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Illinois R.Ph. sues over dispensing rule

State and federal regulators are beginning to question discounts greater than 90% on drugs used in hospitals. The practice, called nominal pricing, could affect drug prices paid by Medicaid.

Terminally ill with cancer, David Pruiett decided to end his life under Oregon's Death with Dignity Act. He went through the legal process, got the lethal prescription in late January, swallowed the liquid laced with powder from 100 barbiturate pills, and fell asleep. Three days later, he woke up and asked his wife why he wasn't dead.

Pharmacists are not pleased with the first Part D contracts they have been receiving from pharmacy benefit managers and prescription drug plans (PDPs). They offer some of the lowest reimbursement rates in memory. Contracts reviewed by Drug Topics call for reimbursement at average wholesale price minus as much as 45% plus dispensing fees as low as $1.

Numerous market obstacles hinder the quest for patient loyalty and compliance. But those manufacturers and pharmacies that manage to win their patients' loyalty stand to gain considerably from their efforts.

The next time you walk into a chain or mass-merchandiser pharmacy, don't be surprised if you find a clinic. Two separate entities, MinuteClinic and WellnessExpress Clinic, are forging partnerships with pharmacy chains, mass merchants, and corporations.

Quad/Graphics, West Allis, Wis., one of the largest printing companies in the United States, spent approximately $6,000 per employee on medical costs last year. This is 30% less than that spent by the average employer in the state. Do these stellar stats have anything to do with the fact that the company provides most of this health care itself?

Companies are, for the most part, in favor of the U.S. government allowing American citizens to purchase prescription drugs from Canada, judging from the results of the 2005 Arxcel Prescription Benefit Research Survey.

Neutropenia—the lowering of the white blood cells that fight infections—is a major dose-limiting side effect of systemic cancer chemotherapy. Neutropenia with fever, or febrile neutropenia, often requires hospitalization for further evaluation and the administration of broad-spectrum antibiotics. In addition to negatively impacting the patient's quality of life, such complications can result in chemotherapy delays or dose reductions, which may compromise clinical outcomes.

Although 65 million Americans have hypertension, nearly 70% of U.S. patients do not have their blood pressure (BP) controlled to goal. "We need to do a better job getting patients to understand that uncontrolled BP is associated with an increased risk of cardiovascular events, vascular disorders and endothelial dysfunction, metabolic syndrome and Type 2 diabetes, target organ damage, and dementia," said Thomas Giles, M.D., a professor of medicine at Louisiana State University School of Medicine in New Orleans. Giles addressed a media briefing on hypertension guidelines that was held recently in New York City. The event was sponsored by Novartis.

The Food & Drug Administration recently approved exenatide (Byetta, Eli Lilly/Amylin Pharmaceuticals) as adjunctive therapy to improve glycemic control in those with Type 2 diabetes who are taking metformin, a sulfonylurea, or a combination of both. Exenatide is a synthetic analog of a peptide found in the saliva of the Gila monster, a poisonous lizard. The drug is currently available in pharmacies.

To help pharmacies meet the legislatively mandated goal of providing useful written consumer medication information (CMI) to patients by 2006, the FDA has issued a draft guidance. The guidance gives recommendations not only on what drug information should be provided to consumers, but also in what sequence, type size, etc. If pharmacies' voluntary CMI efforts fail to meet FDA standards by next year, the agency could resort to a mandatory approach. For more information, refer to the May 26 Federal Register or click on www.fda.gov/cder/guidance/index.htm.

Distributors of diverted drugs indicted

Consultant pharmacists can find plenty to like about Medicare Part D. The new prescription benefit that debuts next Jan. 1 is still provoking questions, but the overall impact on long-term care (LTC) pharmacy seems to be positive. "There are several very positive aspects in medication management and prescription drug plans [PDPs] for both long-term care pharmacy and long-term care pharmacists," said Tom Clark, director of policy and advocacy for the American Society of Consultant Pharmacists.

In 2002, with data supplied by the British National Health Service, newspapers in England began publishing the names of hospitals with high infection rates. By 2004, every hospital in Great Britain was required to display its infection rate in a prominent place where patients could see it.

Pharmacists are gaining new support in the organ transplantation world. UNOS, the United Network for Organ Sharing, is encouraging all transplant centers to include at least one clinical R.Ph. on each transplant team. UNOS coordinates organ donation and transplantation specialists nationwide.

Scios Inc., a Johnson & Johnson company, has changed its package labeling to add data about deaths associated with its heart failure drug nesiritide (Natrecor) after studies in prominent medical journals raised questions about an increased risk of fatal renal problems. The Food & Drug Administration-approved label change, which stops short of an outright warning, indicated that in clinical trials 5.3% of the patients treated with nesiritide died, compared with 4.3% who took other agents, including diuretics and intravenous nitroglycerin. However, the new label states that the data might not be statistically significant because of the small number of patients involved.

Does your state require the reporting of medication errors? If the answer is No, get ready for a change. Twenty-three states, including California, Florida, New York, and other major hospital population centers, already mandate med-error reports. Another six states are actively considering legislation, according to on-line publisher NETSCAN, based in Falls Church, Va.

Innovative supermarket pharmacy programs can persuade customers filling prescriptions to shop the whole store. Results of a study, formulated by the Educational Foundation of the General Merchandise Distributors Council (GMDC), were presented at the Food Marketing Institute's 18th Annual Supermarket Pharmacy Conference in New Orleans.

What's red, flat, and comes with six different colored rubber band rings? It's a new prescription bottle that is part of ClearRx, a packaging system created by graphic designer Deborah Adler that will debut exclusively at Target pharmacies.

Attempts continue unabated in the courts and state legislatures this year to make the dealings of pharmacy benefit managers more transparent, to make the organizations personally liable as "fiduciaries" under the Employee Retirement Income Security Act (ERISA), or to otherwise regulate them.

The Centers for Medicare & Medicaid Services is designing a comprehensive Medicare information Web site for pharmacists, as well as a pharmacy kit. The agency will also be sharing more information through continuing education and special pharmacist outreach events.

If a vote were held tomorrow on whether to unionize their workplace, 18% of nonunion staff pharmacists would say Yes, according to a six-state study by researchers at Midwestern University Chicago College of Pharmacy.

The American College of Physicians (ACP) recently issued guidelines for the management of obesity. Prepared by ACP's clinical efficacy assessment subcommittee, the paper was published in the April 5 issue of Annals of Internal Medicine.

New evidence-based guidelines for the treatment of cancer pain were presented at the 24th Annual Scientific Meeting of the American Pain Society (APS) in Boston last month. The meeting was designed to help clinicians and patients better control the pain associated with the disease. According to APS, approximately 1.2 million people are diagnosed with cancer each year. While effective treatment for pain exists, studies have reported significant undertreatment.

How do we improve medication-error rates? Indeed, how do we even set up systems to know whether med-error rates are improving? Should reporting of errors be voluntary or mandatory? And should agencies that receive such reports give the public information on them?

You might see specialty pharmacies compete tooth and nail under a new Medicare Part B program proposed by the Centers for Medicare & Medicaid Services. Under the proposal, physicians can continue buying Part B drugs on their own. Under this scenario, their reimbursement switches from average wholesale price (AWP) minus 5% to average sales price (ASP) plus 6%. Or physicians can opt into a competitive acquisition program (CAP).