Community pharmacy coalition calls on state attorneys general to block PBM merger
WASHINGTON — The Preserve Community Pharmacy Access NOW! coalition — formed in opposition of the proposed Express Scripts-Medco merger — Wednesday afternoon hosted a press conference making a direct appeal to attorneys general to block the ESI-Medco merger in the courts should the Federal Trade Commission approve the merger.
"There are few mergers I’ve ever seen that are as anticompetitive as this meger," said David Balto, antitrust attorney and former FTC policy director. "When the states think there’s a problem, and they’ve already recognized there’s a problem involving PBMs, they are as every bit as capable … litigators as the FTC," he said. "Ultimately, if [the states] bring a case, it isn’t a bureaucrat in Washington who’s going to make a decision whether or not this merger is anticompetitive, it is a federal court judge."
Balto pointed out that as many as 78 Congress members have written the FTC advocating that this merger be disallowed.
Balto outlined four reasons why an ESI-Medco merger would be detrimental to consumers of health care:
One, many consumers will lose access to their community pharmacies because they’ll be forced into mail order;
Two, because more patients are pressured into mail-order participation, drug prices actually will rise because of a lower rate of generic substitution;
Three, $4-generics available through many retail pharmacies will disappear as the merged PBM will be able to significantly reduce reimbursements for these low-cost pharmaceuticals; and
Four, prices will increase across specialty pharmacy offerings as a larger PBM is able to dominate this marketplace through a greater buying power.
History has shown, Balto said, that when Express Scripts "gets exclusivity, they significantly ratchet up prices."
Balto and others project an Express Scripts-Medco merger will eliminate many community pharmacies. "How convenient — the pharmacies disappear and the PBMs take consumers from an open, competitive channel and funnel them into a closed, mail order [system]," said Steve Pociask, president of the American Consumer Institute.
Express Scripts earlier Wednesday filed a Form 8-K with the Securities Exchange Commission that they expect the proposed merger to close as early as next week, suggesting that an FTC decision may be imminent.
According to published reports, attorneys general in New York, Pennsylvania, Ohio, Texas and California already are considering filing suit to block the merger if it is passed without serious conditions.
FDA approves Omontys for kidney disease-related anemia
SILVER SPRING, Md. — The Food and Drug Administration has approved a new treatment for anemia in patients with chronic kidney disease.
The FDA announced the approval of Affymax’s Omontys (peginesatide), a drug belonging to the class known as erythropoiesis-stimulating agents, designed to aid the formation of red blood cells.
"Omontys represents the first new FDA-approved and marketed ESA for this condition since 2001," FDA Office of Hematology and Oncology Products director Richard Pazdur said. "This new drug offers patients and healthcare providers the convenience of receiving ESA therapy just once per month instead of more frequent injections."
Techs are front-line warriors to boost drug safety
If you’re a pharmacy technician in any practice setting, you’re at the front lines of an escalating battle to prevent medication errors and save lives. Spurred by growing alarm over the human and financial toll of adverse drug events, a web of powerful health agencies, professional pharmacy organizations and patient-safety advocates are waging a campaign to reduce medication errors by boosting safeguards in the pharmacy and educating patients. But the success of that effort hinges in large part on how pharmacy technicians perform their duties at the nexus of care between patient and pharmacist.
“Reducing medication errors … has become a significant priority, especially over the last few years,” noted Megan Sheahan, director of professional affairs for the Pharmacy Technician Certification Board. “But there are still a lot of things that need to happen within every pharmacy to reduce errors.”
One priority, Sheahan said, is improving communication among techs and pharmacists. “Technicians need to have increased dialogue with the pharmacist throughout all the checking processes and every other part of the medication fill process they’re involved in,” she asserted. “And technicians need to be empowered to initiate that dialogue.”
Mike Johnston, chairman and CEO of the National Pharmacy Technician Association, also stressed the need for a team approach to eliminating medication misadventures. “Pharmacy technicians are going to be essential in addressing medication errors,” he said. “The role of the technician is completely embedded in the process of preventing medication errors and misadventures.”
The reason is simple, Johnston told Collaborative Care: “For a majority of patients, their first interaction with the pharmacy is going to be with the technician. If the tech is able to review what the script was at time of drop-off and have a verbal communication with the patient there, if there are any discrepancies, it triggers action.”
