptions issued by telehealth providers now considered null and void?
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Can't have this both ways. Our "wonderful" war on drugs has made anyone in the chain potentially liable both civilly and criminally for drug abuse, no matter how many Is are dotted or Ts crossed. No pharmacist is going to fill anything remotely questionable, and it sucks to be you.
FDA (Score:5, Interesting)
Over the last 15 years or so, the FDA has consistently been shifting the burden of regulation from themselves onto the medical industry.
Meaning, at one point in the past, the FDA would come up with best practices, or guidance, that, if followed, would mean you were in compliance and, while not completely immune from lawsuits, provided some protection against them.
Now, the FDA offers little guidance, and will let you know that you are not in compliance with their sometimes vague and confusing regulations by suing you.
So, yeah, it's reaching the point that it is safer to simply not carry products than to guess how to follow regulations.
Re:Is that legal? (Score:5, Funny)
Our "wonderful" war on drugs has made anyone in the chain potentially liable both civilly and criminally for drug abuse, no matter how many Is are dotted or Ts crossed.
Congratulations to drugs for winning that war.
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The prescriptions might be valid but are pharmacies under obligation to fill them?
Re:Is that legal? (Score:4, Insightful)
The situation has got crazy.
Our local pharmacy won't fill prescriptions for anything containing codeine. Prescriptions that come from local doctors that the pharmacist has been accepting prescriptions from for years.
These same pill are over-the-counter in the UK.
Re: Is that legal? (Score:2)
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It's nothing to do with any dangers from taking the drug: it's to stop raids on pharmacies. Apparently some have been broken into and pharmacists have been held at gunpoint while an accomplice steals the codeine products.
I don't know why codeine is valuable on the street, but apparently it is valuable enough to steal at gunpoint.
Re: Is that legal? (Score:2)
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I've had pharmacies refuse to fill a legit prescription.
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aren't the prescriptions already issued still considered valid? Or are all prescriptions issued by telehealth providers now considered null and void?
If they accepted the prescription and don't completely fill it, it sounds like a breach of contract to me. Unless they provide some mechanism for the patient to get the remainder filled elsewhere without having to get a whole new prescription it seems quite unethical. I did not RTFA, but the appropriate thing to do would be to honor existing scrips and just not accept new ones.
Moralizing pricks, as usual (Score:2)
Weren't CVS also the ones who got on their high-horse about withdrawing tobacco products?
Yeah, glad I shop at Walgreen's.
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Yeah, glad I shop at CVS!
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Weren't CVS also the ones who got on their high-horse about withdrawing tobacco products?
Walgreens was looking into getting rid of cigarettes, too. [orlandosentinel.com] I'm not sure if anything ever became of it. I was actually pretty surprised that ditching smokes didn't bite CVS in the ass, because I knew someone who worked for a CVS and they said tobacco products made up the bulk of their front counter sales.
I guess they must make a decent enough profit on prescriptions.
Re:Moralizing pricks, as usual (Score:5, Informative)
Walgreens has their moralizing pricks too.
I bailed out of Walgreens when one of their pharmacists refused... and she was the lead pharmacist at that location and wouldn't even let one of her minions hand the bottle over to me instead... to fill my prescription for PrEP (Truvada); and corporate refused to do anything about the her aside from the usual empty "we apologize for the inconvenience" platitudes and a suggestion that I try getting it filled at another location. There's only one... a very obvious one... reason to deny someone a scrip for PrEP, and it's 100% a moralizing prick move (And this was in the Bay Area, no less.). I had my doctor pull all my prescriptions out of Walgreens and move them over to Amazon Pharmacy. Thus far, I have no complaints.
If your ad is "offering" a diagnosis... (Score:3)
There's something wrong with you diagnostic process. Looking for a particular outcome before evidence is present is a red flag. You're supposed to be practicing science, not divination.
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It should be up to your doctor to offer you choices not the drug company.
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You mean like this one [deviantart.com]?
Illegal (Score:5, Interesting)
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Re:Illegal (Score:4, Funny)
Paid shill right here.
Thanks for announcing it. Who are you paid by and what are you shilling?
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> what are you shilling
Shillings are not used since Decimal Day
https://en.wikipedia.org/wiki/... [wikipedia.org]
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He probably talks like a wall of text in real life. Maybe he should cut down on the meds.
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You don't know the law then. A pharmacist can refuse to fill a prescription using their professional judgement.
