Thursday, June 5, 2008

Walgreen to Pay $35 Million in Drug Switching

Source: The Philadelphia Inquirer Publication date: 2008-06-05

Jun. 5--Walgreen Co. has agreed to pay $35 million to settle claims that it improperly switched patients' prescription drugs to more expensive ones in order to increase its reimbursement from Medicaid, the U.S. Justice Department announced yesterday.
New Jersey and Pennsylvania will receive part of the money from the case, which was filed by a whistle-blower who sued major pharmacies in two other high-profile cases that netted $87 million in settlements.
Walgreen, of Deerfield, Ill., operates more than 5,000 retail pharmacies throughout the United States. It has about 3,500 employees in the Philadelphia region.
From 2001 to 2005, Walgreen switched the prescriptions for Medicaid patients who were prescribed 150-mg or 300-mg tablets of ulcer-fighting Ranitidine to more expensive capsules; prescriptions for 10-mg or 20-mg capsules of the antidepressant Fluoxetine to more expensive tablets; and prescriptions for 5-mg tablets of the Parkinson's drug Eldepryl to more expensive capsules, according to yesterday's settlement.
The Justice Department said that by switching the prescriptions, Walgreen substantially increased its Medicaid reimbursement while providing no additional medical benefit to the affected patients -- in violation of federal and state regulations.
The suit was filed in 2003 by Bernard Lisitza, a licensed pharmacist in Illinois, on behalf of federal and state governments.
Lisitza, who was temping for another pharmacy and filling some prescriptions for Walgreen's, contended in his suit that the drug-switching programs he observed by Walgreen's were schemes to increase pharmacy profits at taxpayers' expense, and that they resulted in no medical benefit to patients.
Recent generic drug-switching cases by Lisitza resulted in a $37 million settlement earlier this year with CVS Caremark Corp., owner of CVS pharmacies, and a $50 million settlement in late 2006 with Omnicare Inc., the nation's largest pharmacy for nursing homes.
Lisitza's attorney, Michael Behn, said his client was fired after reporting the drug switching at Omnicare and could find only temporary work far from his home in Northbrook, a suburb of Chicago.
"It's one thing to substitute a less-expensive generic for the brand name," Behn said in an interview yesterday from his Chicago office. "It's a different story when a pharmacy is switching to a more expensive drug."
Lisitza will get about $5 million under the Walgreen's settlement. The federal share of the settlement is about $18.6 million.
Forty-six states and Puerto Rico will share about $16.4 million under separate agreements. New Jersey will receive $1.2 million and Pennsylvania about $9,000.
Last month, pharmacy-benefits manager Express Scripts Inc., of St. Louis, agreed to pay $9.5 million under an agreement with the attorneys general of 28 states, including Pennsylvania, over switching patients' cholesterol-drug brands to control costs. The attorneys general claimed that the switches resulted in Express Scripts' profiting by getting drugmaker rebates, and that such cost savings were never passed on to consumers.
Walgreen shares closed unchanged yesterday at $36.34 on the New York Stock Exchange.
Contact staff writer Suzette Parmley at 215-854-2594 or sparmley@phillynews.com.
-----
To see more of The Philadelphia Inquirer, or to subscribe to the newspaper, go to http://www.philly.com.
Copyright (c) 2008, The Philadelphia Inquirer
Distributed by McClatchy-Tribune Information Services.
For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
NYSE:WAG, NYSE:CVS, NYSE:OCR, NASDAQ-NMS:ESRX,
A service of YellowBrix, Inc.
Publication date: 2008-06-05© 2008, YellowBrix, Inc.

Thursday, May 29, 2008

Law prevents proposed restriction on offender use of medical marijuana

Contributed by Bob" ,Internet:
NEWSRELEASE Montana Department of Corrections * 1539 11th Avenue
Helena, Montana 59620 * 444-3930 * Fax: 444-4920
FOR IMMEDIATE RELEASE
Thursday, May 29, 2008
CONTACT: Diana Koch, 444-9593

Corrections: Law prevents proposed restriction on offender use of medical marijuana
A proposed change in Department of Corrections rules imposing standard conditions for offenders on parole or probation will not include a restriction on physician-approved use of marijuana for medical purposes, the agency said Thursday.

Diana Koch, chief legal counsel for the department, said the decision to exclude the marijuana provision from the rules does not mean the department endorses the use of marijuana. "The use of marijuana is not in the best interest of the public or of offenders, who are responsible for rehabilitating themselves while under supervision in the community, she said.

