Pharmacy Edge

Pharmacy Edge Magazin

Issue

Nine

e

November/2016

Psychological Factors of Behavior Drug Security in the Independent Pharmacy: A Safe Choice The Pharmacist’s Guide to Preventing Medical Errors

SO THEY

SAY

The Path to Becoming Specialty Pharmacy’s Most Trusted Strategist

The Pharmacy Choice online network is collectively the most popular destination on the internet for pharmacy professionals.

The Pharmacy Choice online network consists of three primary web portals PharmacyChoice.com, RxSchool.com and RxCareerCenter.com. Each of these portals serves a specific purpose while leveraging the marketing power of the others.

Combined, these portals are the most visited websites in the pharmacy industry.

Pharmacy Choice ®

RxSchool AMN Healthcare Education Services

RxSchool offers the best Live Internet education available through the popular RxSchool Live seminar room. Our leading internet delivery solution provides pharmacy professionals with a convenient way to get quality live education that qualifies for live CE credit.

The Pharmacy Choice web portal provides pharmacists, pharmacy technicians, students and others in the pharmacy industry with the most comprehensive suite of web-based tools and information available, including drug information, industry news, career opportunities and educational programs.

Rx Career Center is home to the largest job board for pharmacy professionals. Job candidates can search career opportunities using a secure and confidential system. Employers have the ability to upload their open jobs and search résumés.

www.rxschool.com

www.pharmacychoice.com

www.rxcareercenter.com

For more information please contact Trevor Oxley  (877)223- 6121  trevor.oxley@pharmacychoice.com

Table of Contents Issue 09 / November, 2016

04

Presidents Message

06

The Path to Becoming Specialty Pharmacy’s Most Trusted Strategist

09

PBMs in the Crosshairs

10

Psychological Factors of Behavior

12

The Complexities of the Drug Supply Chain Security Act

16

PHARMACIST WATCHDOG GROUP CALLS OUT DONALD TRUMP AND HILLARY CLINTON

18

Drug Security in the Independent Pharmacy: A Safe Choice

19

SO THEY SAY

20

The Pharmacist ’s Guide to Preventing Medical Errors

22

Is Transparency Possible?....

Yes!

President’s message Joshua Pirestani Dear Friends, Welcome to issue 9 of the Pharmacy Edge magazine. This issue will showcase a pharmacist’s guide to preventing medical errors, discussions about drug security in Independent pharmacies, and Psychological factors of behavior. Information about how APPA has aligned its goals with FisherBroyles, LLP to bring Industry awareness on the PBM crisis is also discussed.

In addition, the American Pharmacy Purchasing Alliance is pleased to announce our new strategic alliance with Rx Career Center, which is part of the Pharmacy Choice family. Teaming up with Rx Career Center will provide our members with the resources to search and post for new jobs.

APPA will also be opening the nominations for the APPA industry awards next month aimed at acknowledging the commitment, dedication, and excellence for distributors, wholesalers, manufac-

4 pharmacy edge

turers, vendors, pharmacy technicians, pharmacists and pharmacy buyers.

Following several concerns from the members, APPA will be launching a Group Purchasing Solutions (GPS) division early next year and this will allow members to save and provide better patient care.

Lastly, on behalf of the APPA team, and at this time of Thanksgiving season, our thoughts turn gratefully to all our members and readers with warm appreciation.

Have a wonderful Thanksgiving.

Subscribe to our Pharmacy Edge Magazine at: http://joinappa.com/pharmacy-edge-magazine/ For more information, contact info@joinappa.com if you have any questions!

Joshua Pirestani President.

Something BIG is about to happen!

APPA Group Purchasing Solutions (GPS) will help navigate your independent pharmacy to better savings and patient care on January 2, 2017.

Email us at info@joinappa.com to be added to our interest mailing list. www.joinappa.com.

The Path to Becoming Specialty Pharmacy’s Most Trusted Strategist President and CEO Suzette DiMascio, CHE, CMCE, CPC, started CSI Specialty Group in 2002 to help connect clients to strategies that would change their lives. What began as a niche company with a specialization in talent acquisition for specialty pharmacy has evolved into a globally recognized consulting firm to many of the world’s most recognized specialty pharmacy

manufacturers, brands, independent operations and health systems.

