GOVERNMENT AND ITS MARQUEE LONG-TERM CARE INSTITUTION

An old-school pharmacy hand-delivers drugs to Congress, a little-known perk for the powerful ...

Grubb's Pharmacy on Capitol Hill. Eric Kruszewski for STAT

WASHINGTON — If House Speaker Paul Ryan comes down with the flu this winter, he and his security detail won’t be screeching off toward the closest CVS for his Tamiflu.

Instead, he can just walk downstairs and pick up the pills, part of a little-known perk open to every member of Congress, from Ryan and Majority Leader Mitch McConnell down to the newest freshman Democrat.

• 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, the reserved 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.

“It makes you kind of sit back and say, ‘Wow, they’re making the highest laws of the land and they might not even remember what happened yesterday.'”

Mike Kim (center), a pharmacist and owner of Grubb’s Pharmacy, prepares a medication with compound technician Ron Thompson. Eric Kruszewski for STAT

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.

The two-story shop, with its bay windows and wood counters, harkens back to that history, though the computer systems and supplements inside aren’t far removed from your typical Walgreens counter — if all of Walgreens’s inventory was shoved into the nooks and crannies of three small aisles and labeled with individual stickers. At Grubb’s, staff will even scoop Hershey’s ice cream into cones out of a small counter in the corner, a modern-day nod to the marble-topped soda fountain once popular with the neighborhood kids.

The pharmacy mostly serves the staffers, lobbyists, and families who make their home in the quiet, leafy neighborhood just to the east of the Capitol building, though Grubb’s five drivers will deliver prescriptions across the entire city. Some 800 prescriptions leave its doors every day, filled by some three dozen pharmacists, technicians, and support staff.

The relationship between Grubb’s and the Capitol has gone nearly unchanged for decades, even as congressional leaders have pushed again and again to overhaul the nation’s broader health care system.

Most lawmakers know far more about the Office of the Attending Physician than about Grubb’s or its arrangement with Congress. In a STAT survey of some two dozen House and Senate members from both parties, only one knew about the single pharmacy that delivers all their drugs: Congress’s only pharmacist, Rep. Buddy Carter (R-Ga.).

“If you have a vote and you can’t get home to your personal physician, you need to see somebody, and I’ll run over between votes and be able to keep my personal responsibilities going,” said Sen. Bill Cassidy, a Louisiana Republican. “It’s a convenience that definitely allows us to be more productive.”  NOW THAT'S AN OXYMORON! 

A ticket dispenser hangs on the wall inside Grubb’s Pharmacy. Eric Kruszewski for STAT

Lawmakers describe the Office of the Attending Physician as a modern space much like a regular doctor’s office — though the $3.7 million budget it enjoyed for 2016 suggests a relatively well-furnished space. It’s strictly off-limits to reporters; staff there declined repeated requests for comment, and a spokesman for the House Administration Committee that helps oversee OAP declined multiple follow-up inquiries.

That’s perhaps because the office is not without controversy. Its services — and the relatively low fees that members must pay for access — were thrust into a harsh spotlight in 2009, as Congress began to debate the Affordable Care Act and as reporters began to ask how lawmakers’ own care might color their perspectives on policy. The central issue is the cost: In 2016, lawmakers paid $611 for annual membership — a fee that, unlike most health care prices, has risen much slower than inflation. In 1992, the first year the office charged a fee, it was $520.

The Office of the Attending Physician itself was formed in 1928, after three members of Congress died in their offices within months of one another — more than 50 years after Grubb’s first opened its doors.

The little red pill being pushed on the elderly exposes inappropriate use of drug in nursing homes ... NOTE: Perhaps as well Long-Term care facilities like congress 
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. 

And much of the money is coming straight from the federal government.

The pill, called Nuedexta, is approved to treat a disorder marked by sudden and uncontrollable laughing or crying -- known as pseudobulbar affect, or PBA. 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 (MS) or ALS, also known as Lou Gehrig's disease.

IF CNN DID THE INVESTIGATION IT MUST BE TRUE!

Nuedexta's financial success, however, 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, CNN found.

In her former nursing home, Lenore Greenfield was diagnosed with PBA and prescribed Nuedexta by California psychiatrist Romeo Isidro, a physician who has received hundreds of thousands of dollars in promotional payments from Avanir.

Since 2012, more than half of all Nuedexta pills have gone to long-term care facilities. The number of pills rose to roughly 14 million in 2016, a jump of nearly 400% in just four years, according to data obtained from QuintilesIMS, which tracks pharmaceutical sales. Total sales of Nuedexta reached almost $300 million that year. 

Nuedexta is being increasingly prescribed in nursing homes even though drugmaker Avanir Pharmaceuticals acknowledges in prescribing information that the drug has not been extensively studied in elderly patients -- prompting critics to liken its use to an uncontrolled experiment. The one study the company conducted solely on patients with Alzheimer's (a type of dementia) had 194 subjects and found that those on Nuedexta experienced falls at more than twice the rate as those on a placebo. 

Avanir declined repeated requests to be interviewed for this article. In an emailed statement, the company said PBA is often "misunderstood" and that the condition can affect people with dementia and other neurological disorders, which are common among residents in long-term care facilities. A company website states PBA can afflict up to roughly 40% of dementia patients -- a figure that is based on an Avanir-funded survey and was repeatedly disputed by medical experts interviewed by CNN, including some of those paid by Avanir.

Nuedexta is approved by the Food and Drug Administration (FDA) to treat anyone with PBA, including those with a variety of neurological conditions such as dementia. But geriatric physicians, dementia researchers and other medical experts told CNN that PBA is extremely rare in dementia patients; several said it affects 5% or less. And state regulators have found doctors inappropriately diagnosing nursing home residents with PBA to justify using Nuedexta to treat patients whose confusion, agitation and unruly behavior make them difficult to manage.