The wording of the 2004 law allowing doctor-authorized marijuana use prevented adoption of the rule, she explained. "Our hands are tied by the way the initiative-passed law was written. As a result, those who have broken law cannot be subject to this reasonable restriction."

Proponents of marijuana use by convicted felons testified at administrative rules hearings that the medical marijuana act prohibits any penalty for using medical marijuana, regardless of an offender's criminal history. After considering the comments, the department acknowledged that the law does not contemplate permitting such restrictions, even for people on probation or parole.

"The process of reviewing and adopting administrative rules works," Koch said. "The public was heard.

"I'm not sure the voters of Montana understood that the medical marijuana act was going to go this far," she added. "There is the very real possibility that a person convicted of drug distribution can get a medical marijuana card, and there is nothing probation and parole officers can do about it."

During the rules process, the Department of Corrections proposed prohibiting all persons on probation or parole from using marijuana, even if they obtained a medical marijuana card. Offenders could have obtained a judicial exemption for medical reasons and the proposed restriction would have ended when offenders completed their sentences.

Most of the remaining rule changes affecting conditions of supervision make more specific existing regulations regarding prohibitions on gambling, firearms and alcohol; allowing searches of an offender's home and random testing of offenders for alcohol or illegal drug use; and offenders' payment of court-ordered fines and restitution. Those rules are scheduled to take effect June 13.
##
________________________________________
A service of the Montana Education Telecommunications Network - METNET
A division of the Montana Office of Public Instruction
Free E-Mail for certified Montana teachers
"ttp://www.metnet.mt.gov/

Saturday, May 3, 2008

PharmAssist/ ARM Update

The PharmAssist Program was created by the 2005 legislature to provide Montana citizens with an avenue to receive one-on-one consultations with a licensed pharmacist about the prescription drugs they are taking.

The addition ACORD has been waived: The ACORD was initially an addendum to the required personal liability insurance. It specifically requested that language be included that the "State of Montana is included as additional insured." Since DPHHS is utilizing personal service contracts that are limited to $5k they are able to remove that requirement as well as the extra $150 cost.

May 12th marks the end of the 45 days that pharmacists have to fill out and return their contracts and supporting information with a copy of their liability insurance. For program information contact Roger Citron, RPh at Montana Medicaid, rcitron@mt.gov or call (406) 444-5951.

Please act quickly and return your contracts with a copy of your personal liability insurance!!! Please visit the DPHHS website for more information on the PharmAssist program at http://www.dphhs.mt.gov/prescriptiondrug/index.shtml

Montana Pharmacy Association Members (MPA) Can Receive Insurance from Pharmacists Mutual Insurance Company: The Montana Department of Public Health and Human Services has informed us that pharmacists wishing to participate in the PharmAssist program must obtain and include a copy of their personal liability insurance when they return their signed contracts.

MPA members interested in the PharmAssist Program should know that our endorsed insurance provider, Pharmacists Mutual Insurance Company, has a policy that meets the needs of this program with an annual premium of only $144. Pharmacists Mutual recognizes that the policy is suitable for an employed pharmacist who will engage in no more than 10 hours per week of outside consulting. (Pharmacists Mutual also has a competitively priced policy for those employed pharmacists who will do more than 10 hours per week of outside consulting.)

Pharmacists Mutual Insurance Company dedicates itself to understanding the pharmacy profession. This premium demonstrates Pharmacists Mutual's understanding of our duties and exemplifies the reason the Montana Pharmacy Association exclusively endorses Pharmacists Mutual. To learn more about this offer, contact Kimberly Dornbier of Pharmacists Mutual at (800) 247-5930 ext. 7441.

To become a Montana Pharmacy Association Member and take advantage of these great prices, not to mention all the other membership benefits, please visit: http://www.rxmt.org for details.

Special thanks to all those at DPHHS, Montana Medicaid, Montana Pharmacy Association, the University of Montana, and Pharmacists Mutual for all their hard work on the PharmAssist program.

In addition, please view the proposed rule for Montana Medicaid:

The department is proposing amendments to ARM 37.86.1105 that would implement a 1.67% increase to the Medicaid pharmacy dispensing fee as allowed by legislative appropriation. This would increase the maximum dispensing fee from $4.86 to $4.94 for in-state providers.

