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The drug cost threshold for Medicare beneficiaries to qualify for medication therapy management (MTM) services was pegged at $4,000 in an operations manual distributed at a recent briefing for potential drug plan sponsors. However, the final rule recently issued by CMS indicated a separate guidance would be issued on the specific dollar amount that would have to be spent in order to qualify beneficiaries taking multiple drugs for multiple disease states for MTM.

Richard Bertin's optimism is contagious. Bertin, the executive director of the Board of Pharmaceutical Specialties (BPS), expressed enthusiastically and in no uncertain terms that the future of specialized training is not only secure but also in the midst of a growth spurt. Bertin's confidence is bolstered by the fact that 2004 was BPS' strongest year in terms of number of new candidates. A total of 1,004 candidates at 34 sites worldwide were administered specialty certification or recertification exams.

When the Centers for Medicare & Medicaid Services was trying to figure out how to implement the Congressional mandate for medication therapy management programs (MTMPs) in the new Medicare prescription drug benefit, the bureaucrats scratched their heads and asked for guidance. Now, the message out of Washington, D.C., is "Never mind."

Last year several of the nations largest pharmacy chains publicly stated that they would not participate in prescription drug benefit plans that mandate the use of mail-order pharmacies. Retail pharmacies oppose mandated mail order because it does away with consumer choice and face-to-face counseling by a pharmacist.

Joe Graedon, pharmacologist, author, and syndicated health talk show host of "People's Pharmacy," is enthusiastic about future growth opportunities for pharmacists. He was very disappointed with the recent Food & Drug Administration decision denying Merck permission to market its statin drug Mevacor (lovastatin) over the counter.

Pulmonary arterial hypertension (PAH) affects roughly 50,000 people in the United States, yet only about 15,000 patients have been diagnosed and are receiving an approved treatment. The median survival time for patients left untreated following diagnosis may be as short as three years.

Long-term care pharmacists who see a link between inappropriate medications and adverse drug events have a new ally. Denys Lau, Ph.D., assistant professor of medicine at Northwestern University, has documented an association between potentially inappropriate prescribing and hospitalization and death among elderly nursing home residents.

How many times have you heard people say pharmacists don't counsel because they're not paid for it? But then payers argue that they don't pay because they haven't seen pharmacists provide the service.

State departments of health sometimes seek to circumvent their own procedural codes and avoid their legislatures by lowering Medicaid reimbursements and dispensing fees through emergency fiat. "They declare a state of budgetary emergency, then declare new rules and regulations," said Paul Baldwin, executive director of the Long Term Care Pharmacy Alliance (LTCPA) in Washington, D.C.

Long-term care pharmacists who see a link between inappropriate medications and adverse drug events have a new ally. Denys Lau, Ph.D., assistant professor of medicine at Northwestern University, has documented an association between potentially inappropriate prescribing and hospitalization and death among elderly nursing home residents.

We spend too much on curative care and not enough on preventive care. Treating disease is one thing; preventing it is even better."

A California researcher who likes crunching death certificate data has discovered that fatalities from prescription drugs spike at the beginning of the month, and he suggests that it's tied to pharmacist workload.

Already hurt by a drug company clampdown on supplies and a falling U.S. dollar that have raised prices to American consumers, Canadian mail-order pharmacies are bracing for a federal regulatory crackdown that they claim will force them to set up shop on friendlier shores.

California is debating the details of a state-sponsored prescription drug discount card set to launch next January. The state's Republican governor, Arnold Schwarzenegger, unveiled the California Pharmacy Assistance Program, dubbed Cal Rx, last month.

Low-income uninsured Americans will soon get the chance to save money on prescription drug purchases under a discount drug card program by 10 drugmakers announced last month.

The healthcare community faces an increasing clinical challenge in preventing and controlling the growing emergence of resistant organisms. Tigecycline (Tygacil, Wyeth) is one of a slim list of new antibiotics in development that shows substantial promise as a broad-spectrum agent with activity against many resistant gram-positive bacteria and, to a lesser extent, gram-negative bacteria.

The number of different devices for delivering inhaled medications has multiplied in the past two to three decades. Dozens of new products have hit the market since the 1970s. While the bounty of choices gives prescribers the flexibility to meet their patients' needs, information guiding prescribers through device selection was not readily available until recently.

Migraine headaches are common in children and occur with increasing frequency through adolescence. The reported prevalence increases from 3% (age three to seven years) to 4%-11% (age seven to 11 years) to 8%-23% (age 11 to 15 and up). The mean age at onset is 7.2 years for boys and 10.9 years for girls.

Every year, approximately 150,000 Americans develop postherpetic neuralgia (PHN), which is often described as a constant stabbing, burning, or electric shock-like sensation.

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).