Pharmacy organizations recently unveiledPharmacy Principles for Health CareReform. The principles identify what isnecessary to fully use the medicationexpertise to address the epidemic ofmedication misuse. They demonstratehow the nation's pharmacies and pharmacistsplay a critical role in improvingaccessible, affordable, and quality healthcare for patients.
The 12 pharmacy organizations thatcollaborated on its development outlined3 goals related to medication access anduse that should be an integral part of anyhealthy reform debate:
Proper use of prescription medicationshelp improve patient quality of life andimprove health outcomes. The healthcare system, incurs >$177 billion annuallyin mostly avoidable health care costs totreat adverse events resulting from failureto take medications as prescribed.
Pharmacists can help reduce thosecosts through pharmacist-provided patientcare services, as well as administeringhealth screenings and immunizations.With current costs to the health caresystem to treat chronic diseases at $1.3trillion annually, taking medications asprescribed can help prevent the need forcatastrophic or emergency care.
A recent report by the Coalition AgainstInsurance Fraud tasks pharmacies, pharmacyregulators, and others in the fieldto reduce the prevalence of prescriptiondrug diversion, particularly of controlledanalgesics.
The report, "Prescription for Peril:How Insurance Fraud Finances Theft andAbuse of Addictive Prescription Drugs,"calls on the pharmacy profession toprovide additional training on prescriptiondrug abuse and diversion in pharmacyeducation curricula and continuingprofessional education. The report alsourges the industry to exert closer pointof-sale scrutiny of certain prescriptionsand patients. Diversion, for example,could be cut significantly if pharmaciesasked for photo identification in connectionwith controlled substance prescriptions.
The report also recommends wideradoption of prescription monitoring programsto maintain statewide recordsof narcotic prescriptions. Furthermore,the coalition calls on lawmakers andlicensing boards to "swiftly and decisivelypenalize the small fraction of prescribersand dispensers who facilitate drug diversionand abuse."
The Board of Pharmaceutical Specialties (BPS) is holding open hearings next monthon the petition for the establishment of a new specialty in Ambulatory Care PharmacyPractice. The hearings are scheduled for April 5 and April 26.
Last November, BPS received a petition to consider this specialty, jointly submittedby the American College of Clinical Pharmacy, the American Pharmacists Association,and the American Society of Health-System Pharmacists. After its own review of thepetition and all comments received, the BPS will determine whether to recognize thenew specialty. A decision is expected later this year.
An Indiana Senatebill would mandatestricter requirementsfor healthclinics located insideretail businesses.The newprotocols call forgreater involvementof patients' primarycare providers (PCPs), aswell as higher levels of monitoring,among other slated rules.
Under the law, retail clinics would berequired to submit reports to patients'PCPs following each visit, as well as torespond quickly to queries about patientsby their primary doctors. In addition,clinic staff would be held to upholdingrelationships with PCPs and other healthcare professionals in the area who wouldprovide necessary referrals for follow-upcare, as part of oversight measures.
Monitoring also would take the formof peer review, as well as review bya collaborating physician, use of evidence-based guidelines, and collectionof data on outcomes and patient surveys.Procedures for emergency response andpatient transfers to hospitals also wouldhave to be implemented.
Clinic staff would need certificationin cardiopulmonary resuscitation, andequipment for both resuscitation anddefibrillation would be required on clinicpremises. The facilities would have todemonstrate compliance with state andfederal laws and guidelines and undergoinspections by the state to ensure conformityto standardized medical protocols.
Electronic health records would bemandated for the clinics, and staff therewould have to provide patients withwritten information on their conditions.Other requirements would include thevisible posting of a price list for servicesand the separation of the clinic from theretail portion of a business, which wouldinclude separate entrances.
The Mediterraneandiet may help preventmild cognitiveimpairmentand alsoreduce theodds of transitioningfrommild cognitivedecline toAlzheimer's disease(AD), accordingto the study reportedin the February 2009 issue of the Archivesof Neurology.
The study, based on 4? years offollow-up, found that 275 of the 1393patients who did not have mild cognitiveimpairment developed the condition. Thepatients who followed a Mediterraneandiet had a 28% lower risk of developingmild cognitive impairment, comparedwith one third of participants who hadthe lowest scores for diet adherence. Themiddle one third group had a 17% lowerrisk of developing mild cognitive impairment,compared with those who ate thefewest Mediterranean foods.
Of the 482 patients who had mildcognitive impairment at study onset, 106were diagnosed with AD nearly 4 yearslater. The one-third of patients with thehighest scores for Mediterranean dietadherence had 48% less odds of developingthe disease, compared with the lowestdiet scores.
Mediterranean cuisine consists of amenu plentiful in vegetables, legumes,and fish, low in fat, meat, and dairy, andhigh in monounsaturated fats.
International health experts predict that cancer will surpass heart disease as theworld's top killer by 2010, part of a trend that should more than double global cancerdeaths by 2030.
The World Health Organization (WHO), which released the report, attributed risingtobacco use in developing countries as a major reason for the shift, especially in Chinaand India, where 40% of the world's smokers now live. WHO says that an annual rise of1% in cases and death is expected—with larger increases in China, Russia, and India.This means cancer cases will likely balloon to 27 millionannually by 2030, with deaths reaching 17 million.
By 2030, WHO reports there could be 75 millionpeople living with cancer around the world, a figurethat many health care systems are not equipped tohandle. "This is going to present an amazing problemat every level in every society worldwide," said PeterBoyle, director of WHO's International Agency forResearch on Cancer.
The organizations are requesting governments toact, asking the United States to provide funding forcervical cancer vaccinations and to ratify an internationaltobacco control treaty.
Despite budgetary woes, legislators in New York and Vermont voted against fundingcuts for pharmacy services. In New York, a proposal to reduce pharmacy reimbursementfor brand name drugs was rejected, and Vermont lawmakers voted down ameasure that would have done away with a prescription program for seniors anddisabled individuals with low income.
The proposed New York cuts would have chopped pharmacy reimbursement forbrand name medications received through Medicaid and the Elderly PharmaceuticalInsurance Coverage Program to average wholesale price minus 17.25%.
Although the industry has averted the cuts, pharmacies in New York took a massivehit last year, with 152 drugstores closing doors due to $100 million in stateimposedreductions over the past 6 months alone. In Vermont, the House HumanServices Committee voted down Republican Gov James Douglas' proposal to eliminateVPharm, a program for low-income seniors and people with disabilities. Because theprogram, established in 2006, is part of state statute, it cannot be dissolved in orderto reduce the state tab. Instead, the committee is looking at ways to reduce costs forthe program.
Douglas is seeking to achieve other savings from the pharmacy arena. A 4% cut todispensation fees paid to pharmacies for each Medicaid prescription filled is slated tosave about $5 million, among other Medicaid reductions that are part of the governor'sfiscal year 2010 budget.
A bill currently before the Wyoming Senate would attach a felony charge to drugprescription forgery. The proposed legislation seeks to assign a penalty of up to 10years in prison with possible fines of up to $10,000 for those found guilty of forging oraltering prescriptions to acquire controlled substances.
Not limited to physically altering or forging a prescription, the bill includes pastprovisions regarding the use of any type of misrepresentation or deception to obtainprescription drugs unlawfully. Set to go into effect July 1, 2009, if passed, the bill is anamendment to the Wyoming Controlled Substance Act of 1971.