The department is proposing amendments to this rule that would allow Medicaid
pharmacy providers to dispense generic maintenance medications in amounts sufficient for a 90-day supply or 100 units, whichever is greater. Other medications would be dispensed in quantities as great as a 34-day supply

For example, the current prescription cost for a 34-day supply of lisinopril 10 mg is $6.97 total ($2.03 for the drug, plus a $4.94 dispensing fee). Multiplied by 3 months, it would cost the department $20.91 for 102 days of medication. The recipient's cost share would be $1.00 each time, a total of $3.00. If the recipient were to pick up 100 doses of this prescription, the cost would be $10.91 ($5.97 for the cost of the drug plus a $4.94 dispensing fee). The recipient's cost share would be $1.00 for that prescription.

Please view the proposed rule on PDF pages 130-134 at: http://www.sos.mt.gov/ARM/Register/archives/MAR2008/MAR08-08.pdf

Please do not call MT Medicaid on this issue: Interested persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to Rhonda Lesofski, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on May 22, 2008. Comments may also be faxed to (406)444-1970 or e-mailed to dphhslegal@mt.gov. The department maintains lists of persons interested in receiving notice of administrative rule changes. These lists are compiled according to subjects or programs of interest. To be included on such a list, please notify this same person or complete a request form at the hearing.

Sunday, January 27, 2008

First Data Bank/ Medi-Span settlement

01/22/08

Community pharmacy learned a lot about the future of AWP at a Federal Court Hearing today. Judge Saris of the Federal District Court of Massachusetts informed those in attendance that she would not approve several aspects of the proposed First Databank/Medi-Span Settlement, but did believe pharmacies were to some degree unjustly enriched at the expense of consumers. With that said, it is clear that the one hurdle that Judge Saris has in approving the Settlement is her concern for putting independent pharmacies out of business. Several times she referenced this fact and ultimately decided that she would consider a 5% roll-back on just those drugs that were involved in the initial "inflation scheme". This would decrease the number of brand name drugs that would be impacted by the AWP roll-back from 8,000 to 1,400 NDCs. Judge Saris went further, however, and will appoint an independent economic advisor to the Court for the limited purpose of determining the impact of this potential new Settlement option on independent pharmacies. Plaintiff's counsel provided data that suggested the 1,400 NDCs would still account for approximately 40% of the brand name drugs sold in 2006. Judge Saris also appeared to be amicable to allowing pharmacies more time than 60 days to renegotiate contracts in the event of any settlement agreement. In addition, Judge Saris ruled out the Settlement provision that would require First DataBank and Medi-Span to stop publishing AWP within two years, indicating that she did not want to be the ongoing arbiter of drug pricing in the United States. Judge Saris also ruled out the provision that would establish a "data room" for third party payers to access in any future AWP lawsuits.
It is important to note that Judge Saris commented, "I have never in my career as a federal judge had such an outpouring of concern from objectors as I did in this case". Objectors heard at the Hearing included attorney's for IPC, NCPA, NACDS, ASCP and PCMA. We still have work to do, but things look much better than just a week ago.


Mark E. Kinney, R.Ph.
Vice President of Government Affairs
Independent Pharmacy Cooperative

*Thanks Mark for all your input...we look forward to future Government News updates.

Thursday, January 17, 2008

Multiple C-II Ruling…Pharmacist’s Ability to Change a C-II???

I would like to apologize to everyone for starting a “state-wide panic” and I would especially like to apologize to the Board of Pharmacy and Compliance Officer for making their lives so difficult these last few days. I would like to reassure everyone that the Board of Pharmacy and Compliance Officer are checking into the matter of a pharmacist’s ability to change a scheduled II prescription with a verbal confirmation and documentation with the DEA in which to have something official IN WRITING to report to you. Unfortunately, my contact at the DEA, whom is a Programs Analyst, Liaison and Policy Section, OD for the DEA in Washington, DC reported to our Compliance Officer that she is not authorized to answer his questions, even though she freely spoke to me about the new policy stating that a “pharmacist can not change anything on a C-II,” which is published on MT RPh NEWS.

Everything I published to you was factual and checked multiple times with multiple questions; however, it was single sourced and needs further investigation. Unfortunately, the Chief, Liaison and Policy Section, at the DEA I really wanted to speak with has not returned any of my 3 phone calls since I started calling him on December 26th. The Program Analyst that is in Marks division was nice enough to promptly return my phone calls on December 28th and January 10th and answered my questions with confidence; however, she won’t produce anything in writing. I encourage everyone to relax about the issue and to use their best judgment until the Montana Board of Pharmacy reaches a decision to publish. As soon as I am able to get something IN WRITING from someone a little higher up at the DEA to post on the site with the assistance of the Board of Pharmacy, or a statement from the Board of Pharmacy, I will do so…of course this may take a while, so I urge you to use the same sound judgment and rules that we have currently been using until that time comes.

