Cerebral stimulant suit

[calvnandhobbs68]

Ex-Cerebral executive files lawsuit claiming the startup overprescribed ADHD meds

A former executive at Cerebral, a well-funded online mental health startup, claims in a labor lawsuit that the company fired him after he complained that the company was too quick to prescribe powe | A former executive at Cerebral, a well-funded online mental health startup, claims in a labor...

www.fiercehealthcare.com

Oh wow whoever could've seen this coming with all the Cerebral ads "if you eat cake too fast, you must have ADHD!"

I think the most egregious thing here is:
"For instance, he told higher-ups that he had found more than 2,000 duplicate shipping addresses in the patient database, suggesting customers were setting up multiple accounts to obtain additional medication. Truebe said he reported the findings to Cerebral CEO Kyle Robertson and other executives but they took no action, and Robertson said the issue was his "lowest priority."

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[Celexa]

Literally was just talking to one of my coresidents about how apparently some pharmacies aren't filling any prescriptions for adderall for new patients. Undoubtedly it's because of **** like this. I hope all these companies burn to the ground and the investors lose every penny.

My money was on benzos being the next big iatrogenic epidemic to make flashy headlines but stimulants seem to have taken an aggressive lead in that race

 

[watto]

Benzos by mail is an excellent idea. You can't spell "Benzos" without "Bezos," after all.

 

[WisNeuro]

When I saw and opened this thread, I was really excited about a wearable suit that could stimulate parts or my cerebrum. I am now very disappointed.

 

[Ironspy]

No one could have predicted this

 

[PsyDr]

WSJ News Exclusive | Walmart, CVS Pharmacies Have Blocked or Delayed Telehealth Adderall Prescriptions

The moves by some of the nation’s largest pharmacies have focused on stimulant prescriptions from telehealth clinicians treating ADHD, pharmacies and people familiar with the issue say.

www.wsj.com

 

[Jules A]

Kudos to the pharmacies and in a perfect world they would be making board complaints also.

 

[PikminOC]

WSJ News Exclusive | Walmart, CVS Pharmacies Have Blocked or Delayed Telehealth Adderall Prescriptions

The moves by some of the nation’s largest pharmacies have focused on stimulant prescriptions from telehealth clinicians treating ADHD, pharmacies and people familiar with the issue say.

www.wsj.com

Many of these places will work with only certain pharmacies to make sure their meds get filled.

 

[PikminOC]

Kudos to the pharmacies and in a perfect world they would be making board complaints also.

Won't matter. The nurses who do this won't get in any trouble

 

[Merovinge]

Won't matter. The nurses who do this won't get in any trouble

They likely won't, but it doesn't mean it's not worth doing.

 

[R. Matey]

I wonder if they actually say no to anyone.

 

[sloh]

I wonder if they actually say no to anyone.

“100% of ADHD patients.”

More like…100% of “ADHD” patients

 

[PikminOC]

They likely won't, but it doesn't mean it's not worth doing.

Takes time.

 

[watto]

Just in today (from WSJ)"

"Cerebral, an online mental-health company based in San Francisco that describes Truepill as its preferred pharmacy, informed its clinicians of Truepill’s decision in a Friday email viewed by The Wall Street Journal. The email said Truepill would no longer support mailing Schedule 2 controlled substances, including Adderall and Vyvanse, “to any of their customers.”

 

[calvnandhobbs68]

Just in today (from WSJ)"

"Cerebral, an online mental-health company based in San Francisco that describes Truepill as its preferred pharmacy, informed its clinicians of Truepill’s decision in a Friday email viewed by The Wall Street Journal. The email said Truepill would no longer support mailing Schedule 2 controlled substances, including Adderall and Vyvanse, “to any of their customers.”

Yeah given the hits they got in the opioid litigation and this move from a major mail order pharmacy that's supposed to be one of Cerebral's big partners, I wonder if it won't be too long before the big pharmacy chains start totally blocking controlled med prescriptions from all "providers" associated with these companies (not just individual people they flag). I bet they're pretty gun shy at this point and it's not like they need the business.

