Pharmacy Computer Services, Inc.

Latest News from the Centers for Medicare and Medicaid Services

2012-02-27T08:49:00.001-08:00

Health Reform Expands the Insurance Market, Supports Consumer-Governed Nonprofit Health Plans

The Centers for Medicare and Medicaid Services today announced that seven Consumer Oriented and Operated Plans (CO-OPs) will receive repayable loans to help them establish private non-profit, consumer-governed health insurance companies. Created by the Affordable Care Act, CO-OP plans will give consumers and small businesses more health insurance choices.

CO-OP loans support the creation of new innovative health insurers, which will promote competition and increase choice in the insurance market. As consumer-directed organizations, CO-OPs are designed to be accountable to members and responsive to the specific health care needs of plan members by using profits to lower premiums, improve quality, and expand benefits or enrollment.

“We are excited to support the health insurance CO-OPs,” said Marilyn Tavenner, Acting Administrator of the Center for Medicare and Medicaid Services (CMS). “CO-OPs will promote competition in the insurance market and respond well to the health care needs of Americans.”

All CO-OP loans must be repaid with interest and loans will only be made to private, nonprofit entities that demonstrate a high probability of becoming financially viable. CMS will closely monitor CO-OPs to ensure they are meeting program milestones. Funds can only be drawn down incrementally as milestones are met. To ensure strong financial management, CO-OPs are required to submit quarterly financial statements, including cash flow and enrollment data, receive site visits, and undergo annual external audits. This monitoring is concurrent with the financial and operational oversight of State insurance regulators.

The CO–OP program contains extensive provisions to protect against fraud, waste, and abuse. CO-OP applicants underwent background checks that included public records searches at the local, State, and national level as well as searches of federal debarment databases. Loan recipients are subject to strict monitoring, audits, and reporting requirements for the length of the loan repayment period plus 10 years.

All CO-OPs receiving loans were selected on a competitive basis through external and independent expert objective reviews and approval by CMS officials with private insurance expertise. Non-profits receiving the loans include: Freelancers CO-OP of Oregon, New Mexico Health Connections, Montana Health Cooperative, Midwest Members Health, Common Ground Healthcare Cooperative, Freelancers CO-OP of New Jersey, and Freelancers Health Service Corporation. Starting in 2014, these CO-OPs will operate in Oregon, New Mexico, Montana, Iowa, Nebraska, Wisconsin, New Jersey, and New York.

Today’s awardees will receive start-up and solvency loans to fund start-up activities required to become a health insurance issuer and enable them to meet State licensure, solvency and reserve requirements. Start-up loans must be repaid in 5 years and solvency loans paid back within 15 years. Like other plans, CO-OPs will meet State and federal standards for qualified health plans to sell coverage through the Exchanges and the State’s Small Business Health Option Programs (SHOP Exchanges).

CMS will continue to review applications and announce additional awardees on a rolling basis. We are pleased with the large number of CO-OP loan applications and encouraged by the strong response. We anticipate receiving more applications in subsequent rounds. The initial application pool consisted of small business coalitions, physician and hospital providers and associations, agricultural organizations, unions and community-based sponsors. Additional CO-OP funding program opportunities will be available throughout 2012. CMS’ goal is to establish a CO-OP in each State and the District of Columbia to increase health insurance options for people across the country.

For more information on today’s announcement visit: http://www.healthcare.gov/news/factsheets/2012/02/coops02212012a.html

Prescribing Errors By GPs Reduced By Up To 50 Percent By In-House Pharmacists

2012-02-23T11:42:00.002-08:00

Original Article
Main Category: Primary Care / General Practice
Also Included In: Pharmacy / Pharmacist; IT / Internet / E-mail
Article Date: 21 Feb 2012 - 2:00 PST

Medication errors are common in primary care but the number of mistakes could be reduced significantly if GPs introduced an in-house pharmacist-led intervention scheme.

These are the findings of a comprehensive study into sustainable ways of preventing patients from being harmed as a result of prescribing errors.

The research was led by Tony Avery, Professor of Primary Health Care in the School of Community Health Sciences at The University of Nottingham and funded by the Patient Safety Research Program of the UK Department of Health. The results are published on Tuesday 21 February 2012 in the Lancet - one of the world's leading medical journals.

The study involved at-risk patients in 72 general practices taking the drugs that are most commonly and consistently associated with medication errors.

The general practices were randomly allocated to receive either computerised feedback on patients at risk, or computerised feedback with support from a pharmacist to correct any errors detected. When followed up six months later the general practices receiving pharmacist support had significantly fewer prescribing errors.

Professor Avery, who is also a practicing GP in Nottingham, has called on the Department of Health and GP clinical commissioning groups to develop a wider roll-out of the intervention scheme. He said: "Our study has shown remarkable reductions in prescribing errors from an approach that could easily be rolled out to general practices in England and the rest of the UK. Most general practices already have in-house pharmacists, but much of their time is spent controlling prescribing costs. What is needed is a commitment for these pharmacists to spend more of their time on patient safety. Not only would this help prevent unnecessary harm to patients, but it may also reduce the costs associated with dealing with prescribing errors, which sometimes require hospital admission".

How the study was set up

Dr Avery and his team, which involved the University of Manchester, the University of Reading, the University of Otago in New Zealand, and the University of Edinburgh, studied GP practices in Nottinghamshire, Staffordshire and Central and Eastern Cheshire, England.

Practices allocated to the simple feedback system received computerised feedback on patients at risk from medication errors and the practices were given brief written information on the importance of each type of error.

GPs allocated to pharmacist-intervention met with a pharmacist at the beginning of intervention period to discuss the problems identified from the computerised feedback and to agree on an action plan. The pharmacist then spent roughly two days a week for the next 12 weeks dealing with the problems and working to improve safety systems. In some cases, patients were invited into the surgery for a prescription review with the pharmacist, or a GP, or to have a blood test, with the aim of correcting medication errors.

The results of the study

Their results showed that GPs were almost 50 per cent less likely to make errors in the monitoring of older people taking ACE inhibitors or diuretics, 42 per cent less likely to make errors in prescribing non-steroidal anti-inflammatory drugs to patients with a history of peptic ulcer (including stomach ulcer), and 27 per cent less likely to make errors in prescribing beta-blockers to patients with asthma.

Professor Avery said: "We know that GPs are aware of the risks of the drugs most commonly associated with adverse events, but errors do occur and our study has shown an effective way of dealing with them. We believe that there is an urgent need to roll out this pharmacist-led intervention to general practices throughout the country to avoid unnecessary errors in the future."

CMS gives consumers access to more details about infection rates at America’s hospitals New data will save lives, cut costs.

2012-02-13T08:18:00.000-08:00

February 7, 2012

CMS gives consumers access to more details about infection rates at America’s hospitals

New data will save lives, cut costs.

Central line-associated bloodstream infections (CLABSIs) are among the most serious of all healthcare-associated infections, resulting in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system. Today, the Centers for Medicare & Medicaid Services (CMS) announced that Hospital Compare will now include data about how often these preventable infections occur in hospital intensive care units across the country. This step will hold hospitals accountable for bringing down these rates, saving thousands of lives and millions of dollars each year.

“Including central line-associated bloodstream infections information on Hospital Compare will save lives and cut costs,” said acting CMS Administrator Marilyn Tavenner. “Adding this information to Hospital Compareextends the Administration’s commitment to make American healthcare safer.”

The Centers for Disease Control and Prevention (CDC) estimates that in 2009, there were about 41,000 CLABSIs in U.S. hospitals. Studies show that up to 25 percent of patients who get a CLABSI will die from the infection. Caring for a patient with a CLABSI adds about $17,000 to a hospitalization. These infections prolong hospitalizations and can cause death.

“Today, consumers are getting access to data provided to hospital leaders and clinicians to monitor progress in reducing CLABSIs,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “This information allows CDC and CMS to highlight prevention and pinpoint where more work is needed on these avoidable infections.”

Today’s announcement builds on HHS’s efforts to make American healthcare safer. In 2011, Secretary Kathleen Sebelius launched the Partnership for Patients initiative, which seeks to reinvent American healthcare delivery in ways that keep patients from being injured or getting sicker in a care system designed to heal them. CMS has already recruited over 6,000 partners, including more than 3,000 hospitals, in this effort, which aims to reduce preventable harm in hospitals by 40 percent by 2014.

