It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 08-20-2008, 11:18 PM   #1
Inactive
(female)
 
Join Date: Jul 2008
Location: U.S.A.
Posts: 287
Confused089 HB User
Interesting Conversation w/ pharmacy about generic brand costs & some questions

Thought I would add a few nuggets to the never-ending questions about different generics (and throw a more questions into the mix as well). From my reading on this board and research, I understood Watson, Roxanne, & Activas/Amide to be "better than average" and Ethex and Malinkrodt to be "worse than average." I thought Endo might lie somewhere in the middle to low range for quality.

Only one of the pharmacies I contacted was willing to order specific generics. The pharmacist said she would check on the cost of different generics for MS Contin and Oxyodone Ir. Most pharmacists told me that they stocked Malinkrodt and wouldn't change their orders for a regular customer. In this case, the pharmacist offered to look into the cost of Activas/Amide, Roxanne, Watson, and Endo. I don't know if I missed any other generics considered to be better than average -- if so, I would appreciate it if you could fill in the gap (for generic oxycontin IR and MS Contin.)

The pharmacist did a little investigating. Watson was the most expensive and not w/i whatever formula the pharmacy uses to calculate their minimum profit for a medication. I believe I have heard the best about Watson - if, indeed their product is closer to brand than the others, I wouldn't be surprised by the significantly higher cost of the generic.

The pharmacist explained that they could order Activas and Roxanne for *low* dose oxycodone and MSContin, but could not order these generic brands for a *high dose* of MSContin. I probably found this last bit the most interesting. At a certain dose level, some generic brands apparently become too expensive for the pharmacy [bear in mind that this is not very scientific analysis- it's an N of 1 ;-), at least in terms of a pharmacy willing to consider ordering a specific brand for a customer - I assume the cost of a generic to different pharmacies is the same, or that the hierarchy of prices is the same [I'm sure they vary according to quantity and possibly region - there may be other variables as well - but, again, I assume that the most expensive is still the most expensive, and so on..].

Malinkrodt seems to be the norm in this area. Another pharmacy that had been ordering activas/Amide for oxycodone has now switched to Malinkrodt and won't order the Activas/Amide brand now since they still have Malinkrodt in stock [there was a recall of the Activas/Amide last month]. At any rate, thought that this was a another interesting piece of the generics puzzle. If Watson is so expensive, why do any pharmacies stock it at all? The pharmacist didn't give me any of their costs, but the Watson was clearly far more expensive than the other generics. It seemed very obvious that Malinkrodt was the big price winner but the cost differential for Roxanne and Activas/Amide wasn't too large for lower doses of medications.

I would think that the large chains [depending on their management] would be better situated to purchase more "expensive" generics since they can purchase in bulk [but that's just an assumption]. I got this impresion after talking with a small independent today that doesn't stock any meds. for chronic pain b/c there aren't enough customers. When he *was* stocking these meds, he said his upfront costs were too high, and that the CP patients who got pain meds from the pharmacy often [?!] changed their dose or medication, and he was stuck with a expensive medication he couldn't sell - it just sat on the shelves and he lost money. In this case, it may have been that demand was too low over the long run to make it work financially.

So, I do have a questions here - for MS Contin, is Endo [the only other possibility the pharmacy offered for high dose MSC], a better bet than Malinkrodt? If anyone has experience or knowledge about how these two compare for MS Contin, I would appreciate it.

Also, Ex, if you happen to jump in here - you have mentioned many times that your dr. said "not to even *call*" if you got Mylan fentanyl patches b/c there were so many problems. Did your doctor ever say what he/she thought the problems were? I've looked at a lot of the threads about the difference between patch brands and I haven't really gotten a clear sense of the specific problems with Mylan. If you could summarize what you know, I would be grateful.

I'm curious if anyone regularly gets Watson, what kind of pharmacy they use, and if they had to request it. The same goes for high dose [she didn't specify what constituted high dose - if this started at 60 or 100 mg] of MS Contin.