“I started CSI because I had a belief that if I could assemble a passionate, patient-driven team to come together to heighten the industry’s knowledge of specialty pharmacy, we could change the world,” says DiMascio. Now, with more than a century of collective

experience helping entrepreneurs, manufacturers, and health systems build, expand and operate specialty pharmacies of all shapes and sizes, CSI Specialty Group is the most recognized change-agent within the industry.

Along the way, DiMascio became an industry icon and distinguished thought-leader in specialty pharmacy.

Suzette DiMascio, President of CSI Specialty Group (right), with son Collin Cooley(center) and husband Timothy Cooley (left).

6 pharmacy edge

CSI Specialty Group President and CEO Suzette DiMascio, CHE, CMCE, CPC

We are here to help build market assets, hire the right people and launch integrated specialty pharmacies with a patient-first focus.

She has been named “the queen of specialty pharmacy” by the APPA and thanks to the success rates and consistently high client satisfaction scores, CSI has staked claim as the industry’s most trusted strategist - but it didn’t happen overnight.

“We’re passionate about success, and committed to creating relationships that match the best and brightest organizations with the tools and talent they need to succeed, whether that’s an orphan drug manufacturer, a large health system or a small oneoff operation in a small community,” says DiMascio.

“Our philosophy has always been to provide clients with a customized strategy and to establish lasting, mutually beneficial relationships. It’s this desire to deeply understand their business and tailor solutions that differentiate us in this industry.”

The Importance of People With experience spanning 100 years and representing expertise from organizations like Accredo, Pfizer, Express Scripts, Prime Therapeutics and more, CSI Specialty Group leverages deep executive relationships and institutional knowledge to cultivate excellence, whether strategizing a successful specialty pharmacy buildout or consulting on how best to acquire the top talent to staff a new specialty pharmacy.

“We recognize how vital a data-driven strategy is to sustainable success for organizations of every size,” says DiMascio. “Coupled with our unique background in talent acquisition and consulting, we’re able to combine the numbers with one of the key differentiators that promotes continued success: people.”

DiMascio and her team recognize, all things being equal, that a strong team with top talent is what will separate one specialty pharmacy from another offering similar products and services. That’s why their philosophy for helping clients drive sustainable growth and deliver top quality care to patients starts and success starts and ends with people.

“We’re dedicated to providing a comprehensive, holistic view of what an organization needs to accomplish in order to compete in this changing healthcare space, so our services are customized to fit the needs of every client,” says DiMascio. “We believe talent is a true component of any great company, and that perspective enables us to make a significant impact on business strategy and organizational growth through all of our services.”

Award-Winning Consulting Services Identifying the right talent is critical, but you must also have a winning

formula when it comes to strategic planning and execution. Whether leveraging CSI’s industry leading consulting team to build a health system’s specialty pharmacy, or expanding an existing specialty pharmacy into new therapeutics arenas, CSI possesses the skill, knowledge and know-how to get clients where they need to be in order to provide a competitive offering in the marketplace.

“We offer a complete program to help our clients attract and maintain the business they desire through our customized consulting and workforce planning initiatives,” says DiMascio. “And, because our foundation is rooted in talent something no other consulting firm can claim - we help clients get to where they want to go with the very best possible team around them.”

The group was named one of the Top 50 Growing Companies in Florida in 2014 by GrowFL and a Top 5 Fastest Growing Firm by Consulting Magazine in 2015 thanks to a growth rate of 639 percent.

“With integrity as our cornerstone, our teams of seasoned, industry professionals continually strive to position CSI Specialty Group as an organization of impeccable service and exceptional results - all teamed with a strong passion and

pharmacy edge

7

determination toward excellence.”

specialty pharmacy for health systems.

Customized Strategies Unlock Potential “We believe if you have the best strategy and the best people, you’re destined for success,” says DiMascio.

“By linking a client’s business strategy to their people strategy, that’s what unlocks a true competitive advantage and differentiator.”

“From working with manufacturers and health systems to develop their market access strategy, to building outpatient hubs and selecting the right specialty pharmacy provider for their unique population, clients can count on the CSI team to help them develop the right program to enhance the patient’s journey,” says DiMascio. “We are here to help build market assets, hire the right people and launch integrated specialty pharmacies with a patient-first focus.”

Consulting Services include, but are not limited to: specialty pharmacy readiness assessments; launch planning and implementation; operational strategy; clinical and adherence programs; sales and marketing preparedness; training and development platforms; management mentorship programs; URAC/ ACHC/ CPPA accreditation assistance; and private equity introductions and liquidity evaluations.

