Monday, October 13, 2014

Is CVS too Aggressive? Customers or Patients?

Just got a call from a CVS pharmacist in Dayton, Ohio.  She identified a "gap in therapy" for one of my patients with diabetes.  "Don't you want to protect their kidneys with an ACE or an ARB?"

The patient did not meet any criteria for a "mandatory" ACE or ARB. Preventing kidney disease from ADA :  "Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria."

I pointed out to the pharmacist what the medical literature says about kidney considerations for diabetics, after she told me "there is one study" that said an ACE or ARB might be indicated.

I told her about guidelines and considerations and mandates and policies and the practice of medicine and the actual medical literature which is fairly vast in the area of diabetes.

She said, "I want my patients to get the best care possible"  After asking that "her patient" be prescribed an unnecessary drug.

What's up with CVS?  Are they foisting partially informed pharmacists on their customers (or "patients") to enhance sales?  Clearly CVS would have been the benefactor of the sale of the unnecessary drug.

Isn't there a slight conflict of interest in CVS pushing unnecessary drugs onto persons with chronic diseases in the name of "a gap in therapy"?  Or is it really a "gap in profits"?

What do you think?

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