One more question while we're at it - Anthem still lists LA oxycodone as a generic. Can they claim that there is actually generic LA oxycodone still out there? I thought it was all gone at this point. It makes a difference for some policies since some policies require you to pay the difference in cost between the generic and brand if the generic is available.

Last edited by Confused089; 08-20-2008 at 11:46 PM.

 
Sponsors Lightbulb
   
Old 08-21-2008, 06:36 AM   #2
Senior Member
(female)
 
Join Date: May 2008
Location: VA
Posts: 154
shananava HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

I checked w/ Walmart and they are ordering Watson fentanyl patches for me to pick up tomorrow. They normally stock them but didnt have enough for me because of 15 a month dose. Luckily I had enough mylan left to make it. Ill have to call every month so they will have them in stock. They also had Sandoz but I want to try Watson due to responses on the board. I just got lucky w/ my hydros being Watson thru mail order program. Good luck!
Shannon
Shannon

 
Old 08-21-2008, 07:00 AM   #3
Veteran
(female)
 
Join Date: Dec 2005
Location: na
Posts: 383
onyxgates HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

I get Watson from Walgreen. I am using only 12 a month (technically) although they never stick or work all the way through to the 60th hour. So I am always calling in early which I hate but that is a different story and pretty typical as my doctor tells me especially during the summer months. Anyway all of a sudden Watson appeared and I really do like them. They are better than the name brand in that they are smaller and stick a bit better.

Good luck in finding your brand.

 
Old 08-21-2008, 07:02 AM   #4
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

We're getting into some "advanced" stuff here......


Quote:
Originally Posted by Confused089 View Post

The pharmacist did a little investigating. Watson was the most expensive and not w/i whatever formula the pharmacy uses to calculate their minimum profit for a medication.
As I've posted before, the way it works is this....When a particular pharmacy submits a claim to insurance, they are reimbursed back to the "average" of the meds in it's class. When they stock meds below the average wholesale cost, they make more money. When they stock meds which have a price above the average wholesale cost, they don't make as much. This is why most pharmacies typically stock the cheapest meds in each class or category. This insurance formula is implemented by the insurance industry and applies to the chains as well as the independents. My pharmacist said that he has a number of situations where they actually "lose" money because his cost on a particular med is way above "average wholesale." He said the patch is a perfect example...Because the Mylan and Sandoz are so cheap, the average wholesale cost is much lower than Watson, so if he stocks Watson, he actually loses money for dispensing. He said there are a # of situations like this with many meds.

However, the big chains have a lot of buying power, thus, they can cut their own deals with the drug companies. Thus, their profit margins get even bigger because they have even cheaper acquisition costs...But they are still reimbursed back to "averge" wholesale, which is an industry standard. So, if a big chain can cut a good deal on say Watson patches, then it makes sense for them to stock them, but other pharmacies won't, thus, you can't find them.

Quote:
Also, Ex, if you happen to jump in here - you have mentioned many times that your dr. said "not to even *call*" if you got Mylan fentanyl patches b/c there were so many problems. Did your doctor ever say what he/she thought the problems were? I've looked at a lot of the threads about the difference between patch brands and I haven't really gotten a clear sense of the specific problems with Mylan. If you could summarize what you know, I would be grateful.
Yes, that is correct in what my Doc said. I asked the same question and he said it's because the active ingredient med, glue, and by products are all mixed up in one mass and stuck on a patch. Therefore, the actual med distribution is very uneven....Due to the other stuff being mixed with it. Additionally, I think it also has to do with the 20% rule and Mylan just puts 20% less in it. Obviously, Docs aren't going to go around and tell you that because it would create a firestorm. Most patients don't have the ability to understand the Hatch-Waxman Act of 1999.

