There’s a dangerous curve in my neighborhood. A dusty road descends a tree-lined hill and turns sharply. The pavement is broken and rutted on one side so that cars traveling in both directions steer onto a single smooth lane. Collisions have been averted (so far), mainly because few cars travel this section of road. However, an accumulation of near-misses has prompted community members to generate plans to prevent a tragedy.
Problem: Sample medications are often available in a variety of settings, including clinics, physicians’ offices, and hospital outpatient units. Most often, samples are dispensed without computer screening for drug interactions, duplicated therapy, allergies, or contraindications and without another practitioner’s check.
The federal government’s drug industry fraud bloodhound—no, not James Sheehan, the U.S. attorney in Philadelphia—has drafted some guidelines on how pharmacy benefit managers (PBMs) might stay on the right side of the law. The Office of the Inspector General (OIG) at the Department of Health and Human Services is the one that does the initial sniffing out of potential defrauding of Medicare and Medicaid and then sends evidence on to the U.S. Department of Justice for potential enforcement action by U.S. attorneys. The OIG is the bloodhound; Mr. Sheehan is just one of its puppies, albeit a feisty one.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has risen more than 18% in the hospital setting in the last two years. Using data from our Hospital Diagnosis and Therapy Audit (HDTA), comparing the second quarter of 2002 with the same time period in 2000, MediMedia USA, Inc., evaluated patient characteristics such as age, sex, and diagnostic information. Most of the patients taking NSAIDs were women between the ages of 18 and 39 who were in the hospital for an obstetrical diagnosis; however, when the concomitant use of aspirin was examined, the patient profile and diagnoses changed dramatically. Although only 10% of the patients who received NSAIDS received aspirin as well, more than 50% of them were men and more than 90% were over age 40.
David’s idea, in a nutshell, is as follows: “Any new prescription drug program should incorporate mechanisms to inform Congress and the public about the benefits or harms associated with the program and create incentives to prescription drug plans, providers, and consumers to make effective use of the new benefit.”2 Under this new Medicare drug benefit that he envisions, public disclosure of information about the performance of prescription drug plans would serve multiple objectives:
By now, most readers of P&T are familiar with the series of recent reports from the Institute of Medicine (IOM) that are encouraging health care organizations and purchasers to implement policies that would enable health care to become more “safe, effective, patient-centered, timely, efficient, and equitable.” These Washington-based policy makers from the IOM have exhorted us to develop the key financing and payment mechanisms to support these goals, but they have not offered specific practical approaches for doing so. My good friend David Lansky, PhD, president of the Foundation for Accountability (FACCT) in Portland, Oregon, has outlined a perspective to effectively deal with this challenge in the policy journal Health Affairs.
Too often, marketing efforts, contractual agreements with purchasing groups or vendors, and costs serve as primary sources of information when decisions are being made about which medical products to purchase and use. Evaluation and input from users of the products are not always sought, and the potential for errors might not be considered ahead of time. Later, these omissions can lead to unforeseen problems in the hands of clinical users.
