Pharmacy News Online: Walgreens, Career Step partner to provide externships

Walgreens, Career Step partner to provide externships

Pharmacy technician students at an online school will be able to perform externships with a major retail pharmacy chain, under a partnership the two companies announced.

Career Step said it would partner with Walgreens to allow students to work at local Walgreens stores after gaining a solid foundation of pharmacy technician knowledge in the program. Externship will typically consist of 180 practical hours.

“These externships are a phenomenal opportunity for our students,” Career Step pharmacy technician instructor Rebekah Hutchins said. “The Career Step pharmacy technician training program already incorporates a variety of teaching methods — including video, simulations and interactive exercises — and now these externships are adding hands-on experience in the real world for our students to thoroughly learn the material and prepare for certification and employment.”

Pharmacists’ role in health reform

How do we get patients – especially those with chronic conditions like diabetes and hypertension — to take their medications faithfully?

Hundreds of billions of dollars are riding on the answer. Spending on prescription medicines in the U.S. annually amounts to $301 billion, about 10 percent of the nation’s total health care tab. But almost as much — $290 billion — is spent each year dealing with the medical effects of Americans not taking their drugs correctly, according to the New England Healthcare Institute.

Getting patients to comply with their prescriptions could significantly cut health care costs.

It won’t be easy. Consider that researchers offered heart-attack survivors a seemingly irresistible incentive to take their medicine: “free” drugs with no co-payments. But the free drugs only modestly improved the survivors’ adherence rates, according to a study published online recently in The New England Journal of Medicine. If free drugs don’t do much, what could make a more significant dent in the problem? Pharmacists could. But the federal government doesn’t recognize them — unlike most other health care professional — as providers, which minimizes their role in helping patients correctly take their medicine and squanders tens of billions of dollars in potential savings.

Research shows that if pharmacists played a treatment role in addition to filling prescriptions, they could considerably lower health care costs. At Kaiser Permanente Colorado, for example, pharmacists set out to help patients with coronary artery disease hit their blood pressure and cholesterol targets.

Working under physician-approved protocols, the pharmacists monitored drug therapies, adjusted dosages, ordered lab tests and added medications when needed. The results? An 89 percent reduction in patients’ overall mortality and a nearly $22,000 annual savings in health care costs per patient, according to a 2007 study.

One of the largest physician-pharmacist collaboration projects is in Asheville, N.C. The city first hired pharmacists to work with its employees who had diabetes in 1997, seeking to improve their health and lower treatment costs.

The results exceeded expectations. From 1997 to 2001, the city reported that annual direct medical costs per worker dropped, on average, by $1,200 to $1,872. The city has since expanded the project to cover other chronic diseases, including hypertension and asthma. It saves an estimated $4 for every $1 invested.

These kinds of improved health outcomes and cost savings could become more widespread if Congress changed provider law to make the expanded services performed by the pharmacists at Kaiser and in Asheville part of standard health insurance coverage.

The training today’s pharmacists undergo qualifies them for provider status. They must complete a four-year postgraduate program focused on managing complex medications – more than 10,000 prescription drugs and counting – that are central to today’s drug treatments.

This knowledge is increasingly in demand. Already, more than half all Americans have one or more chronic diseases, and for 90 percent of them medications are the first-line of treatment. Health experts expect chronic-disease rates to rise as the population grays.

Yes, allowing pharmacists to play a treatment role in patient care, and collect fees for doing it, may initially increase medical costs. But over time, as the Asheville project demonstrates, it saves money.

When you factor in improved patient adherence to prescribed drug regimens because of regular pharmacist oversight, overall savings could be significant.

The Affordable Care Act offers an opportunity to put new pressure on Congress. Under the health care law, every plan sold on the new insurance exchanges will be required to cover a set of “essential health benefits,” like physician services and hospitalizations. The Department of Health and Human Services and the individual states are to decide the definition of those benefits. Making pharmacist-supervised medication management an essential benefit would help bring our health care system into the 21st century.