Sandoz is made by Janssen, who makes Duragesic....Same factory. However, they use less of the active ingredient because they are allowed to....More profit for them, and it protects the brand to an extent. I've tried both Sandoz and Duragesic and not only is Duragesic much more powerful, it has much better glue. The generics cut cost where ever they can, and I don't blame them. Same situation, just different industry.

When I was working, I worked for a fortune 5 manufacturing company. The company is known for good quality American made branded products. However, we also made quite frequently, "off brands." I can say without a doubt, we made those "off brand" products with much less quality. Would they work...yes. Would they work well....Probably. But, they weren't up to the quality of the branded product.

Quote:
One more question while we're at it - Anthem still lists LA oxycodone as a generic. Can they claim that there is actually generic LA oxycodone still out there? I thought it was all gone at this point. It makes a difference for some policies since some policies require you to pay the difference in cost between the generic and brand if the generic is available.
There is some lag time between what you see and what they see. Your particular area may be "out" of generic, but there is still some in the pipeline in other areas of the country and because Anthem is nationwide, they must be consistent. Plus, it works in their advantage because the policy holder is "penalized" by getting brand even though generic isn't available in some places....More money for Anthem....Think about it.

Hope this helps.

Regards,

Ex

Last edited by Executor; 08-21-2008 at 07:10 AM.

 
Old 08-21-2008, 07:27 AM   #5
Inactive
(male)
 
Join Date: Aug 2008
Location: good ole' u.s. of a.
Posts: 16
zfennel HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Great Thread!!!

Im on methadone and it surprised me one day when I went in to get my scripts and the pharmacist said,"Hi zac,would you prefer Roxanne or Mallinkrodt."And of course as everyone else who is sane,I said Roxanne.
The very first time I went to this pharmacy with my methadone script they gave me methadoSe pills,the second-mallinkrodt(oblong),the third-Roxanne,I just thought it was pretty cool how they had several different brands in stock for me to choose from.
Now I know that the first time I got the MethadoSe brand it was more than likey b/c these were older pills from a while back that I got stuck with b/c noone else got as many pills as I did or they just never got rid of them.B/C now I notice the only brands I have to choose from are the Roxanne and Mallinkrodt.
Also,it pisses me off b/c the money makers like Walgreens and CVS order the crappy brands like mallinkrodt for hydrocodone etc in my area,b/c when I used to get lortabs everytime I would use a different pharmacy to try and get Watson I would try CVS and W@lgreens and I got those damned Mallinkrodt pills.I just think that the moneymaking chains like cvs and walgreens should be customer friendly and buy the "good" brands for us CP sufferers,cuz you know they have had complaints from some of us who hate the mallinkrodt brand but here in Paducah,KY they still got the crappy mallinkrodt generics for hydrocodone.
Anyways,just letting off a little steam.
Have A Pain Free Night Everyone!
Fennel~

Last edited by zfennel; 08-21-2008 at 07:30 AM. Reason: bad spelling again

 
Old 08-21-2008, 10:54 AM   #6
Senior Veteran
(female)
 
Join Date: Jul 2002
Location: WA, USA
Posts: 897
trowftd3 HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

I know the feeling. I have called every pharmacy within a reasonable driving distance and all of them carry Mallincrap(I take 5mg oxycodone) and none of them will order anything else!

Is there a 'name brand' 5 mg oxycodone? What would my doctor have to write for me to get something different? Thanks, Mush
__________________
undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease

 
Old 08-21-2008, 01:26 PM   #7
Newbie
(female)
 
Join Date: Jun 2008
Location: va
Posts: 5
painsuks HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

I take 60mg ms contin and the walmart in my area uses endo brand I have no problem at all with them.