So at this point in time, just realize that the Federal Register, which was finalized on December 19th, does state:

“In addition, because the CSA states that prescriptions for schedule II controlledsubstances must be written (21 U.S.C. 829(a)), the essential elements of theprescription written by the practitioner (such as the name of the controlledsubstance, strength, dosage form, and quantity prescribed, and-in the case ofmultiple prescriptions under this Final Rule-the earliest date on which theprescription may be filled) may not be modified orally.”

And that the matter is being looked into by Montana’s finest. The Pharmacist Letter is also covering this issue regarding the “discrepancy” so they may have an answer in their February Article. I encourage you to use your best judgment until matters are even further clarified officially IN WRITING. In addition, I would also encourage anyone who has questions about this issue to contact the Board of Pharmacy or Compliance Officer if needing further advice on dispensing under this new ruling, especially if you are thinking of turning a customer away do to an error on the prescription that you are able to clarify and document. Thank you!

Eric Shields, Pharm.D.

Monday, January 14, 2008

Newsletter Updates

The Board of Pharmacy has just recently updated the Newsletter site to include November’s BOP Newsletter as well as the January BOP Newsletter…you may use this link… (http://www.mtpharmacist.org/) to read both of them. Please view these newsletters for updates on Laws, Notices, etc. Since the format had changed to pharmacists having to obtain the Newsletters off the BOP site, it has been my experience, through interactions with colleagues, that fewer BOP Newsletters are reviewed, therefore, I have created a link on http://www.mtpharmacist.org/BOP Newsletters”. However, regarding the November Newsletter, please be aware that I confirmed with the DEA on December 28th, 2008 and January 10th, 2008 that pharmacists are NO LONGER ABLE TO CHANGE C-II PRESCRIPTIONS…please read at MT RPh News.

The Drug Information Newsletters have changed slightly since the new updates to the University of Montana websites…you can now easily use the links on http://www.mtpharmacist.org/ to navigate to the newsletters, home page, as well as the Skaggs home page. In addition, don’t hesitate to use the Drug Information Services (DIS) for hard to find questions? Use the DIS Services for Healthcare Professionals.

If you don’t receive the Montana MedicaidClaim Jumper Newsletter” it is easily viewed from http://www.mtpharmacist.org/ in the MT Medicaid section as well as Montana Medicaid’s: Preferred Drug List (PDL), Passport to Health Links, CMS Links, OPA, RPh Provider Website, etc. Don’t forget to get all your NPI numbers…use the NPI Registry at http://www.mtpharmacist.org/ to find all those hard to find NPI’s you are missing and will be required to use for reimbursement!!!

Please feel free to email me, comment, add suggestions, give input on topics/ notices, give your opinion on matters, or whatever…on the record or off the record…anything to improve this network or bring pharmacists together! You may email me at grizrph@hotmail.com or use the anonymous form. Thank you!!!

Eric Shields, PharmD

Friday, January 11, 2008

DEA Proposed Rule of DEA 222 Forms

The proposed new format for DEA Form 222 will employ a single-sheet
form. In executing a transaction of a schedule I and/or II controlled substance, a DEA registrant will process the new single-sheet form in a similar manner to the processing of the current three-part form. The change in processing will be that the single-sheet form will have to be copied rather than having the copies pre-printed. DEA will continue to preprint and issue the original form.

The new form is being initiated to improve security and to allow better ease in handling. The new form will have enhanced security features over the current three-part form. DEA will preprint the new form on sturdier paper with a special embedded watermark of the DEA emblem making it more difficult to copy for counterfeit purposes. If photocopied, the photocopy
of the new form will display the DEA emblem and the statement ‘‘Copy’’ to hinder counterfeiting. It is anticipated that the new form will be more convenient for DEA registrants to utilize. The old three-part form format was created more than thirty years ago and the processing of a transaction with carbon copies is an outdated concept. Today, new office
technology exists such as laser printers and photocopiers which will allow DEA registrants greater ease in utilizing the single-sheet form.

The single-sheet form will be beneficial for DEA as well. The equipment used to print the interleaved carbon forms is old, and finding replacement parts and otherwise maintaining the equipment is costly, difficult, and time-consuming. Please read full part of Federal Register.