Call Kurtis: The Risks of Using Online Pharmacies

Her online pharmacy shipped her the wrong pills.

“They sent me 40 milligrams of Lipitor,” said Watrous, who has taken Zocor by prescription for years. “I’ve never taken Lipitor.”

Watrous notified the online pharmacy of the mistake and sent the pills back, only to receive the wrong prescription by mail again.

“They just kept telling me the same thing, and I said, ‘Wait a minute, you don’t understand,’” she said. “I do not take this medication.”

“You can get very seriously injured by taking the wrong drug,” said Virginia Herold, Executive Director of the California Board of Pharmacy.

Customers typically have a bit more difficulty following up with online pharmacies when things go wrong, she said.

Online pharmacies are required by law to have 1-800 numbers to answer questions, but Watrous said the number didn’t help her.

The reality is that mistakes do occasionally happen, but physical pharmacies still offer customers more thorough service, according to pharmacist John Ortego.

“If you’re in a pharmacy, you can confirm with the pharmacist, ‘What is this drug for?’” he said.

Ortego admits some online pharmacies can be slightly cheaper, but by using them he said customers give up that face-to-face consultation that can catch mistakes.

“Part of being a pharmacist is you take responsibility for people’s lives,” he said.

Watrous has since learned her doctor’s office at Sutter Health actually ordered the wrong prescription from the online pharmacy.

Sutter Health told CBS Sacramento, “The Lipitor was simply ordered in error and mailed before we could cancel it.”

Watrous has since been shipped the right pills and said her doctor apologized.

“I just felt that she was really sincere,” she said, “and that made me feel good.”


Pharmacy News Online: APhA Releases Two Nuclear Pharmacy Books

APhA Releases Two Nuclear Pharmacy Books

The American Pharmacists Association (APhA) has just released two new references on the use of radiopharmaceuticals and the use of pharmacologic agents in diagnostic imaging. The books are entitled Nuclear Pharmacy Quick Reference and Diagnostic Imaging for Pharmacists.

Nuclear Pharmacy Quick Reference (ISBN 978-1-58212-151-2; spiral bound; 145 pages; $29.95 [$24.00 for APhA members]) compiles key information that nuclear pharmacists rely on in their daily tasks. Much of the information was drawn from the third edition of the classic Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine by Richard Kowalsky and Steven Falen. In addition, Nicki L. Hilliard, PharmD, BCNP, supplied helpful new tables on drug interactions and Kara D. Weatherman, PharmD, BCNP, contributed a useful review of the clinical uses of radiopharmaceuticals.

The book was edited by Clyde N. Cole, MS, Stanley M. Shaw, PhD, and Richard J. Kowalsky, PharmD. Cole is director of pharmacy standards for GE Healthcare in Chicago, IL. Shaw is professor emeritus of nuclear pharmacy at Purdue University College of Pharmacy, West Lafayette, IN. Kowalsky is associate professor of pharmacy and radiology at the University of North Carolina, Chapel Hill, and director of the Nuclear Pharmacy Laboratory at UNC Hospitals.

Diagnostic Imaging for Pharmacists (ISBN 978-1-58212-153-6; softbound; 273 pages; $74.95 [$60.00 for APhA members]) provides practicing pharmacists, pharmacy technicians and radiology department personnel with a basic understanding of the pharmaceuticals used as part of the imaging process. The book presents practical information, not covered in most pharmacy school curricula, on diagnostic imaging techniques and the proper use, indications and routes of administration for each pharmacologic agent. Included is an introduction to each of the following imaging modalities: x-ray, nuclear medicine and PET imaging, MRI and ultrasound.

Blaine Templar Smith, BSPharm, PhD, and Kara D. Weatherman, PharmD, BCNP, edited the work. Smith was chair, Department of Pharmaceutical Sciences, Saint Joseph College School of Pharmacy, Hartford, CT, when the book was written. Weatherman is clinical assistant professor of pharmacy practice at Purdue University College of Pharmacy with primary responsibility in the areas of nuclear pharmacy and diagnostic imaging.

