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Under the final rule issued by CMS for the Medicare Rx drug benefit, the pharmacy access standard has been changed to apply on a state-by-state, rather than a regionwide, basis. In addition, the final rule will now allow certain nonretail pharmacies, such as federally qualified health centers, to be in Rx plan networks; will follow any-willing-provider provisions to allow any pharmacy of any type to join a network under standard contract terms; and will make it easier for beneficiaries to get drugs from non-network pharmacies.

Medicare reform has produced an unexpected crop of beneficiaries. Hundreds of rural and small urban hospitals are eligible to join the 340B drug discount program thanks to the 2003 Medicare law. Savings depend on the details of each hospital's drug spend, but more than half of 340B participants reported saving more than 30% in a recent survey.

Of overall computer entry errors, 56% are caused by distractions, according to a U.S. Pharmacopoeia 2003 MEDMARX study. In addition, distractions were cited in 78% of computerized physician order entry (CPOE) errors in reports "that documented a contributing factor other than 'none,'" said John Santell, director of educational program initiatives for the U.S. Pharmacopoeia in Rockville, Md.

Virginia Mason Medical Center in Seattle didn't waste any time issuing a public apology when a 69-year-old patient died as a result of a preventable error. The tragedy occurred when the patient was injected with the antiseptic skin prep solution chlorhexidine instead of a contrast medium designed for radiological procedures. Both solutions were clear and available in the sterile field in unlabeled basins at the time of occurrence.

If you have a leaky pipe, you call a plumber, not an electrician. Similarly, if you are in a hospital and receiving prescription drugs, having a pharmacist—the drug expert—review your medication orders is the right thing to do. Certainly, the Joint Commission on Accreditation of HealthCare Organizations thinks so.

Coming soon to a hospital near you: medication reconciliation. That's the directive from the Joint Commission on Accreditation of Healthcare Organizations, which made medication reconciliation one of a dozen National Patient Safety Goals for 2005. JCAHO surveyors started looking for evidence of compliance on Jan. 3.

Picture this. Ten thousand employees of a large casino are required to park their car in a nearby seven-storey garage. On the main floor of the garage there is an employee center that houses a fitness center, a branch of the local hospital, a bank, computer center, training center, travel agency, dry cleaner, and a pharmacy.

Proposed changes to the nursing facility State Operations Manual are well-meaning but far from ideal. That's the reaction from consultant pharmacists who have studied the latest proposals from the Centers for Medicare & Medicaid Services (CMS).

I had an architect practically come out and tell me I'm stupid. Actually he was talking about all pharmacists and he didn't use the word stupid, but his message was very clear.

A recent trend toward greater oversight of technicians continued last year as more state pharmacy boards acted to bring the pharmacist's chief helper into the regulatory fold, according to the 2005 National Association of Boards of Pharmacy Survey of Pharmacy Law.

The human immunodeficiency virus (HIV) may be the closest thing to a perfect virus we have encountered. It is variable, it destroys the patient's defenses, it can hide, and it allows time to spread before it kills. Fortunately, it is not highly infectious. Over the past year, there have been a multitude of clinical trials studying various antiretroviral therapies resulting in an accumulation of data. So much so that the Department of Health & Human Services (HHS) has released its newly revised Guidelines for Antiretroviral Agents in HIV-1 Infected Adults and Adolescents for review and comment even though it released the last version just this past March.

Overactive bladder (OAB) is a condition that affects an estimated 33 million Americans. At least 16% of the population over the age of 40 is affected by the chronic symptoms of OAB.

Insomnia is one of the most common sleep disturbances in the United States, affecting an estimated 100 million Americans. According to the 2002 Sleep in America poll from the National Sleep Foundation, 58% of adults experience symptoms of insomnia a few nights or more per week at some point in their lives. The total economic costs associated with insomnia have been estimated at $17.5 billion.

The black eye the FDA received recently over its handling of Vioxx (rofecoxib, Merck) and antidepressants hasn't slowed the agency's new drug approval rate for 2004. It cleared 31 new molecular entities (NMEs) last year, up from 21 in 2003.

Pharmacy groups that had been hoping the Centers for Medicare & Medicaid Services (CMS) would set up each state as a separate Medicare prescription drug plan (PDP) region got half a loaf. The agency named 25 states as stand-alone areas, but the rest were grouped into nine regions to be served by plans offering the Rx benefit beginning January 2006.

Hepatitis B virus (HBV) is a major healthcare problem around the world. It is estimated that 350 million to 400 million people are chronically infected. The development and approval of oral antihepatitis B virus agents, lamivudine, and, more recently, adefovir dipivoxil, revolutionized the treatment of chronic hepatitis B. However, the emergence of resistant HBV mutants remains the main factor limiting the efficacy of antiviral therapy.With lamivudine, the problem of resistance is very frequent and progressively increases with prolongation of therapy (> 50% at three years).

A federal task force that cautioned against legalizing drug imports in December has failed to end debate on the topic.

If you think the Medicare discount cards were confusing when they took effect last year, wait till the Part D drug benefit starts up in 2006, warned Philip Burgess, R.Ph., national director of pharmacy affairs at Walgreen Co. It might be a good idea for community pharmacists to take cover on Jan. 1, 2006, or better still, go on leave for the whole month of January, he quipped.

Do you routinely check the inactive ingredients of a drug product? Do you routinely ask patients about food allergies in addition to drug-related allergies? If you answered no to these questions, then you may not be aware that some patients with food allergies may have allergic reactions to ingredients in some drug products.

Regarding the practice of having pharmacy technicians call for verification/ clarification of prescriptions over illegible drug name, strength, quantity, refills, and directions, I live in Illinois and have worked for an organization that allows this. I am curious to know if the laws were being followed or violated.

There's help coming for those who have resolved to quit drinking in the new year. With the pending release of the second drug in the past half century to treat alcoholism, researchers say the whole treatment field may be at a tipping point.

Register with DEA before ordering narcotics in states

As patients in long-term care settings are huge consumers of pharmaceuticals, getting the right medications at the right time to these patients is a formidable challenge.

True to form, ASHP took the high road on several issues during a press conference at its midyear meeting in Orlando last month.

A customer engaged me in a lengthy conversation about his prescription. He had taken it for a few weeks and was concerned about the side effects. "Is IBS one of the side effects?" he asked.

Luteinizing hormone-releasing hormone (LHRH) agonists are a mainstay in treating locally advanced and metastatic prostate cancer, with the U.S. market for these therapies representing more than $1 billion in annual sales. The market is dominated by four-month and shorter depot injections and implants, such as leupro-lide acetate (Lupron, TAP Pharmaceuticals) for depot suspension and goserelin acetate (Zoladex, Astra Zeneca) implant.

Vesicare treats the symptoms of overactive bladder, such as urinary urgency and incontinence.

Overactive bladder (OAB) affects approximately 17 million to 20 million people in the United States, yet few realize that it is a treatable condition. Many people believe that it is a natural part of the aging process and are embarrassed to discuss it. It is estimated that costs related to OAB were nearly $14 billion in this country in 2000, similar to that of gynecological and breast cancers, osteoporosis, or arthritis.