Resources for Manufacturers and Health Systems Recently, CSI expanded its team to help even more health system and manufacturers of rare and orphan drugs open successful specialty pharmacies. DiMascio and the team at Johns Hopkins have been speaking collaboratively at conferences to promote the importance of building a

8 pharmacy edge

DiMascio and her team also host the leading weekly Specialty Pharmacy Podcast on iTunes. The show offers news, discussion, insights and interviews with specialty pharmacy experts and decision makers.

Suzette’s favorite crown, of course, is being the Queen of her family. She and her husband, Tim Cooley, can usually be found in the fall, cheering on their beloved West Point Black Knights Football team and spending time with their son, Collin Cooley, a West Point cadet.

Whether tackling the specialty pharmacy industry or tackling the pressures of West Point, it seems success is no stranger to this family.

PBMs in the Crosshairs PBMs in the As recently reported in the Wall Street Journal (“Drugmakers Point Finger at Middlemen for Rising Drug Prices”), prescription drug manufacturers are increasingly laying the blame for skyrocketing pharmaceutical prices on the so-called “middlemen” in the drug distribution life-cycle. Pharmaceutical executives, from Mylan CEO Heather Bresch to Pfizer Chief Executive Ian Read, are pushing back firmly on accusations that the blame for the rising cost of drugs in the U.S. rests solely with the manufacturers.

They are instead accusing Pharmacy Benefit Managers (PBMs) of acting as the primary drivers of price increases for drugs.

The CEOs cite companies like Express Scripts, Caremark, and OptumRx and their near stranglehold

Brian E. Dickerson, Esq. brian.dickerson@fisherbroyles.com 202.570.0248

on drug formularies and the practice of wresting huge rebates from manufacturers as the true causes of higher drug costs. As noted in our prior client alert, “PBMs and Drug Pricing: Congress and Major U.S. Employers Start to Unravel the Hidden Pricing Mechanisms of PBMs,” a number of entities—including Congress—are also taking note of the PBM business model and its deleterious effects on drug prices. PBMs control not only pharmaceutical company access to their customers via formularies, but often keep consumers, pharmacies, and drug manufacturers completely blind as to the actual costs of the drugs through their rebate programs. The entry of PBMs into the specialty pharmacy business (particularly in the realm of mailorder drugs) and the management

Anthony j. Calamunci anthony.calamunci@fisherbroyles.com 419.376.1776

of patient assistance programs are also serving to distort the market in ways that have only wound up damaging consumers.

While many independent pharmacies, patient-advocacy groups, and state and federal committees and task forces call for greater transparency in PBM pricing practices, actual solutions to the problem appear to be thin on the ground. As the issues wend their way through the courts and halls of government, the FisherBroyles Pharmacy Law team will continue to track issues of importance to pharmacies, including matters related to PBM investigations and litigation. We welcome your questions, so please do not hesitate to contact any one of the following attorneys:

Nicole H. Waid nicole.waid@fisherbroyles.com 202-906-9572

Amy L. Butler amy.butler@fisherbroyles.com 419.340.8466

pharmacy edge

9

Psychological Factors of Behavior Last month we discussed motivational factors. This month, we take a look at how perceptions influence our decisions. A motivated person is ready to act, but how the person acts is influenced by his or her own perception. Perception is the process by which people select, organize, and interpret information to form a picture of their world.

Did you know that people are exposed to an estimated 3,000 -

5,000 advertising messages every day? It is impossible for everyone to pay attention to it all - so we tend to focus on just those things that mean something to us and develop perceptions about brands that we favor, as well as those we dislike.

Because of this near constant flow of ads, it is important to remember that it may take some time for your marketing message to sink in and even longer to change someone’s

perception of your pharmacy.

Offering relevant, as well as, a variety of products and services, consistently providing exceptional customer service and developing relationships with your patients are ways to solidify your place in the perception people hold of your pharmacy.

For more information or if you have any questions, be sure to contact your GRX Marketing rep.

With the influx of new and current customers, lets dig a bit more into some of the psychological factors that play a part in consumer behavior - to help you understand what goes on in your customers’ minds.

10 pharmacy edge

Would You Give Your Marketing a Thumbs Up? 2016 is almost over, how did your marketing work this year?

Did you reach the right people? Not Sure?

If you don’t know what the right strategy is, give us a call. Now is a great time to refocus and get ready for 2017. With our program, your designated Marketing Specialist will not only give you ideas to grow your business, but also implement most of them too! With more than 18 years of pharmacy marketing experience, we know what works.