Hospital Compare is one of Medicare’s most popular web tools. The site receives about 1 million page views each month and is available in English and in Spanish. More information about Hospital Compare is online at http://www.hospitalcompare.hhs.gov

Consumers have relied on Hospital Compare since 2005 to provide information about the quality of care provided in over 4,700 of America’s acute-care, critical access and children’s hospitals. The website features free, easy-to-use information about these hospitals, including mortality and readmission rates for each, along with 10 measures that capture patient experience with hospital care, 17 measures that assess patient safety at each hospital, 25 process-of-care measures and three children’s asthma care measures.

Click here to view the CMS video with Nancy Foster, Vice President of Quality and Patient Safety Policy at the American Hospital Association discusses CMS' Hospital Compare: http://www.youtube.com/user/CMSHHSgov?feature=mhee#p/u/0/cf99WBNhYEc

Questions to Ask Your Vendor for the Version 5010 Upgrade

2012-02-06T08:51:00.001-08:00

The compliance deadline to upgrade to Version 5010 from Version 4010/4010A wasJanuary 1, 2012. The Centers for Medicare & Medicaid Services (CMS) announced an enforcement discretion period for 90 days until March 31, 2012, during which it would not initiate enforcement action with respect to any HIPAA-covered entity that is non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. However, you should continue to upgrade your systems as promptly as possible in order to meet this deadline.

In order to ensure a smooth upgrade prior to April, you will need to complete both phase I internal and phase II external testing of Version 5010 transactions. As part of your external testing, you will need to conduct tests with outside trading partners, which include vendors, clearinghouses, billing services, and payers. Your vendor is a critical partner in achieving Version 5010 compliance.

You should take the following steps to evaluate your vendor and vendor products to ensure a timely Version 5010 upgrade:

Establish a tracking system and timeline for milestones
Review existing and new contractual obligations with vendors
Coordinate vendor capabilities with your practice needs and expectations
Evaluate ease of use of vendor products

You might want to also ask your vendor some of the following questions about the Version 5010 upgrade to help assess your readiness for this upgrade:

Have they upgraded their systems to meet Version 5010 standards?
If they have not yet upgraded, when will they do so?
What will be the cost for each upgrade?
What versions of their software will be upgraded, and will these upgrades require any additional hardware upgrades?
How often will updates occur and what is the delivery method?
How are issues logged and how will they be addressed?
Is there training available for new system changes and/or functionalities?

Please visit the CMS ICD-10 website for additional information and resources about the Version 5010 upgrade.

Keep Up to Date on Version 5010 and ICD-10.

Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!

Commercial E-Prescribing Cuts Medication Errors in Hospitals

2012-02-01T13:44:00.000-08:00

February 1, 2012 — Implementation of 2 commercial e-prescribing systems significantly reduced prescribing errors, including serious errors, at 2 Australian hospitals, according to results from a studypublished online January 31 in PloS Medicine.

"Considerable investments are being made in commercial electronic prescribing systems (e-prescribing) in many countries," write lead author Professor Johanna Westbrook, PhD, from the University of New South Wales, Sydney, Australia, and colleagues.

However, they note, "Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system use."

These researchers evaluated the effect of 2 commercially available e-prescribing systems on reducing prescribing errors and assessed their propensity for creating new types of errors.

The authors looked for procedural and clinical errors in medication charts at 2 Sydney teaching hospitals, both before and after the introduction of e-prescribing systems. Procedural errors included unclear, incomplete, or illegal prescribing orders, and clinical errors included prescribing an incorrect drug or incorrect dose.

At hospital A, the Cerner Millennium e-prescribing system was introduced on a single geriatric ward. Three other wards (a renal/vascular ward, a respiratory ward, and another geriatric ward) served as controls.

At hospital B, the researchers compared error rates in 2 wards (psychiatry and cardiology) both before and after the iSoft MedChart system was introduced.

"The introduction of an e-prescribing system was associated with a substantial reduction in error rates in the three intervention wards; error rates on the control wards did not change significantly during the study," the researchers write.

In hospital A, error rates declined from 6.25 (95% confidence interval [CI], 5.23 - 7.28) to 2.12 (95% CI, 1.71 - 2.54; P < .0001) per admission after the e-prescribing system was put into use, the researchers say.

Similar results were seen in hospital B, with error rates falling from 3.62 (95% CI, 3.30 - 3.93) to 1.46 (95% CI, 1.20 - 1.73; P < .0001) per admission.

The researchers attributed the decline in error rates primarily to reductions in procedural errors; clinical errors showed only modest reductions.

However, the authors stress that the introduction of e-prescribing had a significant effect on serious errors, defined as errors that would be likely to lead to death. Rates for serious errors fell across all the intervention wards, from 0.25 per admission to 0.14 per admission (P = .0002), which is a 44% decline.

In contrast, serious error rates in control wards declined by only 17% during the study.

System-related errors (eg, choosing an incorrect drug from a drop-down menu) were responsible for about 35% of the errors seen in the intervention wards after the e-prescribing systems were put into place, the authors write.

That high rate of system-related errors is worrisome, the authors concede, but they say such errors could be corrected by tweaking the systems and improving user training.

The authors point out several limitations of the study, including lack of control wards in hospital B and the inability to randomize hospital wards to the intervention.

Commenting on the study, Lyman Dennis, MBA, PhD, who heads El Dorado Health Consulting in Fairfield, California, told Medscape Medical News, "This study is important because it verifies that electronic systems do improve care, both in terms of improving the accuracy of procedural steps as well as clinical execution. But it also clearly shows that the factor of human error is not removed simply by utilizing these information systems."

Dr. Dennis says another point highlighted by the findings is that hospitals need to have implementation of e-prescribing systems imbedded in some sort of quality improvement process. "You shouldn't have the expectation that when you've finished implementing the system everything is immediately going to proceed smoothly," he said.

Most e-prescribing systems offer a multitude of choices when navigating various screens, and Dr. Dennis points out that although having lots of choices creates flexibility, it can also cause errors. "When many options are offered, making the proper selection can involve a rather fine mouse click, or a fine touch of the screen, and it can be easy to make an incorrect choice," he said.

However, on balance, Dr. Dennis says, e-prescribing makes sense for hospitals. "Though, as we've seen in this study, such systems are associated with an increase in system-related errors, the reduction in serious procedural and clinical errors more than makes up for that," he said.

The research was supported by grants from the National Health and Medical Research Council. One of the study authors has, in the past, had shares and acted as a consultant to give general advice on incident reporting to Patient Safety International. He also was a board member of Patient Safety International, which at that stage was, but is no longer, a subsidiary of the not-for-profit research organization the Australian Patient Safety Foundation, of which he has been and is president. Another coauthor spoke on "Electronic Medication Management and the Hospital Pharmacist" at the Cerner Regional User Group meeting in 2010 at the request of her employer. She personally received no honorarium or fees from this speaking engagement. The other authors and Dr. Dennis have disclosed no relevant financial relationships.

PloS Med. Published online January 31, 2012. Article

USPHS report calls for pharmacists to be recognized as providers

2012-01-25T11:32:00.001-08:00

Evidence-based outcomes provide evidence for expanded role; Surgeon General endorses report.

The U.S. Public Health Service (USPHS) released a report identifying “rationale and compelling discussion to support health reform through pharmacists delivering expanded patient care services,” according to Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice: A Report to the Surgeon General 2011.

“The federal sector has already implemented and embraced such a health care delivery model through physician–pharmacist collaboration,” according to the report. “This collaboration, through extensive performance data, has demonstrated that patient care services delivered by pharmacists can improve patient outcomes, promote patient involvement, increase cost efficiency, and reduce demands affecting the health care system.”

In a letter, U.S. Surgeon General Regina Benjamin, MD, MBA, of commended lead author and Assistant Surgeon General RADM Scott Giberson, BSPharm, PhC, NCPS-PP, MPH, USPHS, and colleagues for their work and expressed her public support for the document. “This report provides the evidence health leaders and policy makers need to support evidence-based models of cost-effective patient care that utilize the expertise and contributions of our nation’s pharmacists as an essential part of the health care team,” Benjamin wrote.

The four focus points of the report are integration of pharmacists as health care providers that already exists, recognition of pharmacists as health care providers via legislation and policy, compensation mechanisms commensurate with the level of services provided, and evidence supporting the alignment of this model with health reform goals.

The report identified three demands within the health system that pharmacist-delivered patient care can help meet: providing care for chronic diseases, which are “the leading causes of death and disability in the United States”; increasing access to care to address “insufficient time for focused or comprehensive disease or medication management and other related health care issues”; and supplementing the primary care provider workforce, which has declined by 50% since 1997 among newly graduated U.S medical students.