"Ballsy doctors?" Maybe those are licensed quacks going against proper protocol?
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>You don't know the law then. A pharmacist can refuse to fill a prescription using their professional judgement.
But it's not the pharmacist applying their professional judgement. It's CVS telling the pharmacists they employ that they cannot use their professional judgement and must take only one course of action.
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Complicated topic.
DEA cracking down and fining pharmacy businesses for enabling addiction.
In California the law has already ruled favorably for CVS senior management refusing to refill opiates an inordinate amount of time for a particular patient, saying matter must go to state's Board of Pharmacy as next step.
Meanwhile in Kentucky things at least temporarily going the other way in a case of CVS not filling.
Things are up in the air right now.
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You don't know the law then. A pharmacist can refuse to fill a prescription using their professional judgement.
If they're allowed professional judgement, Then they need to be Liable for damages and harm (Including punitive damages, pain and suffering damages, Additional treatment/office visit expenses, etc) if their decision turns out to be wrong and they deny medication causing interference with their treatment - Much like the physician would be if they judged treatment not required.
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You're funny making proclamations. Meanwhile the law is clear. Board certified dope dealers and quacks abound. Pharmacists are allowed to be control on that and can bring down the hammer.
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You're funny making proclamations. Meanwhile the law is clear. Board certified dope dealers and quacks abound. Pharmacists are allowed to be control on that and can bring down the hammer.
The whole idea of pharmacists harkens back to the days they would blend compounds of their own in the lab - coca leaves, mineral oil, eye of newt, etc.
Machines can count factory manufactured pills just fine. If all they are is a middleman with a hammer it seems a good argument that pharmacists are not really even needed anymore..
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Or you are unaware of all the things pharmacists do. You start with a fallacy about all pills and other medicines being machine manufactured, thinking all pharmacists do is pour those out of bottles. guess again.
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Or you are unaware of all the things pharmacists do. You start with a fallacy about all pills and other medicines being machine manufactured, thinking all pharmacists do is pour those out of bottles. guess again.
Your response is light on examples. Actually now that I think of it, pharmacists here do give flu and COVID shots as well, so there is that.
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funny, I thought people could look up what a pharmacist actually does for a living, I know a couple. It isn't just reading horrible handwriting, pouring tablets out of big bottles into little ones and labeling them. the APA for example would be glad for people to look at their site.
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Definition of compounding is broad, most pharmicists do it to some extent.
APhA says it's âoethe preparation, mixing, assembling, altering, packaging, and labeling of a drug, drug-delivery device, or device"
Can robots do some of that? They may someday but that day isn't today.
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You are free to get the prescription. CVS is free to refuse to fill it. Certainly no shortage of pharmacies in this country.
Why? (Score:2)
Re:Why? (Score:4, Informative)
https://www.justice.gov/usao-n... [justice.gov]
Because they can be liable under the law. CVS does not want to be part of another wave of issues with prescription drugs.
Fix the underlying problem instead. (Score:3)
It also seems odd to me that the fix for hyperactivity is to give someone a stimulant. But eh I'm not a doctor being courted by big Drug companies.
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It does seem odd, but I've known a couple of kids for which it worked.
OTOH, one grew up to be a violent schizophrenic. But that's anecdote, not data.
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There are concerns that there is a causal relationship. This arises from the observed medical histories of young males that go on shooting rampages.
Has the research been done to test this hypothesis? Of course not. That might interrupt profits.
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Nobody is saying the drug doesn't work - not even the FDA or the DEA. That's why it's "schedule 2" instead of "schedule 1" - the difference between the two is sched. 2 drugs have recognized therapeutic uses and can be prescribed with a DEA license. Schedule 1 drugs are only legal for research purposes.
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It does seem odd, but I've known a couple of kids for which it worked.
There's been a few long term studies that followed up with ADD/ADHD kids as they grew into adults. Stimulant meds make the kids more manageable in school, but ultimately they don't make the kids more successful.
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the science behind this is pretty solid, from wiki: ADHD is now a well-validated clinical diagnosis in children and adults, and the debate in the scientific community mainly centers on how it is diagnosed and treated... Stimulant me
Re:Why? (Score:5, Informative)
I don't understand why pharmacies feel the need to get between doctors and their patients. I mean, I assume Cerebral and Done are licensed providers with DEA-registered physicians. Shouldn't any action like this be under the purview of the DEA? Pharmacies have way too much arbitrary discretion. We need pharmacy neutrality.