State AG seeks action on prescription drug abuse ‘crisis’

Hoping to attack the growing problem of prescription drug abuse, state Attorney General Eric T. Schneiderman today called for legislation that would require doctors and pharmacists to use a statewide Internet database to review patients’ prescription histories and report when new prescriptions are written and filled.

The abuse of legitimately produced controlled substances that are channeled into the illicit drug trade is “the nation’s fastest growing drug problem, and in recent years has reached epidemic proportions,” Schneiderman says in a new, 42-page report. “It affects every sector of society, straining our healthcare and criminal justice systems, and endangering the future of our younger generations.”

The report touts Schneiderman’s proposed Internet System for Tracking Over-Prescribing (I-STOP) Act as legislation “that would exponentially enhance the effectiveness of New York’s existing (prescription monitoring program) to increase detection of prescription fraud and drug diversion.”

Gregg Dworkin, a recovering abuser who has lectured at high schools in Westchester and Rockland counties, half-jokingly said he came up with the I-STOP idea in the 1990s, after he crashed his motorcycle on a desert highway in Tempe, Ariz.

He nearly lost his leg in the 120-mph wipeout, and started abusing painkillers.

“When I was running around chasing doctors, doctor shopping, I just couldn’t believe I was getting away with this,” said Dworkin, 39. “I was going to Duane Reade on one corner and CVS on another to fill prescriptions, really laughing at the system. It occurred to me how easy it would be to stop me from doing this.”

But doctors, pharmacists and some in law enforcement expect big-time abusers and dealers will still find a way around the system by using fake identities to fill multiple orders, and by selling and buying prescription narcotics on the black market.

“There are positives and negatives in something like this,” said Jay Rothbaum, owner of Hillcrest Thriftmed Pharmacy in Nanuet and treasurer of the 300-member Westchester and Rockland Society of Pharmacists. “There certainly are people who abuse prescription medications, and this would be a tool to help identify them, but it wouldn’t be foolproof. People use false identification all the time to get around things like this. There are also privacy issues.”

Some also fear good doctors might drop certain patients who are in serious need of medication.

“If there are many requirements, or sanctions applied to physicians who prescribe controlled substances to people who might have abused these (medications), it may very well be a deterrent to good physicians to treat patients with addictions or abuse problems,” said Dr. Gregory Bunt, medical director of Daytop Village treatment services and president-elect of the New York Society of Addiction Medicine.

Bunt supports the initiative but said the “the devil is in the details.”

Under Schneiderman’s proposal, the state Health Department would establish an online controlled substance reporting system that operates in “real time” and mandates its use by doctors when writing prescriptions and pharmacists when filling them. The current system, he says, “is outdated with regard to how and when data is collected, who has access to it and how it is used.”

The start-up price tag would be up to $10 million, but would not add much in ongoing costs to the state budget, his office says.

I-STOP — first proposed last year — would allow doctors and pharmacists to provide controlled medications to patients who need them and “arm them with the necessary data to detect potentially dangerous drug interactions, identify patterns of abuse by patients, doctors and pharmacists, help those who suffer from crippling addictions and prevent potential addiction before it starts,” the report says.

Schneiderman points to a number of studies that identify the abuse of prescription medications as the nation’s fastest-growing drug problem, noting that painkiller overdoses killed nearly 15,000 people nationwide in 2008. The report says that in New York, the number of painkiller prescriptions being written grew from 16.6 million in 2007 to almost 22.5 million in 2009. A National Survey on Drug Use and Health by the federal government revealed that from 2002-09 the use of cocaine and methamphetamine among adults 18 to 25 decreased while the abuse of prescription drugs increased. Access to prescription narcotics through legal and illegal means has grown four-fold in the past decade, Schneiderman said.