“Pharmacists in USPHS have been positively affecting the lives of their patients while saving money for nearly 50 years,” Giberson said. “This report demonstrates the value pharmacists bring when they become full members of the health care team. Pharmacists are clearly an important part of the solution to rapidly escalating health care costs and to improving health care delivery.”

In the report, Giberson and his coauthors noted that pharmacists can provide the following services through collaborative practice agreements:

Perform patient assessment (subjective and objective data including physical assessment)
Have prescriptive authority (initiate, adjust, or discontinue treatment) to manage disease through medication use and deliver collaborative drug therapy or medication management
Order, interpret, and monitor laboratory tests
Formulate clinical assessments and develop therapeutic plans
Provide care coordination and other health services for wellness and prevention of disease
Develop partnerships with patients for ongoing (follow-up) care

“APhA is excited to see the amazing recognition of pharmacists as health care providers that this report has earned throughout the medical community, especially from Dr. Benjamin,” Thomas Menighan, BSPharm, MBA, ScD (Hon.), APhA CEO and Executive Vice President, said. “The report clearly demonstrates that pharmacists can increase quality and decrease costs when barriers are removed. The time has come for pharmacists to be recognized as health care providers and essential members of the health care team.”

The report specifically calls for lawmakers to “enact legislation to recognize and compensate pharmacists—reflecting a change in the pharmacy practice that has already occurred [emphasis in original].” The authors identified their major objectives as enlisting the support of the U.S. Surgeon General—which she offered in her letter to Giberson—and encouraging legislators and policy makers to “advance beyond discussion … of the expanded roles of pharmacist-delivered patient care and move toward health system implementation.”

Posted by Alex Egerváry (aegervary@aphanet.org) - see the original article by clicking here
January 9, 2012, 5:30 pm

Remington Honor Medal to go to director of St. Jude Children's Research Hospital

2012-01-24T14:41:00.001-08:00

Full Article
Jan 24, 2012
By: From staff reportsDrug Topics Community Pharmacists' Report

William Edward Evans, PharmD, director and CEO at St Jude Children’s Research Hospital, has been selected to receive pharmacy’s highest award, the Remington Honor Medal, the American Pharmacists Association (APhA) announced.

Evans was selected for his research with anticancer agents and pharmacogenomics, as well as his work with the advancement of the Memphis hospital. “Dr. Evans is a cutting- edge scientist who has made a difference in the lives of children throughout the world,” a colleague said about him, according to the APhA.

The Remington Honor Medal was named for eminent community pharmacist, manufacturer, and educator Joseph P. Remington.

Also, the APhA’s Academy of Student Pharmacists named Hewitt W. Matthews, PhD, dean and vice president for the Health Sciences and professor of Pharmaceutical Sciences, Mercer University College of Pharmacy and Health Sciences, as the winner of its Outstanding Dean Award.

Gary DeLander, PhD, executive associate dean and department chair, Pharmaceutical Sciences, Oregon State University College of Pharmacy, received the Outstanding Chapter Advisor Award.

Evans, Matthews, Delander, and other winners will be honored during the APhA Annual Meeting and Exposition in New Orleans, March 9-12, 2012.

Other APhA award winners:

Community Pharmacy Residency Excellence in Precepting Award – Melissa Somma McGivney, PharmD, FCCP, director, Community Practice Residency Program and associate professor of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy.

Distinguished Federal Pharmacist Award – Jannet M. Carmichael, PharmD, FCCP, FAPhA, BCPS, VISN 21 Pharmacy Executive for the VA Sierra Pacific Network covering Northern Nevada, Northern California, and Hawaii.

Distinguished New Practitioner Award – David R. Bright, PharmD, BCACP, assistant professor of Pharmacy Practice, Ohio Northern University Raabe College of Pharmacy.

Generation Rx Award – Megan E. Thompson, PharmD, director of Advanced Professional Pharmacy Experiences (APPE), interim associate dean for Professional and Graduate Education and associate professor of Pharmacy Practice, University of New Mexico College of Pharmacy.

Gloria Niemeyer Francke Leadership Mentor Award – Cynthia Boyle, PharmD, FAPhA, professor and chair of the Department of Pharmacy Practice and Administration at the University of Maryland Eastern Shore School of Pharmacy and Health Professions.

Good Government Pharmacist-of-the-Year Award – Patricia Freeman, BSPharm, PhD, clinical associate professor, Pharmacy Practice and Science Department and director, Professional Practice Programs at the University of Kentucky College of Pharmacy.

Good Government Student Pharmacist-of-the-Year Award – Kyle J. Hampson, PharmD candidate at Duquesne University Mylan School of Pharmacy.

H.A.B. Dunning Award – Novartis Vaccines and Diagnostics, Inc.

Honorary Member – S. Miles Rudd, MD, FAAFP, clinical director of the Indian Health Services, Warm Springs Health & Wellness Center.

Honorary President – Daniel A. Hussar, PhD, FAPhA, Remington Professor of Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia.

Hubert H. Humphrey Award - Stephen W. Schondelmeyer, PharmD, PhD, professor of Pharmaceutical Management & Economics, director of the PRIME Institute and head of the Dept. of Pharmaceutical Care & Health Systems at the University of Minnesota College of Pharmacy.

Hugo H. Schaefer Award – Jeffry N. Baldwin, PharmD, FAPhA, FASHP, vice chair for Education, and professor of Pharmacy Practice at The University of Nebraska Medical Center College of Pharmacy.

Third Anniversary of ICD-10 Rule

2012-01-23T08:11:00.001-08:00

Three years ago, on January 16, 2009, the U.S. Department of Health and Human Services published final rules mandating that all organizations covered by HIPAA upgrade to Version 5010 by January 1, 2012 and transition to ICD-10 coding sets byOctober 1, 2013. As a result of the enforcement discretion period for Version 5010, all organizations must complete their Version 5010 upgrade by no later than March 31, 2012. . Upgrading to Version 5010 is an important step to take before transitioning to ICD-10, which is quickly approaching.

To help with this transition, CMS has developed a number of resources available on the CMS ICD-10 website. These resources include:

Fact sheets , including: Ensuring a Smooth Transition to Version 5010, ICD-10 Transition: An Introduction, ICD-10 Basics for Medical Practices, ICD-10 FAQS, and Talking to Your Vendors about the Transition to ICD-10.
Implementation widget, which outline the steps to take to ensure compliance with Version 5010 and ICD-10, available in a widget format. CMS encourages you to download or share the widget and take advantage of printer-friendly versions of the timelines available for small provider practices, large provider practices, payers, and vendors .
Timelines: Printer-friendly checklists that complement the widget, which are available for small providers, large providers, payers, and vendors.

Keep Up to Date on Version 5010 and ICD-10.

Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!

Draft Affordable Care Act Federal Upper Limits

2012-01-23T08:10:00.001-08:00

The Affordable Care Act modified the previous statutory provisions that establish a Federal Upper Limit(FUL) on multiple source drugs. Effective October 1, 2010, the Social Security Act was revised to require that the Secretary calculate FULs as no less than 175 percent of the weighted average (determined on the basis of manufacturer utilization) of the most recently reported monthly average manufacturer prices (AMP). In order to facilitate this change, CMS is issuing draft FUL reimbursement files (for review and comment only), for multiple source drugs, including the draft methodology used to calculate the FULs in accordance with the Affordable Care Act. These draft FUL prices are based on the most recently reported monthly AMP and AMP unit data. For example, we used the monthly AMP and AMP unit data for covered outpatient drugs that manufacturers reported to CMS for the month of August 2011 to develop the files that we released in October 2011.

To begin our implementation of these changes, we are posting the draft FUL files (July 2011 [ZIP], August 2011 [ZIP], September 2011 [ZIP]) and October 2011 [2011] and the draft Affordable Care Act Federal Upper Limit Methodology and Data Elements Guide to the draft FUL files. We are not posting monthly AMPs for individual drugs on any of the draft FUL files. Rather, we are posting the weighted average of monthly AMPs in a FUL group. Further, we note that section 2503(d) of the Affordable Care Act specifies that the FULs amendments "shall take effect … without regard to whether or not final regulations to carry out such amendments have been promulgated by such date." Please note that the draft FULs do not apply to B-rated drugs.