 

[littlefred]

Yeah given the hits they got in the opioid litigation and this move from a major mail order pharmacy that's supposed to be one of Cerebral's big partners, I wonder if it won't be too long before the big pharmacy chains start totally blocking controlled med prescriptions from all "providers" associated with these companies (not just individual people they flag). I bet they're pretty gun shy at this point and it's not like they need the business.

Playing devils advocate here, in none of our DEA registrations there is mention of place of employment... rather the listed information is the address of practice. How are they going to know you're prescribing from one of the online pill mills?

 

[deleted1100659]

Do they even do drug testing or anything prior to initiation of a stimulant? Well i probably already know the answer. Or at least check the PDMP..

This company is such a joke, and still their recruiters email me periodically. I did respond one time out of sheer curiosity but sadly no response

 

[Merovinge]

Do they even do drug testing or anything prior to initiation of a stimulant? Well i probably already know the answer. Or at least check the PDMP..

This company is such a joke, and still their recruiters email me periodically. I did respond one time out of sheer curiosity but sadly no response

Jokes are supposed to be funny, not cause significant societal harm. These guys are closer to tobacco companies than Seth Rogan.

 

[deleted1100659]

Jokes are supposed to be funny, not cause significant societal harm. These guys are closer to tobacco companies than Seth Rogan.

I would be very curious to see the number of controlled substances prescribed by NPs/PAs vs physicians out of sheer curiosity.

 

[deleted1100659]

Side note: if you google cerebral psychiatry, under questions "people also ask" one of the most popular questions is "Does cerebral prescribe xanax?" lolol.

 

[allantois]

Pharmacies in our area have been having shortages of adderall and Ritalin (not so much vyvanse or concerta). Had office staff call independent pharmacies in the area for a patient all of whom said they are not taking on new adderall patients. Some I have been able to switch to Wellbutrin..

 

[Merovinge]

Pharmacies in our area have been having shortages of adderall and Ritalin (not so much vyvanse or concerta). Had office staff call independent pharmacies in the area for a patient all of whom said they are not taking on new adderall patients. Some I have been able to switch to Wellbutrin..

If unregulated capitalism for healthcare making generic Adderall go on backorder doesn't impress you, I don't know what will!? Anyone for bringing back Black Beauties via mail order NP prescription?

 

[allantois]

If unregulated capitalism for healthcare making generic Adderall go on backorder doesn't impress you, I don't know what will!? Anyone for bringing back Black Beauties via mail order NP prescription?

I’m guessing there’s not much money in making Adderall.. or maybe pharma learned their lesson from opioids

 

[Chrish]

Pharmacies in our area have been having shortages of adderall and Ritalin (not so much vyvanse or concerta). Had office staff call independent pharmacies in the area for a patient all of whom said they are not taking on new adderall patients. Some I have been able to switch to Wellbutrin..

Can confirm about b/o. We are also having issues getting Focalin generic.

 

[calvnandhobbs68]

Can confirm about b/o. We are also having issues getting Focalin generic.

I had one pharmacy today tell me they couldn't get Metadate CD generic until August. So yeah. Luckily another pharmacy in the area has more stock I transferred it to.

 

[Merovinge]

I had one pharmacy today tell me they couldn't get Metadate CD generic until August. So yeah. Luckily another pharmacy in the area has more stock I transferred it to.

Metadate has been intermittently backlogged around my area on/off for the past 4-5 years so that's actually not a fallout from these horrendous companies. Focalin XR is honestly a better med in most cases though and readily available.

 

[FlowRate]

I’m guessing there’s not much money in making Adderall.. or maybe pharma learned their lesson from opioids

Some quick google numbers show on the order of 10-20 million US adults taking stimulants. XR retails at $50ish at most pharmacies around here. So there's $1B per month. (20million*$50) Obviously IR forms are cheaper and Vyvanse is much more expensive, so you can scale from that baseline figure of stimulants being a roughly $10B per year market.