Because CVS was just part of a nearly $900 million settlement in an opioid epidemic lawsuit. "The plaintiffs’ lawyers argued that the pharmacies had ignored the many red flags raised by suspicious orders for opioids at both the local pharmacy level and the headquarters where there should have been oversight." So now CVS is paying attention to red flags.
Re:Why? (Score:4, Informative)
I don't understand why pharmacies feel the need to get between doctors and their patients.
Because: https://www.npr.org/2021/11/23... [npr.org]
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Because pharmacies don't like being sued for hundreds of millions of dollars as a result of ethically questionable doctors writing questionable prescriptions for controlled substances.
Re: Why? (Score:2)
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I have seen pharmacist discretion from both sides. A family friend of my parents' generation would stay in contact by phone a couple of times per year. During one call, her speech seemed different, and she complained of memory problems, while also saying that she used 3-4 doctors. I asked her to read me some of her pill bottles: more than one benzodiazepine. I told her to put all of her pill bottles in a bag, take them to the pharmacist, and get the uncoordinated meds sorted out. She sounded better on
How does this fit with the opiod crisis? USians? (Score:2)
So on one hand ADHD candidates have an increasing difficulty getting their hands on drugs they need and OTOH we have an US opiod crisis that is being said stems from USians being able to binge on opiod drugs like others do on smarties and gummybears. This doesn't seen to fit together - can anybody from the USA enlighten a confused European here, I'd like to understand. Thanks.
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So on one hand ADHD candidates have an increasing difficulty getting their hands on drugs they need and OTOH we have an US opiod crisis that is being said stems from USians being able to binge on opiod drugs like others do on smarties and gummybears. This doesn't seen to fit together - can anybody from the USA enlighten a confused European here, I'd like to understand. Thanks.
I'm a European living in the US. In the US, the days of opioids with your breakfast serial seem to be over and they are not so easy to get a doctor to prescribe for and it's not so easy to find a pharmacist that would dispense them. This is because the DEA rides the arse of a doctor that prescribes them 'too much' and pharmacists that dispense them 'too much'. Of course this is done with no reference to the actual number of people a doctor is seeing that legitimately would benefit from them and decisions ar
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How did you come to the conclusion that people are having difficulty getting their required medications?
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Your two hands are "effect" and "cause." As a result of the overuse of opiods, the courts have decided that the manufacturers and the pharmacists are the reason for the drug problem. As a result of lawsuits, the pharmacists are taking the tack that "I'm not filling that prescription if I think there is any potential liability to me as a result of doing so." It's rather hard to blame them.
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If having to go see a real doctor is "increased difficulty" to obtaining a drug that is easily abusable, then boo hoo. The two organizations being blacklisted here are online pill mills.
There's still plenty of other doctors and health care organizations that you can see to get the same prescription, which CVS would happily fill. They're protecting themselves from a very obvious future lawsuit and possible business-ruining action from the DEA.
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Coulda been a Steely Dan (or Donald Fagen) title (Score:2)
Done with Done
ADHD most underdiagnosed (Score:3)
ADHD is the most underdiagnosed brain condition, especially among adults.
A local screening can cost you $5000 so many people go online.
The proper assessments have questionnaires that take two hours to complete, skills tests, and essays.
There could be corruption but refusing treatment isn't the right approach. That's a tort itself in some states.
If properly diagnosed and prescribed the stimulants are unlikely to become habit forming because they just bring the brain up to normal levels of dopamine and norepinephrine.
Support your independent pharmacy if you can.
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If properly diagnosed and prescribed the stimulants are unlikely to become habit forming because they just bring the brain up to normal levels of dopamine and norepinephrine.
I was diagnosed with ADD as a kid, and prescribed Ritalin. Most of the time, I spat it out. I taught myself to be mindful of my behavior in class, so no one would question if I had taken my meds. I wasn't doing it as an act of defiance; the medication gave me anxiety, insomnia, and a sedated feeling that I really did not enjoy.
The only thing the drug is good for is to trick your brain into believing that otherwise boring tasks are actually worth completing. Maybe that's useful if you're in school, but i
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ADHD isn't about not being able to do "boring jobs". It affects everything. Yeah, it'll cause you trouble at work, but it makes it hard to do things you actually want to do as well! Plus all of the other problems, like constantly forgetting stuff, sleep issues, inability to keep track of time, losing things, ... - it affects your entire life.
This is an interesting way of putting
HAHA (Score:1)
meh (Score:3)