Starting with the files that we post to our website in January 2012 (based on the monthly AMP and AMP unit data for covered outpatient drugs that manufacturers reported to CMS starting with the month of October 2011), we changed the information technology system and grouping methodology we use to establish a FUL Product Group and assign national drug codes (NDC) to each of those groups. This has alleviated the need for an Unmatched File.

We will accept comments (link to) on the draft Affordable Care Act FULs and the methodology used to calculate the FUL. Please submit your comments toFUL@cms.hhs.gov. We will consider all comments received, but we do not plan to respond to individual comments.

Following a period of releasing the FULS in draft format, CMS plans to publish the final Affordable Care Act FULs. At that time, the prior FULs calculated using the methodology at 42 CFR 447.332 (FUL Changes Made To Transmittal No.37 and Transmittal No.37 - FUL November 20, 2001), as in effect on December 31, 2006, under the authority of the Medicare Improvements for Patients and Providers Act of 2008 will no longer be in effect.

Federal Upper Limits Prior to the Affordable Care Act

In 1987, regulations limited the amount which Medicaid could reimburse for drugs with available generic drugs under the Federal Upper Limit (FUL) Program. These limits are intended to assure that the Federal government acts as a prudent buyer of drugs. The concept of the upper limits program is to achieve savings by taking advantage of the current market prices.

Until the passage of the Omnibus Budget Reconciliation Action of 1990 (OBRA '90), FUL could be established only if all versions of a drug product had been classified as therapeutically equivalent (A-rated) by the Food and Drug Administration (FDA) in its publication "Approved Drug Products with Therapeutic Equivalence Evaluations" and at least three suppliers were listed in the current editions of published national compendia. OBRA '90 expanded that criteria and permitted the establishment of a FUL for a drug product if there are three (or more) versions of the product rated therapeutically equivalent (A-rated) regardless of the rating of other versions (B-rated) and at least three suppliers are listed in the current editions of published national compendia.

On July 15, 2008, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Public Law 110-275, was enacted. As a result of this legislation, we are prohibited from taking any action, prior to October 1, 2009, to impose FULs for multiple source drugs established under 42 CFR 447.514(b) as published in the final rule on July 17, 2007. In accordance with the law, the specific upper limit under 42 CFR 447.332 (as in effect on December 31, 2006) applicable to payments for multiple source drugs shall continue to apply through September 30, 2009, for purposes of Federal financial participation. Accordingly, the Centers for Medicare & Medicaid Services (CMS) resumed publishing the FULs for multiple source drugs, using the methodology in 42 CFR 447.332 as in effect on December 31, 2006.

Effective December 15, 2010, CMS will not apply the FULs to B-rated drugs.

Growth in U.S. Health Spending Remains Slow in 2010

2012-01-16T08:10:00.001-08:00

Health spending growth at historic lows for second consecutive year

U.S. health care spending experienced historically low rates of growth in 2009 and 2010 according to the annual report of national health expenditures (NHE) published in the January issue of the journal Health Affairs.

Analysts at the Centers for Medicare & Medicaid Services (CMS) report in the article that the increase in spending for 2009 represents the lowest rate of increase in the entire 51 year history of the NHE. The low rate of growth, the data show, reflects lower utilization in health care than in previous years. The report notes that U.S. health care spending grew only 3.9 percent in 2010, reaching $2.6 trillion or $8,402 per person, just 0.1 percentage point faster than in 2009.

In 2010, as health spending growth remained low, growth in U.S. economy as reflected in gross domestic product (GDP) (4.2 percent) rebounded. As such in 2010, the health spending share of the overall economy was unchanged at 17.9 percent. In the past, this share has increased, rising over time from 5.2 percent in 1960.

“We have worked hard since the passage of the Affordable Care Act in 2010 to lower health care cost growth,” said Marilyn Tavenner, acting CMS administrator. “We believe that the tools in health reform will help keep health care cost growth low while improving the value of care for consumers.”

Key findings from the new report include:

· Household health care spending equaled $725.5 billion in 2010 and represented 28 percent of total health spending, slightly lower than its 29 percent share in 2007. Growth in total private health insurance premiums slowed in 2010 to 2.4 percent from 2.6 percent in 2009, continuing a slowdown that began in 2003. Despite this deceleration, for the first time in seven years, the growth in premiums exceeded the growth in insurer spending on health care benefits, with the net cost of insurance increasing by 8.4 percent or $11.3 billion in 2010. Out-of-pocket spending by consumers increased 1.8 percent in 2010, accelerating from 0.2-percent growth in 2009.

· Retail prescription drug spending (10 percent of total health care spending) grew only 1.2 percent to $259.1 billion in 2010, a substantial slowdown from 5.1-percent growth in 2009 and the slowest rate of growth for prescription drug spending recorded in the NHE.

· The federal government financed 29 percent of the nation’s health care spending in 2010, an increase of six percentage points from its share in 2007 of 23 percent, and reached $742.7 billion. Part of that increase came from enhanced Federal matching funds for State Medicaid programs under the American Recovery & Reinvestment Act which expired in 2011. Medicare spending grew 5.0 percent in 2010, a deceleration from growth of 7.0 percent in 2009.

· Medicaid spending increased 7.2 percent in 2010, slowing from 8.9-percent growth in 2009.

· The state and local government share of total health spending declined from 18 percent in 2007 to 16 percent in 2010 and totaled $421.1 billion, in part due to the temporary assistance in the Recovery Act.

· Hospital spending, which accounted for roughly 30 percent of total health care spending, grew 4.9 percent to $814.0 billion in 2010, compared to growth of 6.4 percent in 2009.

· Growth in private health insurance spending for hospital services, which in 2010 accounted for 35 percent of all hospital care, slowed considerably in 2010.

· Physician and clinical services spending, which accounted for 20 percent of total health care spending, grew 2.5 percent to reach $515.5 billion in 2010, slowing from 3.3-percent growth in 2009.

· Private businesses financed $534.5 billion, or 21 percent of total health spending in 2010, down from a 23-percent share in 2007.

The NHE report, prepared annually by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary, summarizes recent trends in health care spending based on the most current data sources. Available historically since 1960, the NHE represents the official estimates of total health care spending in the United States and measures annual health spending by the types of goods and services delivered (hospital care, physician services, retail prescription drugs, etc.), by the programs and payers that pay for that care (private health insurance, Medicare, Medicaid, etc.), and by the sponsors who are ultimately responsible for financing that care (private business, households, and governments).

Information in this report can be accessed at the following web location:

http://www.cms.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage

USPHS report calls for pharmacists to be recognized as providers

2012-01-13T11:17:00.001-08:00

Evidence-based outcomes provide evidence for expanded role; Surgeon General endorses report.

Original Article

In the report, Giberson and his coauthors noted that pharmacists can provide the following services through collaborative practice agreements:

Perform patient assessment (subjective and objective data including physical assessment)
Have prescriptive authority (initiate, adjust, or discontinue treatment) to manage disease through medication use and deliver collaborative drug therapy or medication management
Order, interpret, and monitor laboratory tests
Formulate clinical assessments and develop therapeutic plans
Provide care coordination and other health services for wellness and prevention of disease
Develop partnerships with patients for ongoing (follow-up) care

Posted by Alex Egerváry (aegervary@aphanet.org)
January 9, 2012, 5:30 pm

Drug shortages hit record levels in 2011; 2012 may not be much better

2012-01-10T09:51:00.000-08:00

Original Article
Jan 10, 2012
By: From staff reportsDrug Topics Community Pharmacists' Report

The number of drug shortages soared in 2011, and the organization that tracks shortages is concerned about similar shortages in 2012.

The University of Utah Drug Information Service (UUDIS), which works in partnership with the American Society of Health-Systems Pharmacists on drug shortages, found that 2011 medication shortages reached 267, which was 56 more than in 2010.

“I certainly hope that we don’t have another record-breaking year in 2012, but I won’t be surprised if we do,” said Erin Fox, manager of the UUDIS. Because manufacturing supply issues often take around a year to resolve, the industry may experience more of the same type of shortages this year.

“When companies have to close down manufacturing lines, it is not a quick fix. For example, most of Bedford Lab’s products [injectables that have been in short supply] will not be available until late 2012,” Fox said.

Hospira, American Regent, and Teva have also had supply problems recently. Hospira’s bupivacaine and Marcaine are currently in short supply due to manufacturing delays. Teva closed its injectable factory in Irvine, Calif., in April 2010, and is not yet back online.