Volume product. Plus lots of people prefer vyvanse so getting the path to vyvanse going would be another way stimulant prescribing could be leading to significant profits.

 

[allantois]

Some quick google numbers show on the order of 10-20 million US adults taking stimulants. XR retails at $50ish at most pharmacies around here. So there's $1B per month. (20million*$50) Obviously IR forms are cheaper and Vyvanse is much more expensive, so you can scale from that baseline figure of stimulants being a roughly $10B per year market.

Volume product. Plus lots of people prefer vyvanse so getting the path to vyvanse going would be another way stimulant prescribing could be leading to significant profits.

Yes, but I’m sure regulations surrounding SII prescriptions must cut into the profit (I’m sure there are requirements for storage as well as transportation of product)

 

[FlowRate]

Yes, but I’m sure regulations surrounding SII prescriptions must cut into the profit (I’m sure there are requirements for storage as well as transportation of product)

Even at 1% margins and above relatively conservative assumptions that's a $100M/yr profit industry.

I don't see why pharma companies would pay to run the ADDitutes magazine if they weren't looking to make more money on higher margin options.

 

[calvnandhobbs68]

Metadate has been intermittently backlogged around my area on/off for the past 4-5 years so that's actually not a fallout from these horrendous companies. Focalin XR is honestly a better med in most cases though and readily available.

I'm just a creature of habit and start a lot of my younger kids on Metadate CD....maybe I should get with the times and start with Focalin instead

 

[smalltownpsych]

Here is a smaller company with a provider in my state that seems to be doing the same thing. Every time I search for things, this is one of the top hits. I should find out who does their seo.
Online ADHD - At Your Service Psychiatry

 

[calvnandhobbs68]

Here is a smaller company with a provider in my state that seems to be doing the same thing. Every time I search for things, this is one of the top hits. I should find out who does their seo.
Online ADHD - At Your Service Psychiatry

Ah a mini horde of NP stimulant peddlers. Again, a ripoff for legit patients, you could go see a private practice psychiatrist for as much if not cheaper (1200 bucks a year (100/month) for "ADHD" pricing...comes out to 300 bucks per q3 month followup for a stable patient). Such obvious peddling to diagnosis seekers it's ridiculous.

 

[Merovinge]

I'm just a creature of habit and start a lot of my younger kids on Metadate CD....maybe I should get with the times and start with Focalin instead

Focalin XR has a cleaner split (50% IR and 50% released on the second bolus), Metadate's 30%/70% release makes no sense to me. Some signal that dexmethlyphenidate at equivalent (i.e. 1/2) dosage to methylphenidate may have less side-effects as well. Never really saw the Metadate appeal once Focalin XR got onto medicaid formularies.

 

[calvnandhobbs68]

Focalin XR has a cleaner split (50% IR and 50% released on the second bolus), Metadate's 30%/70% release makes no sense to me. Some signal that dexmethlyphenidate at equivalent (i.e. 1/2) dosage to methylphenidate may have less side-effects as well. Never really saw the Metadate appeal once Focalin XR got onto medicaid formularies.

See I always viewed it as a possible benefit to getting better symptom control later in the day with the 30/70 split since you're getting more with the second bolus, esp for kids who are doing okay in the morning but worse as they get more tired later in the day. I can't say I have any hard evidence this is the case vs a 50/50 split dosing though. I guess I just don't frequently start with Focalin unless someone's having side effects but seem to be benefitting from methylphenidate since you can do Ritalin LA for the 50/50 split too.

I still see pediatricians around here prescribing Metadate ER (the tablet) though, which is like the weirdest one to me since it's just a single extended pulse release tab that never gets to the same serum concentrations as BID Ritalin dosing.

 

[randomdoc1]

Here is a smaller company with a provider in my state that seems to be doing the same thing. Every time I search for things, this is one of the top hits. I should find out who does their seo.
Online ADHD - At Your Service Psychiatry

That's one of the ways I shop for good SEO lol! Good legit SEO is super pricey though. Although, for good reason.