The increase in prescription drug abuse inevitably manifests itself in criminal activity, as shown by incidents in the lower Hudson Valley, including:

– the case of Harrison pharmacist Scott Burko, who in June was sentenced to two years in federal prison after admitting that he stole $400,000 worth of steroids from Stop & Shop pharmacies in Westchester, Orange and Dutchess counties between 2003-06.

– the arrest in November of a New City psychiatrist, a Ramapo pharmacist and 13 others on charges of selling tens of thousands of prescription pills across Rockland County.

– the arrest of a Mohegan Lake pharmacy technician accused of trying to sell oxycodone, hydrocodone and Xanax to federal agents in a suburban Buffalo parking lot. Charles O’Garro, of Yorktown, faces up to 20 years in prison and a $1 million fine if convicted.

Will Plummer, special agent in charge of the New York City regional office of the U.S. Drug Enforcement Administration, said his agents have seen a 286 percent increase in prescription drug cases since 2009. That includes suburban communities throughout Westchester, Rockland and Putnam counties.

Guy Repicky, a Westchester County detective, is assigned to a DEA task force that focuses on prescription narcotics. He said the most dangerous trend now is for abusers to crush up and snort heavy-duty painkillers designed to be released over 12 hours.

These new extended-release (ER) tablets have literally been landing users in the emergency room.

“It’s deceiving to a teenager who crushes the pill up and doesn’t realize he’s getting the full dose immediately,” Repicky said. “We’ve had some overdoses as a result of this.”

Dr. Robert Marcus, director of the emergency department at Northern Westchester Hospital in Mount Kisco, said the state database could help his staff counter the growing problem they’re experiencing with addicts who report chronic pain in order to fuel their habit.

“In the ER (emergency room), we only know what’s been prescribed in our hospital,” he said. “Many of these patients go to different physicians, and those physicians prescribe medication without knowing they have multiple prescriptions from elsewhere and are either abusing or selling them.”

Marcus said he’s written prescriptions for five or six pills, only to learn later from a conscientious pharmacist that a patient has added a zero to try to get 50 or 60 pills.

Rothbaum, of the pharmacy association, said his main concern when filling prescriptions “is to make sure I’m not giving someone a drug that might hurt them. As pharmacists, we have to be able to make judgements about the people we’re dispensing medications to. I’m confident that the customers that I fill prescriptions for are using them for legitimate purposes. I don’t want to hassle the grandma coming from the dentist with a prescription for 12 Tylenol with codeine. To mandate that I enter information into the database would have limited value. I don’t think it would accompish what they want.”

Marc Levitt, pharmacist and owner of Marinelli’s Village Pharmacy in Elmsford, said the database would help him crack down on the increasing number of customers who present stolen prescriptions and engage in doctor and pharmacy “hopping.”

He’ll call police when he suspects someone, but perpetrators typically run out the door as soon as he picks up the phone.

“If someone walks into us with a prescription, we really have no way of knowing now if the patient had another one filled yesterday,” Levitt said.

He said the database could be a great tool but believes many people would still circumvent it.

“For the average person that’s just looking for drugs on a casual basis, I think this system would be great,” he said. “But for someone that is using this as a business, they’re going to find ways around it by using different names. That’s a story for another day.”


Pharmacy News Online: Remedi SeniorCare® Wins Ohio State Board of Pharmacy’s First and Only Approval for Electronic Prescribing in State of Ohio

Remedi SeniorCare® Wins Ohio State Board of Pharmacy’s First and Only Approval for Electronic Prescribing in State of Ohio

Remedi SeniorCare, one of the nation’s largest independent long-term care (LTC) pharmacy providers to skilled nursing, assisted living and retirement communities, announced that effective Dec. 22, 2011, it is the first and only long-term care pharmacy to have its electronic order entry software approved by the Ohio State Board of Pharmacy for electronic prescribing.