Despite the glum outlook, the pace of drug shortages has been dropping, according to the UUDIS. “For the first 90 days of 2011, we were on a pace of a shortage a day. Luckily, that pace has decreased,” Fox said. She attributes the decline to the increase in FDA’s activities on preventing drug shortages.

Statins cost 4 times more in U.S. than in U.K.

2012-01-10T09:50:00.000-08:00

Original Article
Jan 10, 2012
By: From staff reportsDrug Topics Community Pharmacists' Report

There is now some data behind complaints that prescription drugs cost more in the United States than in other industrialized nations. A study in the current issue ofPharmacotherapy found that the cost for drugs used to lower cholesterol is more than 400% higher in the United States than in the United Kingdom.

The findings on the costs of statins are the first direct comparisons of prescription drug costs between the 2 countries. The study was done by the Boston University School of Medicine, Boston Collaborative Drug Surveillance Program.

Results are based on the MarketScan Commercial Claims and Encounters Database in the United States and the General Practice Research Database in the United Kingdom for the year 2005. The U.S. database represents patients under the age of 65 with private insurance; the U.K. database represents similar patients covered by the National Health System.

Statins were prescribed to about 32.7% of the U.S. sample compared to 24.4% for the U.K. sample. Annual U.S. costs ranged from $1,428 for simvastatin (Zocor, Merck, no generic available) to $314 for lovastatin (Mevacor, Merck, generic available). U.K. costs ranged from $500 for atorvastatin (Lipitor, Pfizer, no generic available) to $164 for simvastatin (Zocor, Merck, generic available).

Researchers found that the cost per pill was between 1.99 times higher (atorvastatin) and 8.69 times higher (simvastatin) in the United States compared to the United Kingdom for all statins. By combining the annual cost for each statin with the number of patients, the estimated cost for U.S. patients with private insurance was $69.5 million compared to $15.7 million for patients in the United Kingdom, more than 4 times more.

Generic availability had an effect on pricing, but did not overcome the general price differential between the 2 markets.

Simvastatin generic was approved in the United States in late June 2006. More than 60% of the U.S. market switched from the brand product to the generic over the next 6 months, reducing simvastatin spending by more than 50%. But despite the steep reduction in cost, U.S. patients continued to pay more than 4 times for simvastatin than similar patients in the United Kingdom.

Latest from the Center for Medicare and Medicaid

2012-01-03T10:13:00.001-08:00

Version 5010 Benefits and Resources

The Version 5010 compliance deadline remains January 1, 2012. Upgrading from Version 4010/4010A standards to Version 5010 is a critical step necessary for the ICD-10 transition, and must be implemented before ICD-10 implementation is possible.

Version 5010 offers great improvement over Version 4010/4010A; for example, Version 5010:

Greatly improves standardization of administrative data and supports both ICD-9 and ICD-10 codes sets;
Supports electronic submission of claims;
Provides greater specificity of clinical data and patient information; and
Has a more logical structure, which will assist in faster code selection and improved ease of use.

Version 5010 Resources
Please visit the Version 5010 and Latest News pages on the CMS ICD-10 website for resources to assist with the Version 5010 transition. Resources include:

Fact sheets about making a smooth Version 5010 transition, Version 5010 readiness, and Frequently Asked Questions on Version 5010
Implementation Handbooks tailored for Large Provider Practices, Payers,Small Hospitals, and Small/Medium Provider Practices
An interactive widget as well as printer friendly timelines for large provider practices, small provider practices, payers, and vendors

Keep Up to Date on Version 5010 and ICD-10.

Pharmacy’s top 10 news stories of 2011

2012-01-03T10:07:00.000-08:00

Click Here To View the Original Story

New drugs, pharmacogenomics among high points in year of extremes.

A year of dichotomies, 2011 saw a large number of new drug approvals—many of them important advances—but also drug shortages that are compromising therapy. Genomics and personalized medicine advanced even as staffing at anticoagulation clinics was reduced by new anticoagulants and research showed that warfarin self-monitoring is feasible. Here’s how 2011 looked through the lens of pharmacist.com.

1. New Drugs Galore: FDA approved some three dozen new chemical/biologic entities, including important new agents for cancers and orphan diseases. Two drugs, crizotinib for lung cancer and vemurafenib for metastatic or unresectable melanoma, were “breakthrough products for personalized medicine,” FDA said.

2. Medication Problems/FDA Reactions: FDA reacted to medication problems with near-daily announcements of warnings and alerts. Important actions included lowering of daily acetaminophen doses to 3 g, restricting the amount of that agent in combination prescription products, and monitoring the safety of drospirenone.

3. Health Care on the Docket: Important new parts of the health care reform law were implemented, including the final regulations for accountable care organizations. With the law headed for the U.S. Supreme Court, the justices dealt with an unusually large number of cases involving pharmacy and drugs—prescription data mining, manufacturer duty to warn about adverse effects of generic drugs, and Medicaid policies.

4. Genomics & Personalized Medicine: Cancers and asthma were among the conditions for which pharmacogenomic approaches and personalized medicine were studied. An APhA white paper on integrating pharmacogenomics into pharmacy practice via medication therapy management (MTM) was published. But the deal is not done, as barriers remain.

5. Rx Drug Overdose Epidemic: The growing number of deaths and hospitalizations caused by prescription drug overdoses constitute an epidemic, the CDC and White House said. Prescription drug abuse was targeted by this year’s National Drug Control Strategy from the White House Office of National Drug Control Policy.

6. Antibiotic Resistance: Another CDC call to action was for conservation of antibiotics in the face of growing resistance, while health-system pharmacists managed the problem with antibiograms and novel dosing protocols.

7. Ups & Downs of Dietary Supplements: Vitamin D continued to surprise, playing a role in a wide variety of conditions. Many other dietary supplements faltered as controlled trials tested their effects and editorialists called for better regulation of these products. Even saw palmetto failed to hold up in clinical studies of the herb’s urologic effects.

8. Putting on the Pounds: The obesity epidemic continued to worsen, and a disconcerting study of hormonal changes in people who have lost weight demonstrated how difficult it is to keep extra pounds off. Influenza vaccine was shown to be particularly needed for morbidly obese patients.

9. Pharmacists’ Future Roles: Whether future pharmacists will practice in medical homes is not yet clear, but the need for MTM by a drug therapy expert was evident in many studies. Pharmacist care was effective for blood pressure control, cardiovascular disease, diabetes, and intensive care. Numerous studies looked at services to older patients, nursing home residents, and Medicare Part D beneficiaries. A study in Connecticut showed MTM saved money.

10. Vaccines a Key: Immunization services have become a mainstay of offerings in community pharmacies of all types. In vaccine research, influenza vaccine can help patients with asthma, rotavirus vaccine reduced health care costs in infants and young children, and extending the administration of human papillomavirus vaccine may provide new options.

Related resources on www.pharmacist.com

Posted here by L. Michael Posey, BSPharm (mposey@aphanet.org), and Diana Yap (dyap@aphanet.org)
December 30, 2011, 12:30 pm EST

Medicare Fee-For-Service (FFS) Policy Regarding 90 Day Discretionary Enforcement Period for Non-Compliant HIPAA Covered Entities

2011-12-27T08:13:00.001-08:00

The Centers for Medicare and Medicaid Services (CMS) announced it would not initiate enforcement action with respect to any HIPAA covered entity that is non-compliant with Version 5010, NCPDP, NCPDP D.0 and 3.0 standards until 90 days after the upcoming January 1, 2012 compliance date. Although compliance will not be enforced for Version 5010 until April 1, 2012, it is important to continue to take the necessary steps to complete your transition to Version 5010 as soon as possible.

What the 90 Day Discretionary Enforcement Period Means For Medicare Fee-For-Service
Medicare FFS has experienced significant increases in 5010 production transactions during the last few months. However, there are many submitters that have tested but not taken the step to move into production for 5010 and D.0. In addition, there are many submitters that have not yet initiated testing with their Medicare Administrative Contractor (MAC). Therefore, to ensure that submitters and receivers continue to make progress, Medicare FFS is planning to take the following steps for submitters and receivers of Medicare Part B and Durable Medical Equipment (DME) transactions:

In December 2011, submitters and receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cutover to the 5010/D.0 versions.
Submitters and receivers that have not yet tested will be notified in December 2011 that they must submit their transition plans and timelines to their MAC within 30 days.
MACs will notify the submitters and receivers, but submitters/receivers have the responsibility to notify the providers they service.

Note: Submitters and receivers of Medicare Part A transactions will follow the same action plan starting 30 days after Part B and DME.