To learn more, contact Nicolle McClure at nicolle.mcclure@grxmarketing.com or 515-280-2913.

www.pharmacymarketing.com @grxmkt

GRX Marketing

The Complexities of the Drug Supply Chain Security Act Debunking the Myths Brought to you by InfiniTrak

W

hile the rollout of the FDA’s Drug Supply Chain Security Act (DSCSA) will continue for the next ten years, there are many regulations that are in place, and being enforced right now. Compliance is a complicated business, and there are a lot of questions – and some misinformation – that need to be addressed.

The current FDA requirements under the Drug Supply Chain Security Act (DSCSA) make it more important than ever that independent pharmacists understand their role as a dispenser in the supply chain. In addition to managing patient medications, pharmacists also serve as the front line of defense to ensure safe pharmaceuticals are dispensed through the supply chain.

While it is vital that pharmacists work with their wholesalers to accurately track and trace products, it is equally important that pharmacists understand their unique responsibilities and how they differ from what wholesalers may be doing on their behalf.

“This new law is only for wholesalers, not me.”

12 pharmacy edge

Wholesalers have specific requirements for compliance, but they are different than the requirements for other dispensers, including pharmacies, hospitals, nursing homes, assisted living facilities, and physicians selling retail products from their offices. It’s important for pharmacists to work with their wholesalers, but not lose sight of their own unique compliance requirements.

“I am not clear on what the requirements of this law are.

I keep good records, so, I think I’m probably already compliant, right?”

Good record keeping is an important first step, but the particulars of DSCSA compliance are complex and require close attention to detail. There are three central requirements.

1. Transaction Date Capture/Retention: Trading Partners must be able to receive track and trace transactional data and store the information with ready access for 6 years.

2. Verification: All purchasers or sellers of pharmaceutical products, called “trading partners”, are required to verify that their trading partners are properly licensed under federal or state law.

Manufacturers, wholesale distributors and dispensers need to be properly licensed to do business in states in which they buy or sell products.

3. Quality Inspection and Reporting:Trading Partners must establish a process to inspect,

investigate and quarantine any suspect or potentially adulterated or counterfeit product and quickly communicate this information up and down the supply chain.

“I’ve never come across a suspect product. That’s likely for larger, city pharmacies in areas of high fraud. I don’t have to worry about this part of the law.”

DSCSA was created in response to the increasing threats to the nation’s drug supply from theft, counterfeiting, and fraud.

Increasingly, these problem are impacting pharmacies big and small, urban and rural.

In order to be fully prepared, and fully compliant, each pharmacy needs to have documentation of its best practices.

“I have my policies and procedures in my head. I don’t really need to have them officially documented. No one has ever asked me for formal policy documents.”

To be fully compliant, every pharmacy is required to document its procedures.

Best practices include the ability to: Process to inspect, investigate & quarantine any suspect, adulterated or counterfeit product “Promptly” conduct any investigations to verify the authenticity of a product in question Quarantine any suspect items until their authenticity can be verified Notify trading partners/FDA of potential suspect product Respond to product information requests from FDA or state regulators within 2 days

“I borrow and lend with other pharmacies but that doesn’t require any special process.”

Just as wholesalers are required to provide transaction data for all products covered under the law, pharmacy to pharmacy transactions require the same. Sale of product to another dispenser (e.g., neighboring pharmacy/hospital) requires delivery of outgoing transaction data along with the product.

For more information visit

www.infinitrak.us pharmacy edge

13

Technology with infinite reach, helping pharmacists improve patient care while ensuring DSCSA compliance.

The current FDA requirements under the Drug Supply Chain Security Act (DSCSA) make it more important than ever that you understanding your role as a dispenser in the supply chain. As you manage patient medications, you also serve as the front line of defense to ensure safe pharmaceuticals are dispensed through the supply chain. DSCSA is a complex set of regulations. InfiniTrak is a cost-effective software solution designed to help you fulfill your role in compliance - putting you in the driver’s seat, controlling your information, ensuring your compliance, and freeing up time to spend on your customers.

Let APPA help you understand your role with the latest regulations. Understand your unique responsibilities and how they differ from what your wholesalers may be doing on your behalf.

There’s a difference. Know your role!

REGISTER HERE!

SUBSCRIBE TO OUR MAGAZINE.

SUBSCRIBE

PHARMACIST WATCHDOG GROUP CALLS OUT DONALD TRUMP AND HILLARY CLINTON Medicare Part D Patients Must Pay $750 for Nexium While a $50 Generic is Available.

