Telemedicine: A remote connection
NEW YORK —The doctor and the pharmacist will see you now. Just look into the webcam on the computer.
Spurred by a perfect storm of conditions—a fractured economy that has made some pharmacy labor costs prohibitive, an explosion in new digital communications technologies and a flood of new federal cash to spur the adoption of health information technology—pharmacies, physicians and managed care organizations increasingly are turning to telemedicine to bring real-time care to hard-to-reach patients in remote locations throughout the United States.
Linking distant, far-flung patients in real time with pharmacists by a secure dispensing and two-way video-communications kiosk at a clinic, retail site or even a dedicated room in a city hall—which is the case in at least one small town that lost its sole pharmacy—can mean accessible pharmacy care for millions of patients in rural and small-town settings. The potential benefits of telemedicine go way beyond pharmacy dispensing and video-link counseling, of course. Properly applied, telemedicine—more broadly defined by some as telehealth—can put patients in immediate touch with a whole battery of healthcare professionals for any number of interventions. Those interventions can range from smart phones that monitor a diabetic patient’s glucose levels to a trauma team walking a medic through a triage procedure for a wounded soldier on a battlefield in Afghanistan—and can come through mobile phones, webcams or any other device that opens an instant link between patient and practitioner.
One big impetus for the growth of telemedicine will be the federal government. As part of the Obama administration’s $787 billion economic stimulus plan contained in the American Recovery and Reinvestment Act, more than $19 billion has been allocated to support the health system’s conversion to electronic record-keeping and health IT—including telemedicine.
Telepharmacy solutions are coming from a slew of technology providers, sometimes in partnership with retail pharmacy chains. For Maple Grove, Minn.-based Thrifty White Drug Stores, its commitment to remote-site dispensing beginning in 2003 was driven by necessity; the high costs of operating a fully staffed pharmacy in some distant, smaller communities were prohibitive.
Thrifty White’s answer: Operate a smaller store with a prescription kiosk, staffed by a technician and monitored by a company pharmacist at a full-service pharmacy dozens of miles away. “Our goal is to provide pharmacy services to these under-served areas and keep the business local” said Gary Boehler, EVP pharmacy operations for Thrifty White.
More recently, another Minnesota pharmacy operator, Sterling Drug, turned to pharmacy automation specialist ScriptPro to install its Telepharmacy unit in the town of Adrian, Minn., after that town lost its one drug store. The unit, staffed by a pharmacy technician, serves the prescription needs of the town’s roughly 1,200 residents from a Sterling Drug location in a larger, nearby town, Worthington, Minn.
“Mail order should not be the answer to these communities,” said Tim Gallager, VP pharmacy operations for Sterling’s parent company, Astrup Drug. “You can expand pharmacy services for less than the cost of opening a new pharmacy and support remote pharmacies without adding staff or recruiting pharmacists.”
Major chains also are weighing in. Rite Aid unveiled a new online chat capability in early August that gives customers enrolled in its wellness+ rewards program direct, 24-hour access to a Rite Aid pharmacist. Wellness+ members can access the feature, called “Ask a Pharmacist—Chat Live Now,” via a link on their online personal health page.
Walgreens also rolled out a new, real-time link between patients and pharmacists early last month called Walgreens Pharmacy Chat. The service puts customers in touch with a pharmacy staff member via an online link, 24/7.
Pittsburgh Business Group on Health’s LivingMyLife program to expand
PITTSBURGH The Pittsburgh Business Group on Health’s LivingMyLife program, which helps diabetes patients with disease management through the use of “coach pharmacists,” will soon do the same for those with other diseases, according to published reports.
The Pittsburgh Tribune-Review reported Friday that LivingMyLife also would help patients with asthma and heart disease. The program, which began in 2006, allows patients to manage their disease with visits to pharmacies, mostly Giant Eagle, Kmart and some independents.
The announcement was made at the annual healthcare symposium of the group and involved more than 100 attendees, the newspaper reported.
Appeals court upholds decision to OK ‘pay-for-delay’ deals
NEW YORK The federal government got a kick in the face Thursday as an appeals court ruled in favor of patent litigation settlements between branded and generic drug companies.
The U.S. Second Circuit Court of Appeals in New York decided not to reconsider a ruling it made earlier this year in the case of Arkansas Carpenters Health and Welfare Fund vs. Bayer AG. The case concerned the legality of a settlement between Bayer and Teva Pharmaceutical Industries subsidiary Barr Labs over the anthrax treatment Cipro (ciprofloxacin), but the court ruled that the deal between the two companies did not violate antitrust laws.
The appeals court’s decision is a major setback for the efforts of the Federal Trade Commission and members of Congress who have sought to ban such settlements.
In most cases, a generic drug company that wishes to market its version of a drug before the branded drug company’s patents expire will file an approval application with the Food and Drug Administration with a paragraph IV certification, a legal assertion that the patents covering the branded drug are invalid, unenforceable or won’t be infringed by the generic drug. In response, the branded drug company usually will sue, but cases frequently result in settlements whereby the generic drug company agrees to hold off launching its drug in exchange for payment of some sort by the branded drug company.
This often comes in the form of an agreement not to use an authorized generic, essentially the branded drug marketed under its generic name, to compete with the generic drug company during its customary six-month market exclusivity period. Legally, the generic company must launch before the patents expire or as soon as they do, and delaying launch after patent expiry would be illegal, though critics such as the FTC and The New York Times’ editorial board have often derided the settlements as “pay-for-delay” deals, with the FTC contending that they cost consumers billions of dollars a year. Nevertheless, most cases that are settled result in launch of the generic drug ahead of patent expiry. In the case of Bayer and Barr, Bayer paid Barr $400 million to hold off launching its version of Cipro.
“Patents, issued by the government, are given the presumption of validity,” read a statement from the Generic Pharmaceutical Association, the generic drug industry’s main lobby. “Any market entry of a generic drug before the brand patent expires –– whether as the result of a finding that the generic product does not infringe the patent, that the patent is not enforceable or through a patent settlement agreement with the brand company –– is a positive, cost-saving event for consumers.”