 
Old 08-21-2008, 01:32 PM   #8
Senior Member
(female)
 
Join Date: May 2008
Location: VA
Posts: 154
shananava HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Have you tried Target if you have one in your area. Know someone else that uses them or drives extra far to a hometown pharmacy for Watson's.
S

 
Old 08-21-2008, 03:13 PM   #9
Senior Veteran
(male)
 
Join Date: Jun 2003
Posts: 3,458
Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Hey Guys, The rerason why we are seeing more and more mallinkrodt is because mallinkrodt is one of a very few number of opiate manufacturers in thsis country. The govt alots a certain amount of drug to be made each year. Only certain companies have the ability to produce the raw procuct and it's very possible that even name brand drugs have the mallinkrodt raw opiate. You don't need to be a producer of morphine to create a long acting version. However this gives mallinkrodt a huge advantage in the market, Full line agreements, meaning cheaper prices to carry an entire line of products or specific catagory lines are a price negotiating point.

5 years ago when their was a giant methadone shortage because the governamant hadn't alotted for the actual need due top changes in medical trends and prescribing of methadone. If you couldn't find any other product, you could count on finding mallinkrodt on someones shelf. They make the bulk Meth and their prodduct line methadose was perfectly positioned to fill the shortage.

Being the manufacturer of opiates and all opiates are now sytheticvally manufacturered, meaning you don't need bulk opium, gives mallinkrodt a huge advantag in the retail end and the wholesale end of opiate sales. Mallinkrodts parent company is Tyco which has anual sales greater then some countries GNP.

IMO. Is this a monopoly? of course, mallinkrodt can price their bulk product at a point no other manufacturer can compete. Is it a corrupt, well the presedent and CEO of Tyco were put in the state pen 3 or 4 years ago on other embezzing charges and it barely phased TYCO's stock. Pharamcuetical lobbist out number insurance, automotive and steel combined and so do their contributions. There were 2 pharma lobyist for every elected official in washington in the last report I read. I think we will continue to see alot of mallinkrodt products in the future, despite their quality.


Take care, Dave.

 
Old 08-22-2008, 03:21 PM   #10
Senior Veteran
(female)
 
Join Date: Jul 2007
Location: USA
Posts: 2,521
sammyo1 HB Usersammyo1 HB Usersammyo1 HB Usersammyo1 HB Usersammyo1 HB Usersammyo1 HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

While this thread is active I will take the chance & ask does anyone ever talk to their pharmacist & request a certain brand or come right out & tell the pharmacist they do not get the relief from say the mallin. brand?
I believe that was the brand of oxycodone I was took at one time & I did not get a great amounnt of relief. I have to say after reading some of the posts about the different brands I have not a single doubt in my mind there is a big difference in generics. I take the Endo percocet & when I was first put on it it worked great. Never tried another brand. I am going to be going on LA hopefully soon so I would rather know what I am getting. Confused hope you dont mind me asking, since it is the same subject thought I would see what you all advised. Thanks, Sammy

 
Old 08-22-2008, 03:43 PM   #11
Inactive
(female)
 
Join Date: Jul 2008
Location: U.S.A.
Posts: 287
Confused089 HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Quote:
Originally Posted by sammyo1 View Post
While this thread is active I will take the chance & ask does anyone ever talk to their pharmacist & request a certain brand or come right out & tell the pharmacist they do not get the relief from say the mallin. brand? Confused hope you dont mind me asking, since it is the same subject thought I would see what you all advised. Thanks, Sammy
Sammy, no, of course not. Glad you asked (And I think it's great you're doing some research into this - I presume you're doing this so that when you go on the LA meds *next week* ;-), you will know which brand to request (teasing you a little - I haven't commented on your thread, but I have been reading it - hope you get the LA meds ASAP!]. I'm hoping people will discuss their experiences asking for certain generics at pharmacies and also talk about which generics have worked best for them.

Thanks to everyone for their comments here. I've found it helpful for understanding how all this works and why Malinkkrodt is ubiquitous. I think it's helpful to know a little about the pharmacies' motivations and restrictions [in terms of profit, etc] when it comes to different generics.