16 pharmacy edge

PHOENIX, AZ (October 17, 2016) – During the second presidential debate, audience member Ken Karpowitz asked, “Affordable Care Act … is not affordable. Premiums have gone up, deductibles have gone up, copays have gone up, prescriptions have gone up, and the coverage

has gone down. What will you do to bring the cost down and make coverage better?”

Pharmacists United For Truth and Transparency (PUTT), a watchdog organization that monitors abuse in the pharmacy industry, has the answer: Pharmacy Benefit Managers, or PBMs, are driving up prescription costs.

PBMs act as third party intermediaries for prescription drug programs between pharmacies and health plan enrollees (employees of private companies, government agencies,

Three of the largest PBMs CVS Caremark, Optum, and Express Scripts - currently control more than 80% of prescription drug coverage in the United States which impacts more than 200 million Americans.

as well as state medicaid). Three of the largest PBMs - CVS Caremark, Optum, and Express Scripts - currently control more than 80% of prescription drug coverage in the United States which impacts more than 200 million Americans. They currently allege to help reduce costs by managing pharmacy benefits, however increasingly the largest PBMs have been called out by both insurers and legislators like Congressman Doug Collins and Buddy Carter on questionable pricing, unfair contracting strategies and passing on costs to plans and patients that makes it difficult to fully understand where the money goes in the supply chain.

PUTT claims one example is the prescription rebate “pay to play” scheme that benefits the manufacturers and PBMs at the expense of patients. Prescription rebates are deals between pharmaceutical manufacturers and PBMs where the bigger the rebate the manufacturer promises the PBM, the more likely the PBM is to ensure the manufacturer’s product has preferential placement on the formulary (or lower tier). Brand manufacturers provide rebates to PBMs for their brand products regardless of whether there is a generic, cheaper alternative in that class of medications. The best example of this is the prescription drug Nexium.

Currently, Nexium brand name costs upwards of $750 and the generic, alternative costs on average approximately $50.

Patients may not immediately feel the pinch in their pockets because of Medicare Part D coverage.

However, most patients have a coverage gap which means coverage for medication is allotted to a certain amount, usually $2000 or more, where they then go into the “donut hole” and have high out of pocket Rx expenses. If a patient has filled more than $2000 worth of medication in a year, their copay may increase from $5 - $20 to half the amount of the brand name medication being

filled. This means patients may find themselves in a situation where their initial copay of $10 for a 90 day supply of Nexium will exponentially increase to an out of pocket cost of $350 or more. Because patients covered by Medicare Part D and Medicaid do not directly pay for the cost of their medications despite being in or even exceeding the coverage gap, taxpayers are left with the burden of paying for brand name medications that easily could have been replaced with cheaper, generic alternatives.

The EpiPen drug hike exposed part of the problem when Mylan Pharmaceuticals CEO attempted to expose how PBMs, brokers, and insurers pocketed more than $280 per prescription within the drug supply chain. The payor pays more in the end, the patient pays a higher copay or higher cost of the medication, and the rebates may or may not go back to the ultimate payor. Yet, in standard contracts with PBMs, providers are forbidden to discuss these tactics and pricing abuses with the ultimate payers or to any one else.

While the Nexium or EpiPen story is not unique in healthcare today, PBMs are quick to refute claims that they are adding to the overall prices of expensive brand drugs with Rx rebates. However, PUTT believes this is happening for most expensive brand drugs— including insulins, inhalers and even expensive speciality medications. Interestingly enough, these are also the fastest growing part of Rx drug plans.

Local legislators, as well as, organizations like PUTT and the National Community Pharmacists Association have called for more investigation into PBMs pricing tactics and have demanded for transparency in prescription drug pricing in America. PUTT believes this is a big step to bringing down the cost of prescriptions for all Americans.

pharmacy edge

17

Drug Security in the Independent Pharmacy: A Safe Choice impact of internal drug diversion and abuse costs $72.5 billion a year.

Research indicates 12 - 16% of all healthcare workers may have or had an addiction to prescription drugs at some point in their career. Whether to prevent theft or diversion, addressing this epidemic starts with securing access.