 

[whopper]

Benzos by mail is an excellent idea. You can't spell "Benzos" without "Bezos," after all.

Isn't Bezos a Superman villian?

 

[allantois]

Whoop, per their website they are not prescribing any more controlled meds. Waiting for new calls for ADHD treatment..

 

[randomdoc1]

Whoop, per their website they are not prescribing any more controlled meds. Waiting for new calls for ADHD treatment..

That and stimulant refugees. That's why phone screening is critical lol.

 

[deleted1100659]

They keep emailing me to supervise NPs, I always reply to see what they pay out of sheer curiosity but they insist on a phone call. Like damn guys, i dont want to actually work for cerebral, im just curious how much your physicians get paid to not give a **** and forego all quality of care.

 

[deleted1022040]

Ex-Cerebral executive files lawsuit claiming the startup overprescribed ADHD meds

A former executive at Cerebral, a well-funded online mental health startup, claims in a labor lawsuit that the company fired him after he complained that the company was too quick to prescribe powe | A former executive at Cerebral, a well-funded online mental health startup, claims in a labor...

www.fiercehealthcare.com

Oh wow whoever could've seen this coming with all the Cerebral ads "if you eat cake too fast, you must have ADHD!"

I think the most egregious thing here is:
"For instance, he told higher-ups that he had found more than 2,000 duplicate shipping addresses in the patient database, suggesting customers were setting up multiple accounts to obtain additional medication. Truebe said he reported the findings to Cerebral CEO Kyle Robertson and other executives but they took no action, and Robertson said the issue was his "lowest priority."

Thank you for putting in that quote by DrSnips. It made my week!

 

[sloh]

WSJ News Exclusive | Mental-Health Startup Cerebral Investigated by FTC

The FTC said it was investigating whether Cerebral engaged in deceptive or unfair practices related to advertising or marketing of mental-health services.

www.wsj.com

Uh oh.

The Federal Trade Commission has begun an investigation into mental-health startup Cerebral Inc., according to a letter the FTC sent the company that was reviewed by The Wall Street Journal.

In the letter dated June 1, the FTC said it was investigating whether Cerebral engaged in deceptive or unfair practices related to advertising or marketing of mental-health services. The letter also directed the company to preserve documents.

The FTC’s letter asks Cerebral to answer dozens of questions related to its business. In particular it seeks information related to any programs where Cerebral continues to bill customers a subscription fee until the customer cancels, also called “negative option programs.”

 

[MedMan80]

 

[PsyDr]

2,000 leaked documents and employees say Silicon Valley healthcare startup Cerebral harmed hundreds of patients and prescribed serious medication with abandon

Cerebral wanted to change mental-health care. Instead, it took on patients it couldn't handle and pushed its providers beyond their expertise.

web.archive.org

 

[Merovinge]

2,000 leaked documents and employees say Silicon Valley healthcare startup Cerebral harmed hundreds of patients and prescribed serious medication with abandon

Cerebral wanted to change mental-health care. Instead, it took on patients it couldn't handle and pushed its providers beyond their expertise.

web.archive.org

This is a perfect case study about how pushing for high throughput, high retention (e.g. controlled substances), and low training with standard business practices makes for absolutely terrible medicine. Many healthcare models are shifting towards this style of practice, just less efficiently than Cerebral was.

 

[calvnandhobbs68]

2,000 leaked documents and employees say Silicon Valley healthcare startup Cerebral harmed hundreds of patients and prescribed serious medication with abandon

Cerebral wanted to change mental-health care. Instead, it took on patients it couldn't handle and pushed its providers beyond their expertise.

web.archive.org

So many great quotes:
At the same time, family nurses commonly prescribed antipsychotics to patients with depression before trying to properly calibrate their existing regimen of antidepressants. "FNPs will just throw antipsychotics around like it's ****ing candy — and it's not," the nurse said. "These are very serious medications with very serious side effects."

