PHARMACY

Pharmacy trends and outlook for 2013

BY Kevin Mahoney

Health care is evolving. As obvious of a statement as that is, it doesn’t change the fact that it is very real. Throughout last year, there was intense discussion on the Patient Protection and Affordable Care Act and what impact the outcome of the presidential election might have on its future. Now that the Supreme Court has ruled and elections are settled, healthcare companies and providers across the country are implementing strategies to meet ACA requirements.

Under ACA, 17 million people are expected to be added to state Medicaid programs in 2014. At the same time, a growing shortage of physicians is developing. The Association of American Medical Colleges estimates our country will have 45,000 too few patient care physicians by 2020. These two factors alone present a tremendous opportunity for an untapped resource of highly trained clinical professionals — pharmacists — to step into a new role.

As physician shortages develop, the pharmacies are in a unique position to not only serve as convenient sites for receiving non-urgent, clinical care, but to also maximize the opportunity to provide patient education on the health benefits of things like immunizations. Pharmacies have focused on that role in recent years and will likely continue to do so. For example, according to the American Pharmacists Association, the number of pharmacists nationwide trained to deliver vaccines has quadrupled since 2007.

Simply put, when it comes to clinical care, the pharmacy is convenient for the patient and can be a cost effective alternative within health care. Just the other day, I went to my regular pharmacy, signed a form, got my flu shot and went home with ice cream. If you’re going to get a shot, why not go home with dessert? My calendar is filled with meetings like many of you. The fact that I was able to do all of this at 8 p.m. just might have been the difference between me receiving my flu shot this year or not.

And, what began with vaccines in the pharmacy is quickly expanding into additional clinical services like medical therapy management, onsite clinics and in some cases lab work. Without a doubt, the way in which patients consume health care is expected to change dramatically in the coming years.

That transformation, coupled with an evolving regulatory environment, drives the need for efficient exchange of healthcare information among all types of providers. Pharmacies will begin to need discharge summaries and lab results, while hospitals and physicians can greatly benefit from having access to patient medication history. How valuable would it be for a physician to know if a prescription is actually filled by the patient, or for the pharmacy to know what medications the patient took at the hospital? Complete and accurate data can improve the efficiency with which the healthcare ecosystem operates. I am optimistic that as the various players in health care begin to work together to share this vital information, we can all better serve the patient and reduce the overall cost of health care. 


Kevin Mahoney
Emdeon EVP of pharmacy services
As EVP of pharmacy services at Emdeon, Kevin Mahoney oversees the company’s entire pharmacy services division including strategic initiatives, industry partnerships and pharmacy product development for all pharmacy products. Mahoney has spent more than 25 years in the healthcare industry with a predominant focus in pharmacy. Mahoney received a Bachelor of Arts in accounting from Belmont Abbey College and an Master of Business Administration from Pace University. 

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Crime story: Detecting and preventing drug diversion

BY Ann Latner

The illegal diversion of prescription medication is a growing problem in this country. Controlled substances have great potential for abuse and addiction. According to the Centers for Disease Control and Prevention, recreational use of prescription drugs is on the rise; in 2010, 2 million people reported using prescription painkillers for recreational purposes for the first time that year.

Drugs are diverted for several reasons. Sometimes patients become addicted to legally prescribed medications. Sometimes the reason for diversion is monetary profit — the street value of a single oxycodone pill can be $30. And other times, it’s simply people trying to get their hands on prescription medications for recreational purposes. Pharmacy technicians have an important role to play in helping to prevent theft and drug diversion in the pharmacy.

Doctor shoppers, prescription forgers and thieves — oh my!
Many prescription drugs of abuse are actually obtained legally, by valid prescription, but are diverted later by people selling or giving away their medication to friends, or by leaving them in a medicine cabinet where they are taken by someone else. However, prescription medication also is diverted by other means, such as doctor shopping, forged prescriptions and pharmacy theft. Pharmacy techs are often the first ones a patient sees when presenting a prescription, so techs are really on the front line of the war against diversion.

“What techs will likely see the most, but may not be aware of, is probably doctor shopping,” said commander John Burke of the Warren County Ohio Drug Task Force. Burke, who also is the current president of the National Association of Drug Diversion Investigators, describes doctor shopping as when patients go to multiple prescribers without their knowledge and obtain prescriptions for controlled substances. These patients also may use multiple pharmacies to fill their scripts, making detection more difficult.