I didn't consider the fact that big chains can cut their own deals with companies as Ex pointed out. I knew it was about profit [it's a business, of course] but wanted to understand the system a little better as well as the hierarchy when it comes to generic meds.

I'm still a bit surprised that a few/some pharmacies stock the higher priced generics since I don't know how many people are aware of the differences between generics and specifically request one brand over another.

Thanks again for everyone's comments. Hope anyone will feel free to post questions about pharmacies and generics here [provided it's ok with the moderators] - it seems like it suits the purpose of the thread.

 
Old 08-22-2008, 10:00 PM   #12
Senior Veteran
(female)
 
Join Date: Feb 2008
Location: NY
Posts: 1,884
cmpgirl HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Quote:
Originally Posted by Shoreline View Post
Pharamcuetical lobbist out number insurance, automotive and steel combined and so do their contributions. There were 2 pharma lobyist for every elected official in washington in the last report I read. I think we will continue to see alot of mallinkrodt products in the future, despite their quality.


Take care, Dave.
Thank you for stating that Dave, This is something I've known for years, having worked in the insurance industry for a very long time and when people would start blaming the insurance companies for the high costs of prescription plans, it always got my hackles up. Still does, actually. I used to tell people, all the time, that if they knew just how massive and strong the pharma lobby was, it would make them choke on their cheerios. I'm not saying that insurance companies are perfect, but they are not always the guilty party. CMP/MM

 
Old 08-22-2008, 10:12 PM   #13
Senior Veteran
(female)
 
Join Date: Feb 2008
Location: NY
Posts: 1,884
cmpgirl HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Quote:
Originally Posted by sammyo1 View Post
While this thread is active I will take the chance & ask does anyone ever talk to their pharmacist & request a certain brand or come right out & tell the pharmacist they do not get the relief from say the mallin. brand?
Sammy, I did just that, yesterday. I called my pharmacy and asked the pharmacist if he could fill my scripts with Watson's generic for Norco, if they had it. I explained that I was aware of the difference allowed by the government regarding generics and that I felt the Mallinkrodt generic that I was given last month was inferior, and did virtually nothing for my BT pain.

He said he was also very aware of that and told me he'd call their distribution center to find out if it was available, and today he called me back and said the Watson had arrived and was on the shelf with my name on the bottle.

I know that I got one of the two "good guys" at our pharm, so I was lucky. I don't know if the other guy would have been so helpful. I would give it a try, if you're having problems. CMP/MM

 
Old 08-22-2008, 10:22 PM   #14
Inactive
(female)
 
Join Date: Jul 2008
Location: U.S.A.
Posts: 287
Confused089 HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Quote:
Originally Posted by cmpgirl View Post
, This is something I've known for years, having worked in the insurance industry for a very long time and when people would start blaming the insurance companies for the high costs of prescription plans, it always got my hackles up. Still does, actually. I used to tell people, all the time, that if they knew just how massive and strong the pharma lobby was, it would make them choke on their cheerios. I'm not saying that insurance companies are perfect, but they are not always the guilty party. CMP/MM
Do you mean you worked for the *evil* insurance companies?! Shame on you...Just teasing cmpgrl - hope I didn't step over the line. You did say your hackles went up... so I don't know how you feel about a little lighthearted teasing. I think the consumer (myself included) always wants to blame some entity for his/her misfortune and that entity is usually the one that *seems* like it's causing the problem for the consumer. I'm certainly unhappy I can't get better insurance, but I'm glad I have *some* insurance! It's the system, not the companies - they work within certain constraints and have to make a profit, like everyone else. If the system doesn't change, then the various pressures and incentives remain the same, and companies will continue to work within those parameters while trying to maximize their profits.

Pharmacies are now putting up signs urging customers to write their representatives about proposed changes in Medicare reimbursement - the last sign I saw said something to the effect that it wasn't fair to make pharmacies pay for the cuts in Medicare and sell medications below cost. I imagine they will find a way to pass the cost to consumers however, tho it will probably be a different group of consumers -not Medicare patients, however since they *have* to make a profit - prices on something else will go up.