In July, a psychiatric nurse practitioner determined her patient had anxiety, depression, bipolar disorder, insomnia, night terrors, and post-traumatic stress disorder, according to a report. She started the patient on five medications at the same time, and the patient soon reported side effects including dilated pupils, difficulty eating, shaking, and anxiety.

That same month, a psychiatric nurse practitioner filed a report, alarmed that a family nurse had given a patient a diagnosis of bipolar disorder without documenting the reason. The family nurse, who did not note which type of bipolar disorder the patient had, prescribed the antipsychotic risperidone, after which the patient gained 30 pounds in just a few months.
The family nurse failed to see the weight gain as a side effect of the drug, continued it, and added the sedative Ambien for sleep and another antipsychotic "without clear reasons why," the report noted.

Unfortunately this kind of stuff isn't terribly uncommon in the community either but I wonder if these FNPs were feeling more fast and loose because they were working for a "mental health" company. Also the stuff about people being bounced around from NP to NP sounds more like a CMHC than a private company you're paying a monthly fee for...I'd have been pissed if I was a patient too.

Like any article though, they bring up some nitpicky stuff that isn't always clinically relevant. Like somehow insinuating you shouldn't prescribe stimulants to anyone who has a family history of cardiac disease without cardiac clearance...

 

[VA Hopeful Dr]

So many great quotes:
At the same time, family nurses commonly prescribed antipsychotics to patients with depression before trying to properly calibrate their existing regimen of antidepressants. "FNPs will just throw antipsychotics around like it's ****ing candy — and it's not," the nurse said. "These are very serious medications with very serious side effects."

In July, a psychiatric nurse practitioner determined her patient had anxiety, depression, bipolar disorder, insomnia, night terrors, and post-traumatic stress disorder, according to a report. She started the patient on five medications at the same time, and the patient soon reported side effects including dilated pupils, difficulty eating, shaking, and anxiety.

That same month, a psychiatric nurse practitioner filed a report, alarmed that a family nurse had given a patient a diagnosis of bipolar disorder without documenting the reason. The family nurse, who did not note which type of bipolar disorder the patient had, prescribed the antipsychotic risperidone, after which the patient gained 30 pounds in just a few months.
The family nurse failed to see the weight gain as a side effect of the drug, continued it, and added the sedative Ambien for sleep and another antipsychotic "without clear reasons why," the report noted.

Unfortunately this kind of stuff isn't terribly uncommon in the community either but I wonder if these FNPs were feeling more fast and loose because they were working for a "mental health" company. Also the stuff about people being bounced around from NP to NP sounds more like a CMHC than a private company you're paying a monthly fee for...I'd have been pissed if I was a patient too.

Like any article though, they bring up some nitpicky stuff that isn't always clinically relevant. Like somehow insinuating you shouldn't prescribe stimulants to anyone who has a family history of cardiac disease without cardiac clearance...

If you can't actually do an exam I don't think that's unreasonable.

 

[calvnandhobbs68]

If you can't actually do an exam I don't think that's unreasonable.

True, hadn't thought about that, since I'm doing a cardiac exam and vitals on all the patients I start on stimulants ha

 

[Merovinge]

True, hadn't thought about that, since I'm doing a cardiac exam and vitals on all the patients I start on stimulants ha

You actually get out the ole stethoscope and listen prior to starting stimulants?

 

[PsyDr]

If you can't actually do an exam I don't think that's unreasonable.

if you don’t read the diagnostic criteria, it’s even easier.

 

[calvnandhobbs68]

You actually get out the ole stethoscope and listen prior to starting stimulants?

Yeah AHA guidelines recommend a cardiac exam and if you look at uptodate "cardiac evaluation of patients receiving pharmacotherapy for ADHD" it also recommends BP/P and cardiac exam. I just basically make sure they don't have a riproaring murmur/irregular/weird heart sounds and normal pulses and makes me feel like I'm actually examining patients