The 12 pharmacy organizations that collaborated on its development outlined 3 goals related to medication access and use that should be an integral part of any healthy reform debate:
Proper use of prescription medications help improve patient quality of life and improve health outcomes. The health care system, incurs >$177 billion annually in mostly avoidable health care costs to treat adverse events resulting from failure to take medications as prescribed.
Pharmacists can help reduce those costs through pharmacist-provided patient care services, as well as administering health screenings and immunizations. With current costs to the health care system to treat chronic diseases at $1.3 trillion annually, taking medications as prescribed can help prevent the need for catastrophic or emergency care.
A recent report by the Coalition Against Insurance Fraud tasks pharmacies, pharmacy regulators, and others in the field to reduce the prevalence of prescription drug diversion, particularly of controlled analgesics.
The report, "Prescription for Peril: How Insurance Fraud Finances Theft and Abuse of Addictive Prescription Drugs," calls on the pharmacy profession to provide additional training on prescription drug abuse and diversion in pharmacy education curricula and continuing professional education. The report also urges the industry to exert closer pointof- sale scrutiny of certain prescriptions and patients. Diversion, for example, could be cut significantly if pharmacies asked for photo identification in connection with controlled substance prescriptions.
The report also recommends wider adoption of prescription monitoring programs to maintain statewide records of narcotic prescriptions. Furthermore, the coalition calls on lawmakers and licensing boards to "swiftly and decisively penalize the small fraction of prescribers and dispensers who facilitate drug diversion and abuse."
The Board of Pharmaceutical Specialties (BPS) is holding open hearings next month on the petition for the establishment of a new specialty in Ambulatory Care Pharmacy Practice. The hearings are scheduled for April 5 and April 26.
Last November, BPS received a petition to consider this specialty, jointly submitted by the American College of Clinical Pharmacy, the American Pharmacists Association, and the American Society of Health-System Pharmacists. After its own review of the petition and all comments received, the BPS will determine whether to recognize the new specialty. A decision is expected later this year.
Under the law, retail clinics would be required to submit reports to patients' PCPs following each visit, as well as to respond quickly to queries about patients by their primary doctors. In addition, clinic staff would be held to upholding relationships with PCPs and other health care professionals in the area who would provide necessary referrals for follow-up care, as part of oversight measures.
Monitoring also would take the form of peer review, as well as review by a collaborating physician, use of evidence-based guidelines, and collection of data on outcomes and patient surveys. Procedures for emergency response and patient transfers to hospitals also would have to be implemented.
Clinic staff would need certification in cardiopulmonary resuscitation, and equipment for both resuscitation and defibrillation would be required on clinic premises. The facilities would have to demonstrate compliance with state and federal laws and guidelines and undergo inspections by the state to ensure conformity to standardized medical protocols.
Electronic health records would be mandated for the clinics, and staff there would have to provide patients with written information on their conditions. Other requirements would include the visible posting of a price list for services and the separation of the clinic from the retail portion of a business, which would include separate entrances.
The study, based on 4? years of follow-up, found that 275 of the 1393 patients who did not have mild cognitive impairment developed the condition. The patients who followed a Mediterranean diet had a 28% lower risk of developing mild cognitive impairment, compared with one third of participants who had the lowest scores for diet adherence. The middle one third group had a 17% lower risk of developing mild cognitive impairment, compared with those who ate the fewest Mediterranean foods.
Of the 482 patients who had mild cognitive impairment at study onset, 106 were diagnosed with AD nearly 4 years later. The one-third of patients with the highest scores for Mediterranean diet adherence had 48% less odds of developing the disease, compared with the lowest diet scores.
Mediterranean cuisine consists of a menu plentiful in vegetables, legumes, and fish, low in fat, meat, and dairy, and high in monounsaturated fats.
The World Health Organization (WHO), which released the report, attributed rising tobacco use in developing countries as a major reason for the shift, especially in China and India, where 40% of the world's smokers now live. WHO says that an annual rise of 1% in cases and death is expected—with larger increases in China, Russia, and India. This means cancer cases will likely balloon to 27 million annually by 2030, with deaths reaching 17 million.
By 2030, WHO reports there could be 75 million people living with cancer around the world, a figure that many health care systems are not equipped to handle. "This is going to present an amazing problem at every level in every society worldwide," said Peter Boyle, director of WHO's International Agency for Research on Cancer.
The organizations are requesting governments to act, asking the United States to provide funding for cervical cancer vaccinations and to ratify an international tobacco control treaty.
Despite budgetary woes, legislators in New York and Vermont voted against funding cuts for pharmacy services. In New York, a proposal to reduce pharmacy reimbursement for brand name drugs was rejected, and Vermont lawmakers voted down a measure that would have done away with a prescription program for seniors and disabled individuals with low income.
The proposed New York cuts would have chopped pharmacy reimbursement for brand name medications received through Medicaid and the Elderly Pharmaceutical Insurance Coverage Program to average wholesale price minus 17.25%.
Although the industry has averted the cuts, pharmacies in New York took a massive hit last year, with 152 drugstores closing doors due to $100 million in stateimposed reductions over the past 6 months alone. In Vermont, the House Human Services Committee voted down Republican Gov James Douglas' proposal to eliminate VPharm, a program for low-income seniors and people with disabilities. Because the program, established in 2006, is part of state statute, it cannot be dissolved in order to reduce the state tab. Instead, the committee is looking at ways to reduce costs for the program.
Douglas is seeking to achieve other savings from the pharmacy arena. A 4% cut to dispensation fees paid to pharmacies for each Medicaid prescription filled is slated to save about $5 million, among other Medicaid reductions that are part of the governor's fiscal year 2010 budget.
Not limited to physically altering or forging a prescription, the bill includes past provisions regarding the use of any type of misrepresentation or deception to obtain prescription drugs unlawfully. Set to go into effect July 1, 2009, if passed, the bill is an amendment to the Wyoming Controlled Substance Act of 1971.
The Oncology Care Pharmacist in Health-System Pharmacy
According to the National Cancer Institute, almost 40% of men and women will be given a diagnosis of some form of cancer in their lifetime.
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