Christopher von Zwehl, Rx Security Specialist and Senior Vice President Scripps Safe Since the CDC declared an epidemic of prescription drug abuse in the United States in 2010, numerous programs and initiatives have been implemented to control access to narcotics. These have included prescription Drug Monitoring, increased DEA activity, addiction treatment funding, changes in prescription guidelines, drug take back programs, crackdowns on pill mills and rescheduling of hydrocodone to schedule II. Unfortunately, despite the push to decrease access, the demand for prescription drugs remains high. In a climate where it is harder than ever to access narcotics and where demand remains high, it’s not surprising to see a continuing and growing problem with burglaries and robberies. – Mike Warren, Risk Manager Christopher provides some insight into a key opportunity to protect against these threats.

In 2015, there were 916 pharmacy robberies, a 25% increase since the CDC declared an epidemic in 2010.

According to the DEA the estimated

18 pharmacy edge

Under current regulation, Title 21 CFR 1301.75, controlled substances shall be stored in a securely locked, substantially constructed cabinet. A simple key locked wooden cabinet does not protect practitioners from internal drug diversion or an armed robbery. If something goes wrong, the DEA’s substantial requirements checklist outlines the factors they will use to evaluate a practitioner’s security system, which can still be found non compliant.

While the initiatives that have been implemented since 2010 to curb access are important, accessibility remains the number one contributing factor to abuse of prescription drugs.

Pharmacists and Doctors who carry controlled substances should first secure them in a steel pharmacy or narcotics safe. Time delay features incorporated into safe design provide additional advantages by deterring robberies and providing an audit control access system to prevent diversion.

Installing a safe is a key step to addressing America’s opioid crisis and protecting practitioners. Adding enhancements like a time delayed entry safe and audit trail access system makes accessibility tougher

and can potentially save billions of dollars and countless lives.

In addition to greater security, a purpose built pharmacy safe with an electronic access control system allows the pharmacist to check the mode the safe is in (delay, ready, administration, alarm, audit, etc.) at any time. The safe is now a functional part of their operating business, not just a locked box. It also prevents inadvertently leaving a safe open, inviting criminal activity.

For additional information about safe technology and time delay safes, contact: Christopher von Zwehl, Rx Security Specialist/ SVP, Scripps Safe, Inc. 1-844-4SAFE-RX (472-3379), or visit www.4saferx.com.

SO THEY

SAY

Studies have shown that people really do take longer to leave a parking spot when someone is waiting for it. Roughly speaking, losing something makes us twice as miserable as gaining the same thing that makes us happy.

In general, we are lousy about realizing where our feelings are coming. 98% of the time when someone says they have to ask us a question, we think of all the bad things we have done recently.

We are all terrible at realizing when we bore others because, well, we all think we are just fascinating. Talking about ourselves, whether in a personal conversation or through social media sites like Facebook and Twitter, triggers the same sensation of pleasure in our brain as food or money.

The art of civilized conversation offers a good tip: is anyone asking you questions about what you are saying?

It is a good idea to have three good stories on hand that reliably entertain, inform, or engage.

Drama, gossip, and reality TV are successful for a reason. We find human behavior fascinating.

An attractive and honest appearance can easily be misleading. We tend to trust appearance more than sincerity.

Parenting is not one-size-fits-all.

Those who sit upright are much happier than those who slouch.

Research shows that excitement from any source, is often associated with the person we are with‌even if they are not the cause of it.

Why do we find musicians so captivating? The music and the crowd stimulate out emotions and we viscerally associate those with the band.

The Pharmacist’s Guide to Preventing Medical Errors

By Kenneth Maxik, Director of Patient Safety, CompleteRx

Earlier this year, the prevalence of medical errors in patient care leapt into the consumer and media spotlight as researchers at John Hopkins School of Medicine argued they should rank as the third leading cause of death in the U.S. While the researchers’ methodology has been widely critiqued, the study has prompted many in the healthcare industry to look to their own practices to determine how – if at all – they and their colleagues may be contributing to the problem, and how better reporting standards could mitigate its impact on patients.

While reducing medical errors can and should be an interdisciplinary effort – after all, in the high stakes world of medicine, each and every person who touches a patient should have the best systems in place to ensure they’re providing optimal care – there are unique steps each department can take to have a positive impact in this space. For example, in the pharmacy, where opportunities to prevent potential errors are abundant, increased awareness to this issue may help set the patient care team up for success from the outset. For example, by:

20 pharmacy edge

• Monitoring vulnerable populations: It’s simple math. The 30 million Americans taking five or more prescription drugs simultaneously (a practice known as polypharmacy, which disproportionately affects older populations) are more vulnerable to medical errors as they have five opportunities a day (or more, depending on dosage) to experience one.

