Heparin Label Changes: Are Your Patients At Risk?

To prevent medication errors, the U.S. Pharmacopeial Convention (USP) revised the label standard for two heparin products: Heparin Sodium Injection, USP and Heparin Lock Flush Solution, USP (including pre-filled heparin flush syringes). As a result, the U.S. Food and Drug Administration (FDA) is requiring manufacturers to change the labels of these products.

Instead of prominently listing the total content of the entire container, previous labels for these multiple-dose vials showed the per-dose volume. To prevent dosing errors, the new labels display the container’s full volume, with the per-dose strength in close proximity. You can learn more and view a side-by-side comparison of the labels in this FDA Drug Safety Communication.

Label images courtesy of FDA

These changes took effect May 1, 2013, so you may already see the label changes in new stock. USP recommends the following steps to protect patients during this label transition:

Community Pharmacy Goes Digital

Alexandria, Va. - The National Community Pharmacists Association (NCPA) and RxWiki, Inc., the leading pharmacy media network, announced today a new partnership that will offer digital solutions to over 23,000 community pharmacies across the country. Through this strategic partnership, NCPA will incorporate RxWiki's Digital Pharmacist™ offering as a new, cost-free benefit for its members. The Digital Pharmacist suite includes website, social media, and mobile solutions for pharmacists to deliver medication information to patients.
"With pharmacists becoming more involved in the delivery and management of patient care, there is a valuable opportunity for greater collaboration with patients to improve overall health outcomes," said NCPA President Donnie Calhoun, RPh, a pharmacy owner in Anniston, Ala.

Raise Awareness About Mental Health

May is Mental Health Month. This year’s theme, Pathways to Wellness —calls attention to strategies and approaches that help all Americans achieve wellness and good mental and overall health. Just as you check your patients’ blood pressure and recommend appropriate screenings, it's a good idea to take periodic readings of their emotional well-being also. Medicare provides payment for several services that can help you check your patients’ emotional well-being.

Mental Health Services Payable by Medicare:

Depression Screening: Medicare covers annual screening for adults for depression in the primary care setting that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up.

Putting Too Much in Company Stock

Putting Too Much in Company Stock. 

A classic mistake that can come back to haunt you.

Have you invested too much of your 401(k) in company stock? This can happen – and you may not be fully aware of it.

Back when corporations offered traditional pension plans, the federal government watched out for this tendency. In 1974, the Employee Retirement Income Security Act (ERISA) made it illegal for pension plans to invest more than 10% of their assets in company shares. These days, the employee-directed 401(k) is the default workplace retirement plan – but ERISA doesn’t limit the amount of 401(k) assets that can be directed into company stock. 1

National Public Awareness Campaign on Medication Adherence Honoring Leaders in Multi-Professional Student Challenge

Second annual Script Your Future contest saw participation by 1,700 future health care professionals, 200 events in 35 states, and reaching more than 3 million consumers nationwide Washington, DC — Today, the National Consumers League (NCL) and its partners announced the awardees of the second annual Script Your Future Medication Adherence Team Challenge for health profession students. This month-long competition engaged health profession students and faculty in developing creative ideas for raising awareness about medication adherence as a critical public health issue. This year's awardees are: St. Louis College of Pharmacy, University of Charleston School of Pharmacy, University of the Pacific Thomas J. Long School of Pharmacy & Health Sciences, Touro University College of Pharmacy California, and The University of Mississippi School of Pharmacy.

Administration Offers Consumers an Unprecedented Look at Hospital Charges

Today, as part of the Obama administration’s work to make our health care system more affordable and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers information on what hospitals charge.  New data released today show significant variation across the country and within communities in what hospitals charge for common inpatient services.  Also today, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency. In an example of how these data might be used, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data to larger audiences.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.” 

The data posted today on CMS’s website include information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays.  Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for an item or service. 

"Transformation of the health care delivery system cannot occur without greater price transparency," said Risa Lavizzo-Mourey, M.D., RWJF president and CEO. "While more work lies ahead, the release of these hospital price data will allow us to shine a light on the often vast variations in hospital charges."

These amounts can vary widely.  For example, average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif. 

Even within the same geographic area, hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss. 

To make these data useful to consumers, HHS is also providing funding to data centers to collect, analyze, and publish health pricing and medical claims reimbursement data.  The data centers’ work helps consumers better understand the comparative price of procedures in a given region or for a specific health insurer or service setting. Businesses and consumers alike can use these data to drive decision-making and reward cost-effective provision of care.

