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Only a handful of the 715 pharmacists on a conference call with CMS officials got to ask questions, but they recited a litany of problems with the implementation of the Part D drug benefit 10 days earlier. Among the snafus most frequently cited were dual eligibles being charged large deductibles and co-pays; hours spent on drug plan help lines; and drug plans denying 30-day transition scripts for drugs requiring prior authorization. When one R.Ph. asked who would reimburse pharmacies for all their lost time spent on Part D, an official said that since pharmacies contract directly with the drug plans, it's not CMS' place to get involved in such issues.

In an era in which large, hospitalwide information systems have become increasingly popular, Pharmacy OneSource (formerly Healthprolink) has taken the opposite tack. The Bellevue, Wash.-based company has seen steady growth of its Quantifi product, a clinical documentation and reporting tool for pharmacies only.

Uncle Sam has come up with a way for pharmacists to fill prescriptions for Medicaid patients who were not automatically enrolled in Medicare Part D and sign them up for a drug plan.

For the first time in more than 10 years, the Food & Drug Administration has granted marketing approval to a drug for kidney cancer. Sorafenib (Nexavar, Bayer/ Onyx) was recently approved for the treatment of advanced renal cell carcinoma, the most common form of the disease. Sorafenib is currently available through specialty pharmacies.

Like a Turkish bazaar, the exhibit floor of the recent ASHP midyear conference, drawing an eye-popping attendance of 20,000 registrants, showcased many new products for health-system pharmacists. Here are some of the new wares displayed at the Las Vegas show

Reducing medical errors during total parenteral nutrition (TPN) processes has been a 25-year challenge for Robert Poole, Pharm.D., director of pharmacy, and his colleagues at Lucile Packard Children's Hospital (LPCH), Stanford University Medical Center.

If your hospital is not using a closed-loop medication management system, it soon will be. That's the prediction from the Fourth Annual Summit on Patient Safety & Information Technology held in San Francisco last month. Bar-coding, radio frequency identification (RFID), computerized physician order entry (CPOE), and other elements of a closed-loop medication system are moving at different speeds in similar directions.

An aggressive program of psychotropic drug prescription management saved the Missouri Medicaid program $7.7 million in fiscal 2004. Named Behavioral Pharmacy Management (BPM), the program analyzed drug claims—including inpatient psychotropic prescriptions— to identify inappropriate prescribing patterns.

Some medical errors are so egregious that lawmakers in four states now require hospitals to publicly report how often they occur, and to prove that they have taken corrective action. These "never events" laws adopted in Illinois, Minnesota, New Jersey, and Connecticut are based on criteria developed by the National Quality Forum (NQF).

To catch a thief

A 55-year-old African-American man, T.F., presents to your ER with headache, fever (102?F), muscle aches, and cough; his symptoms have rapidly worsened since onset (24 hours). T.F. received the inactivated influenza immunization 10 days earlier but is diagnosed with influenza A. T.F. had a renal transplant several years ago. His current medicines include tacrolimus (Prograf, Astellas Pharma), prednisone, mycophenolate mofetil (MMF) (CellCept, Roche), and furosemide 40 mg daily. T.F.'s SrCr51.8. The resident is considering antiviral therapy and asks your opinion. What do you suggest?

Percutaneous coronary intervention (PCI) encompasses a variety of procedures, including percutaneous transluminal coronary angioplasty (PTCA), intracoronary stenting, and atheroablative technologies used to diagnose and treat patients with coronary artery syndromes such as heart attacks and angina. In the United States, more than one million PCI procedures are performed annually, and it is estimated that about two million procedures are performed annually worldwide. Patients undergoing PCIs are at risk for developing blood clots in the coronary artery, which can result in a variety of complications including heart attack, emergency surgery, and even death.

Hospitals and health systems accredited by the Joint Commission on Accreditation of Healthcare Organizations are getting ready for the first truly unannounced, no-appointment-necessary, on-site surveys. Under the new policy, JCAHO surveyors can show up anytime between Jan. 1, 2006, and Dec. 31, 2006. The only warning facilities will get is a 7:00 a.m. e-mail notification on the morning of the survey.

Confused patients lacking drug plan ID cards, an overwhelmed electronic eligibility system, and excruciatingly long waits on help desk phone calls marred the debut of the Medicare Part D, according to frustrated retail pharmacists reporting from the trenches.

CMS has set up a dedicated telephone help line for pharmacists with Part D problems at 1-(866) 835-7595, available Monday through Friday from 8:00 a.m. to 8:00 p.m.

CMS has set up a dedicated telephone help line for pharmacists with Part D problems at 1-(866) 835-7595, available Monday through Friday from 8:00 A.M. to 8:00 P.M. Officials stressed that pharmacists should not give the phone number to patients or advocacy groups. Pharmacists who have questions about dual eligibles or WellPoint should phone 1-(800) 662-0210, and those trying to check whether a Medicare patient is enrolled in Part D should phone 1-(800) 388-2316.

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