Keep Up to Date on Version 5010 and ICD-10. Please visit the CMS ICD-10 website for the latest news and resources, and to download and share the implementation widget today!

Pharmacy Computer Services Newsletter

2011-12-20T16:05:00.000-08:00

The Quarterly Cursor

Issue No. 1

In This Article

A New Day Dawns

A sneak peak into 2012.

Rx3000 Product Tip

A tip for the m/i field rejections during online billing.

Industry News

What's happening in pharmacy and software?

Why "Quarterly Cursor"?

A cursor indicates where the next character will be typed in a document. PCSI is beginning a new page in 2012, so we felt it was appropriate.

News

CMS Extends D.0 compliance deadline

http://tinyurl.com/7ngs4gz

ICD-10 Conversion Tips

http://tinyurl.com/czvtbte

Contact Us

For demonstrations of the Rx3000 and other products

541-471-7270

For customer support

541-471-7274

Join Our Mailing List

A New Day Dawns

2012 will mark Pharmacy Computer Services' 34th year developing and selling pharmacy management software. Many things have changed since our five pharmacist-founders first sat down with a developer in 1978 to bring their ideas to life.

Some of our biggest and most exciting changes have happened only recently. For example, last year at this time each of our customers were running a different version of the application, creating challenges for the pharmacy as well as for our support, development, and implementations teams. It was also at this time last year that we began to make significant adjustments to ultimately change this direction.

Consequently, by January 1, 2012 (and for the first time in 34 years) every customer will be running the same version of the Rx3000 Pharmacy Management System. From now on, customers will receive scheduled updates throughout the year. No more application versions to keep track of. No more waiting in line for general updates.

The Q4 2011 upgrade includes several enhancements to the current application like: NCPDP D.0 compliance, BIN/PCN search, pre-editing, and additional billing features designed to make financial reporting simpler. Additionally, last month PCSI launched a beta version of a new and improved inventory product hosted in the cloud. We refer to this product as "Mazama Inventory".

We chose the name Mazama because of the history associated with it. Mount Mazama was a large volcano on Oregon's Cascade Range (only an hour drive from our office). Estimated to have exploded in 5,677 B.C. Mount Mazama became what we know today as Crater Lake - one of the deepest and most beautiful lakes in the world (see the picture above). To those of us at PCSI this signifies a new and dynamic beginning following unprecedented progress in 2011.

As we embark on a new year, we work diligently to continue the progress of 2011 and bring those changes from our office to our clients' pharmacy. By the end of March 2012, we anticipate the release of new technologies and services including the market release of both Mazama Inventory and an IV module. These updates will be communicated via regular email updates and newsletters.

Rx3000 Product Tip

Issue: I'm getting a rejection related to the m/i fields during online billing. What do I do?

To edit the carrier prompts:

Go to Main -> File Maintenance -> Carriers
Enter the third party attached to the carrier you need to edit
Select your carrier (the carrier information should populate once you do this)
To add a prompt, go to the prompts field and add your prompt. Separate your prompt fields by commas.
Select the OK button to save. Cancel out of any third party screens that may still display.
You should see your prompt changes without having to exit the application by reprocessing the prescription.

If you have any other concerns or need further explanation, please contact Support.

New York law stops mail-order pharmacy mandate

2011-12-19T10:46:00.000-08:00

Publish date: Dec 20, 2011
By: From staff reportsFull Article

Independent pharmacies in New York can breathe a sigh of relief with the passage of the Anti-Mandatory Mail Order Bill, which allows consumers the choice of where to fill their prescriptions.

This bipartisan bill (5502-B), introduced by Assemblyman Carl E. Heastie (D-Bronx) and State Senator George D. Maziarz (R-62nd Senate District), was signed into law by New York Governor Andrew Cuomo (D), enabling prescriptions to be filled at a local pharmacy or through mail-order without any added copayments or fees.

The National Community Pharmacists Association (NCPA) praised the passage of the legislation and the leadership of Governor Cuomo, the original sponsors, and the efforts of Pharmacists Society of the State of New York (PSSNY). PSSNY stated that the requirement to use mail-order pharmacies had resulted in more than $5 billion leaving the state every year, according to an NCPA statement.

"Enactment of this bill into law is a signal to community pharmacists across the country as to what can be accomplished nationally and in their own states by working together through grassroots activism. In this instance, legislation that protects patient choice and helps to align the interests of the patient, payer, plan, and the pharmacist is now state law," according to NCPA.

Majority of emergency department visits are due to adverse drug reactions, study finds

2011-12-15T10:41:00.001-08:00

Dec 8, 2011
By: From staff reportsDrug Topics Hospital Pharmacists' ReportFull Article

A surprisingly few medication classes are responsible for the majority of emergency department (ED) visits due to adverse drug reactions among U.S. adults aged 65 years and older, according to a study published in the November 24 issue of the New England Journal of Medicine.

The study, lead by Dr. Daniel Budnitz, director of the U.S. Centers for Disease Control and Prevention's medication safety program, found that there were an estimated 265,802 ED visits for adverse drug events among U.S. adults aged 65 years or older each year from 2007 through 2009. Over one-third of these visits (99,628) required hospitalization. Nearly half of the hospitalizations for adverse drug events (48.1%) were among adults aged 80 years and older.

Nearly two-thirds of the hospitalizations (67%) were due to 4 medication classes used alone or in combination: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). The authors found these drugs remained consistently the most commonly implicated when stratified by age group (65 to 74 years, 75 to 84 years, and 85 years and older) and sex. And of hospitalizations involving warfarin, insulins, or oral hypoglycemic agents, nearly all hospitalizations were the result of unintentional overdose. High-risk medications were implicated in only 1.2% of hospitalizations.

Dr. Budnitz and colleagues used adverse-event data between 2007 and 2009 from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project.

“The finding that more than 66,000 emergency hospitalizations were for adverse effects of a few, commonly prescribed antithrombotic and antidiabetic agents has important implications for efforts to reduce harm to patients and to reduce healthcare costs,” the authors wrote.

Community pharmacists key to improving pain management

2011-12-15T10:40:00.000-08:00

Dec 15, 2011
By: Fred Gebhart, Contributing EditorDrug TopicsVolume 155, Issue 12 Full Article

More than 200 medications crucial in fighting conditions such as leukemia, breast and colon cancer, and infectious diseases are in short supply in the United States. As a result, compounding pharmacists and pharmacies that have the resources to compound sterile injectable formulations and other forms of drugs are being called on to help deal with these shortages.

Community pharmacists have a tremendous opportunity to help patients manage pain more effectively. That's the message from pain and palliative care specialist Scott Strassels, PharmD, PhD, BCPS, assistant professor of pharmacy, University of Texas at Austin. Strassels explored pain management in the community setting with Health Mart pharmacy owners in San Francisco during McKesson's annual ideaShare trade show.

Pain is everywhere

Scott Strassels

The problem, he said, is that pain afflicts about 116 million people in the United States. That's about one-third of the population.

"Pain is much more common than we realize," Strassels told Drug Topics. "Even people who don't look like they are presenting in pain may have to deal with it on a regular basis, for themselves or a family member. There is a significant opportunity for pharmacists to get involved."

Pain is everywhere. Cardiovascular disease, cancer, and stroke, the 3 leading causes of death in the United States, are associated with pain. There is pain in arthritis, HIV/AIDS, depression, trauma injuries, and diabetes. Three of the 20 most common reasons for outpatient medical visits in the United States involve complaints of pain to the stomach, head, or back.

Fully 86% of postoperative patients have moderate-to-extreme pain. In addition, because the majority of surgeries are outpatient procedures, most patients suffering surgical pain are served by community pharmacy. The data suggest that pharmacists could do a better job of supporting these patients than they are receiving now. Of all unexpected hospital readmissions, 38% are for pain.

Need for patient awareness

Analgesia gaps are common when pain treatment changes or when patients are discharged, said Strassels. Because pain is largely a subjective experience, there is no good way to predict who will have pain. Part of the problem for patients is that they may not realize that pain can be managed. The common attitude is that surgery and other medical procedures are painful and nothing can be done to ease the discomfort.

Patients also may not realize that their community pharmacists can be advocates for more appropriate, more effective pain management. And pharmacists themselves may not recognize the potential for greater involvement in more effective pain management.