Pharmacists should be mindful of this fact, and consider implementing special measures to protect these patients – for example, by encouraging patients to use pill separators, so they can see exactly what they’ve taken and when, or by offering follow-up visits to patients’ homes to offer counsel on correct usage.

• Encouraging accurate reporting: One of the single, most important things those in the healthcare industry can do to prevent future medical errors is to ensure that those that have already occurred are accurately reported. This way, organizations may identify the most common and dangerous problems, and enact system-wide changes to reduce their occurrence. For example, promoting a “just culture” – where behaviors rather than individuals are targeted – can make staff members feel more comfortable coming forward and sharing critical knowledge of medical errors in their organizations. Simplifying reporting systems, so that pharmacists who catch errors have only to report an incident has occurred, while a third-party handles the investigation from there, can help organizations overcome another common barrier to accurate reporting: staff workloads.

• Taking a system approach: Once an organization determines it’s at risk for a specific medical error, it should take steps to analyze the system processes leading up to the error, and adjust them to prevent it from continuing to occur. For example, one ICU reduced medication errors from 0.8 to 0.53 per patient day by targeting two particularly common and harmful behaviors: inaccurate order documentation and delays in getting medications to patients. The team then brought in a third party to observe and identify the root cause: multiple members of medical staff, from different disciplines, writing patient orders within a short time frame and the centralized pharmacy model causing a physical distance between pharmacists and patients. In response, the team had new order sets approved through the Medical Staff and decentralized a pharmacist in the intensive care

unit, dramatically reducing the occurrence of these types of errors.

• Starting at purchasing: Within pharmacy, there are many ways (some, as early as purchasing) to head off medical errors before they have even a chance of occurring. For example, drug buyers may purchase each size of a generic medication from a different manufacturer, so doses of the same medication are packaged differently, and therefore, are clearly visually delineated. As soon as new stock comes in, pharmacists should barcode the medication to make sure the order is correct, requesting another set of eyes if necessary. The team responsible for placing new medications on the shelves may also play a role by physically separating visually similar medications to effectively reduce the risk of “look alike, sound alike” errors.

• Double checking technology: In its recent analysis of patient safety errors, the ECRI Institute found that patient identification issues are a leading contributor to medical errors (and in fact, the Joint Commission, also recognizing this trend, has made accurate patient identification one of its National Patient Safety Goals since 2003). The organization’s study found that while designed to dramatically reduce medical errors, technology is not immune to mistakes. In particular, EMR systems may not recognize slight variations in the spelling of names, leading to duplicate patient files or blended data for two or more people. As a result, pharmacists should build “human checks” into their processes, such as keeping patient photos in their files and asking patients to provide verification information, such as their name and address.

Kenneth Maxik has worked with interdisciplinary hospital teams for more than 20 years on quality, patient safety and compliance. In his role as director of patient safety at CompleteRx — a hospital pharmacy management and patient care company —Mr. Maxik develops and annually updates a proprietary 250-point patient safety checklist for clients, including medical error measures, leveraging the data he collects to recommend protocols that improve patient safety at client facilities.

pharmacy edge

21

Is Transparency Possible?....Yes! We’ve all read articles about entrepreneurs, and how they became successful.

We’ve read about their failures, and their perseverance. This is not one of those articles. Instead, we would like to talk about why we started United Rx Solutions, and different ways we are cleaning up the expired returns industry.

22 pharmacy edge

The four partners at United Rx Solutions have almost 100 years of combined experience in the reverse distribution industry. During our time with our previous employer, we listened as many pharmacists voiced their displeasure and frustration when dealing with expired medication returns.

That displeasure and frustration is understandable, and we decided to do something about it.

Too often, we heard pharmacists tell us they had no idea what they were getting credit for, and what they weren’t getting credit for. We heard pharmacists say they didn’t know what fee they were paying their return company. Very few knew that they were paying extra hidden fees for destruction of non-returnable products. Many prospective clients tell us they have lost faith in the entire returns industry. Having dedicated half our lives to pharmaceutical returns, it pains us to hear these things. We started United Rx Solutions last year to give pharmacists more transparency, and more control over their own money.

We all know that strange things can happen when you put your return company in charge of your money. “Batching” companies mix your expired products with expired products from hundreds or even thousands of other pharmacies. The return company receives the money from the manufacturers, decides how much money your pharmacy should receive out of the batch, and sends you a check. Many pharmacists are happy to receive that one check, but is the amount of the check really what your expired medications were worth? What if your return company’s estimate for your expired medications was $5000, and they received $6000 from the manufacturers? Are you sure they are going to send you the extra $1000?