“This is an incredibly important milestone for Remedi SeniorCare,” said Remedi’s President and CEO Michael Bronfein. “Known across the country to hold medication software systems to a high standard, Ohio is recognized as the ‘acid test’ for such system approvals. After a rigorous series of evaluations, comments by State representatives were highly complimentary of the Remedi product and its focus on safety. Remedi’s ability to secure the State’s approval for this system on its first attempt is a strong endorsement of the quality, safety and value of our eOE service provides our customers.”

Laurel Health Care Company, Remedi’s largest customer, has agreed to pilot the software in its Ohio facilities. Because Remedi believes strongly in the value of its innovative software solutions, the company is offering customers a 60-day free trail without obligation.

About Remedi SeniorCare®

Remedi SeniorCare®, a leading-edge pharmacy provider, enables long-term care facilities to deliver better business results and provide exceptional resident-centered care. At the forefront of implementing high-tech advancements for the industry, Remedi redefined medication administration and management with the launch of the Paxit automated medication dispensing system delivering superior accuracy, efficiency and medication cost reduction. Remedi’s online and electronic tools via MyRemedi web portal and Connexit™ electronic data interchange further drive business management efficiency and overall cost reduction. Remedi supports nearly 25,000 residents across eight states with RapidResponse(SM) customer service, ensuring prompt access to medication delivery, expertise and comprehensive support.

Next IT Expands Bench of Pharmaceutical Industry Expertise

Next IT, a leading provider of Intelligent Virtual Assistants for business, is expanding its sales team to address the significant customer support needs of the healthcare and pharmaceutical industries. Victor Morrison and Mitch Lawrence, formerly of Teva Pharmaceutical Industries, bring valuable experience and perspective to tailor online self-service solutions that improve pharmaceutical compliance and healthcare outcomes.

During his 22 years at Teva — the world’s largest manufacturer of generic drugs and a world leader in the treatment of multiple sclerosis (MS) — Victor played a critical role in defining Teva’s vision for pharmacy and specialty pharmacy interaction. He also conceived and developed the parameters for the clinical study of an enhanced interface between MS patients, specialty pharmacies and physicians and its impact on compliance, adherence and, most importantly, patient outcomes.

“Next IT’s Human Emulation Technology will transform the patient experience,” says Mr. Morrison. “It gives patients the ability to interact with a virtual assistant knowledgeable about them, their disease and their therapy, 24/7, via the web, smartphone or SMS. From the payer perspective, healthcare entities will have unlimited opportunities to engage the patient with dosing reminders, education, coaching and counseling and, importantly, to move the interaction to a live pharmacist or nurse when appropriate. Compliance and adherence to medication regimens should be dramatically increased, which will lead to better outcomes while decreasing the overall cost of care.”

Mitch Lawrence, with nearly 27 years of experience in sales gained in medical, pharmaceutical and information technology, is a born leader with a knack for the creation and development of highly effective sales and account-management teams. Most recently, he was accountable for all of Teva’s formulary, contracting and brand initiatives with third-party payer accounts in the Western U.S., overseeing and training an award-winning staff of account managers.

“Advancing Next IT’s technology across the healthcare industry is an exciting prospect. The potential benefit is huge,” says Lawrence. “Conversational interfaces allow people to use their own words to find the exact piece of information they’re looking for, allowing electronically stored resources to be of much greater practical value because they’re easier to use. I can see widespread applications, from guiding people through insurance billing forms to answering questions about medications and more. It truly gives patients a powerful tool for efficiently and effectively serving themselves.”

Emergency Medications: Why Are they So Hard to Get?

A friend of mine went on vacation for just a few days the other week out-of-state. She called me in a panic.

“I forgot my meds!”

“I wish I could help you out. Have you tried calling your doctor?”

“I did, and I got this weird message about needing to unblock my phone, press *87 for a callback. That was hours ago, and still no call back!”

Hmm, no callback after hours?

So I offered to call her doctor for her on a landline, got right through, and got a real phone number that she was then able to use with little trouble. However, she still had to leave a message for the physician on call, and is still sitting there, waiting patiently for a callback that may or may not come.