Techs should be alert to patients who are bringing in prescriptions for the same medications from different physicians. Some states have prescription monitoring programs, and Burke suggested that utilizing those can help cut down on doctor shoppers. According to Burke, doctor shoppers are usually addicts who may be taking large doses of their drug of choice while selling some pills to support the expenses. However, some doctor shoppers are strictly in it for the profit.

The next most common form of diversion that techs are likely to see is prescription forging or alteration. “If something doesn’t look right on the script, make sure you always verify it by alerting the pharmacist and calling the prescriber’s office to make sure it is good,” Burke advised.

Yes, it’s an extra step, and yes, your day is already busy, but verifying a suspicious script is necessary if anything seems amiss. Stolen prescription pads and scanned duplicates of prescriptions are other ways that drug abusers are diverting medication. Pharmacy techs should be aware of unusual patterns. For example, a physician who normally doesn’t write prescriptions for opioids suddenly appears to be writing a large number of them — this could indicate a stolen prescription pad. Other tip-offs that a prescription may be altered or forged include unusual quantities of medication, unusual directions, no abbreviations, apparent erasures, unusual legibility and signs of photocopying.

Drug theft from the pharmacy can take place in two ways: robbery of the pharmacy or theft by an employee. Unfortunately, medications do sometimes get diverted by pharmacy staff. Be aware of suspicious activity, especially by new or temporary pharmacy employees, and if you have concerns, speak to your supervisor.

Pharmacy robbery: What to do, tips for prevention
It doesn’t take more than a casual perusal of the news to tell that pharmacy robberies are on the rise. Criminals, often armed and frequently addicted to prescription painkillers themselves, are viewing pharmacies as easy targets for big scores of drugs.

What should you do in the event of a robbery? “Cooperate,” Burke said. “Don’t ever put yourself in danger in trying to deal with someone diverting drugs. The goal is to give them the drugs and/or money they want and get them out of the store.” He added that while a robbery isn’t the time to be a hero, there are some things you can do to help police make an arrest. “Do everything you can to remember what the person looks like,” Burke advised. “Make a mental note of distinguishing features, clothing, hair, etc. The use of a height chart placed inside many pharmacies will assist in any description you need to give to police if the person leaves before they arrive.” Burke also recommended making sure the pharmacy’s camera system is operational. “If you are sure you have a crime,” Burke said, “try to notify law enforcement covertly and have them respond.” If you can’t report the crime until afterward, make sure to get as good a description as you can.

How can you help prevent robberies? “Stay alert to what is going on in the store, and even outside,” Burke advised. “Be careful of people hanging around the pharmacy with no prescription who seem to be ‘casing’ the pharmacy and the drugs on the shelves behind you.” According to Burke, most pharmacy robbers have been in the store several times before deciding to commit the crime.

In the meantime, new ways to thwart crooks are being introduced. For example, the New York Police Department recently began an initiative to hide fake, GPS-equipped pill bottles among the shelves of New York area pharmacies to help catch thieves in the event of a robbery.

A final caution
While drug diversion is a significant problem, it’s important to remember that the vast majority of people getting prescription drugs are legitimate patients. “Try and weed out those who are diverting medications, but be careful not to negatively impact legitimate patients,” Burke said. “Sometimes we can be so zealous in our work to identify the drug diverter that we unwittingly deprive those who desperately need the medication for pain relief.” 

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FDA approves three new drugs for Type 2 diabetes

BY Alaric DeArment

SILVER SPRING, Md. — The Food and Drug Administration has approved three new drugs for Type 2 diabetes made by Takeda, the agency said Friday.

The FDA announced the approval of Nesina (alogliptin), Kazano (alogliptin and metformin) and Oseni (alogliptin and pioglitazone) tablets.

Alogliptin is a new active ingredient, while metformin and pioglitazone are drugs already on the market.

"Controlling blood sugar levels is very important in the overall treatment and care of diabetes," FDA Division of Metabolism and Endocrinology Products director Mary Parks said. "Alogliptin helps stimulate the release of insulin after a meal, which leads to better blood sugar control."


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