When you give control of your money to your return company, you are also giving them the ability to overcharge you without notifying you. Once they receive the money from the manufacturers, the return company take out their fee first. Many times, this fee is more than what you agreed to, and many times they will add on additional charges. We’ve come across many instances when a pharmacist thought they were paying 5% or 6%, when, in fact, they were paying over 20% once the additional charges were added on.

At United Rx Solutions, we created our “Traditional Program”. Clients who use this program receive checks directly from manufacturers, or credits

directly from their wholesaler. We never touch your money...We don’t want to touch your money. We took a big risk going back to the old way of doing things, but our clients are amazed at how quickly they receive their checks and credits. They’re also surprised to see how transparent pharmaceutical returns can be when they actually see what they are getting credit for.

For those pharmacists who seek transparency and fast money for their returned products, the Traditional Program is what you’ve been looking for.

United Rx Solutions also offers a Batching Program for clients who prefer the large, lump sum credits, because we want to give our clients as many options as possible. As we said earlier, batching programs are not very transparent, but we have created the most transparent batching program in the industry.

When a customer tells us how happy they are with the transparency of our reports, and how fast they are receiving their checks and credits, it reaffirms for us the decision we made to be different than the other return companies.

Take back control of your money, and see what you are receiving credit for by calling United Rx Solutions at 1-844-741-9718. We will also answer any questions you might have about our Traditional Program vs. Batching Programs.

UNITED Rx SOLUTIONS

78 Crossways Drive East ∙ Bohemia NY 11716 [P]844-741-9718 [F]631-319-1340 www.unitedrxsolutions.com

United Rx Solutions is a reverse distributor for expired medications. For more information about exclusion lists, or if you need us to handle your expired medications, give us a call at 844-741-9718. We are definitely NOT on any excluded lists!

pharmacy edge

23

United RX Solutions Why United Rx Solutions? »» »» »» »» »»

Exceptional On-Site Service!

Quick & Easy Mail-In Service!

Store-Level Reporting & Crediting!

Efficiency & Accuracy!

Service Manifests Including Dashboard Chart Analysis

With ownership having over 90 years of combined industry knowledge, pharmaceutical returns is not just our business, it’s our passion! With Honesty and Integrity as our guide, we strive to elevate the status quo and be the innovators of the future. We value the rights and reputation of our clients as well as our employees and endeavor to always ensure the satisfaction of all parties.

www.unitedrxsolutions.com Contact Number: 844-741-9718 78 Crossways Drive East, Bohemia, NY 11716

Patient Communication & Adherence Platform fusion-Rx provides a feature-rich pharmacy adherence platform that fully integrates Advanced Inbound IVR and Star Adherence outbound communication as part of patient, pharmacy, and prescriber services.

Our sophisticated, next generation platform engages patients with the ease and choices that are in demand: 24/7 access to the pharmacy via telephone, online, and mobile devices.

Providing pharmacies with the edge to compete in today’s competitive market through:

Advanced Inbound (IVR)

Online & Mobile Integration

Star Adherence Outbound

VoIP Connectivity or Traditional Lines

Security Data Safeguards

Hosted, Centralized or Store Based

fusion-Rx Increases Adherence, Revenue & Loyalty...

The fully integrated platform that does it ALL!

Pharmacies who have implemented fusion-Rx experience many positive outcomes relating to their business and patients!

• 1:4 ROI for every dollar spent on fusion-Rx. • A decrease in Return to Stock by 50% or more!

• Improved patient satisfaction and adherence ratings!

A provider of pharmacy growth solutions for over 20 years!

551 N. Cattlemen Rd - Suite 300 • Sarasota, FL 34232 • 800.325.2017 A Proud Sponsor Of

To request a presentation on our latest fusion-Rx technology advancements,

visit voicetechinc.com to fill out a Sales Contact Request, OR email us at sales@voicetechinc.com.

2016SEP/APPA

The latest and the most significant industry-related news and trending stories.

This magazine is produced by APPA - American Pharmacy Purchasing Alliance If you wish to submit an article-to Pharmacy Edge, or would like to request a media kit for sponsorship opportunities, send an email to info@joinappa.com.

18000 Studebaker Road, Cerritos CA, 90703

Connect us on social media