It got me to wondering… Shouldn’t there be a more reliable system in place for people who are taking everyday medications, but forget them when they go away? Or, inadvertantly run out of them and get them through mail-order?

The current system is one based largely on hope and trust. Hope that your doctor (or their covering physician) gets your message, and trust that they actually act on that information in a timely manner.

If the problem occurs during normal business hours on a weekday, you have good reason to believe your problem will be resolved quickly. A call will be made to the local pharmacy of wherever you’re staying, and your prescription will be ready in just an hour or two.

But what happens when it’s the weekend? Or worse, a holiday? Or even worse yet, a weekend holiday?

Then, you’re at the luck of the draw. While doctors are of course have coverage during these times too, weekends and holidays mean the doctor may not be as readily available to listen to his or her messages, then sit down and take the time to attend to them until much later… if at all. (I can’t tell you how many stories I’ve heard throughout the years of people falling through the cracks of this crazy “system.”)

There’s a much easier solution to this problem.
One Solution: A National “Emergency Prescription” Database

Pharmacies could be empowered to dispense certain prescription medications without a prescription and in very limited quantities (say, less than 3 or 4 pills). A nationwide, secure database could be created to track such prescriptions, to reduce abuse.

Here’s how it might work:
Person is on vacation and forgets their medications. The medication is important to their daily life functioning.

Person stops by local pharmacy to obtain a new, temporary refill for medication based upon the information the person provides.
Person shows photo ID.
The person’s personal information is entered into a nationwide, secure emergency prescription database and is checked for duplicates (to stop pharmacy shopping and gaining more than the maximum allotted allowance of 3 or 4 pills).
If person checks out in the database, person is given emergency refill of 3 or 4 pills of medication. Since the person’s information is now in the emergency prescription database, they can’t get another emergency refill for at least X number of days.
Person must pay out of pocket for emergency refill (so you don’t have to worry about insurance issues).
Only certain medications would be available under this plan, such as antidepressants or similar medications where the risk of abuse is low and the risk of being off of them for a few days imposing significant negative side effects is high.
Another Solution: A National Prescription Database

An alternative solution to this concern is even easier, and I’m frankly surprised is not readily available.

You can already transfer “scripts” (the prescription your doctor writes) from one pharmacy to another. But in my friend’s case (it being the weekend, I guess), they said it would take 2 days to do that (she’d be home in 3, so not much point in doing that).

In this day and age, why can’t scripts be available to all pharmacies at all times?

All prescriptions written by your doctor should be scanned into a national, secure database. It is available to any authorized medical professional or pharmacist.

So when you go away on vacation and forget your meds, all the local pharmacist need do is consult this nationwide database, see your valid and active prescription, and offer you an emergency supply (even if the prescription is just expired or goes over the usual limits, given the emergency nature).

This national prescription database, not your local pharmacy’s database, would now keep track of how many pills are left on your prescription. That would also have the added benefit of cutting down on all the prescription abuse problems seen today already (such as a person taking one script, copying it, and having it filled at multiple pharmacies).

How is it that in 2012 and electronic medical records everywhere that this kind of system isn’t already in place?
* * *

After waiting all day for a call back from the doctor on call, the call came only after the pharmacy was closed for the day. Apparently some doctors have no sense that pharmacies in the U.S. generally are only open during daylight, business hours.

Some people react very badly when they miss one (much less more than one) dose of a prescribed medication. Their body — so used to getting this particular medication — freaks out, and in my friend’s case, she becomes very queasy and nauseous. She got her medications the next day when the pharmacy re-opened.

The simple answer, “Get another doctor!”, doesn’t help in situations like this. There has to be a better way. My friend’s vacation went from “Yay, vacation!” to “Yay, anxiety attack!” overnight while trying to deal with the situation.

I know, in a true emergency, there’s always the E.R. But who wants to spend hours in an overbooked and understaffed E.R. waiting for a single antidepressant pill while on vacation?