In addition, NPTA’s CEO said, “the tech is going to be the individual entering the prescription order into the computer system in most cases. And in most cases, the technician is the last individual to communicate with the patient when they pick up the prescription, review the medication and go over the patient’s and the doctor’s name. So you’ve got three critical points there in the life cycle of a potential medication misadventure, where a pharmacy technician can take a very proactive role in prevention.”
A team approach
Pharmacists, for their part, are fully supportive of pharmacy techs as allies in the campaign to prevent errors and improve safety. “Pharmacy technicians are valuable employees when it comes to safe and accurate dispensing,” agreed Lisa Schwartz, PharmD, who directs management affairs for the National Community Pharmacists Association. “Technicians are capable of detecting medication errors at the point of data entry, during prescription preparation and when patients pick up their order. Pharmacists can leverage technicians to prevent confirmation bias and gather information from patients to prevent errors.”
For instance, Schwartz noted, “is the Casodex prescription written for J. Doe for Jane or her husband, John?” In addition, she told Collaborative Care, “pharmacists rely on technicians to detect unusual dose or direction changes and as the technician gains experience, possibly unusual drug selection.”
For that reason, Schwartz said, “in addition to a basic screening of incoming prescriptions, technicians must pay great attention to detail and accurately transcribe information on a prescription to the label for dispensing; accurately select and count or measure the medication; and ensure that the verified prescriptions get to the right patient. And depending on pharmacy workflow, the pharmacist or technician may be responsible for assembling the will-call bag.”
The nation’s oldest national pharmacist organization, the American Pharmacists Association, also is enlisting pharmacy technicians in the campaign to improve drug safety. Among the group’s recommendations are advances in “accredited education and training programs that develop qualified pharmacy technicians who will support pharmacists in ensuring patient safety and enhancing patient care,” according to APhA spokeswoman Michelle Fritts.
Citing an analysis of medication errors made by pharmacy techs from [the United States Pharmacopeial Convention] and the Institute for Safe Medication Practices, the APhA noted that while many of those errors were intercepted prior to reaching patients, 12% of those that weren’t caught led to a near-death experience or death. The answer, according to the pharmacist group: increased training and a “uniform set of standards” for techs.
The APhA developed a set of recommendations for error-prevention techniques within the pharmacy, many of which involve the typical duties of pharmacy technicians. Among them: working on one patient’s script at a time and keeping each in a separate bin; returning stock bottles to shelves immediately after use to avoid overcrowding the work counter; turning a used drug stock bottle upside-down to avoid mix-ups; double-checking bar codes against the national drug code number; and having two different staff members check the prescription.
That last point can be critical. “Up to 90% of errors will be caught when another set of eyes is looking at the prescription and doing a double check,” observed Allen Vaida, EVP of the Institute for Safe Medication Practices. “The technicians present that extra set of eyes.”
The PTCB, for its part, is working to enhance the tech’s role in drug safety. For instance, Sheahan said, “we want techs to learn how to report medication errors” through the National Medication Errors Reporting Program, a Web-based reporting system offered through ISMP that tracks and compiles data on drug dispensing errors, adverse drug reactions and other threats to medication safety. “Pharmacy technicians can play an integral role in that program,” she noted.
PTCB will soon launch a new toolbox for technicians on its website that includes links to ISMP and other resources, Sheahan said. “These resources are out there and available to technicians, but we wanted to find a way to simplify it and put it all in one place.”
The speed versus accuracy debate
One trend pharmacy advocates see as extremely counterproductive to the drive for improved dispensing accuracy is the effort by some retail pharmacies to speed up the dispensing process as a customer convenience. Promises to fill customers’ prescriptions within 15 minutes, for instance, run counter to the drug safety effort, they asserted.
The two goals, Vaida said, are contradictory. “But that’s often the consumer’s perception: ‘How fast can I get in and get out?’ And if the pharmacy is now promoting that message, it just adds to the problem,” he noted. NPTA’s Johnston agreed, and said the competition over who can get a script out the fastest is putting pharmacists and technicians under “tremendous pressure.”
“Something’s got to give,” he warned. “As a profession and an industry, we’re doing the population a great disservice to promote speed over accuracy. The purpose of pharmacy is not to get the med out as quickly as possible; it’s to provide accurate and effective pharmaceutical care. And part of that is going to require patient education … to dispel those myths on what the public perceives as the goal of the pharmacy team. If the public really understood that, I think we could lessen the burden and expectations of a fast-food mentality.”
“Patients are willing to sit for hours to go to a physician they can trust. I don’t think it’s inappropriate for there to be the same expectation of an adequate waiting time to go to a pharmacy they can trust,”