Could We Be Approaching "Common Ground"?

Tom Curb, R.Ph.

The May 2004 Journal of the American Pharmacists Association (APhA) posted an article about adverse drug events. With other statistics, it quoted a 1999 Institute of Medicine report claiming that "Between 44,000 to 98,000…die annually from medical errors…, (with) medication errors as a major subcategory…" and that;

"....aging of the population…increasing complexity of medication regimens…and a fragmented health care system…make the occurrence of serious drug-to-drug interactions (DDIs) even more likely."

The Journal further reported that "The direct (medical) costs (from DDI’s) in 2000 (were) $177.4 billion…and more than $1 is consumed for direct medical costs related to drug ‘misadventures’ for every dollar spent on the medications themselves." (One example was the medical cost of $17,213 to treat an interaction between flouxetine and selegiline – two of the most commonly prescribed drugs.)

The Journal also affirmed that "Most (retail) pharmacies use… software that provides real-time, concurrent review of medication regimens to identify potential drug therapy problems and prevent adverse events, including DDIs, and that... many pharmacy benefit managers (PBMs) and claims processors operate…software that provides review of medication regimens, and…one advantage of PBM-initiated (real-time) prospective DUR (drug utilization review) is that all of the patients' medication claims can be reviewed, not just those filled by a particular pharmacy or chain."

In 2002, realization of the medical necessity of such a mechanism precipitated the development of an internationally-accessible technological interface - Expedite-Rx, because "…due to increasing public awareness of cheaper foreign drugs and ease of acquisition via the Internet, perceptive healthcare providers rapidly recognized a potential for eminent danger to their members’ health and to the financial resources of their benefits plans. To fulfill their mission of protecting their members’ health and the plans’ resources, client plans took preemptive steps to incorporate appropriate and accepted patient protective safety measures into their benefits designs."

With this quondam revelation of a major retail pharmacy association’s acknowledgement and admission of patient dangers inherent in the lack of a comprehensive patient profile that enables identification of drug-to-drug interactions, one must wonder why John Rector, spokesman for The National Community Pharmacists Association (NCPA) – another pharmacy organization having membership common to APhA – levied invalid complaints and false allegations against me personally and against Expedite-Rx – a technological interface that provides these protective measures to U.S. citizens who choose to directly import their personal prescriptions.

Mr. Rector alleged that his actions were "on behalf of the non-publicly held pharmacies in Texas and the independent pharmacists…and represent(ing) the proprietary and professional interests of 25,000 independent pharmacies and an estimated 70,000 pharmacists." While Mr. Rector’s "objectives" are high-sounding, they – like his allegations – are both invalid and misdirected.

Neither Mr. Rector nor those he claims to represent have exclusive (proprietary) rights to provision of healthcare services – especially those that are proven to be patient protective, and his flagrant attempt to perpetuate the patient dangers inherent in the U.S.’s above-quoted "fragmentary healthcare system" testify to their continuing inadequacies.

(I am a product of the "old school" of pharmacy – one that set forth patient protection as the pharmacist’s primary "professional interest." Yet, during more than forty years as a pharmacist, it has been my observation that such "professional" organizations, institutions and regulatory agencies have been both willing and quick to sacrifice the public’s health and welfare to satisfy a vociferous and influential minority.)

As with their historic protectionist efforts, the true concern of these entities has been money – yet therein even that less-than-professional concern is invalid and misdirected. Instead of this "professional" posturing to intervene against the interests of American consumers, such organizations should direct their members toward cooperative efforts having universal rewards. Such a prototype was described in my April 14 presentation before the HHS Commission convened to research a safe and cost-effective process for importation. It was described thusly:

"U.S. retail pharmacies would be allowed and encouraged to establish cooperative relationships with Canadian pharmacies and/or U.S. PBMs that would enable them to become involved in their customers’ importation process. This would include: Incorporating imported drug data into the pharmacy’s patient profile and/or submitting customers’ prescriptions to a claims processor’s central profile that maintains that data; counseling customers as to the feasibility of importing specific drugs and about imported drugs they have received; and to offset their ‘lost revenue’, receiving a reasonable counseling fee for their services.

In the (above) described scenario, participating U.S. retail pharmacies would realize more net profit per prescription from Canadian ‘consulting fees’ than they do from sale of the affected brand name drugs, and they would be relieved of stocking expensive medications and ancillary costs of prescription dispensing. They would retain all prescriptions for generics (which are their greatest profit generator), controlled substances, environmentally sensitive, and acute and immediate need drugs. An important fringe benefit would be that their customers would have hundreds of extra dollars that could be spent in the local community rather than being passed on to the international drug cartel."

As I further stated about such a mechanism, "…recognizing the danger from data omission in customers’ drug profiles, (some) visionary retail pharmacists have tried to fill that obvious void (of incomplete patient utilization data)…they offered to supplement their in-house patient profiles with imported drug data; to inform their ‘importing’ customers of safer mechanisms; to advise them on relative costs of domestic versus imported medications; and to answer customers’ questions about the products that they may choose to import."

These far-sighted and truly professional retailers were rewarded for their altruism with intensive intimidation by professional and regulatory agencies – up to and including threats against their store licenses.

This leaves only the multinational drug manufacturers as the beneficiaries of their efforts.