I want to echo cmpgrl's comment - I spoke with two different people at the same pharmacy - one said no way will we change our order for the customer. I called back a few weeks later and spoke with someone else [no Watson, alas, but better than Malinkrodt] She put a note under my name in the computer to order specific brands for me. Once I establish more of a relationship w/ the pharmacy, I may be able to persuade someone to make an exception and order Watson [tho, really, not sure b/c it seemed to fall outside their "margin" - kind of like there was a "stop" sign at a certain price level.

It did make me think of another incentive however. Good customer service really breeds goodwill. No way will I have them preorder my meds for me until I am certain it is ok to switch pharmacies. I appreciate the pharmacists willingness to work with me and would certainly try to take more of my business there (unfortunately, they are overpriced in most areas so my good will will only go so far given my very real and serious financial constraints].

Anyway, the pt., Sammy, was to underscore cmpgrl's suggestion -- if you don't succeed with one pharmacist, try a different day/different pharmacist. Once they begin ordering a certain brand for you, hopefully they will continue.

Last edited by Confused089; 08-22-2008 at 10:33 PM.

 
Old 08-22-2008, 11:51 PM   #15
Senior Veteran
(female)
 
Join Date: Feb 2008
Location: NY
Posts: 1,884
cmpgirl HB User
Re: Interesting Conversation w/ pharmacy about generic brand costs & some questions

Quote:
Originally Posted by Confused089 View Post
Quote:
Do you mean you worked for the *evil* insurance companies?! Shame on you...Just teasing cmpgrl - hope I didn't step over the line. You did say your hackles went up... so I don't know how you feel about a little lighthearted teasing.
No offense taken. As you can probably imagine, having worked in such a "hated" industry for so long, I have a pretty thick skin.

Quote:
It's the system, not the companies - they work within certain constraints and have to make a profit, like everyone else. If the system doesn't change, then the various pressures and incentives remain the same, and companies will continue to work within those parameters while trying to maximize their profits.
Insurance is a business, just like any other. And they have to make a profit somehow. All insurers, even the NFP's, have to have reserves, according to federal law. When doctor's and big pharma's prices go up, the insurance company has to get the money to pay the new, higher, fee schedules from somewhere. The government isn't exactly forking over any subsidization.


Quote:
I imagine they will find a way to pass the cost to consumers however, tho it will probably be a different group of consumers -not Medicare patients, however since they *have* to make a profit - prices on something else will go up.
The cost differentials will likely be spread out amongst the many sundry items that most every pharmacy carries. You won't see it in the actual pharmacy, because there are contracts and fee schedules with insurance companies that they have to abide by. The only reason Medicare gets away with a reduction in reimbursement, is that they are a federally backed monopoly. Can you tell that I'm still a little bitter??? Anyway......... Just thought I'd put my two cents in. Take care, CMP/MM

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Fentanyl patch help needed ASAP krit Pain Management 9 07-01-2011 08:21 AM
Interesting, want to share Madison104 Pain Management 12 03-16-2010 11:48 PM
Possible to get 90 day supply of CII meds through mail-order insurance pharmacy brianpain33 Pain Management 5 12-09-2009 07:24 PM
Brand vs Generic- Major Findings Executor Pain Management 42 03-17-2009 07:18 PM
Problems with Pharmacy not stocking OC Wren9 Pain Management 1 06-19-2007 10:40 AM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



tortoisegirl (159), gmak (156), Shoreline (151), BB07 (92), backhurtz (84), katlin09 (69), Ilovemycutedog (53), galalena (50), jonnstar (35), Isotope (34)

Site Wide Totals

teteri66 (1180), MSJayhawk (1013), Apollo123 (909), Titchou (856), janewhite1 (823), Gabriel (763), ladybud (755), midwest1 (670), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 01:22 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!