The Affordable Care Act also makes available many tools to help ensure consumers, Medicare, and other payers get the best value for their health care dollar.  Medicare is beginning to pay providers based on the quality they provide rather than just the quantity of services they furnish by implementing new programs such as value-based purchasing and readmissions reductions.  HHS awarded $170 million to states to enhance their rate review programs, and since the passage of the Affordable Care Act, the proportion of insurance company requests for double-digit rate increases fell from 75 percent in 2010 to 14 percent so far in 2013.

To view the new hospital dataset, please go to: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html.

To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA # 93.511.

For more information on HHS efforts to build a health care system that will ensure quality care, please see the fact sheet “Lower Costs, Better Care: Reforming Our Health Care Delivery System,” at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4550.

To read a fact sheet about the Medicare data showing variation in hospital charges, please see: http://www.cms.gov/apps/media/fact_sheets.asp.

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NCPA Endorses Bipartisan Bill to Address Egregious Pharmacy Audit, Reimbursement Tactics in Medicare

Alexandria, Va. May 7, 2013 - Bipartisan legislation that would let pharmacists devote more time to Medicare beneficiaries and less to haggling with drug benefit middlemen over clerical issues and below-cost payments for generic drugs was introduced in the U.S. Senate and won the backing of the National Community Pharmacists Association (NCPA) today.

"Patients trust independent community pharmacists for the expert medication counseling and other services that they provide, such as immunizations and diabetes counseling," said B. Douglas Hoey, RPh, MBA. "Unfortunately, these pharmacist, small business owners face an increasing number of indefensible barriers to providing the level of care that their patients deserve and have come to expect. Often this is due to the unchecked authority that pharmacy benefit managers (PBMs) have over community pharmacies. This bipartisan legislation would achieve a more balanced business relationship between PBMs and community pharmacies and thereby allow pharmacists to continue putting patients first in health care."

AHRQ Launches Regional Partnership Development Initiative to Promote Comparative Effectiveness Research

The Federal Agency for Healthcare Research and Quality (AHRQ) recently launched efforts to promote comparative effectiveness research (CER), a type of patient-centered outcomes research, in patient and professional communities in all 50 states, Washington, D.C., and the U.S. territories. AHRQ has established five Regional Partnership Development Offices that are cultivating sustainable partnerships with hospitals and health systems, patient advocacy organizations, businesses, and other groups that serve clinicians, consumers, and policymakers. You’re invited to learn more about CER and to partner with AHRQ by using and encouraging others to use free CER reports and materials, which support efforts to improve the quality of health care in communities.

What is comparative effectiveness research?

Comparative effectiveness research provides information that helps clinicians and patients

Pharmacists Commend Congress' Concern over Medicare Preferred Pharmacy Drug Plans

Alexandria, Va. March 21, 2013 - Thirty-one U.S. Representatives and a U.S. Senator have written to Medicare raising questions about the impact of so-called "preferred pharmacy" drug plans, which may actually raise costs to the Medicare Part D program and taxpayers, according to a recent statement by Medicare officials and an analysis by the National Community Pharmacists Association (NCPA).

Preferred pharmacy plans differ from traditional drug benefit plans in that they establish tiers of pharmacies. The plans allow most pharmacies to participate as "network" pharmacies in order to allow the plan to satisfy Medicare's geographic access requirements. But only a limited number of pharmacies are allowed by the plan to participate as a "preferred" pharmacy authorized to offer the plan's lowest, advertised co-pays. Most plans do not allow independently owned pharmacies to participate as a preferred pharmacy in their network. The increasing number of preferred pharmacy plans are especially challenging for seniors in rural areas, where independent or regional pharmacies are often the closest pharmacy and where the nearest preferred pharmacy may be 20 miles or more away.

"We have been hearing increasing concern from Medicare beneficiaries and small business owners regarding Medicare Part D plans that feature preferred pharmacy networks," wrote U.S. Representatives H. Morgan Griffith (R-Va.), Peter Welch (D-Vt.) and 29 other Representatives, adding that "we fear these networks could lead to a decrease in access to quality care and threaten the survival of community pharmacies."

The lawmakers noted they were concerned over questions about the usefulness of the Medicare Plan Finder website and the fact that some plans may require seniors to travel long distances to reach a preferred pharmacy. They asked the Acting Administrator of the U.S. Centers for Medicare & Medicaid Services (CMS) to "outline a plan to mitigate any hardship" that the plans may cause beneficiaries and community pharmacists, and asked if Medicare plans to "expand opportunities for independent pharmacies to join and compete with the Part D preferred networks on a level playing field."

Separately, U.S. Sen. Jerry Moran (R-Kan.) has also written to CMS raising questions about the plans. In his letter, he cited the unique pharmacy access challenges of a rural state like Kansas; questioned whether the preferred pharmacy plans are accurately marketed to beneficiaries; and whether independent pharmacies are allowed to participate. "I believe that local pharmacists play a very important role in the delivery of health care across our country because in many rural communities they are often the most accessible provider," Senator Moran wrote.

