Community Practice

About 400 independent pharmacists hit Washington recently to ask Congress for legislation to require pharmacy benefit managers to negotiate with them on a number of issues.

About 400 independent pharmacists hit Washington recently to ask Congress for legislation to require pharmacy benefit managers to negotiate with them on a number of issues.

Prescription drugs accounted for 92% of all sales rung up by independent pharmacies last year, according to preliminary data from the 2005 NCPA-Pfizer Digest. The report is an annual snapshot of the sector's operational landscape.

Pharmacists who wonder whether they've still got what it takes can now go on-line to get a confidential evaluation of their professional savvy using a tool developed by the National Association of Boards of Pharmacy.

The American Pharmacists Association and the National Association of Chain Drug Stores have developed a model to help community pharmacists scratching their heads over how to implement the profession's concept du jour—medication therapy management (MTM).

A Chicago pharmacist's refusal to dispense the morning-after pill and the Wisconsin pharmacy board's discipline of a pharmacist who refused to transfer a script for birth control pills have triggered a flurry of media attention on pharmacy.

A 40-year-old HIV-positive man, V.L., is hospitalized with Pneumocystis carinii pneumonia (PCP). His current viral RNA load > 50,000 copies/ ml, CD4 = 40 cells/mcl.

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.

Are hospitalized heart failure patients getting adequate discharge instructions, such as counseling on diet, exercise, medication management, and smoking cessation? Not according to the results of a new study released by the world's largest heart failure registry-ADHERE (Acute Decompensated Heart Failure National Registry).

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.

Workers who teamed with local pharmacists to better control their diabetes improved their blood glucose numbers and saved their bosses an average of $918 per year in a pilot program developed by the American Pharmacists Association Foundation.

Minnesota Blue Cross and Blue Shield is now offering beneficiaries the option of going to a participating retail pharmacy to fill their 90-day prescriptions for maintenance drugs.

For the third year in a row, a record number of pharmacists had their licenses transferred to other states in 2004, according to an annual year-end review by the National Association of Boards of Pharmacy.

During the annual meeting of the American Pharmacists Association in Orlando, Fla., last month, the house of delegates adopted resolutions on clinical trials, compounding, and methamphetamine precursors. But it passed the buck to the board of trustees on several other issues, including confusing ingredients in some over-the-counter products and a call for a study of mail order as a potential terrorist target.

Help is on the way for patients who cannot afford prescription drug care. Pharmacy and pharmaceutical manufacturers have rolled out clearinghouse services to guide pharmacists, prescribers, and the public through the tangle of patient assistance programs (PAPs) that provide free or discounted medications to qualifying patients.

Sensing that the time has come for the profession to take responsibility for policing what many view as a pharmacist"s cherished prerogative—compounding—Kenneth Baker has accepted the job of implementing a way for compounding pharmacies to earn a stamp of approval from the Pharmacy Compounding Accreditation Board (PCAB).

A 22-year-old woman, L.N., arrived at your emergency department after a "spell." Based on her symptoms and EEG findings, her physician has diagnosed the spell as a complex partial seizure that generalized to a secondary tonic-clonic seizure. L.N.'s neurological exam, physical exam, complete blood count, serum glucose, electrolytes, drug/alcohol screen, and lumber puncture were normal. However, while in the hospital, she experienced a second seizure, prompting her physician to consider antiepileptic drug (AED) therapy. Because L.N. is two months pregnant, her doctor requests a pharmacist consult. What do you recommend?

The always high-interest Late Breaking Clinical Trials at the Annual Scientific Session of the American College of Cardiology, held in Orlando, Fla., were particularly notable this year. First, they included an unprecedented three individual sessions on the antiplatelet agent Plavix (clopidogrel, Sanofi-Aventis). Second, justifying the plunge to lower and lower LDL-cholesterol (LDL-C) targets, they included strong results for a trial of 80 mg of atorvastatin (Lipitor, Pfizer), and, finally, they featured a session with conflicting messages on the risks of COX-2 inhibitors.

Uncle Sam has given up to 145 clinical pharmacists the job of reviewing the formularies of drug plan sponsors seeking to be part of the Medicare prescription drug benefit that is set to begin on New Year's Day, 2006.

Compounding pharmacies were put on the defensive recently after a group of health organizations asked federal regulators to crack down on how the pharmacies market their products.

Interest in pharmacy as a career remains high as the nation's pharmacy schools reported a 54% jump in admission applications and awarded a record number of Pharm.D. degrees last year, according to an annual survey of the profession's educational landscape.

The California Pharmacists Association has created a new network to leverage the professional knowledge of community pharmacists to help meet the cost and quality-related medication needs of the healthcare marketplace.

A Wisconsin judge has recommended a reprimand and remedial ethics classes for a pharmacist who refused to transfer a prescription for oral contraceptives based on his religious beliefs.

Is there a renal dialysis center in your future? There could be if the Centers for Medicare & Medicaid Services gets its wish.

Management strategies for nosocomial pneumonia are changing. The American Thoracic Society and the Infectious Diseases Society of America just issued the first new guidelines for the treatment of hospital and healthcare-related pneumonia in nine years. They appeared in the February issue of American Journal of Respiratory and Critical Care Medicine.

Most hospitals are not complying with standard guidelines for antibiotic (ABX) prophylaxis before surgery. Barely more than half of patients in a recent study received antibiotics within one hour of the initial incision. Less than half of patients were taken off ABX prophylaxis within 24 hours following surgery. The result is an unknown number of surgical site infections that could have been prevented with more appropriate treatment.

Medication therapy management (MTM) is mandated in the new Medicare drug benefit. And Gina Upchurch, R.Ph., MPH, hopes that will bring attention to the kind of comprehensive service provided by the MTM program she directs and supported by the local pharmacists in Durham, N.C.

A 60-year-old woman, A.R., with rheumatoid arthritis for two years, is being discharged from your hospital after acute myocardial infarction (MI). She uses methotrexate (MTX) 30 mg weekly subcutaneously but still experiences joint pain and swelling; she takes naproxen regularly. Dismissal orders are nitroglycerin 0.4 mg sublingual p.r.n., metoprolol 25 mg, atorvastatin 40 mg, aspirin 162 mg, warfarin 2.5 mg (all q.d.); INR level twice weekly; lipid levels in six weeks. Her physician is pondering whether to add etanercept (Enbrel, Immunex) or another disease-modifying antirheumatic drug (DMARD) to MTX to better control RA. What do you recommend?

Is there a renal dialysis center in your future? There could be if the Centers for Medicare & Medicaid Services gets its wish.

Gauging that the time is right to help independent pharmacies get into the long-term care marketplace, the National Community Pharmacists Association plans to build a network of practitioners trained to deliver pharmacist services to seniors.