Ask more questions

"Beyond your standard counseling on how to take medication, you can throw in information and questions that are important," Strassels said. "Add things like 'Here's what you can expect from your medication, and here's what it can't do.' Tell patients what to do if their pain med isn't working as well as they think it might. Help them lose the fear of asking if this level of pain relief is really as good as it gets. Tell them up front than an opioid is likely to cause constipation.

"Remind patients that there are a lot of pain medications, and if this one isn't right for any reason, they should come back and talk. There is a tremendous opportunity for community pharmacists to tell people that they don't have to suffer and that they don't have to suffer in silence."

New products for pharmacists: Rx, OTC, and generics (December 2011)

2011-12-15T10:39:00.000-08:00

Dec 15, 2011
Drug TopicsVolume 155, Issue 12 Full article

New drugs

FDA has approved Watson's Androderm transdermal system of testosterone replacement in 2-mg and 4-mg formulations. The smaller-sized patch reflects a 20% reduction of active ingredient from the original strength. (www.androderm.com / 800-272-5525)

ApoPharma's Ferriprox (deferiprone) is approved to treat iron overload resulting from blood transfusions in thalassemia patients who showed inadequate response to previous chelation therapy. (www.ferriprox.com / 800-706-5575)

Archimedes Pharma announced the availability under a REMS program ofLazanda (fentanyl nasal spray) for the management of breakthrough pain in cancer patients 18 years or older who are already receiving and are tolerant to opioid therapy for underlying persistent cancer pain.(www.lazanda.com / 866-435-6775)

FDA has approved Abbott's supplemental New Drug Application forLupron Depot-PED (leuprolide acetate for depot suspension) in 1-month formulation to treat central precocious puberty. Labeling now includes long-term (18 years) data, including outcomes specified for puberty, height, and reproductive function. (www.lupronped.com / 800-621-1020)

New generics

FDA has approved a 60-mg tablet of fluoxetine (generic for Lilly's Prozac) manufactured by Edgemont Pharmaceuticals. Indicated for major depressive disorder, obsessive compulsive disorder in adults and pediatrics, and bulimia nervosa and panic disorder in adults, Fluoxetine is already available in a variety of dosage strengths.(www.edgemontpharma.com.)

FDA has approved the first olanzapine tablets (generic for Lilly's Zyprexa) and olanzapine orally disintegrating tablets (generic for Zyprexa Zydis) to treat schizophrenia and bipolar disorder. Dr. Reddy's and Teva USA will manufacture the generic olanzapine tablets. The orally disintegrating generic will be manufactured by Apotex, Dr. Reddy's, and Par. (908-203-4900)

OTC

Ferrer's CerAxon Oral Solution, a medical food containing citicoline, is available for dietary management of brain ischemia resulting from stroke or traumatic brain injury in patients who have difficulty swallowing. It is available without prescription, by special request, at pharmacies and requires a doctor's supervision. (www.ceraxon.com / 877-423-7296)

Photo courtesy of Garden Botanika

Garden Botanika's Skin Renewing Face Treatment combines alpha and beta hydroxy acids with an amino acid/salicylic acid compound to help reduce the appearance of fine lines and wrinkles. Product contains no parabens, gluten, alcohol, glycols, PEGs, phthalates, or artificial dyes. (www.gardenbotanika.com)

Abbott Nutrition's Glucerna Hunger Smart meal-replacement shakes and snack bars for diabetic patients feature low-glycemic, slowly digestible carbohydrates designed to help minimize blood sugar spikes. (www.glucerna.com / 800-227-5767)

Photo courtesy of Nordic Naturals

From Nordic Naturals: Arctic Omega Fortify, a food- and water-soluble, micro-encapsulated cod liver oil in powder form. Neutral-flavored formula can be mixed into drinks or food. A single-serving pack contains 500 mg of EPA+DHA, an important omega-3 source of heart, joint, and immune-function support. (www.nordicnaturals.com / 800-662-2544)

Photo courtesy of Johnson & Johnson

Listerine's newest zero-alcohol mouthwash, Total Care Zero, with less intense flavor, provides all the healthy-mouth benefits of the Listerine Total Care, restoring enamel, helping to prevent cavities, strengthening teeth, and killing germs that cause bad breath. (888-222-0182)

AHRQ releases toolkit to help reduce adverse drug events

2011-12-15T10:36:00.001-08:00

Dec 15, 2011
By: From staff reportsDrug Topics Hospital Pharmacists' ReportFull article

The Agency for Healthcare Research and Quality (AHRQ) has released a new toolkit to help hospitals improve their medication reconciliation processes to reduce adverse drug events.

The Medications at Transitions and Clinical Handoffs (MATCH) Toolkit provides detailed, step-by-step by instructions on how to improve reconciliation, including planning, pilot testing, implementation, and evaluation.

One important key to improving hospitals’ reconciliation processes is to enhance communication and support from leadership. “The concept of medication reconciliation is not that sophisticated. The foundation of the project is support from leadership within the organization. Being explicit and targeted about what activities and tasks that those different roles can do to help support such a program is a very helpful thing that this toolkit does: it lays it all out,” said Jeff Brady, MD, patient safety portfloilo lead for the Center for Quality Improvement and Patient Safety at AHRQ.

The MATCH Toolkit also explains how to evaluate medication reconciliation programs with the right technology. “Data collection can help refine a pretty well-functioning program…[so there is] continuous improvement,” Brady said.

Hospital pharmacists and other health professionals can use the Toolkit’s website and workbook to “walk themselves through” the reconciliation improvement process, Brady said.

ASHP Midyear in New Orleans

2011-12-13T11:51:00.000-08:00

This year's ASHP Midyear show was nothing short of a good time both in the booth and in New Orleans.

In the booth:
OK, business first. As is tradition, we hosted a side-by-side booth with our long time partner Emporos Systems. This allowed ASHP attendees to view the Emporos MerchantSoft point of sale system and the newest release of the Rx3000 Pharmacy Management System.

Emporos' proved why its MerchantSoft system is a market leader. The simple process and multiple short cut keys makes processing a sale quick and easy.

We were excited to show off the new features of the Rx3000 Pharmacy Management System such as BIN/PCN search, pre-editing, enhanced reporting and more. These additions to our system allow pharmacies to do more within the Rx3000 application than ever before.

Our current and soon-to-be customers also got to see a demo of our new inventory platform and other technologies set to come out in 2012!

In New Orleans:
Who can forget New Orleans? The lights of Bourbon Street, the views of the Mississippi, and the local cuisine made the post-event activities equally as memorable. The jambalaya, gumbo, and even the alligator certainly aren't items you see every day in Southern Oregon!

We look forward to unveiling even more at next year's show in Las Vegas at Mandalay Bay.

Read more about PCSI at www.Rx3000.com
Read more about Emporos at www.emporos.net

Opposition to ESI/Medco merger is expressed at Senate hearing

2011-12-13T08:29:00.000-08:00

Dec 13, 2011
By: From staff reportsDrug Topics Community Pharmacists' ReportRead full article

Pharmacy chains and organizations continue to actively oppose the merger of Express Scripts Inc. and Medco Health Solutions.

At the recent hearing on the merger, held by U.S. Senate Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights, drug store executives and representatives from the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) testified.

Mike Bettiga, chief operating officer of the NACDS-member Shopko Stores Operating Company, testified that the merger would limit patients’ access to services and addressed pharmacy benefit managers’ (PBMs’) “deceptive” practices. “There is little proof that PBMs pass along their purported savings to health plans, employers, or consumers,” Bettiga said. “A mega-PBM would have an increased ability to engage in similar egregious conduct to the detriment of consumers, payers, and pharmacy providers.”

Sue Sutter, RPh, owner of 3 community pharmacies in Wisconsin and NCPA member, also urged the Federal Trade Commission to block the merger. She said it would reduce competition in the delivery of pharmacy benefits, leading to higher prices; limit patient choices on where they fill their prescriptions; and threaten the existence of community pharmacies.

Sutter projected “unparalleled market concentration in the PBM industry with the merged entity controlling anywhere from one-third to two-thirds of all prescriptions filled in community pharmacies. This market dominance and significant reduction in competition will result in reduced choices for federal and state programs and third-party payers, decreased patient access to pharmacy services, and ultimately lead to higher prescription drug costs paid by plan sponsors and consumers.”

How the Version 5010 Changes Modify Your Transition

2011-12-09T17:12:00.001-08:00

90-Day Period of Enforcement Discretion for Compliance with Version 5010 Deadline

The Centers for Medicare & Medicaid Services (CMS) recently announced a 90-day enforcement discretion period for all HIPAA covered entities regarding the Version 5010 (ASC X12 Version 5010) transition.