"Independent community pharmacists and the patients they serve greatly appreciate the leadership of these officials in posing exactly the right questions to Medicare," said NCPA CEO B. Douglas Hoey, RPh, MBA. "Some seniors are surprised to learn that they must travel great distances to obtain the lowest advertised co-pays. Medicare officials bought into these plans with the expectation that they would help to reduce costs. However, a comparison on Medicare Plan Finder's website suggests that the Plan Finder full cost may be the same or even higher at preferred pharmacies and mail order than they are at non-preferred, network ones, such as locally owned pharmacies. In addition, community pharmacies are losing longtime patients to rival pharmacies without having any opportunity to participate as a preferred pharmacy. It is high time for Medicare to ensure seniors preserve their right to choose their pharmacy rather than being led into certain pharmacies."
In an analysis, NCPA staff looked at four common drugs (generic version of Lipitor—atorvastatin calcium Tab 20mg 90 day supply; generic version of Plavix—clopidogrel Tab 75mg 90 day supply; diovan—Tab 80mg 90 day supply; and Nexium—Cap 40mg 90 day supply) on Medicare's Plan Finder website. Looking at two large preferred pharmacy plans (AARP MedicareRx Preferred and Humana Walmart Preferred Rx), the cost of the drugs was compared between preferred pharmacies, mail order pharmacies and non-preferred pharmacies in eight cities (Helena, MT; Salt Lake City, UT; Pierre, SD; Cheyenne, WY; Boise, ID; Denver, CO; Salem, OR; and Des Moines, IA). Across the eight cities, the Plan Finder full cost of the preferred network pharmacy was moreexpensive than the Plan Finder full cost of the non-preferred network pharmacy 75 percent of the time. Furthermore, the Plan Finder full cost when comparing mail pharmacy to a non-preferred network pharmacy, was again higher 94 percent of the time.

Last month, Medicare officials hinted at such cost discrepancies, saying, "We are concerned because our initial results suggest that aggregate unit costs weighted by utilization (for the top 25 brand and top 25 generic drugs) may be higher in preferred networks than in non-preferred networks in some plans." In addition, the Medicare Payment Advisory Commission (MedPAC), Congress' advisory board on Medicare issues, at both its January meeting and in its most recent quarterly report to Congress, raised questions about preferred pharmacy plans' impact on program costs, beneficiary costs and beneficiary access.
"Community pharmacists have raised concerns about beneficiary access in preferred pharmacy plans since day one," Hoey added. "Now those concerns have been heard by members of Congress and many others."

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The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent an $88.5 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, athttp://ncpanet.wordpress.com/.

NCPA Statement on 60 Minutes' Coverage of Meningitis Tragedy, Pharmacy Compounding

Alexandria, Va. March 11, 2013 - National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA issued the following statement today regarding a story on "60 Minutes" on the 2012 meningitis outbreak and the New England Compounding Center (NECC):

"This story appropriately shines a spotlight on the terrible patient suffering that occurred as a result of the irresponsible actions of NECC, and it reinforces the need to ensure proper oversight by health officials. The accounts of former NECC employees that were reported in the story persuasively reinforce the views of NCPA and others that NECC was in fact evading necessary regulation in part by purporting to be a compounding pharmacy.

"As congressional hearings and investigations have made clear, prior to the tragic meningitis outbreak, the Food and Drug Administration (FDA) and the Massachusetts Board of Pharmacy had adequate authority to take action against NECC. They could have acted to mitigate or potentially even prevent patient suffering. Sadly, they did not.

"Every day thousands of patients benefit tremendously from the services of compounding pharmacies. Compounding pharmacies help avert allergic reactions to mass-produced drugs, flavor medication for a child's consumption and meet countless veterinary needs. The FDA itself has endorsed compounding pharmacies' role in alleviating drug shortages, such as with Tamiflu during the 2009 H1N1 flu outbreak, or in the compounding of the drug Makena used in preterm births. In addition, some estimates put the number of intravenous medications used in hospitals made by compounding pharmacies at 40 percent. Without these providers, many thousands of patients would not have access to these medications and parts of the U.S. health care system would come to a standstill. Unfortunately, "60 Minutes'" account did not reflect any of these facts.

"As a country, we must strike the right balance to go after rogue entities like NECC while preserving patients' access to the safe and essential compounded medications that their physicians prescribe. If more resources and training are required, such as for boards of pharmacies and their investigators, then those needs must be accommodated. NCPA members and staff pledge to continue to work constructively with policymakers and health officials toward these goals."

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The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent an $88.5 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com/.