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What’s it mean to be green?

BY Michael Johnsen

Green. It’s a buzzword, but, what does the growing awareness around green mean to pharmacy operators, beyond trading the white lab coats for olive?

For starters, become a receiving repository for pharmaceutical waste. Already two West-Coast pharmacies that trade on a “natural” druggist brand identity—Pharmaca and Elephant Pharmacy—have agreed to accept unused medicines and have them incinerated in the San Francisco Bay area.

Recent studies found that more than 80 percent of waterways tested in the United States contained traces of common medications such as acetaminophen, hormones, antidepressants, blood pressure medicine, codeine and antibiotics. Presently, as many as 54 percent of consumers throw medicines in the trash and 35 percent flush them down the toilet.

The Teleosis Institute, a not-for-profit organization offering a green solution on the problem of pharmaceutical waste, reported that more than 700 pounds of unused and expired medicines were diverted from San Francisco waterways in 2007, thanks to partners East Bay Municipal Utility District, Save The Bay, Kaiser Permanente, Elephant Pharmacy, Pharmaca, Whole Foods and the City of Berkeley.

Pharmaca has been the most successful with the new program, Joel Kreisberg, executive director of the Institute, told Drug Store News. “They fill up a 7-gallon bin every 10 days,” he said.

And that’s not a full calendar year of results—Teleosis launched the Green Pharmacy Program in May 2007.

The costs to implement a Green Pharmacy program aren’t extravagant—totaling a little more than $100 per month per take-back location.

Currently, 12 pilot take-back sites are operating in Bay area pharmacies, doctor and dental offices, veterinarian hospitals, healthcare facilities and local recycling events. Staff at take-back sites document all returned medicines and screen for controlled substances, which are turned away because of current DEA restrictions. Medications are collected from take-back bins for incineration (the most environmentally safe disposal method) by Integrated Waste Control, a Hayward-based waste hauler.

Green Pharmacy is unique in that the site manager documents all returned medicines through the Unused & Expired Medicine Registry, a program developed by the Community Medical Foundation for Patient Safety in Texas, which compiles national statistics on medicines returned and reasons for disposal. Once a statistically significant sample is documented, that data will be presented to pharmaceutical researchers, manufacturers and governmental organizations to build support for take-back programs nationwide.

According to Kreisberg, the purpose of collecting data on unused medicine is to identify which pharmaceuticals are most often unused or over-prescribed. “We can better comprehend the effectiveness of our current pharmacological approaches to illness.” he said.

That idea will go with the message that purchasing less affords less opportunity for more waste. The concept is especially relevant across all those acute remedies, whether nonprescription or prescription, due to the expiration dates. While this message may not bode well for club retailers or mail-order operators filling 90-day prescriptions, it’s a message that will resonate positively with operators trading on convenience, equating to more trips to the store. Reducing prescriptions to a 28-day supply cuts the amount of discarded medicines by as much as 30 percent, Kreisberg reported.

Even some medicines are becoming more eco-friendly. For instance, the Food and Drug Administration last month met regarding its proposed expansion of a ban on the use of ozone-depleting substances in metered-dose inhalers, which includes products containing epinephrine. Already, asthma inhalers containing albuterol will need to switch from chlorofluorocarbon-producing metered-dose inhalers to the propellant hydrofluoroalkane, which carries medicine into the lungs without emitting any known ozone-depleting chemicals, by December 2008.

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S&P revises outlook on Rite Aid

BY Michael Johnsen

NEW YORK Standard & Poor’s Ratings Services revised its outlook on chain drug retailer Rite Aid to negative from stable, the firm reported Friday. At the same time, S&P affirmed the ‘B’ corporate credit rating on Rite Aid.

“The outlook change reflects the company’s weak same-store sales and our expectation that this trend will continue over the next few quarters,” stated Standard & Poor’s credit analyst Diane Shand. Rite Aid faces a more cautious consumer, strong growth of lower-priced generics and intense competition, she said. In addition, the current environment could make it more challenging for the company to integrate its recently-acquired Brooks/Eckerd stores.

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Boston Mayor decries in-store health clinics

BY Antoinette Alexander

BOSTON On the heels of the Massachusetts Public Health Council approving regulations allowing for in-store health clinics in the state, Boston Mayor Thomas Menino is reportedly looking to ban the clinics from opening in the city.

The decision by the health council “jeopardizes patient safety,” Menino said in a written statement, according to a Boston Globe report. “Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong.”

The newspaper also reported that, in a separate letter, the mayor urged members of the city’s Public Health Commission to consider banning the clinics from opening within Boston. CVS has plans to open 20 to 30 MinuteClinics in the Greater Boston area but it is unclear how many of those would be within the city’s limits.

Defending its decision to allow clinics to operate, the state Public Health Council issued a statement that read: “The members of the Public Health Council were deliberative and thoughtful in their review of the limited service clinic regulation. We believe these types of clinics, operated either as part of a retail operation or in a nonprofit setting, can provide the public access to safe, convenient, and quality care for minor health issues.”

Officials at MinuteClinic were not immediately available for comment.

On Jan. 9, the state Public Health Council approved rules for limited service medical clinics. The new regulations took effect immediately.

“This is a new model for health care delivery that can benefit many people in the Commonwealth. These regulations will improve consumer convenience and make it easier for non-profit organizations to establish satellite clinics in a variety of settings to serve vulnerable populations,” stated secretary of Health and Human Services JudyAnn Bigby in a statement issued after the approval.

Added John Auerbach, commissioner of the Department of Public Health and chair of the PHC, “Properly regulated, these types of clinics will serve an important function, making care for minor medical care more convenient. The council was mindful of not wanting to create a stand-alone system of health care, so these regulations require coordination and linkages to primary care providers.”

The approval came at the end of a long review process that included two public hearings and the submission of hundreds of pages of testimony regarding the regulations, including testimony in favor of the clinics from the Convenient Care Association.

“We appreciate the Public Health Council’s careful deliberation regarding the adopted regulations that will now guide the operation of limited services clinics in Massachusetts. These retail-based clinics are providing consumers in 35 other states with easy access to high-quality, affordable health care in the face of a nationwide primary care physician shortage. Since this growing shortage is well documented in Massachusetts, and its related health care access issues have been exacerbated by the state’s near-universal healthcare coverage, we appreciate the Council embracing limited services clinics as a partial solution to these serious problems,” said Web Golinkin, president of the CCA and chief executive officer of in-store clinic operator RediClinic, in a statement issued after the council’s decision.

Sparking the move to create specialized regulations for these clinics was CVS’ application to open a MinuteClinic in one of its stores in Weymouth. According to the council, early in the application review process it became clear that DPH regulations governing medical clinics did not address the operation of medical clinics with limited scope of services. Rather than consider applications requiring numerous waivers from full-service clinic regulations, the department decided to create a specialized set of rules.

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