The compliance deadline for the implementation of Version 5010 is still January 1, 2012; however, CMS will not initiate enforcement action until March 31, 2012. CMS made this decision based on industry feedback that many organizations and their trading partners were not yet ready to finalize system upgrades for this transition.

CMS encourages you to continue internal testing and external testing of Version 5010 transactions with trading partners to ensure compliance for Version 5010. Although enforcement action will not be taken prior to March 31, 2012, it is important that you continue to move forward to meet Version 5010 requirements as soon as possible.

During the 90-day enforcement discretion period, the Office of E-Health Standards and Services (OESS) will continue to accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards beginning January 1, 2012. HIPAA covered entities that are subject to these complaints must produce evidence of either compliance or an established plan to become compliant within the enforcement discretion period. In addition to testing, if you have not yet created a transition plan for Version 5010, you should do so in order to meet these compliance deadlines.

Please visit the CMS ICD-10 Website Latest News page for additional resources and more information on this enforcement discretion period.

Keep Up to Date on Version 5010 and ICD-10.

Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!

First generic version of cholesterol-lowering Lipitor approved

2011-12-01T10:46:00.001-08:00

Dec 1, 2011
By: From staff reportsDrug TopicsFull Story

FDA approved the first generic version of the cholesterol-lowering drug Lipitor (atorvastatin calcium tablets).

Ranbaxy Laboratories has gained approval to make generic atorvastatin calcium tablets in 10-mg, 20-mg, 40-mg, and 80-mg strengths. The drug will be manufactured by Ohm Laboratories in New Brunswick, NJ.

"This medication is widely used by people who must manage their high cholesterol over time, so it is important to have affordable treatment options," said Janet Woodcock, MD, director of FDA's Center for Drug Evaluation and Research. "We are working very hard to get generic drugs to people as soon as the law will allow."

Not all cholesterol in your blood is bad. There are 3 kinds of blood cholesterol: high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. HDL (good cholesterol) helps keep cholesterol from building up in the arteries. LDL (bad cholesterol) is the main source of cholesterol buildup and blockage in the arteries, which can prevent proper blood flow to your heart and lead to a heart attack. Triglycerides can lead to hardening of the arteries.

Atorvastatin is a statin, a type of drug that lowers cholesterol in the body by blocking an enzyme in the liver. Atorvastatin is used along with a low-fat diet to lower the LDL cholesterol and triglycerides in the blood. The drug can raise HDL cholesterol as well. Atorvastatin lowers the risk for heart attack, stroke, certain types of heart surgery, and chest pain in patients who have heart disease or risk factors for heart disease such as age, smoking, high blood pressure, low HDL, or family history of early heart disease.

In the clinical trials for Lipitor, the most commonly reported adverse reactions in patients were: inflammation of the nasal passages, joint pain, diarrhea, and urinary tract infection.

Mylan, Teva, and Dr Reddy’s Laboratories are among generic-drug makers seeking FDA approval to sell generic Lipitor after Ranbaxy’s 6-month exclusivity expires, according to US court filings.

For more information on FDA: Understanding Generic Drugs, click here.

E-Prescribing Is Safe And Efficient, But Barriers Remain

2011-12-01T10:36:00.000-08:00

Main Category: Pharmacy / Pharmacist
Also Included In: IT / Internet / E-mail
Article Date: 30 Nov 2011 - 1:00 PST

Full Story

Physician practices and pharmacies generally view electronic prescribing as an important tool to improve patient safety and save time, but both groups face barriers to realizing the technology's full benefit, according to a study funded by the U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ). The study is published online today in the Journal of the American Medical Informatics Association.

Electronic prescribing, or e-prescribing, has multiple potential benefits, including helping to reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions. The study focused on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed.

Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. However, prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists particularly drug name, dosage form, quantity, and patient instructions continue to pose problems.

"Physicians and pharmacies have come a long way in their use of e-prescribing, and that's a very positive trend for safer patient care and improved efficiency," said AHRQ Director Carolyn M. Clancy, M.D. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients."

Researchers at the Center for Studying Health System Change, Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies.

Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than a quarter of the community pharmacies reported that they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently.

Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.

The study noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology in response to federal incentives. Physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40 percent of all prescriptions to pharmacies electronically, excluding prescriptions for controlled substances, as part of the HITECH Act of 2009.

Other key study findings include:

About three-quarters of physician practices reported problems sending new prescriptions and renewals electronically to mail-order pharmacies. Many practices were unsure which mail-order pharmacies accepted e-prescriptions and believed that, even when a mail-order company did accept them, the process was unreliable.

Pharmacies noted the need to sometimes manually edit certain prescription information, such as drug name, dosage and quantity. One common cause reported by both physicians and pharmacists was that physicians must select medications with more specificity when e-prescribing and make decisions about such factors as packaging and drug form. Such decisions had typically been made by pharmacists for handwritten prescriptions.

Nearly half of pharmacies reported that patient instructions typically had to be rewritten for patients to understand them.

The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," concludes that a broad group of public and private stakeholders will need to work together to address these issues.

Enforcement Discretion Regarding Compliance with New HIPAA Standards

2011-11-28T09:24:00.001-08:00

Enforcement Discretion Regarding Compliance with New HIPAA Standards

This Informational Bulletin relates to the enforcement of data transaction standards. The Centers for Medicare & Medicaid Services (CMS) has announced today that it would not initiate enforcement action with respect to any HIPAA covered entity non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after the January 1, 2012 compliance date. Notwithstanding CMS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012.

For more information, visit: Cms.hhs.gov

PCSI at ASHP in December

2011-11-22T08:44:00.001-08:00

Pharmacy Computer Services, Inc. will in New Orleans, LA from December 4th to December 8th for the American Society of Health System Pharmacists 46th Midyear Clinical Meeting and Exhibition.

PCSI will be located at booth space 425.

This year, PCSI will be demonstrating a brand new inventory system, sharing plans for 2012 including D.0 and electronic prescribing for controlled substances (EPCS) and sharing the new features in the most recent release of the Rx3000 Pharmacy Management System.

To schedule a time to visit the booth, please email us.

Pharmacy Invoices Show Flaws in Drug Pricing Benchmarks

2011-11-17T09:39:00.001-08:00

Pharmacy Invoices Show Flawsin Drug Pricing Benchmarks

Anew Office of Inspector General (OIG) report provides pretty compellingevidence that pharmaceutical reimbursement models need to change.

http://www.drugchannels.net/2011/11/pharmacy-invoices-show-flaws-in-drug.html?m=1

Patients Have Security Concerns On Data Sharing

2011-11-17T08:59:00.001-08:00

Patients Have Security Concerns On Data Sharing
New report by PwC reveals what consumers think about data sharing, privacy and security, online consultations, social media in healthcare, and more.
By Marianne Kolbasuk McGee, InformationWeek
November 17, 2011
URL: http://www.informationweek.com/news/healthcare/security-privacy/231903174

Xigris Withdrawn After Study Shows No Benefit in Severe Sepsis

2011-11-16T16:16:00.001-08:00

Xigris Withdrawn After Study Shows No Benefit in Severe Sepsis

http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=November+2011&i_id=787&a_id=19668

Drug manufacturer Eli Lilly and Co., has withdrawn drotrecogin alfa (Xigris) from the market in the wake of the release of the PROWESS-SHOCK trial, which found no statistically significant reduction in 28-day all-cause mortality in patients treated with the sepsis drug compared with placebo. The company advised that patients currently taking drotrecogin alfa should stop use, and physicians should not start new patients on the medication.

Healthcare ICD-10 Conversion: One Expert's Tips

2011-11-16T15:53:00.000-08:00

Healthcare ICD-10 Conversion: One Expert's Tips
As the ICD-10 conversion deadline approaches, consider this advice from Booz Allen Hamilton's Beth Mahan to make the best of a painful transition.
By Nicole Lewis, InformationWeek
November 14, 2011
URL: http://www.informationweek.com/news/healthcare/policy/231902916

How Secure Are Your Clinicians' Mobile Devices?

2011-11-16T15:49:00.000-08:00

How Secure Are Your Clinicians' Mobile Devices?
Doctors and nurses have been swept away by smartphones and tablets, but they create one gigantic headache for IT managers. Here's some practical advice on how to cope.
By Marianne Kolbasuk McGee, InformationWeek
November 16, 2011
URL: http://www.informationweek.com/news/healthcare/mobile-wireless/231903089